Prevalence and Severity of Circumferential Alveolar Bone Loss Using CBCT Images: A Retrospective Study of 20,620 Surfaces of 5155 Teeth.

Periodontal disease is a site-specific disease affecting the supporting tissues of the teeth. It is useful for the clinician to have information about the prevalence and severity of alveolar bone loss (ABL) according to the site, location, and position of the teeth for a better treatment plan and expected prognosis. This study aimed to assess the prevalence and severity of ABL at mesial, distal, buccal and lingual sites of teeth in different locations, positions and sides of the dentition. The ABL of 20,620 sites of 5155 teeth in 212 patients was assessed using cone-beam computed tomography from the cemento-enamel junction to the crest of the alveolar bone. The prevalence of ABL was higher in the interproximal sites as well as anterior and mandibular teeth compared to their counterparts. Buccal sites and anterior teeth revealed higher ABL levels than the other tooth sites and posterior teeth, respectively. Furthermore, associations in the severity of ABL were observed between distal and mesial sites, buccal and lingual sites, maxillary and mandibular teeth, anterior and posterior teeth, and right and left sides. This study showed that the prevalence and severity of ABL differ from one tooth site to another and according to the tooth's location in the dentition. Higher prevalences were found in the interproximal sites, anterior teeth and mandibular teeth; higher ABL was found in buccal and distal sites, with the strongest associations between distal and mesial sites, buccal and lingual sites, and right and left sides.

Effect of Curcumin gel on inflammatory and anti-inflammatory biomarkers in experimental induced periodontitis in rats: a biochemical and immunological study.

This study aimed to determine the effect of local application of curcumin gels as adjunct to scaling and root planing (SRP) on the inflammatory biomarkers matrix metalloproteinase-8 (MMP-8), interleukin-6 (IL-6), C-reactive protein (CRP), and alkaline phosphatase (ALP), and the anti-inflammatory biomarker interleukin-10 (IL-10) in rats with experimentally induced periodontitis. Fifty-five adult Wistar rats with experimentally induced periodontitis were randomly divided into four groups: 15 rats received SRP + curcumin gel (CU), 15 rats received SRP + Tetracycline gel (Tet), 15 rats were treated with SRP alone, and 5 rats had experimental periodontitis without treatment (EP). Five systemically healthy rats without experimental periodontitis were used as the controls. Blood samples were collected by cardiac puncture from all groups after 2, 4, and 6 weeks of therapy. Biomarker levels determined by enzyme-linked immunosorbent assay (ELISA) and, ANOVA were used to compare the study groups. The results showed a significant increase in pro-inflammatory biomarkers and a significant decrease in anti-inflammatory biomarkers in the EP group compared with the control group (p < 0.05). The local application of curcumin or tetracycline gels resulted in a significant reduction in all inflammatory biomarkers at all periods of examination compared to the EP group. IL-10 levels gradually increased after 2 weeks, peaked at 4 weeks, and then decreased after 6 weeks, however, Tet showed statistically significant improvement compared to CU (p < 0.05). Adjunctive application of CU gel was as effective as Tet gel in the treatment of EP in rats by reducing inflammatory biomarkers and enhancing anti-inflammatory cytokines.

Dispersion and Homogeneity of MgO and Ag Nanoparticles Mixed with Polymethylmethacrylate.

This study aims to examine the impact of the direct and indirect mixing techniques on the dispersion and homogeneity of magnesium oxide (MgO) and silver (Ag) nanoparticles (NPs) mixed with polymethylmethacrylate (PMMA). NPs were mixed with PMMA powder directly (non-ethanol-assisted) and indirectly (ethanol-assisted) with the aid of ethanol as solvent. X-ray diffraction (XRD), energy-dispersive X-ray spectroscopy (EDX), and scanning electron microscope (SEM) were used to evaluate the dispersion and homogeneity of MgO and Ag NPs within the PMMA-NPs nanocomposite matrix. Prepared discs of PMMA-MgO and PMMA-Ag nanocomposite were analyzed for dispersion and agglomeration by Stereo microscope. XRD showed that the average crystallite size of NPs within PMMA-NP nanocomposite powder was smaller in the case of ethanol-assisted mixing compared to non-ethanol-assisted mixing. Furthermore, EDX and SEM revealed good dispersion and homogeneity of both NPs on PMMA particles with ethanol-assisted mixing compared to the non-ethanol-assisted one. Again, the PMMA-MgO and PMMA-Ag nanocomposite discs were found to have better dispersion and no agglomeration with ethanol-assisted mixing when compared to the non-ethanol-assisted mixing technique. Ethanol-assisted mixing of MgO and Ag NPs with PMMA powder obtained better dispersion, better homogeneity, and no agglomeration of NPs within the PMMA-NP matrix.

In vitro evaluation of dental color stability using various aesthetic restorative materials after immersion in different drinks.

BACKGROUND: Currently, the demands for restorations have increased considerably; thus, improvements and modifications have been made in dental composite technologies especially using materials that have been claimed to improve color stability. OBJECTIVE: This study aimed to determine the effect of various solutions on the color stability of different restorative materials in vitro study. METHODS: This study used three types of esthetic restorative materials. The samples comprised 45 discs, including 15 micro-hybrids, 15 nano-hybrids, and 15 glass ionomers). These discs were immersed in various beverages an hour a day for one month at room temperature. The color stability was measured using a spectrophotometer before/after immersion (days 7 and 30). RESULTS: We realized a significant difference in color change with Coca-Cola and tea-milk solution after seven days and 30 days (p < 0.05). However, no significant difference was found in the samples immersed in DM after seven days and 30 days (p > 0.05). The highest value of lightness (∆L) and stainability (∆a) was seen in micro-hybrid after 30 days of immersion in tea-milk solution (- 12.16 ± 1.74 and 11.4 ± 3.82, respectively), while most samples had a positive ∆b value. CONCLUSION: After one month, the tea-milk solution affected the color stability of all used restorative materials. In addition, micro-hybrid had higher color stability than nano-hybrid and glass ionomer.

Determination of the Accuracy of Salivary Biomarkers for Periodontal Diagnosis.

BACKGROUND: We aimed to investigate the accuracy of salivary matrix metalloproteinases (MMP)-8 and -9, and tissue inhibitor of metalloproteinase (TIMP)-1 in diagnosing periodontitis and in distinguishing periodontitis stages (S)1 to S3. METHODS: This study was a case-control study that included patients with periodontitis S1 to S3 and subjects with healthy periodontia (controls). Saliva was collected, and then, clinical parameters were recorded, including plaque index, bleeding on probing, probing pocket depth, and clinical attachment level. Diagnosis was confirmed by assessing the alveolar bone level using radiography. Salivary biomarkers were assayed using an enzyme-linked immunosorbent assay. RESULTS: A total of 45 patients (15 for each stage) and 18 healthy subjects as controls were included. The levels of all salivary biomarkers and clinical parameters were significantly higher in periodontitis subjects than in the controls. The ROC curve showed that MMP-8, MMP-9, TIMP-1, MMP-8/TIMP-1, and MMP-9/TIMP-1 had statistically significant diagnostic accuracy, with areas under the curve (AUCs) of 0.892, 0.844, 0.920, 0.986, and 1.000, respectively, when distinguishing periodontitis from the controls. Similarly, these biomarkers showed significant diagnostic accuracy in the differentiation of S1 periodontitis from the controls (AUC range from 0.902 to 1.000). CONCLUSIONS: This study suggested that salivary biomarkers exhibited high diagnostic accuracy in distinguishing periodontal health from periodontitis in general as well as S1 periodontitis. Furthermore, TIMP-1 could differentiate S1 from S3.

Knowledge about Hepatitis B Virus and Relevant Safety Precautions among Dental Students in Kurdistan Region, Iraq.

Background: Hepatitis B virus (HBV) is still a major health problem worldwide, placing healthcare workers, medical and dental students, and professionals at higher occupational risk. The present study aimed to evaluate the level of knowledge about this virus and relevant safety precautions among dental students in the Kurdistan region of Iraq. Materials and methods. This cross-sectional study was conducted among the third, fourth, and fifth stage dental students of Hawler Medical, Sulaimani, and Duhok universities. Data on the students' demographic characteristics and their knowledge about HBV (16 close-ended questions) and safety precaution measures (10 close-ended questions) were collected by means of a questionnaire. Analysis of variance was used to compare the mean of knowledge and safety precaution scores. Results: In total, 372 students (mean age 21.77 ± 1.31 years) completed the questionnaires. The mean scores for knowledge and safety precautions were 13.17 ± 2.09 and 8.05 ± 1.61, respectively. Respondents from Hawler Medical University showed statistically significantly higher knowledge levels than their counterparts in Sulaimani and Duhok universities (p = 0.012). Conclusions: The majority of surveyed dental students are aware of HBV, its mode of transmission, infection, complications, vaccination, and safety precautions required to prevent the spreading of the virus. While the levels of knowledge about HBV and safety precautions among the dental students in the Kurdistan region of Iraq were generally acceptable, differences in knowledge level were identified between the universities, and these may be related to their educational and training programs.

Incidence of Gingival Black Triangles following Treatment with Fixed Orthodontic Appliance: A Systematic Review.

This systematic review aimed to investigate the relation between orthodontic treatment (OT) and the incidence of the gingival black triangle (GBT) after completing treatment with a fixed orthodontic appliance, as well as the associated risk factors and the level of alveolar bone. Electronic and hand searches were conducted in three electronic databases for relevant articles published up to March 2022. Retrieved articles went through a two-step screening procedure, and the risk of bias (RoB) was assessed by the Joanna Briggs Institute checklists. The incidence of GBT after OT was set as the primary outcome, while the secondary outcomes were the risk factors associated with GBT and alveolar bone loss following OT. Out of 421 papers, 5 were selected for the final analysis. The RoBs of three studies were moderate and the remaining two were low. The incidence of GBT following OT ranged from 38% to 58%. In addition, three studies reported that alveolar bone loss was reduced significantly following OT and associated with GBT, while one study found the opposite. Regarding the risk factors associated with GBT, the reported results attributed GBT to several factors including age, tooth-related factors, treatment duration, and soft tissue factors. The analysis indicates an increased incidence of GBT following OT; however, a firm conclusion cannot be drawn. Additionally, it was not possible to reach a consensus on risk factors associated with GBT due to the heterogeneity of the data. Therefore, further randomized clinical trials are highly recommended to draw a firm conclusion.

Antioxidant Effects of Curcumin Gel in Experimental Induced Diabetes and Periodontitis in Rats.

This study aimed to evaluate the effect of curcumin gel on antioxidant marker level in experimental induced diabetes and periodontitis (EDP) in rats. Adult Wistar rats were randomized into five groups (20 each): (1) EDP treated with scaling and root planing (SRP) + curcumin gel (CU), (2) EDP treated with CU, (3) EDP treated with SRP, (4) EDP without treatment, and (5) systemically healthy and without ligature (control). Each group was subdivided equally into 4 subgroups of 5 rats. Diabetes was induced by intraperitoneal injection of streptozotocin (STZ), and periodontitis was induced by a ligature. Blood samples were collected by cardiac puncture at 0, 7, 14, and 21 days to assess oxidative stress of malondialdehyde (MDA) and antioxidant enzymes of glutathione peroxidase (GPx), catalase (CAT), and suproxidase dismutase (SOD) levels. The results showed a significant increase in serum MDA and antioxidant enzyme levels in the untreated EDP group compared to the control group (p < 0.05). The adjuvant use of CU to SRP resulted in a significant reduction of MDA and CAT levels as compared to the SRP group (p < 0.05); however, significant reduction of GPX and SOD levels can be found only at day 7. It can be concluded that the decreased level of antioxidant enzymes can be construed as a result of decreased oxidative stress by curcumin therapy.

Effects of Curcumin and Tetracycline Gel on Experimental Induced Periodontitis as an Anti-Inflammatory, Osteogenesis Promoter and Enhanced Bone Density through Altered Iron Levels: Histopathological Study.

Adjunctive use of antimicrobials with scaling and root planing (SRP) is necessary to better eradicate dental biofilm. Tetracycline (T) is the most commonly used antimicrobial; however, it has limitations. This study evaluates the effect of curcumin (CU) as adjunct to SRP on inflammatory markers, collagen fiber deposition, and altered iron level. A total of 32 Wistar rats were divided into five groups: no experimental periodontitis (healthy control), experimental periodontitis (EPD), EPD treated with SRP alone (SRP), EPD treated with SRP+T (SRP+T), and EPD treated with SRP+CU (SRP+CU). After 2 and 4 weeks of treatment, tissue samples were assessed by hematoxylin and eosin, and special stains (Perls' stain and Masson's Trichrome) for counting of inflammatory cells, angiogenesis, collagen fibers, and iron deposition. Significant reductions in inflammatory cells infiltration and alveolar bone resorption with angiogenesis and collagen fibers deposition were detected after 2 and 4 weeks in both SRP+T and SRP+CU groups. SRP+CU resulted in a significant reduction in osteoclast numbers (week 2) and iron deposition (week 4) in bone trabeculae as compared to SRP and SRP+T groups. The adjunctive use of CU showed comparable results to T in the reduction in inflammation and bone resorption. Furthermore, CU has potential osteogenesis and healing effects.

Efficacy of MMP-8 Level in Gingival Crevicular Fluid to Predict the Outcome of Nonsurgical Periodontal Treatment: A Systematic Review.

Purpose: To explore whether baseline matrix metalloproteinase (MMP)-8 level in gingival crevicular fluid (GCF) (exposure) can predict the outcome (reduction in probing pocket depth (PPD) (outcome)) of nonsurgical periodontal therapy (NSPT) (manual or ultrasonic or both) in patients with periodontitis (population/problem) after 3 months. Methods: Six databases (PubMed, Cochrane library, ProQuest, Ovid, Scopus, EBSCO) were searched for relevant articles published until 30 July 2021. Retrieved articles were passed through a three-phase filtration process on the basis of the eligibility criteria. The primary outcome was the change in PPD after 3 months. Quality of the selected articles was assessed using Cochrane Risk of Bias tool (RoB2) and Risk of Bias In Non-Randomized Studies of Interventions (ROBINS-I) tools. Results: From 1306 articles, five were selected for analysis. The results showed high variations in the level of GCF MMP-8 level at baseline. The average amount of reduction in PPD was 1.20 and 2.30 mm for pockets with initial depth of 4−6 mm and >6 mm, respectively. Conclusion: On the basis of available evidence, it was not possible to reach a consensus on the ability of baseline GCF MMP-8 to forecast the outcome of NSPT. This could have been due to variation in clinical and laboratory techniques used. However, consistency in mean PPD reduction after 3 months was shown.

Association of matrix metalloproteinase-1-1607 1G/2G single nucleotide polymorphism genotypes with periodontitis in Iraqi population / Associação entre genótipos de polimorfismo de nucleotídeo único de metaloproteinase-1-1607 1G/2G da matriz e periodontite em população iraquiana

Objective and background: Periodontitis is an inflammatory disease which is characterized by a progressive loss in the matrix of soft and hard tissue of periodontium particularly the collagen fibers which are cleaved by matrix Metalloproteinase (MMP). Indeed, increased activity of MMP mediates progression of periodontal diseases but population-based genetic variations could determine the susceptibility to the disease. The aim was to investigate association between MMP-1-1607 polymorphism with periodontitis among Iraqi individuals. Subjects and methods: The design of this study was a case-control for Iraqi individuals who were divided into two groups; periodontitis group (cases) and those with healthy periodontium (Control). For each subject, clinical periodontal parameters and demographic characteristics were recorded and venous blood was withdrawn for genetic analysis of MMP-1 by using PCR technique and DNA sequencing. Results: Analysis of MMP-1-1607 genotypes, by Hardy-Weinberg equilibrium, showed significant differences in the total sample. The most predominant MMP-1-1607 genotype among Controls was 1G/2G which was significantly different from periodontitis cohorts. Overall, 13 SNP were detected in periodontitis group versus 17 SNP in Control group. In addition, the periodontitis group showed a significant negative association between the probing pocket depth and MMP-1-1607. Conclusion: Results suggested that polymorphisms in MMP-1-1607 1G/2G may play a protective role and decreasing the susceptibility to periodontitis. (AU)

Introdução e objetivo: A periodontite é uma doença inflamatória caracterizada pela perda progressiva da matriz dos tecidos moles e duros do periodonto, particularmente as fibras de colágeno clivadas pelas metaloproteinases da matriz (MMPs). De fato, o aumento da atividade de MMPs medeia a progressão das doenças periodontais, mas as variações genéticas baseadas na população podem determinar a suscetibilidade à doença. O objetivo foi investigar a associação entre o polimorfismo MMP-1-1607 e periodontite em indivíduos iraquianos. População e método: O desenho deste estudo foi um caso-controle com indivíduos iraquianos, os quais foram divididos em dois grupos: grupo periodontite (casos) e indivíduos com periodonto saudável (controle). Para cada sujeito, os parâmetros clínicos periodontais e as características demográficas foram registrados, e o sangue venoso foi coletado para análise genética de MMP-1 por meio da técnica de PCR e sequenciamento de DNA. Resultados: A análise dos genótipos MMP-1-1607, pelo equilíbrio de Hardy-Weinberg, mostrou diferenças significativas na amostra total. O genótipo MMP-1-1607 mais predominante entre os controles foi 1G/2G, o qual foi significativamente diferente das coortes de periodontite. No geral, 13 SNP foram detectados no grupo periodontite versus 17 SNP no grupo controle. Além disso, o grupo periodontite mostrou uma associação negativa significativa entre a profundidade da bolsa de sondagem e MMP-1-1607. Conclusão: Os resultados sugerem que polimorfismos em MMP-1-1607 1G/2G podem desempenhar um papel protetor e diminuir a suscetibilidade à periodontite. (AU)

Effects of curcumin gel on osteoclastogenic bone markers in experimental periodontitis and alveolar bone loss in wistar rats.

BACKGROUND/PURPOSE: Curcumin has anti-inflammatory impacts and was suggested as an inflammatory disease therapy. This study aimed to investigate the implications of curcumin gel on experimental periodontitis (EPD) and alveolar bone loss in rats. MATERIALS AND METHODS: In this study, twenty-four male Wistar rats were divided equally into four groups: negative control (with no EPD); positive control (EPD induced around lower centrals without treatment); control-treated group: EPD treated with chlorhexidine; and test EPD group treated with curcumin. After 30 days, the serum concentrations of RANKL and IL-1ß were measured via ELISA. All animals were sacrificed, and mandibular central incisors with the periodontium were removed. The lingual probing depth and radiographical alveolar bone loss were measured, then samples processed for routine preparation of H&E stained sections and histologically assessed for counting inflammatory cells, osteoclasts, and PDL width. RESULTS: A significant decrease in the inflammatory cells infiltration, probing depth, and osteoclast numbers with the improvement of PDL associated with a reduction in RANKL and IL-1ß serum concentration were seen in both EPD treated groups. CONCLUSION: Curcumin is as effective as chlorhexidine in treating experimental periodontitis in rats. It was demonstrated to stop bone destruction related to periodontitis by regulating the RANKL and IL-1ß markers level in the blood.

Association of dental and gingival health status with level of salivary characteristics and Streptococcus mutans in children.

BACKGROUND/PURPOSE: Caries and periodontal diseases are the most common oral diseases that lead to teeth loss. The aim of this study is to assess the association of combination of salivary characteristics, Streptococcus mutans levels and clinical parameters to the dental and gingival health statuses of children. MATERIALS AND METHODS: Saliva samples were collected from 89 children. Children were allocated to the low caries group (45 children: mean DMFT/dmft ≤ 2) or high caries group (44 children: mean DMFT/dmft ≥ 5) according to WHO method and criteria. Additionally, gingival health status was assessed as fair (gingival index and plaque index < 2) or bad (gingival index and plaque index ≥ 2). Each participant's resting saliva hydration (RSH), viscosity (RSV), pH (RSpH), stimulated saliva flow rate (SSFR), buffering capacity of saliva (BCSS) and level of S. mutans (SSM) were determined by chair side test kits. RESULTS: The result showed statistically significant differences in all salivary characteristics and SSM levels for both types of dentition between the low and active caries groups as well as between fair and bad gingival health status (except for RSH for permanent teeth and RSH plus SSFR for primary teeth). Logistic regression showed that combination of plaque index (PI), RSH, RSV, RSpH and SSM provided accurate association (permanent teeth: 92.1%, primary teeth: 100%) of caries status and PI plus BCSS provided accurate association (permanent teeth: 92.1%, primary teeth: 93%) of gingival health status. CONCLUSION: This study has suggested that combination of salivary characteristics, PI and SSM levels could provide significant association of caries and gingival health statuses of children.

Assessment of Creeping Attachment after Free Gingival Graft in Treatment of Isolated Gingival Recession.

BACKGROUND: This longitudinal clinical study aimed to determine the amount of creeping attachment and its relation to baseline recession depth after placement of free gingival grafts (FGG) apical to class I, II, and III Miller's recession defects. MATERIALS AND METHODS: Twenty subjects with Miller class I, II, and III gingival recession defects requiring FGG were recruited into this longitudinal clinical study. Site-specific clinical parameters (pocket depth, depth and width of gingival recession and width of keratinized gingiva apical to the recession) were recorded at baseline, 3 month and 6 month time points using a digital caliper. All subjects received motivation, oral hygiene instruction, full mouth scaling, and root surface debridement. FGG were placed using standard protocols for all subjects. Pearson correlation was used to determine the correlation between the amount of recession reduction at the six-month and baseline clinical parameters. RESULTS: Sixteen subjects completed the six-month follow-up. FGG resulted in significant improvements in all clinical parameters except pocket depth. Recession depth showed a significant reduction from 3.14±1.16mm at baseline to 1.87±0.92mm at the six-month time point (P= 0.001) and the amount of creeping attachment significantly correlated t the depth of recession at baseline (r= 0.66, P=0.01). CONCLUSIONS: FGG placed apical to recession areas resulted in a significant decrease of recession depth by creeping attachment. The amount of creeping attachment was associated with baseline recession depth.

Prevalence of impacted mandibular third molars and its association with distal caries in mandibular second molars using cone beam computed tomography / Prevalencia de terceros molares mandibulares impactados y su asociación con caries distales en segundos molares mandibulares mediante tomografía computarizada de haz cónico

This study evaluated the prevalence and eruption's pattern of impacted mandibular third molars (IMTM) and the influence of their eruption status on the distal caries of mandibular second molars (MSM) using cone-beam computed tomography (CBCT). Material and methods: CBCT images taken for different purposes in private dental practices were analyzed retrospectively. Radiographic assessment included: prevalence of IMTM, degree of angulation, level of impaction and type of IMTM. Furthermore, the distance between the cement-enamel junctions (CEJ) of second and third molars and the occurrence of caries lesion on the distal surface of MSM was also evaluated. Data were analyzed by chi square test and logistic regression was used to find the association between distal caries of MSM and eruption status of IMTM. Results: Three hundred and eight CBCTs were screened, the prevalence of IMTM was 36.88% and their angulation degree were mostly less than 90º (mesioangular). Amongst those with impaction, 58 subjects (43%) had distal caries on MSM, 29.6% in females and 30.4% in the age group 19-27 years. Caries on the distal side of MSM were significantly associated with age, level and type of impaction, angulation degree and CEJ distances (p<0.05). Conclusions: The prevalence of IMTM is high (36.88%) and there are significant relationships between angulation degree, level and type of impaction, and CEJ distances with caries on the distal side of MSM.

Introducción: Este estudio evaluó la prevalencia y el patrón de erupción de terceros molares mandibulares impactados (TMMI), y la influencia de su estado de erupción en la caries distal de los segundos molares mandibulares (SMM) mediante tomografía computarizada de haz cónico (TCHC). Material y métodos: se analizaron retrospectivamente las imágenes de TCHC tomadas para diferentes fines en prácticas dentales privadas. La evaluación radiográfica incluyó: prevalencia de TMMI, grado de angulación, nivel de impacto y tipo de TMMI. Además, también se evaluó la distancia entre la unión amelocementaria (UAC) de los segundos y terceros molares y la aparición de lesión de caries en la superficie distal de SMM. Los datos se analizaron mediante la prueba de chi cuadrado y se usó la regresión logística para evaluar asociaciones entre la caries distal de SMM y el estado de erupción de TMMI. Resultados: Se examinaron 308 TCHC, la prevalencia de TMMI fue de 36.88% y su grado de angulación fue mayoritariamente menor a 90º (mesioangular). Entre aquellos con impacto, 58 sujetos (43%) tenían caries distales en los SMM, 29.6% eran mujeres y 30.4% pertenecieron al grupo de edad de 19-27 años. Las caries en el lado distal de MSM se asociaron significativamente con la edad, el nivel y el tipo de impactación, el grado de angulación y las distancias UAC (p<0.05). Conclusiones: la prevalencia de TMMI es alta (36.88%) y existen relaciones significativas entre el grado de angulación, el nivel y el tipo de impacto, y las distancias UAC con presencia de caries en el lado distal de los SMM.