DIAGNOSTIC PERFORMANCE OF CONE-BEAM COMPUTED TOMOGRAPHY TO DIAGNOSE IN VIVO/IN VITRO ROOT RESORPTION: A SYSTEMATIC REVIEW AND META-ANALYSIS.

BACKGROUND: This review analyses the diagnostic performance of cone-beam computed tomography (CBCT) for the in vivo/in vitro detection of external root resorption (ERR) and critically analyses current and past methods of measuring or classifying ERR in vivo/in vitro in terms of radiation doses and cumulative radiation risks. METHODS: A diagnostic test accuracy (DTA) protocol was used for a systematic review of diagnostic methods following PRISMA guidelines. The protocol was registered with PROSPERO (ID: CRD42019120513). A thorough and exhaustive electronic search of 6 core electronic databases was performed, applying the ISSG Search Filter Resource. The eligibility criteria were designed [problem-intervention-comparison-outcomes (PICO) statement: Population, Index test, Comparator, Outcome] and methodological quality was assessed by QUADAS-2. RESULTS: Seventeen papers were selected from a total of 7841 articles. Six in vivo studies were assessed as having a low risk of bias. The overall sensitivity and specificity of CBCT for diagnosis of ERR was 78.12% and 79.25%, respectively. The highest and lowest sensitivity and specificity of CBCT for diagnosis of external root resorption are 42%-98% and 49.3%-96.3%. DISCUSSION: Most of the selected studies reported quantitative diagnoses with single linear measurements of ERR even though multislice radiographs were available. The cumulative radiation dose (µS) to radiation-sensitive structures, such as the bone marrow, brain and thyroid, was observed to increase using the 3-dimensional (3D) radiography methods reported. CONCLUSIONS: The highest and lowest sensitivity and specificity of CBCT for diagnosis of external root resorption are 42%-98% and 49.3%-96.3%. The minimum and maximum effective doses of dental CBCT for external root resorption diagnosis are 34 µSv and 1073 µSv.

Unusual Case of Extraction of Maxillary Lateral Incisors and Mandibular Central Incisors.

INTRODUCTION: This article's purpose is to report a case where maxillary lateral incisors and mandibular central incisors are extracted and a canine substitution was performed as the best therapeutic option in order to obtain symmetry in a malocclusion with an upper lateral incisor with poor prognostic, solve moderate crowding, get enough space for the permanent dentition, and provide stability to the results. CASE REPORT: An 11-year-old boy with straight profile with acute-to-normal nasolabial angle and protruded lips, mixed dentition, lower and upper severe crowding, and a bilateral molar angle Class I. The left maxillary lateral incisor failed endodontic treatment secondary to an intrusive traumatic lesion in the primary and permanent dentition. The treatment of choice was the extraction of both upper lateral incisors and both central lower incisors. The patient finished with molar and canine angle Class I and coincident midlines and was functionally stable; both lateral and protrusive jaw movements were effectively made by the first premolars and central incisors and canines without improper contacts of the rest of the teeth. Overbite of one-third and correct overjet were also achieved, and the esthetic outcome was satisfactory due to the composed material restorations of both the central and lateral incisors, as well as recontouring of the first maxillary premolars.

Decoronation: An Alternative Treatment for Replacement Root Resorption.

INTRODUCTION: Ankylosis and disrupted or altered root development are frequent complications associated with intrusive luxation and tooth avulsion lesions. Various forms of treatment have been described according to the severity of the trauma and root development. The literature shows that decoronation is an ideal treatment in cases where replacement resorption occurs. METHODS: Two clinical cases are presented: involving intrusive luxation [15-year-old female patient with an affected maxillary left lateral incisor (2.2)] and a replanted avulsed tooth [8-year-old male patient with avulsion of the right maxillary central incisor (1.1)]; both cases presented advanced root resorption so that decoronation with a prosthetic tooth replacement was decided as the final treatment option. RESULTS: In the short-term follow-up, patients were asymptomatic and had no functional problems. Radiographs showed that crestal bone height had been preserved. CONCLUSIONS: Preserving the decoronated root in the alveolar process not only helps to maintain bone volume but also enables vertical bone growth and facilitates the future insertion of an implant.

Five radiographic methods for assessing skeletal maturity in a Spanish population: is there a correlation?

OBJECTIVES: The need for accurate techniques of estimating age has sharply increased in line with the rise in illegal migration and the political, economic and socio-demographic problems that this poses in developed countries today. The methods routinely employed for determining chronological age are mainly based on determining skeletal maturation using radiological techniques. The objective of this study was to correlate five different methods for assessing skeletal maturation. MATERIALS AND METHODS: 606 radiographs of growing patients were analyzed, and each patient was classified according to two cervical vertebral-based methods, two hand-wrist-based methods and one tooth-based method. Spearman's rank-order correlation coefficient was applied to assess the relationship between chronological age and the five methods of assessing maturation, as well as correlations between the five methods (p < 0.05). RESULTS: Spearman's rank correlation coefficients for chronological age and cervical vertebral maturation stage using both methods were 0.656/0.693 (p < 0.001), respectively, for males. For females, the correlation was stronger for both methods. The correlation coefficients for chronological age against the two hand-wrist assessment methods were statistically significant only for Fishman's method, 0.722 (p < 0.001) and 0.839 (p < 0.001), respectively for males and females. CONCLUSIONS: The cervical vertebral, hand-wrist and dental maturation methods of assessment were all found to correlate strongly with each other, irrespective of gender, except for Grave and Brown's method. The results found the strongest correlation between the second molars and females, and the second premolar and males. CLINICAL RELEVANCE: This study sheds light on and correlates with the five radiographic methods most commonly used for assessing skeletal maturation in a Spanish population in southern Europe.

Orthodontically induced external apical root resorption in patients treated with fixed appliances vs removable aligners.

OBJECTIVE: To determine whether orthodontic treatment with removable aligners vs fixed orthodontic appliances is associated with a different frequency of orthodontically induced external apical root resorption (OIEARR) when genetic, radiographic, and clinical factors are accounted for. MATERIALS AND METHODS: Three hundred seventy-two orthodontic patients treated with removable aligners (Invisalign) or fixed appliances were genetically screened for interleukin 1B gene (IL1B) (rs1143634), interleukin 1 receptor antagonist gene (IL1RN) (rs419598), and osteopontin gene (SPP1) (rs9138/rs11730582). Twelve clinical variables, potentially associated with OIEARR, were also considered. Subjects were divided according to the presence of radiographically determined OIEARR (>2 mm). The association between OIEARR and appliance type, and radiographic, clinical and genetic factors, was assessed using backward stepwise conditional logistic regression. Odds ratios (ORs) and 95% confidence intervals (CIs) were reported. RESULTS: Reliability of the methods was adequate. Clinical case complexity (American Board of Orthodontics [ABO] Discrepancy Index) (OR: 1.032; 95% CI: 1.005-1.061; P = .021) and extent of incisor apical displacement in the sagittal plane (OR: 1.478; 95% CI: 1.285-1.699; P = .001) were associated with an increased OIEARR risk. After adjusting for associations between clinical/radiographic/genetic factors, there were no statistically significant differences with respect to OIEARR or type of orthodontic appliance used, whether removable aligners or fixed appliances (OR: 1.662; 95% CI: 0.945-2.924; P = .078). Only subjects homozygous for the T allele of IL1RN (rs419598) were more prone to OIEARR during orthodontic treatment (OR: 3.121; CI: 1.93-5.03; P < .001). CONCLUSIONS: A similar OIEARR predisposition was identified using either removable aligners (Invisalign) or fixed appliances.

Short-term effect of removal of fixed orthodontic appliances on gingival health and subgingival microbiota: a prospective cohort study.

OBJECTIVE: The aim of this prospective longitudinal study was to assess and compare the microbiological and clinical parameters of patients wearing a fixed orthodontic appliance, as opposed to 10 days after the bracket had been removed following treatment. MATERIALS AND METHODS: In total, 122 patients participated in this study; 61 of the subjects were assessed at baseline (wearing a fixed orthodontic appliance: T1) and 10 days after bracket removal (T2). The other 61 individuals had never worn an orthodontic appliance before and these subjects served as controls (CT). Subgingival plaque samples were assessed for bleeding on probing (GBI) and plaque index (VPI). PCR of 16s rDNA, followed by reverse species-specific hybridization for Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia and Treponema denticola were performed. A descriptive analysis was conducted; chi-squared, Student's matched and unmatched t-tests, the point biserial correlation coefficient and the McNemar test were used to test for differences between groups (p < 0.05). RESULTS: The GBI and VPI clinical parameters showed statistical differences (p < 0.05) between T1-T2, T1-CT and T2-CT. The prevalence of T. denticola had significantly decreased (p = 0.039) 10 days after appliance removal. At T2, a significant positive correlation was found between GBI and A. actinomycetemcomitans (p < 0.01) and between clinical parameters and P. intermedia. In patients without a fixed orthodontic appliance (T2 and CT), there was a significant positive correlation between T. forsythia and VPI. CONCLUSION: Local factors associated with the wearing of a fixed orthodontic appliance influence changes in subgingival plaque that leads to more inflammation and bleeding.

Current Approaches of Bone Morphogenetic Proteins in Dentistry.

Bone morphogenic proteins (BMPs) are a group of osteoinductive proteins obtained from nonmineralized bone matrix; they are capable of stimulating the differentiation of pluripotent mesenchymal cells to osteoprogenitor cells. They have become a likely treatment option, given their action on regeneration and remodeling of bone lesions and increasing the bone response around alloplastic materials. It may be feasible in the near future for BMPs to replace autologous and allogenic bone grafts. The application of specific growth factors for osteoinduction without using a bone graft constitutes a real impact on bone regeneration. The use of BMP is not only focused on osteogenic regeneration: There are a variety of studies investigating other properties, such as periodontal or dental regeneration from the conservative viewpoint. In this review, we will highlight the role of the BMP in bone, periodontal and dental regeneration.

Prospective double-blind clinical trial evaluating the effectiveness of Bromelain in the third molar extraction postoperative period

OBJECTIVES: To evaluate the anti-inflammatory and analgesic effect of Bromelain (pineapple extract) administered orally in the postoperative after extraction of impacted lower molars. Study DESIGN: This is a prospective, placebo-controlled, unicentric, double-blind study; the sample size was 34 patients. The pre and postoperative outcomes, evaluated on the third (D3) and eighth day (D8), included inflamtion, pain and oral aperture, as well as the need for analgesics. One group received Bromelain 150mg per day for three days and 100mg on days 4 to 7. The other group received placebo in the same dosage. All outcomes werrecorded quantitatively and analyzed with the Mann-Whitney U test for independent samples. RESULTS: Although there were no statistically significant differences between the treatment groups, a trend towards less inflammation and improved oral aperture was observed in the group that received Bromelain, compared to the group that received placebo. This trend can be attributed completely to random reasons, since there is no statistical difference in the results. CONCLUSIONS: Further studies are necessary to analyze different administration patterns and doses of Bromelain for the use in the postoperative of impacted third molars

Mechanical behavior of single-layer ceramized zirconia abutments for dental implant prosthetic rehabilitation.

OBJECTIVES: This study was undertaken to characterize the mechanical response of bare (as-received) and single-layer ceramized zirconia abutments with both internal and external connections that have been developed to enhanced aesthetic restorations. MATERIAL AND METHODS: Sixteen zirconia implant abutments (ZiReal Post®, Biomet 3i, USA) with internal and external connections have been analyzed. Half of the specimens were coated with a 0.5mm-thick layer of a low-fusing fluroapatite ceramic. Mechanical tests were carried out under static (constant cross-head speed of 1mm/min until fracture) and dynamic (between 100 and 400N at a frequency of 1Hz) loading conditions. The failure location was identified by electron microscopy. The removal torque of the retaining screws after testing was also evaluated. RESULTS: The average fracture strength was above 300N for all the abutments, regardless of connection geometry and coating. In most of the cases (94%), failure occurred by abutment fracture. No significant differences were observed either in fatigue behavior and removal torque between the different abutment groups. CONCLUSIONS: Mechanical behavior of Zireal zirconia abutments is independent of the type of internal/external connection and the presence/absence of ceramic coating. This may be clinically valuable in dental rehabilitation to improve the aesthetic outcome of zirconia-based dental implant systems. Key words:Dental implant, zirconia, ceramic structure, mechanical properties.

Management of occlusal canting with miniscrews.

A 14-year-old boy with a skeletal Class II malocclusion and open bite whose chief complaint was a posterior crossbite showed a canted occlusal plane with asymmetric gummy smile and mandibular deviation at clinical examination. The treatment with miniscrews focused on the bilateral intrusion of the maxillary posterior teeth and, after resolving the open bite, a new biomechanical technique involving joined miniscrews was applied for an en masse intrusion of the left side. This treatment strategy achieved optimal occlusion with improvements to the sagittal, vertical, and transverse relationships and achieved a harmonious smile.

Determination of periodontopathogens in patients with Cri du chat syndrome

OBJECTIVES: Cri du chat syndrome is a genetic alteration associated with some oral pathologies. However, it has not been described previously any clinical relationship between the periodontal disease and the syndrome. The pur-pose of this comparative study was to compare periodontopathogenic flora in a group with Cri du chat syndrome and another without the síndrome, to assess a potential microbiological predisposition to suffer a periodontitis.Study DESIGN: The study compared nineteen subjects with Cri du chat Syndrome with a control group of nineteen patients without it. All patients were clinically evaluated by periodontal probing, valuing the pocket depth, the clinical attachmente level and bleeding on probing. There were no significant differences between both groups. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia and Treponema denticola were detected by multiplex-PCR using 16S rDNA (microIDENT).RESULTS: When A. actinomycetemcomitans, P. gingivalis, P. intermedia and T. denticola were compared, no statis-tically significant differences were found between the two groups (p > 0.05). The value of T. forsythia was signifi-cantly higher for Cri du chat syndrome (31.6%) than for the control group (5.3%). The odds ratio for T. forsythia was 8.3.CONCLUSIONS: In the present study T. forsythia is associated with Cri du chat syndrome subjects and not with healthy subjects

Determination of periodontopathogens in patients with Cri du chat syndrome.

OBJECTIVES: Cri du chat syndrome is a genetic alteration associated with some oral pathologies. However, it has not been described previously any clinical relationship between the periodontal disease and the syndrome. The purpose of this comparative study was to compare periodontopathogenic flora in a group with Cri du chat syndrome and another without the síndrome, to assess a potential microbiological predisposition to suffer a periodontitis. STUDY DESIGN: The study compared nineteen subjects with Cri du chat Syndrome with a control group of nineteen patients without it. All patients were clinically evaluated by periodontal probing, valuing the pocket depth, the clinical attachmente level and bleeding on probing. There were no significant differences between both groups. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Tannerella forsythia and Treponema denticola were detected by multiplex-PCR using 16S rDNA (microIDENT). RESULTS: When A. actinomycetemcomitans, P. gingivalis, P. intermedia and T. denticola were compared, no statistically significant differences were found between the two groups (p>0.05). The value of T. forsythia was significantly higher for Cri du chat syndrome (31.6%) than for the control group (5.3%). The odds ratio for T. forsythia was 8.3. CONCLUSION: In the present study T. forsythia is associated with Cri du chat syndrome subjects and not with healthy subjects.

Bone- and dentoalveolar-anchored dentofacial orthopedics for Class III malocclusion: new approaches, similar objectives? : a systematic review.

OBJECTIVES: To analyze the scientific literature and compare in the results of conventional orthopedic appliances with those obtained from recent bone-anchored orthopedics for Class III malocclusion. MATERIALS AND METHODS: The literature was systematically reviewed using PubMed/Medline, Scopus, and Scirus databases up to January 2012. Articles were selected by two different researchers (kappa index  =  0.83), based on established inclusion/exclusion criteria. Methodologic quality was classified as high, medium, or low quality. RESULTS: The search strategy identified 1020 titles. Thirty studies were selected after applying the criteria (high quality  =  9, medium quality  =  21). Protraction rates differed within a range of one- to twofold between bone-anchored and dentoalveolar therapies (P < .001). All studies noted the effect of clockwise rotation on the mandible and an increase in inferior-anterior and total facial height; this was more obvious in dentoalveolar therapy than in bone-anchored orthopedics (P < .001). CONCLUSIONS: Dental parameters like overjet increased significantly with both sets of groups, ranging from 1.7 to 7.9 mm with dentoalveolar therapy and from 2.7 to 7.6 mm with bone-anchored orthopedics.

Stem cells in current paediatric dentistry practice.

New protocols for regenerative endodontic treatment along with the parallel development of tissue engineering technologies are changing traditional knowledge and treatment possibilities for young patients with pulp-affected permanent immature teeth. The regeneration and completion of apical root development in pathological situations such as these is a clinical challenge that traditional treatments have not so far been able to resolve with complete success. In clinical terms, the decision of whether to perform apexogenesis or apexification on an immature tooth is determined by whether the pulp tissue is vital or non-vital. Recent evidence and reports in the literature have questioned the old dogmas. In this respect, the ever growing scientific literature in this field makes it essential to compile a critical reflection and summary of everything that has been written to date, in order to understand the biological basis of current clinical advances and ensuing lines of future therapy. In this paper, we wish to give scientific coverage and background to more recent clinical and molecular advances described in the field of apical regeneration using stem cell therapy and their potentially key role in the future clinical success of new pulp regenerative protocols.

A descriptive epidemiologic study of cleft lip and palate in Spain.

OBJECTIVE: The purpose of this study was to investigate the distribution of different cleft patterns by sex, side of the cleft, and family history of clefts in a referral hospital in the south of Spain. STUDY DESIGN: One hundred twenty-three consecutive cleft lip subjects, with or without palates, attending the Stomatology Unit in the Virgen del Rocío University Hospital and in the Virgen Macarena University Hospital from October 2009 to May 2010 were studied. RESULTS: The unilateral complete cleft lip and palate (54.4%) was most frequently found, followed by the bilateral complete cleft lip and palate (16.3%). Male patients (60.97%) and the left side (41.46%) were the most affected. A positive family history was observed in 21.94% of subjects. CONCLUSIONS: The most frequent profile in the affected population was male with left unilateral complete cleft lip and palate. The high incidence of family history of cleft on the father's side prompts us to recommend further genetic research in this area.

Association between condylar asymmetry and temporomandibular disorders using 3D-CT

Objectives: Using reconstructed three-dimensional computed tomography (3D-CT) models, the purpose of this study was to analyze and compare mandibular condyle morphology in patients with and without temporomandibular disorder (TMD). Study Design: Thirty-two patients were divided into two groups: the first comprised those with TMD (n=18), and the second those who did not have TMD (n=14). A CT of each patient was obtained and reconstructed as a 3D model. The 64 resulting 3D condylar models were evaluated for possible TMD-associated length, width and height asymmetries of the condylar process. Descriptive statistics were used to assess the results and student’s t tests applied to compare the two groups. Results: Statistically significant (p<0.05) vertical, mediolateral and sagittal asymmetries of the condylar process were observed between TMD and non-TMD groups. TMD patients showed less condylar height (p<0.05) in comparison with their asymptomatic counterparts. Conclusions: Using 3D-CT, it was shown that condylar width, height and length asymmetries were a common feature of TMD (AU)

Dental impactions related to pseudoxanthoma elasticum.

Pseudoxanthoma elasticum is a rare genetic disorder causing degeneration and calcification of elastic fibers, leading to injuries in the skin, retina, and cardiovascular system. This report describes a case of a 30-year-old woman whose diagnosis of pseudoxanthoma elasticum was confirmed after a skin biopsy. The patient presented at the Clinical Management Unit of the Department of Oral and Maxillofacial Surgery, Virgen del Rocio Hospital (Seville, Spain) with pain related to a semi-erupted lower first molar. Radiologic examination disclosed multiple dental impactions. Cases of oligodontia, amelogenesis imperfecta, and mucosal lesions related to pseudoxanthoma elasticum were found in the current literature, but there were no reports of multiple dental impactions.

Postorthodontic external root resorption in root-filled teeth is influenced by interleukin-1ß polymorphism.

INTRODUCTION: External apical root resorption (EARR) is a frequent iatrogenic effect of orthodontic treatment. The way root-filled teeth respond to orthodontic forces with respect to EARR has been reported as varying widely between individuals. Genetic variants in the interleukin-1 gene have been associated with an increased risk of experiencing postorthodontic EARR on vital teeth. The objective of this study is to determine whether variants in the interleukin-1 gene have a positive or negative influence on EARR on teeth that have been endodontically treated. METHODS: Ninety-three orthodontic patients underwent genetic screening for 2 single nucleotide polymorphisms (rs1800587, rs1143634) in the IL1 gene cluster. Subjects were divided into 2 groups depending on the presence (affected group) or absence (control group) of more than 2 mm of EARR on root-filled teeth after orthodontic treatment as shown by radiography. Logistic regression analysis was used to obtain adjusted estimates of EARR and IL1 polymorphisms. Allele frequencies, genotype distributions, and adjusted odds ratios were also calculated (95% confidence interval). RESULTS: No positive or negative statistical association was found between postorthodontic treatment EARR in root-filled teeth and genetic variations in IL1A (P > .05). A direct relationship was found for the IL1B gene in the comparative analysis of homozygous subjects (2/2[TT]) and (1/1[CC]), which led to an increased risk of experiencing postorthodontic treatment EARR in root-filled teeth (odds ratio = 11.59; P = .006; confidence interval, 95%) and (odds ratio = 2.54; P = .035; confidence interval, 95%), respectively. CONCLUSIONS: The development of EARR in subjects with root-filled teeth who undergo orthodontic treatment might be attributable to genetic variations in the interleukin-1ß gene (rs1143634).

Association between condylar asymmetry and temporomandibular disorders using 3D-CT.

OBJECTIVES: Using reconstructed three-dimensional computed tomography (3D-CT) models, the purpose of this study was to analyze and compare mandibular condyle morphology in patients with and without temporomandibular disorder (TMD). STUDY DESIGN: Thirty-two patients were divided into two groups: the first comprised those with TMD (n=18), and the second those who did not have TMD (n=14). A CT of each patient was obtained and reconstructed as a 3D model. The 64 resulting 3D condylar models were evaluated for possible TMD-associated length, width and height asymmetries of the condylar process. Descriptive statistics were used to assess the results and student' s t tests applied to compare the two groups. RESULTS: Statistically significant (p<0.05) vertical, mediolateral and sagittal asymmetries of the condylar process were observed between TMD and non-TMD groups. TMD patients showed less condylar height (p<0.05) in comparison with their asymptomatic counterparts. CONCLUSIONS: Using 3D-CT, it was shown that condylar width, height and length asymmetries were a common feature of TMD.

Corticotomy-assisted orthodontic enhancement by bone morphogenetic protein-2 administration.

PURPOSE: To determine the possibility of synergistically enhancing orthodontic tooth movement (OTM) and bone formation in vivo by administering bone morphogenetic protein type 2 (BMP-2) on the tension side or in combination with corticotomy on the pressure side. MATERIALS AND METHODS: The sample consisted of 56 Wistar rats that were subjected to experimental OTM for 32 days using a split-mouth design. The sample was divided into 4 groups: a control group, a corticotomy group, a BMP-2 group, and a corticotomy plus BMP-2 group. An OTM force of 10 cN was applied to each group. BMP-2 18 µL was administered locally on the tension side alone or in conjunction with corticotomy and then compared with the controls using fluorescence-based tartrate-resistant acid phosphatase staining for osteoclast counts, histologic bone resorption, and clinical OTM results. RESULTS: Corticotomy surgery increased the OTM rate (P < .05) by more than 20%. The injection of BMP-2 alone on the tension side did not induce significant changes in the degree of OTM compared with the vehicle-treated or control group (P > .05). When BMP-2 was combined with corticotomy on the tension and pressure sides (corticotomy plus BMP-2 group), respectively, nonsignificant OTM rates were observed (P > .05) compared with the controls; however, decreased osteoclast counts, bone resorption, and clinical results were observed in the corticotomy plus BMP-2 group. CONCLUSIONS: In contrast to reports published to date, the present preliminary study suggests that there are limits to OTM acceleration by bone formation on the tension side and agrees with the idea that there is a single continuous periodontal compartment in OTM, rather than a pressure side and a tension side.