Bite force of children and adolescents: a systematic review and meta-analysis.

This systematic review aimed to assess bite force measurements in children and adolescents and to study the various devices that measure Maximum Voluntary Bite Force (MVBF). This systematic review included observational studies and experimental studies in children and adolescents (upto 19 years of age) which evaluated MVBF using a bite force measuring device. Studies on participants with systemic conditions were excluded. Databases such as PubMed, Embase, LILACS, and the Cochrane library were searched until September 2022, for which screening and quality assessment were performed. Newcastle-Ottawa, modified Newcastle-Ottawa and ROBINS-I tools were used to assess the Risk-of-bias. All observational studies reporting overall bite force values of participants were included for meta-analyses. A total of 8864 participants (3491 males and 3623 females) were included from 61 studies. Meta-analyses were conducted to evaluate mean average bite force value for each included dentition using R software v2.4-0. Estimation was done to derive an average BF value for variables such as age (dentition), gender, side, site, device and ethnicity. MVBF values were reported as mean average in the form of MLN with 95% CI (Confidence Interval). Using a random-effects model, 29 forest plots were generated. I2 values varied between 90% and 100%. Bite force ranged from 246.22 N (220.47; 274.98) to 311.72 N (255.99; 379.59) and 489.35 N (399.86; 598.87) in primary, mixed, and permanent dentitions, respectively. Six different sites for recording bite force and 11 different types of devices were reported with portable occlusal bite force gauge being the most common device. Outcomes of this review provide useful baseline reference values of bite force for clinicians and researchers.

Endodontic Management of Dilacerated Maxillary Central Incisor fused to a Supernumerary Tooth using Cone Beam Computed Tomography: An Unusual Clinical Presentation.

AIM: The purpose of this report is to present a case of endodontic management of a dilacerated maxillary central incisor fused to supernumerary tooth unusually appearing as a labial tubercle using cone beam computed tomography (CBCT) as a diagnostic aid. BACKGROUND: Anterior teeth are commonly encountered with aberrant anatomical variations in the crown, number of roots, and root canals. Fusion is an infrequent developmental abnormality in shape of the tooth caused by the union of two adjacent tooth germs. A complete knowledge of such complex anatomies is mandatory for a successful root canal treatment. It highlights the endodontic and restorative approach in the functional and esthetic rehabilitation of the involved tooth. CASE REPORT: Three-dimensional imaging using CBCT was used in this case to differentiate single labial canal and palatal C-shaped canal. The endodontic treatment was performed with the aid of dental operating microscope, and the root canals were obturated with a combination of single cone, carrier based, and cold flowable gutta-percha obturation system. The tooth remained asymptomatic without reinfection and symptoms of failure for 18 months. CONCLUSION: Cone beam computed tomography is indispensable in treatment planning for cases where the radiographs cannot reveal useful information regarding the root canal shape. Postobturation CBCT has helped in avoiding further retreatment of the tooth, which otherwise is a challenging task. CLINICAL SIGNIFICANCE: The use of sophisticated equipment, such as dental operating microscope and CBCT has helped in accurate diagnosis and treatment planning of fused central incisor respectively.

Anatomic symmetry of root and root canal morphology of posterior teeth in Indian subpopulation using cone beam computed tomography: A retrospective study.

OBJECTIVE: To investigate the anatomic symmetry of maxillary and mandibular posteriors in Indian subpopulation using cone beam computed tomography (CBCT). MATERIALS AND METHODS: CBCT images of 246 patients that had at least one noncarious, posterior tooth free of restorations in each quadrant were enrolled for retrospective analysis. A total of 3015 teeth (811 maxillary premolars, 845 mandibular premolars, 738 maxillary molars, and 621 mandibular molars) were analyzed for number of roots and root canals, canal morphology and anatomic symmetry, and concurrent types between the maxilla and mandible. RESULTS: There was no difference in the percentage of symmetry for maxillary first (81.5%) and second (81.5%) premolars. Mandibular second premolars (98.3%) exhibited greater symmetry than mandibular first premolars (96.1%). First molars (77.5% and 82.1%) showed greater symmetry than second molars (70.8% and 78.6%), in both maxillary and mandibular arches, respectively. The most common anatomy observed were: maxillary first premolars - 2 roots with 2 canals, maxillary second premolars - 1 root with 2 canals, mandibular first and second premolars - 1 root with 1 canal, maxillary first and second molars - 3 roots with 4 canals, and mandibular first and second molars - 2 roots with 3 canals. When compared with any other teeth, maximum asymmetry was observed in maxillary second molar (29.2%). CONCLUSION: The percentage of symmetry observed in the present study varied from 70% to 98% with least percentage of symmetry in maxillary second molars. These data should alert the clinicians while treating homonymous teeth of the same patient.