Comparison between two viscosupplementation protocols for temporomandibular joint osteoarthritis.

OBJECTIVE: This clinical trial aimed to compare the efficacy of two protocols using high molecular weight hyaluronic acid (HA) intra-articular injection in patients with temporomandibular joint (TMJ) osteoarthritis and evaluate involvement of subchondral bone changes and psychosocial factors as predictors of HA treatment. METHODS: Twenty-one individuals were divided into two groups: (A) received three intra-articular HA injections, and (B) received one injection. Outcomes observed were pain intensity, functional limitation, maximum voluntary mouth opening, maximum assisted mouth opening, and treatment tolerability. Follow-ups were performed weekly for 21 days, and two months after the treatment started. RESULTS: No statistically significant intergroup differences were observed in any of the evaluated outcomes. However, Group A showed significant improvement in all outcomes, whereas Group B showed significant improvement only in pain intensity and functional limitation. CONCLUSION: This study demonstrated the effectiveness of both protocols in terms of pain intensity and functional limitation caused by osteoarthritis.

Determination of the Initial Apical Canal Diameter by the First File to Bind or Cone-beam Computed Tomographic Measurements Using Micro-computed Tomography as the Gold Standard: An Ex Vivo Study in Human Cadavers.

INTRODUCTION: This study evaluated the accuracy and reliability of the tactile perception of the first apical binding file (FABF) and cone-beam computed tomographic (CBCT) imaging in estimating the canal diameter at the working length (WL). METHODS: Ten anterior mandible segments were obtained from cadavers maintained in formalin and scanned using CBCT and high-resolution micro-computed tomographic (micro-CT) imaging. Scans were used to measure the smallest canal diameter of 38 mandibular incisors at 1 mm short of the root apex. After coronal access preparation, the canals of these teeth were explored with a size 08 K-file up to the radiographic apex, and the WL was established 1 mm shorter. Larger K-files were passively introduced in the canal up to the WL until binding was felt and the next instrument size could not reach this point. This instrument was regarded as the FABF. The accuracy and level of agreement (reliability) of the FABF and CBCT imaging in determining the initial apical canal size were determined using the Pearson correlation coefficient and the intraclass correlation coefficient, respectively, considering the micro-CT measurements as the gold standard. RESULTS: The Pearson correlation coefficient and the intraclass correlation coefficient were statistically significant when CBCT imaging was compared with micro-CT imaging (P < .01), showing a moderate accuracy (r = 0.61) and good reliability (0.74). On the other hand, FABF was inaccurate and unreliable (P > .05). The means of the smallest root canal diameter obtained by micro-CT and CBCT imaging were 0.22 mm (range, 0.14-0.34 mm) and 0.23 mm (range, 0.13-0.37 mm), respectively. The mean of the FABF diameter was 0.15 mm (range, 0.08-0.30 mm). CONCLUSIONS: Although FABF did not accurately reflect the diameter of the apical canal at the WL, CBCT imaging showed good accuracy and reliability. Data from CBCT imaging regarding the initial apical canal size may be used to plan root canal enlargement.

Staging hand-wrist and cervical vertebrae images: a comparison of reproducibility.

OBJECTIVES: The aim of this study was to compare the reproducibility of skeletal maturation assessments by raters with similar orthodontic experience using hand-wrist (HW) and cervical vertebral maturation (CVM) methods. METHODS: HW and lateral cephalometric radiographs from 15 subjects (8 males and 7 females; ages, 9-16 years) were selected randomly. HW skeletal maturation was evaluated by the method of Greulich and Pyle, and CVM staging was evaluated by the method of Baccetti et al. Six orthodontic residents evaluated all images at three time periods: T1, initial evaluation; T2, re-evaluation after 7 days and T3, final evaluation after 5 weeks. Intra- and interexaminer reproducibility was evaluated with the intraclass correlation coefficient; the limits of agreement (LoA) were determined by using the Bland-Altman method. RESULTS: The intraexaminer reliability assessed by intraclass correlation coefficient was scored as good for both of methods (T1-T2-T3 HW = 0.89 and CVM = 0.80; T1-T2 HW = 0.87 and CVM = 0.77; T2-T3 HW0 = 0.90 and CVM = 0.81), as well as the interexaminer evaluation, with the exception of HW-T1, which scored excellent (0.92). The width of LoA from Bland-Altman plot of cervical vertebra method was narrower (CVM T1-T2: -2.3 and +1.8; CVM T2-T3: -2.0 and +2.0) than the HW method (HW T1-T2: -3.9 and +4.8; HW T2-T3: -4.0 and +3.5). CONCLUSIONS: Both HW and CVM methods presented good reproducibility for intra- and interexaminer correlation assessments. The small LoA indicated that the CVM is a reproducible method.