Association between clinical symptoms and MRI image findings in symptomatic temporomandibular joint (TMJ) disease: A systematic review.

To evaluate the association between clinical signs and symptoms of temporomandibular joint (TMJ) and magnetic resonance image (MRI) findings in patients with temporomandibular disorders (TMD). Relevant articles on humans over 18 years of age were obtained from five databases (Ovid MEDLINE, PubMed, Scopus, Web of Science, and Google Scholar) up to August 2022. Risk of bias assessment was completed using the Joanna Briggs Institute critical appraisal tools. The GRADEpro (Grading of Recommendations, Assessment, Development, and Evaluation) instrument was applied to assess the level of evidence across studies in a GRADE Summary of Findings table. In total, 22 studies were included in this systematic review. Of these, 11 studies highlighted that joint pain was positively associated with particular MRI findings: joint effusion, bone marrow edema, disk displacement with/without reduction, and condylar erosion. Masticatory muscle pain was found to have a strong positive correlation with disk displacement in four studies. Five studies found no significant association between MRI findings and masticatory muscle pain. Range of motion and MRI findings were examined in six studies. Limited mouth opening was found to be correlated with disk displacement in five studies. Of the 11 studies evaluating the correlation between joint noise and MRI findings, eight reported a significant association between disk displacement and TMJ noise. The results suggested that patients with joint pain and limited range of motion may benefit from MRI. Patients exhibiting primarily muscle pain are unlikely to benefit clinically from MRI. Future studies with improved quality are warranted.

Comparison of the effects of target-controlled infusion-remifentanil/midazolam and manual fentanyl/midazolam administration on patient parameters in dental procedures.

Background: Moderate sedation is an integral part of dental care delivery. Target-controlled infusion (TCI) has the potential to improve patient safety and outcome. We compared the effects of using TCI to administer remifentanil/manual bolus midazolam with manual bolus fentanyl/midazolam administration on patient safety parameters, drug administration times, and patient recovery times. Methods: In this retrospective chart review, records of patients who underwent moderate intravenous sedation over 12 months in a private dental clinic were assessed. Patient indicators (pre-, intra-, and post-procedure noninvasive systolic and diastolic blood pressure, respiration, and heart rate) were compared using independent t-test analysis. Patient recovery time, procedure length, and midazolam dosage required were also compared between the two groups. Results: Eighty-five patient charts were included in the final analysis: 47 received TCI-remifentanil/midazolam sedation, and 38 received manual fentanyl/midazolam sedation. Among the physiological parameters, diastolic blood pressure showed slightly higher changes in the fentanyl group (P = 0.049), respiratory rate changes showed higher changes in the fentanyl group (P = 0.032), and the average EtCO2 was slightly higher in the remifentanil group (P = 0.041). There was no significant difference in the minimum SpO2 levels and average procedure length between the fentanyl and remifentanil TCI pump groups (P > 0.05). However, a significant difference was observed in the time required for discharge from the chair (P = 0.048), indicating that patients who received remifentanil required less time for discharge from the chair than those who received fentanyl. The dosage of midazolam used in the fentanyl group was 0.487 mg more than that in the remifentanil group; however, the difference was not significant (P > 0.05). Conclusion: The combination of TCI administered remifentanil combined with manual administered midazolam has the potential to shorten the recovery time and reduce respiration rate changes when compared to manual administration of fentanyl/midazolam. This is possibly due to either the lower midazolam dosage required with TCI remifentanil administration or achieving a stable, steady-state low dose remifentanil concentration for the duration of the procedure.

Development of an electronic learning progression dashboard to monitor student clinical experiences.

INTRODUCTION: Clinical experience tracking mechanisms for students at dental schools provide patient assignment, student experience, and learning progression feedback. The purpose of this study was to evaluate dental students' clinical experiences following the implementation of a learning progression dashboard (LPD). METHODS: After developing and deploying an electronic LPD using PHP, secondary data analysis on dental students' clinical experiences from 2017-2019 was conducted. Student experience differences were compared between the year before continuous use of the LPD and the first year using it. LPD data contained the required clinical procedures dentistry students must perform across all disciplines and the number of planned, in progress, and completed tasks each student has accomplished. Using two time points, the students' experiences were compared. Univariate statistics and independent t-tests were conducted in R for detecting the differences in the number and categories of codes. RESULTS: The number and category of codes showed significant differences between the academic year 2017-2018 and 2018-2019 for both third- and fourth-year dental students after one and two terms. Overall, students recorded a 26% greater number of treatment codes and experienced a 26% greater number of code categories compared to the previous year. CONCLUSION: Applying information management methods such as dashboards can better inform educators on student clinical experiences and improve clinical learning outcomes for students.

Comparison of the effects of toothpastes containing nanohydroxyapatite and fluoride on white spot lesions in orthodontic patients: A randomized clinical trial.

BACKGROUND: Studies show that fluoride (F) and nano-hydroxyapatite (nano-HA) would result in remineralization of white spot lesions (WSLs), which are among the most prevalent consequences of fixed orthodontic treatment. The present study evaluates and compares the clinical effects of an Iranian toothpaste containing nano-HA with F-containing one on early enamel lesions. MATERIALS AND METHODS: In this randomized clinical trial study, 50 patients who had received fixed orthodontic treatment were recruited immediately after debonding. Three photographs, including frontal, lateral right and left views of occlusion, were obtained. Moreover, surfaces with WSLs were recorded using DIAGNOdent. Plaque index of each patient determined using disclosing agents. At first visit, each patient was asked to select one type of toothpaste (nano-HA containing vs. F containing named A or B), randomly and were instructed how to brush their teeth (25 patients in each group). Examination was done at 1, 3, and 6 months' intervals. Finally, photographs were analyzed by Digimizer (V5) software, and the lesion extent was recorded in pixels. SAS 9.4 was used to analyze data and was set at 0.05. RESULTS: According to data, lesion extent showed a significant decrease (P < 0.001). At baseline, the difference between the two groups regarding the lesion extent was 268 pixels while it dropped to 89 pixels after 6 months. DIAGNOdent results showed that at baseline, fluorescence difference was 0.3 while it reached the number of 0.8 after 6 months, indicating the outperformance of nano-HA containing toothpaste. CONCLUSION: The Iranian nano-HA containing toothpaste performed better than F-containing one in terms of the amount of remineralization and diminishing the lesion extent.

Maxillary molar distalization using conventional versus skeletal anchorage devices: A systematic review and meta-analysis.

INTRODUCTION: The purpose of this study was to systematically review the evidence regarding conventional versus skeletal anchorage devices for molar distalization. METHOD: An electronic search was conducted. Hand searching was done in the reference lists of included studies and some journals. Studies comparing conventional and skeletal anchorage for molar distalization in Angle class I or II malocclusions were assessed. Presence of periodontal disease, second or third molar extraction and application of tooth accelerating methods led to exclusion of studies. Generic-inverse variance approach was used for meta-analysis by use of the mean difference and random-effect model. Risk of bias was evaluated in included studies. RESULTS: A total of 1996 articles were found; of which, 1991 were excluded. The mean amounts of molar distalization/tipping in skeletal anchorage and conventional anchorage groups were 5.35mm/8.44° and 4.25mm/8.31°, respectively, which were not significantly different. The mean amounts of premolar movement in skeletal anchorage and conventional anchorage groups were -0.96mm and +2.21mm, respectively, which was statistically significant (P=0.004). Duration of treatment in skeletal anchorage and conventional anchorage groups was 8.23 months and 7.95 months, respectively, which were significantly different (P=0.0001). Risk of bias was assessed to be high. CONCLUSION: The conventional and skeletal anchorage devices were not significantly different in terms of the amount of molar distalization/tipping. However, the anchorage loss was lower in the skeletal anchorage group. The treatment time was shorter in the conventional anchorage group. More studies with proper design are required.

Effect of Intranasal Sedation Using Ketamine and Midazolam on Behavior of 3-6 Year-Old Uncooperative Children in Dental Office: A Clinical Trial.

OBJECTIVES: The aim of the present study was to compare the effects of intranasal ketamine and midazolam on behavior of 3-6 year-old children during dental treatments. MATERIALS AND METHODS: In this randomized cross-over clinical trial, 17 uncooperative children requiring at least two dental treatments were selected and randomly received ketamine (0.5mg/kg) or midazolam (0.2mg/kg) prior to treatment. The other medication was used in the next visit. The children's behavioral pattern was determined according to the Houpt's scale regarding sleep, movement, crying and overall behavior. Physiological parameters were also measured at different time intervals. The data were subjected to Wilcoxon Signed Rank test and two-way repeated measures ANOVA. RESULTS: The frequency of crying decreased significantly following ketamine administration compared to midazolam (P=0.002); movement of children decreased with fewer incidence of treatment interruption (P=0.001) while their sleepiness increased (P=0.003). Despite higher success of sedation with ketamine compared to midazolam, no significant differences were found between the two regarding patients' overall behavior (P>0.05). The patients had higher heart rate and blood pressure with ketamine; however, no significant difference was found regarding respiratory rate and oxygen saturation (P>0.05). CONCLUSIONS: Ketamine (0.5mg/kg) led to fewer movements, less crying and more sleepiness compared to midazolam (0.2mg/kg). No significant differences were found between the two drugs regarding children's overall behavior and sedation efficiency. Both drugs demonstrated positive efficacy for sedation of children during dental treatments.

Evaluation of enamel surface roughness after orthodontic bracket debonding with atomic force microscopy.

INTRODUCTION: Achieving a smooth enamel surface after orthodontic bracket debonding is imperative. In this study, we sought to compare the enamel surface roughness values after orthodontic bracket debonding and resin removal using a white stone bur, a tungsten carbide bur, and a tungsten carbide bur under loupe magnification. METHODS: Thirty sound premolars were randomly divided into 3 groups, and their buccal surfaces were subjected to atomic force microscopy to measure initial surface roughness. Brackets were bonded to the buccal surfaces and debonded after 24 hours. Resin remnants were removed using a white stone bur, a tungsten carbide bur, or a tungsten carbide bur under loupe magnification. The teeth were then subjected to atomic force microscopy again. The time required for composite removal was calculated. Data were analyzed using repeated-measures analysis of variance, 1-way analysis of variance, and the Tukey test. RESULTS: Resin removal increased the enamel surface roughness compared with the initial values (P <0.001); however, no significant differences were noted among the 3 groups in this respect after resin removal. The mean times required for smoothing by the tungsten carbide bur and the tungsten carbide bur with a dental loupe were similar (P >0.05): significantly lower than the time with the white stone bur (both, P <0.001). CONCLUSIONS: The tungsten carbide bur is still recommended for composite removal.

Evaluating the role of maternal folic acid supplementation in modifying the effects of methylenetetrahydrofolate reductase (C677T and A1298C) gene polymorphisms in oral cleft children.

BACKGROUND: We studied the role of maternal folic acid supplementation in modifying the effects of methylenetetrahydrofolate reductase (MTHFR C677T and A1298C) gene polymorphisms in Iranian children with oral clefts. MATERIALS AND METHODS: Forty-seven newborn infants with orofacial cleft and their mothers were selected randomly. Mothers were matched regarding dietary folate intake. The genotyping on venous blood was carried out. Consistency between maternal and child genotypes was analyzed. RESULTS: Genotype consistency was not statistically significant in both C677T and A1298C gene variants (P > 0.05). CONCLUSION: Maternal folic acid consumption may not have any significant effect on modifying C677T and A1298C polymorphisms in children.

Incidence Assessment of MTHFR C677T and A1298C Polymorphisms in Iranian Non-syndromic Cleft Lip and/or Palate Patients.

Background and aims. The aim of the present study is to determine the incidence of MTHFR C677 T and A1298C muta-tions in Iranian patients with cleft lip and/or cleft palate. Materials and methods. We screened 61 Iranian patients with cleft lip and/or cleft palate for mutations in the two alleles of MTHFR gene associated with cleft lip and/or palate: A1298C and C677T, using Polymerase Chain Reaction following by RFLP. Results. The 677T and 1298C homozygote genotypes showed a frequency of 36.1% and 11.4%, respectively. Combined genotype frequencies in newborns having oral clefts showed that the highest genotype was 677TT/1298AA (22.9%) and 677TT/1298CC genotypes were not observed. Conclusion. The results showed that 65.6% of all patients had at least one T mutant allele in C677T and 58.9% C mutant allele for A1298C. According to the frequencies of homozygosity of mutant alleles, it could be said that MTHFR genotype of 677TT shows a greater role in having oral clefts.

Maternal Supplementary Folate Intake, Methylenetetrahydrofolate Reductase (MTHFR) C677T and A1298C Polymorphisms and the Risk of Orofacial Cleft in Iranian Children.

BACKGROUND: The purpose of this study was to describe the association of MTHFR gene single nucleotide polymorphisms (C677T and A1298C) and maternal supplementary folate intake with orofacial clefts in the Iranian population. METHODS: In this case-control study, peripheral venous blood was taken from 65 patients with orofacial clefts and 215 unaffected controls for DNA extraction and kept in EDTA for further analysis. The genotyping was carried out using Polymerase Chain Reaction (PCR) followed by Restriction Fragment Length Polymorphism (RFLP) and gel electrophoresis. Data were analyzed using Chi square test and logistic regression tests. RESULTS: Genotype frequencies of 677TT were reported to be 13.5 and 36.1% in controls and CL/P patients, respectively, which showed a significant difference compared to CC as reference (OR=4.118; 95% CI=1.997-8.492; p=0.001). Conversely, 1298CC with frequencies of 10.8 and 12.7% in controls and patients, respectively, showed no significant difference compared to AA (OR=2.359; 95% CI=0.792-7.023; p=0.123). Comparing patients whose mothers did not report the folate supplement intake during pregnancy, to controls, it was observed that lack of folate intake was a predisposing factor for having a child with oral clefts (OR=5/718, p=0.000). CONCLUSION: Children carrying the 677TT variant of the MTHFR gene may have an increased risk of CL/P. In addition, the finding that the risk associated with this allele was obviously higher when the mothers didn't use folic acid, supports the hypothesis that folic acid may play a role in the etiology of CL/P.

Comparison of the skeletal and dental changes of tooth-borne vs. bone-borne expansion devices in surgically assisted rapid palatal expansion: A finite element study.

BACKGROUND: The aim of this study was to compare the skeletal and dental changes of a tooth-borne (Hyrax) and a bone-borne (Smile distractor) expansion devices using three-dimensional model of a human skull. MATERIALS AND METHODS: A finite element model of human skull was generated using data from 3-D CT scans of an 11-year-old female child. Then a Hyrax expander (tooth-borne appliance) and Smile distractor (bone-borne appliance) in three different positions were adapted to the finite element model and expanded for 0.5 mm simulating the clinical situation. The 3-D pattern of displacement and stress distribution was then analyzed. RESULTS: The results of this study showed that screw position affects the stress and displacement pattern within the nasomaxillary complex and maxillary dental arch. CONCLUSION: Closer teeth feel more stress and undergo more displacement than the farther ones. Moreover, skeletal effects of the Smile distractor were greater than of Hyrax in all different positions.

The 808 nm Laser-Assisted Surgery as an Adjunct to Orthodontic Treatment of Delayed Tooth Eruption.

INTRODUCTION: Failure of teeth to erupt from gingival tissues at usual developmental time is called delayed tooth eruption (DTE). Delayed tooth eruption lead to prolonged fixed orthodontic treatment and its eventual complications. The purpose of the present study was to evaluate the effect of laser-assisted (808 nm) surgical uncovering, on the tooth emergence and orthodontic treatment of DTE. METHODS: A total of 16 orthodontic patients were included in this study and were equally assigned to an experimental and a control group. Subjects for experiment consisted of eight patients (6 girls and 2 boys) with a mean age of 14±0.9 years. All patients exhibited delayed second premolar eruption. The laser wavelength was 810 nm and it was set in a continuous wave mode at a power output of 1.6 watt with a 0.3-mm diameter fiber tip. When the target tissue was sufficiently anesthetized, the tip was directed at an angle of 10 to 20 degrees to the tissue (light contact mode); and was applied continuously for approximately 12 Seconds until an acceptable tooth exposure area was visible. The facial axis of the clinical crown (FACC) line represents the most prominent portion of the facial central lobe for premolars. All orthodontic brackets are aligned along this reference and are located on FA (Facial Axis) point. The standard for adequate tooth eruption was the accessibility of facial axis of the clinical crown (FACC) for bonding the brackets. Data gathered from the patients were statistically surveyed and compared by means of Tukey's Test and Analysis of Variance (ANOVA). RESULTS: All patients showed good gingival status, no significant bleeding during or immediately after the surgery, and acceptable level of healing after laser surgery. The biologic width of the teeth was preserved and no violation of this important periodontal parameter was observed. The average time for accessing the FA point in experimental group was 11±1.1 weeks and the mentioned period was increased to 25±1.8 weeks in control group. The data analysis showed that in patients with DTE, laser intervention significantly accelerated tooth eruption (P < 0.05). CONCLUSION: Laser-assisted surgical removal of the fibrous tissue over erupting premolars (DTE) with appropriate irradiation parameters appears to be a promising adjunct to orthodontic treatment for bringing the premolar to the aligned and leveled dental arch.

Resultados da atratividade do perfil facial nas dimensões sagital e vertical utilizando previsão computadorizada / Facial profile attractiveness outcome in sagital and vertical dimensions, using computerized prediction

Aim: To assess the perception of facial attractiveness in profile digital images in the sagital and vertical plan. Methods: The facial profiles of 80 patients (20 Class II, 20 Class III, 20 open bite and 20 deep bite) male and female samples were evaluated. The lateral cephalometry radiographs of the all samples were digitized and systematically altered regarding the location of the mandible and maxilla in the sagital and vertical plan, using Dolphin Imaging software program (version 10.0). Five manipulated profile images together with the patients' own profile were presented to the raters including laypersons, orthodontists and surgeons. The facial attractiveness of the profile images were assessed using a 6-scaled (visual analogue scale). The data were analyzed using Kruskal Wallis and Mann Whitney U tests. Results: The most attractive facial profiles were normal images in both patients' groups as assessed by all judges Severe Class III facial profiles in both Class II and Class III patients' images and severe open bite facial profiles in both deep bite and open bite patients' images ranked as the least attractive. No significant differences were found in the overall rankings of male and female profile images between female and male raters. Conclusion: The profile attractiveness decreased with the more deviations from the normal profile proportions and more scattered ideas were shown by raters. Specialists can use the results of the beauty perception by the laypersons to modify the treatments and consequently increase the patients' satisfaction.

Objetivo: Avaliar a percepção da atratividade facial em imagens digitais de perfil no plano sagital e vertical. Método: Foram avaliados perfis faciais de 80 pacientes (20 Classe II, 20 Classe III, 20 mordida aberta e 20 mordida profunda), pertencentes ao sexo masculino e ao feminino. As radiografias cefalométricas de todos os indivíduos foram digitalizadas e sistematicamente alteradas em relação à localização da mandíbula e da maxila no plano sagital e vertical, usando o software Dolphin Imaging (versão 10.0). Cinco imagens de perfil, manipuladas em conjunto com o perfil dos próprios pacientes, foram apresentadas aos avaliadores, incluindo leigos, ortodontistas e cirurgiões. A atratividade facial das imagens de perfil foram avaliadas através de uma escala visual analógica. Os dados foram analisados pelo teste de Kruskal Wallis e Mann Whitney. Resultados: Os perfis faciais mais atrativos foram os de imagens normais, em ambos os grupos de pacientes, sendo considerado por todos os avaliadores perfis faciais graves os casos de Classe III. Tanto as imagens de pacientes graves Classe II e Classe III, como os perfis faciais de mordida aberta e mordida profunda, foram classificados como menos atraentes. Não foram encontradas diferenças significativas na classificação geral de imagens de perfil masculino e feminino entre avaliadores do sexo feminino e masculino. Conclusão: A atratividade do perfil diminuiu na medida em que maiores eram os desvios das proporções do perfil normal e opiniões mais divergentes foram emitidas pelos avaliadores. Especialistas podem usar os resultados da percepção da beleza pelos leigos para modificar os tratamentos e, consequentemente, aumentar a satisfação dos pacientes.