Effect of Vitamin D on Bone Regeneration: A Review.

Background and Objectives: Vitamin D (Vit. D) is known for its role in the skeletal system. Vit. D deficiency is also widely researched for its effects on the healing of fractures, bone defects, and osseointegration of implants. In the literature, there are studies that investigated the effects of dietary supplementation with Vit. D to reduce Vit. D deficiency, but increasing the serum level of this vitamin takes time. Therefore, an attempt has been made to combat the effect of Vit. D deficiency through topical applications. The aim of this article was to conduct a review of the existing bibliographic data that investigate the effect of Vit. D on bone regeneration. Materials and Methods: In order to carry out this review, an electronic search was made in several databases and the articles found were selected and analyzed. Results: The in vitro studies' results demonstrated that Vit. D has a high therapeutic potential by enhancing the differentiation of stem cells in osteoblasts. Human and animal studies were conducting using various methods, but most of them revealed that Vit. D has a positive influence on the process of bone regeneration. Conclusions: The overall results of the research showed that, indeed, Vit. D is beneficial for bone regeneration; however, most of the studies imply that a thorough research is still needed for finding the most effective mode of administration and the dose needed in order to achieve the desired effect.

Understanding the basis of medical use of poly-lactide-based resorbable polymers and composites - a review of the clinical and metabolic impact.

This review intended to comparatively explain and present the most important medical use and biological impact of poly-lactides and lactide-based composites. The utilization and degradation of compounds based on lactic acid and polylactides is described in detail. Understanding the metabolism and degradation phenomenon and the factors that potentially influence it is key to modulating their properties as well as their characteristics driven from the fabrication procedures and the fields of use. All these are commented according to the clinician's criteria. The current debate on the advantages and shortcomings of various resorbable polymeric materials categories is also analyzed, from the perspective of the users of resorbable polylactide-based biomaterials. The scientific literature comprises either distinct chemical and physical or specific animal or medical description of resorbable materials; so that in compensation, the present review covers all topics for the most appropriate comprehensive update of the reader.

Early and long-term changes in the muscles of the mandible following orthognathic surgery.

OBJECTIVES: The aim of the present study is to evaluate the early and long-term postoperative dimensional changes of the muscles of the mandible in patients with orthognathic surgery for class II and class III malocclusions by using ultrasonography (US). MATERIAL AND METHODS: Twenty-six patients who underwent bimaxillary orthognathic surgery for class II or class III malocclusions (14 and 12 patients, respectively) were ultrasonographically examined. The length, width, and cross-sectional area of the masseter and suprahyoid muscles were measured at three different time points: T0 (preoperatively), T1 (early postoperatively at 1 month after the surgery), and T2 (late postoperatively at 9 months). A repeated measures ANOVA was used to calculate statistically significant dimensional changes of the mandibular muscles. RESULTS: Statistically significant dimensional changes were found postoperatively in class II malocclusion patients only. The digastric muscle showed higher values for the length and lower values for the width (p < .05) at T1. The geniohyoid muscles were higher in length at T1 and lower in cross-sectional area (CSA) (p < .05) at T2. A decreased measured length and an increased measured width were found in case of the mylohyoid muscle (p < .05) at T2. The early and long-term postoperative dimensional changes of the masseter muscle were not statistically significant. CONCLUSIONS: The mandibular muscles showed a variable adaptive response to the orthognathic surgery. US should be considered for the long-term follow-up of muscular dimensional changes in class II malocclusion patients. CLINICAL RELEVANCE: From a clinical perspective, US is a reliable, non-invasive, and widely available method, which allows monitoring the postoperative muscular changes occurring in class II malocclusion patients.

Cone-beam CT in paediatric dentistry: DIMITRA project position statement.

DIMITRA (dentomaxillofacial paediatric imaging: an investigation towards low-dose radiation induced risks) is a European multicenter and multidisciplinary project focused on optimizing cone-beam CT exposures for children and adolescents. With increasing use of cone-beam CT for dentomaxillofacial diagnostics, concern arises regarding radiation risks associated with this imaging modality, especially for children. Research evidence concerning cone-beam CT indications in children remains limited, while reports mention inconsistent recommendations for dose reduction. Furthermore, there is no paper using the combined and integrated information on the required indication-oriented image quality and the related patient dose levels. In this paper, therefore, the authors initiate an integrated approach based on current evidence regarding image quality and dose, together with the expertise of DIMITRA's members searching for a state of the art. The aim of this DIMITRA position statement is to provide indication-oriented and patient-specific recommendations regarding the main cone-beam CT applications in the pediatric field. The authors will review this position statement document when results regarding multidisciplinary approaches evolve, in a period of 5 years or earlier.

Estimation of the radiation dose for pediatric CBCT indications: a prospective study on ProMax3D.

BACKGROUND: An increasing number of CBCT units and a wide variability of radiation doses have been reported in dentistry lately. AIM: To estimate the effective, cumulative, and organ absorbed doses in children exposed to CBCT over 2 years. DESIGN: A prospective study was conducted in children who underwent CBCT diagnostic imaging with the ProMax3D machine. Organ and effective doses were calculated by Monte Carlo simulation using 5- and 8-year-old pediatric voxel phantoms. Extrapolation procedures were applied to estimate doses for other ages and CBCT protocols used in clinical conditions. RESULTS: The median effective dose was 137.9 µSv, and the median cumulative dose was 231.4 µSv. Statistically significant differences in the effective doses and cumulative doses were found for various indications of CBCT in children (P < 0.001). The median absorbed organ dose for brain and thyroid was significantly higher for the clinical condition that required large FOVs (2.5 mGy and 1.05 mGy, respectively) compared to medium (0.19 and 0.51 mGy) and small FOVs (0.07 and 0.24 mGy; P < 0.05). The radiation dose of salivary glands did not vary significantly with FOV. CONCLUSION: The results revealed the variation of CBCT doses and the influence of FOV size in pediatric exposure.

In quest of optimal drug-supported and targeted bone regeneration in the cranio facial area: a review of techniques and methods.

Craniofacial bone structures are frequently and extensively affected by trauma, tumors, bone infections and diseases, age-related degeneration and atrophy, as well as congenital malformations and developmental anomalies. Consequently, severe encumbrances are imposed on both patients and healthcare systems due to the complex and lengthy treatment duration. The search for alternative methods to bone transplantation, grafting and the use of homologous or heterologous bone thus responds to one of the most significant problems in human medicine. This review focuses on the current consensus of bone-tissue engineering in the craniofacial area with emphasis on drug-induced stem cell differentiation and induced bone regeneration.

The Applicability of Nanostructured Materials in Regenerating Soft and Bone Tissue in the Oral Cavity-A Review.

BACKGROUND AND OBJECTIVES: Two of the most exciting new technologies are biotechnology and nanotechnology. The science of nanostructures, or nanotechnology, is concerned with the development, testing, and use of structures and molecules with nanoscale dimensions ranging from 1 to 100 nm. The development of materials and tools with high specificity that interact directly at the subcellular level is what makes nanotechnology valuable in the medical sciences. At the cellular or tissue level, this might be converted into focused clinical applications with the greatest possible therapeutic benefits and the fewest possible side effects. The purpose of the present study was to review the literature and explore the applicability of the nanostructured materials in the process of the regeneration of the soft and hard tissues of the oral cavity. MATERIALS AND METHODS: An electronic search of articles was conducted in several databases, such as PubMed, Embase, and Web of Science, to conduct this study, and the 183 articles that were discovered were chosen and examined, and only 22 articles met the inclusion criteria in this review. RESULTS: The findings of this study demonstrate that using nanoparticles can improve the mechanical properties, biocompatibility, and osteoinductivity of biomaterials. CONCLUSIONS: Most recently, breakthroughs in tissue engineering and nanotechnology have led to significant advancements in the design and production of bone graft substitutes and hold tremendous promise for the treatment of bone abnormalities. The creation of intelligent nanostructured materials is essential for various applications and therapies, as it allows for the precise and long-term delivery of medication, which yields better results.

Teeth segmentation and carious lesions segmentation in panoramic X-ray images using CariSeg, a networks' ensemble.

Background: Dental cavities are common oral diseases that can lead to pain, discomfort, and eventually, tooth loss. Early detection and treatment of cavities can prevent these negative consequences. We propose CariSeg, an intelligent system composed of four neural networks that result in the detection of cavities in dental X-rays with 99.42% accuracy. Method: The first model of CariSeg, trained using the U-Net architecture, segments the area of interest, the teeth, and crops the radiograph around it. The next component segments the carious lesions and it is an ensemble composed of three architectures: U-Net, Feature Pyramid Network, and DeeplabV3. For tooth identification two merged datasets were used: The Tufts Dental Database consisting of 1000 panoramic radiography images and another dataset of 116 anonymized panoramic X-rays, taken at Noor Medical Imaging Center, Qom. For carious lesion segmentation, a dataset consisting of 150 panoramic X-ray images was acquired from the Department of Oral and Maxillofacial Surgery and Radiology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca. Results: The experiments demonstrate that our approach results in 99.42% accuracy and a mean 68.2% Dice coefficient. Conclusions: AI helps in detecting carious lesions by analyzing dental X-rays and identifying cavities that might be missed by human observers, leading to earlier detection and treatment of cavities and resulting in better oral health outcomes.

Pre- and postoperative assessment of sinus grafting procedures using cone-beam computed tomography compared with panoramic radiographs.

OBJECTIVES: The present study evaluated the clinical validity of cone-beam computed tomography (CBCT) scans in comparison to panoramic radiographs regarding preoperative implant planning in combination with sinus grafting procedures. MATERIALS AND METHODS: Preoperative assessment of the maxillary sinuses and implant planning using panoramic radiographs and CBCT scans was performed on 16 sinuses (13 patients) and comprised choice of treatment, timing of implant placement, sinus morphology, level of confidence, complication prediction and graft volume assessment. Six examiners were involved in the study. RESULTS: In the majority of cases there was a concordance between the treatment type based on either panoramic radiographs or CBCT. If any difference was found, this was due to an overestimation of bone quantity and quality on panoramic radiographs. The assessment of sinus morphology showed a significantly higher detection rate of sinus mucosal hypertrophy on CBCT. The most appealing result is a significant increase in surgical confidence and a significantly better prediction of complications when using CBCT. CONCLUSIONS: A preoperative planning based on CBCT seems to improve sinus diagnostics and surgical confidence.

Disk and joint morphology variations on coronal and sagittal MRI in temporomandibular joint disorders.

OBJECTIVES: This study aims to assess the disk morphology and the condyle position in subjects with temporomandibular (TMJ) disk displacements on sagittal and coronal magnetic resonance imaging (MRI). MATERIALS AND METHODS: Seventy-four TMJs (from 37 patients) with positive clinical TMD symptoms according to the RDC/TMD axis I protocol were evaluated by 1.5 T MRI. Disk position, disk morphology, sagittal and coronal condyle position, joint effusion, joint space, and coronal condyle angulation were evaluated. Multivariate logistic regression was used to explore the relationship between disk displacement and MRI variables. RESULTS: Disk displacement with reduction (DDR) was found in 36.48 % and without reduction (DDwR), in 21.62 % of the joints. Disk displacement was anterior in 35.1 %, anterior-medial in 13.5 %, and anterior-lateral in 9.45 % of cases. The thickened posterior band (94.48 OR, p = 0.001) and the posterior condyle position (4.57 OR, p = 0.03) were more likely found on sagittal MRI in disk displacements. On coronal slices, the disk displacement was significantly associated with the distance from the most medial condyle point to the midplane (p < 0.05). CONCLUSIONS: Disk displacement is associated with changes of disk shape, disk dimension, and condyle position on sagittal MRI. A significant variation of the distance from the most medial condyle point to the midplane in disk displacement was found on coronal MRI. CLINICAL RELEVANCE: Our study highlights the existence of changes on coronal MRI in TMD patients which should be assessed for better understanding of the clinical evolution of temporomandibular disorders.

Oral splints in the management of nociceptive pain and migraines: A scoping review.

Temporomandibular disorders (TMDs) are characterized by numerous pain manifestations. Their treatment often involves the use of an oral splint. Recent research has found a relationship between migraines, nociceptive pain and TMDs. The aim of the present study was to perform a scoping review of studies in order to evaluate the effectiveness of the various types of oral splint in the treatment of migraine or nociceptive pain. Publications were retrieved from seven databases (PubMed, Web of Science, EMBASE, Scopus, ProQuest, SpringerLink and Ovid). Out of the 15 included publications, three studies were before and after studies, with no control group, whereas the other twelve studies were clinical trials, among which two publications were crossover studies. A clear, single distinction of pain was difficult to describe. Therefore, numerous publications focused on a combination of various types of pains, including myofascial, temporomandibular joint, headaches and migraine-like symptoms, all of which mimicked TMD pain. Overall, six studies used the stabilization splint (SS), three explored the comparison between the SS and the nociceptive trigeminal inhibition splint (NTIS) and two the NTIS. The majority of publications reported a positive outcome of splint therapy. Regarding the type of oral splint usage, the most commonly used one was the SS, followed by the NTIS. The definition and assessment of pain were heterogenous in the identified articles. The findings of the current study showed that occlusal splints may help with pain management, and that effective treatment of TMD-related pain at an early stage can enhance the quality of life of patients.

Testing the Accuracy of Pont's Index in Diagnosing Maxillary Transverse Discrepancy as Compared to the University of Pennsylvania CBCT Analysis.

Introduction: Assessment of maxillary transverse discrepancy requires an accurate tool in order to implement the appropriate treatment plan. Aim: To evaluate the accuracy of Pont's Index in confirming a transverse maxillary deficiency by comparing its results with the corresponding results yielded by the University of Pennsylvania CBCT analysis. Material and methods: The study was performed on dental casts and CBCT's of 60 randomly selected patients by adopting a cluster sampling method. The results of Pont's Index and University of Pennsylvania CBCT analysis were analyzed through McNemar's test using Excel Data Analysis, and the accuracy indicators for Pont's Index were computed using MedCalc Ltd. Results: Mc Nemar's test revealed a p-value of 0.85. The accuracy indicators of Pont's Index were: sensitivity: 69%; specificity: 16.6%; positive predictive value: 65%; negative predictive value: 18.75%; positive likelihood ratio: 0.83; negative likelihood ratio: 1.86; and accuracy: 53.28%. Conclusion: Due to the fact that CBCT is not used on a daily basis and Pont's Index has a relatively high sensitivity (69%) making it suitable to detect patients with a narrow maxilla, assessment of the maxillary deficiency on CBCT can be recommended for cases were the midpalatal suture maturation should be evaluated.

Post-Traumatic-Related Technical Errors in Orthopantomographic Imaging.

Background: This study aimed at identifying errors encountered in orthopantomography (OPG) in post-traumatic patients caused by limitations in performing a correct technique. Methods: A retrospective observational study was performed. Diagnosis, exposure/processing mistakes, positioning-related errors, and bimaxillary immobilization were evaluated. Results: Thirty panoramic radiographs with mandible fractures were examined. Twelve error types were encountered: errors in exposure or processing, air radiolucency in the palatoglossal space, errors in the alignment of the Frankfort horizontal plane: head in flexion, with a joyful expression or head extended, with a somber appearance, errors towards the mid-sagittal plane (lateral head inclination, deviation, or rotation), errors caused by the non-use of the bite-block or inappropriate position on the device, errors caused by positioning outside the focal plane, artifacts/shadow images produced by post-operative metal plates, and bimaxillary immobilization errors. The number of errors per radiograph ranged from two to a maximum of five. The most dominant ones were inappropriate alignment in the focal plane and lateral rotation of the head in over 70% of cases. Lateral deviation and palatoglossal air were present in more than 50% of images. Conclusions: In trauma cases, technical difficulties in obtaining a proper OPG image are common and often insurmountable, limiting the diagnosis.

Perineural spread in head and neck malignancies: imaging findings - an updated literature review.

Perineural spread (PNS) represents the tumor's ability to disseminate along nerves. The aim of this article is to review the relevant literature about the PNS in head and neck tumors (HN). The important information for imaging analysis is summarized in a diagnostic flow-chart. The pathogenesis, clinical signs, prognostic importance, and technical considerations for computer tomography and magnetic resonance imaging are briefly discussed. The anatomical pathways of the cranial nerves (CNs) and the main check-points are synthesized. Most commonly affected nerves are the trigeminal and facial, although any of the CNs may be involved. The described imaging features represent important clues for an optimal differential diagnosis. PNS worsens the prognosis and significantly changes the treatment, thus radiologists should be aware of this entity and be able to find it on imaging in the appropriate clinical context.

Lateral Cephalometric Analytical Uses for Temporomandibular Joint Disorders: The Importance of Cervical Posture and Hyoid Position.

The temporomandibular joint disorder (TMD) is a syndrome that affects the masticatory muscles and temporomandibular joint (TMJ). Its pathophysiology is not yet fully known. Cephalometric analysis is used for routine evaluation regarding orthodontic treatment and other purposes. The aim of this study was to assess if using cephalometric analysis and TMJ conservative therapy to evaluate the hyoid bone position and the cervical posture reduced symptoms in adults with TMDs compared to no intervention. The authors conducted a systematic review of the literature (PubMed, Cochrane, Web of Science, Scopus, and Embase) for clinical studies of TMDs with conservative treatment and lateral cephalometric analysis of the hyoid and cervical posture. To assess the risk of bias for non-randomized clinical trials ROBINS-I tool was used. Out of 137 studies found, 6 remained to be included. Most of them found a link between TMD and lateral cephalometric analysis, but there was a high risk of bias. This review found a possible link between TMDs, the neck and cervical posture. There is a benefit reported regarding the use of the lateral cephalometry as a treatment, but more extensive prospective randomized clinical trials are necessary to be able to draw definitive conclusions.

Ultrasound dimensional changes of the anterior belly of the digastric muscle induced by orthognathic surgery and botulinum toxin A injection in Class II malocclusion.

OBJECTIVES: The aim of the study is to evaluate the ultrasonographic dimensional changes of the anterior belly of the digastric muscle (ABDM), occurring after intramuscular botulinum toxin A (BTX-A) injection during orthognathic surgery, in a series of five Class II malocclusion patients. METHODS: All the patients received 20 units of BTX-A, into both ABDM, intraoperatively. The length, width and cross-sectional area (CSA) of the ABDM were ultrasonographically measured at three different time points: T0 (preoperatively), T1 (postoperatively at 2 weeks after the surgical intervention), and T2 (postoperatively at 6-9 months). RESULTS: A statistically significant higher length of the ABDM was noted postoperatively, at T1 and T2 compared to T0. The patients showed an increased length by 12.2% at 2 weeks postoperatively and continued to increase, reaching 24.6% at 6 months. A decreased width of ABDM by 6.5% at T1 compared with T0 was also found. CONCLUSIONS: Postoperative ultrasound (US) follow-up measurements in patients with Class II malocclusion, orthognathic surgery and intraoperative BTX-A injection in the ABDM, showed dimensional changes of the muscle, with elongation and thinning. The muscular modifications were more pronounced at 6 months postoperatively, indicating consistency and potential benefit of using BTX-A in reducing the risk of surgical relapse. Further data on longer-term follow-up and larger number of cases are necessary.

Salivary exosomal microRNAs as biomarkers for head and neck cancer detection-a literature review.

BACKGROUND: MicroRNAs (miRs) are small, non-coding mRNA molecules which regulate cellular processes in tumorigenesis. miRs were discovered in extracellular environment and biological fluids, carrying marks of head and neck squamous cell carcinoma (HNSCC). They were also identified in abundance in salivary exosomes, in which they are protected by exosome lipid barrier against enzymatic injuries and therefore, the accuracy of exosomal miR-based cancer detection increase. This systematic review aimed to reveal and inventorize the most reliable exosomal miRNAs in saliva samples which can be used as novel biomarkers for early detection of HNSCC. MATERIALS AND METHODS: A systematic literature search, according to PRISMA guideline, was performed on Pubmed and Google Academic libraries, based on specific keywords. Original articles published between 2010 and 2021 were selected. The quality of each paper was assessed using the Quality Evaluation Scoring Tool. RESULTS: At the end of selection process, five studies met the inclusion criteria. These studies analyzed twelve salivary exosomal miRs, presenting different methods of exosome and miR identification for HNSCC detection. A comprehensive explanation of the miR pathways of action was drawn and illustrated in this review. CONCLUSION: Exosomal miRs are promising biomarkers for oral cavity and oropharyngeal cancer detection. miR-10b-5p, miR-486-5p, miR-24-3p and miR-200a stand as the most useful ones in saliva sample examination.

Engaging a polylactide copolymer in oral tissue regeneration: first validation of Suprathel® for guided epithelial and osseous healing.

The present study investigated the capacity of Suprathel® (a copolymer membrane, so far validated for skin regeneration) to also regenerate oral tissue - mucosa and bone, by comparing this biomaterial, in a split-mouth rabbit model, to Mucoderm®, a xenogeneic collagen matrix certified for keratinized oral mucosa healing. The clinical reason behind this experimental animal model was to determine whether the benefits of this advanced skin regeneration product (Suprathel®) could be conveyed for future evaluation in clinical trials of oral tissue regeneration in humans. The outcomes of this study validated the use of Suprathel®, a terpolymer of polylactide with trimethylene carbonate and ε-caprolactone, for stimulation of oral epithelium and alveolar bone regeneration in rabbits. Both Suprathel® and Mucoderm® exhibited comparable results and the null hypothesis stating a comparable regenerating effect of these two materials could not be rejected.

An Overview of the Post-Traumatic Mandibular Bifid Condyle.

Objectives: To review the main clinical, radiological and treatment aspects of patients with post-traumatic bifid mandibular condyles (BMC), to report a new case of BMC in a patient with history of trauma and to discuss the long term adaptive changes of the opposite condylar head. Methods: An electronic search in major medical databases was accomplished. Case series and case reports, prospective or retrospective cohort studies of patients with characteristics of traumatic BMC were included. Extracted data included demographic variables, clinical aspects, imagining examinations and treatment methods performed. Results: The systematic review included 60 patients with 72 post-traumatic BMC. The unilateral involvement (73.3%) and mediolateral condylar orientation (75%) were the most common types of post-traumatic BMC described. Most of the patients were symptomatic, with ankylosis (60%), limitation in mandibular movements (55%) and facial asymmetry (41.6%) being the most common clinical signs. Conclusion: The presence of the post-traumatic BMC is accompanied by important clinical signs, a correct and an early evaluation being essential for an optimal treatment.

Financial efficiency estimation for a dental radiology laboratory.

BACKGROUND AND AIMS: Considering nowadays trend among dentists to install a radiology laboratory beside their current practice, we proposed to investigate the aspect of financial efficiency related to such investment. METHODS: We evaluate two existing options: simple investment, consisting of intra-oral equipment and accessories, or investment in a radiology center that includes panoramic and CBCT equipment. The initial investment includes equipment acquisition, fitting out of the location, radiology accreditation and other miscellaneous expenses. Costs were estimated based on current quotations on the specific market available in Romania. We also described a financial model to estimate the financial risk. RESULTS: The analysis was made under the assumptions that the laboratory is operated by the dentist who made the investment in the form of a legal person and paying corporate tax like all Romanian entities. The analysis took into account current fees for different types of X-rays, usual expenses of such a laboratory, and describes the approach to this analysis, starting with the initial investment estimation and forecast of revenues and expenses. Based on these projections and assessment of the working capital, we have built the cash flows forecast. Following a risk analysis we could assess the financial efficiency of the two investment alternatives. CONCLUSIONS: Our study reveals that the radiology center represents a more profitable investment due to the higher economic return rate.