Does clinical experience affect occlusal caries diagnosis and sealant recommendation? An in vitro study

The purpose of this in vitro study was to evaluate the effect of the length of clinical experience on clinician's diagnosing caries and recommending sealants on the occlusal surfaces of permanent/caries free third molars. The third molars involved in this study had been extracted prior to eruption. There were three study groups: dental students, clinicians with five to ten years experience, and clinicians with fifteen to twenty years of practice. Twenty-four percent of the entire sample diagnosed caries. Clinicians with five to ten years of practice diagnosed occlusal caries significantly more than clinicians with fifteen to twenty years of practice, but not significantly differently than senior dental students. Clinicians recommended sealants significantly more than dental students. The most frequent reason for sealant indication was prevention. The results indicate that clinical experience alone does not impart better caries diagnosis and sealant recommendation criteria.     

Does irradiation affect the protein composition of saliva?

The purpose of this study was to compare the relative amount of low molecular weight salivary proteins in patients with head and neck tumours treated with radiotherapy and healthy subjects. Reverse-phase high-pressure liquid chromatography was used for protein separation. Nine protein fractions (including acidic and basic proline-rich proteins (PRPs), cystatins, histatins and statherin) were identified in saliva from irradiated patients as well as healthy subjects. However, compared with non-irradiated healthy subjects, the fraction of acidic PRPs was significantly reduced in irradiated patients. These data indicate an alteration of the relative amount of low molecular weight salivary proteins in irradiated patients besides the reduction of salivary flow.     

Does the method of resection affect the margins of tumours in the oral cavity? Prospective controlled study in pigs

It is important to obtain tumour-free resection margins in patients with oral cancer. Pathological processing is known to cause tissue to shrink, which affects the reported margins, and it is postulated that the method of resection also has an effect. We marked standardised simulated lesions on the tongues of 15 live anaesthetised pigs and divided each lesion into four equal sections. They were resected each with a margin of 10 mm using cutting diathermy, coagulative diathermy, Harmonic scalpel, and a conventional scalpel. After processing, the excision margins were measured. With cutting diathermy and coagulative diathermy, shrinkage of the soft tissues was minimal relative to the margin of the simulated lesion compared with the Harmonic scalpel (p = 0.001) and conventional scalpel (p = 0.001). Cutting diathermy and coagulative diathermy caused significant thermal damage (p = 0.001). The method of resection affects the surgical margin. Diathermy resulted in thermal injury and denaturing of the underlying muscle, but there was less tissue contraction than when the Harmonic scalpel and conventional scalpel were used. The ethics committee approved the study, which was undertaken in a registered European Scientific Institute in Hamburg.     

Does regional socioeconomic context affect the dental caries experience? A multilevel study of Korean adults

Recent thinking about the role of regional socioeconomic context in generating health inequalities has argued for the collection of true 'area' data that accurately reflect the characteristics of a region. We investigated whether a range of attributes of regional environments, constructed from factor analysis of various regional socioeconomic indices, is associated with the dental caries experience of adults, and whether the nature of this association changes according to age. A linked data set comprising information on 6,402 individuals from the Korean National Oral Health Survey of 2000 and regional information from 118 districts where our study population lived, were examined using multilevel analysis. The regional contextual variables, 'density of service and medical facilities' and 'dependence on manufacturing industry', were negatively associated with dental caries experience after controlling for individual characteristics, and these associations differed by age groups, especially in the older age group. Our findings suggest that hypotheses about specific chains of causation which might link service affluence or industrialization with dental caries need to be investigated further using more detailed indices.     

Influence of examiner’s clinical experience on the reproducibility and accuracy of radiographic examination in detecting occlusal caries

The aim of this in vitro study was to assess the influence of varying examiner’s clinical experience on the reproducibility and accuracy of radiographic examination for occlusal caries detection. Standardized bitewing radiographs were obtained from 166 permanent molars. Radiographic examination was performed by final-year dental students from two universities (A, n = 5; B, n = 5) and by dentists with 5 to 7 years of experience who work in two different countries (C, n = 5; D, n = 5). All examinations were repeated after 1-week interval. The teeth were histologically prepared and assessed for caries extension. For intraexaminer reproducibility, the unweighted kappa values were: A (0.11–0.40), B (0.12–0.33), C (0.47–0.58), and D (0.42–0.71). Interexaminer reproducibility statistics were computed based on means ± SD of unweighted kappa values: A (0.07 ± 0.05), B (0.12 ± 0.09), C (0.24 ± 0.08), and D (0.33 ± 0.10). Sensitivity, specificity, and accuracy were calculated at D₁ and D₃ thresholds and compared by performing McNemar test (p = 0.05). D₁ sensitivity ranged between 0.29 and 0.75 and specificity between 0.24 and 0.85. D₃ specificity was moderate to high (between 0.62 and 0.95) for all groups, with statistically significant difference between the dentists groups (C and D). Sensitivity was low to moderate (between 0.21 and 0.57) with statistically significant difference for groups B and D. Accuracy was similar for all groups (0.55). Spearman’s correlations were: A (0.12), B (0.24), C (0.30), and D (0.38). In conclusion, the reproducibility of radiographic examination was influenced by the examiner’s clinical experience, training, and dental education as well as the accuracy in detecting occlusal caries.     

Does pulp cavity affect the center of resistance in three-dimensional tooth model? A finite element method study

Clinical Oral Investigations - To compare the center of resistance (Cres) of the maxillary central incisor in models with and without the pulp cavity and to evaluate the association of pulp...     

Does the mode of administration of the Oral Health Impact Profile-49 affect the outcome score?

Objective

To determine if there are differences in outcome scores if the Oral Health Impact Profile-49 (OHIP-49) is delivered by two different modes of administration (manual-self complete versus telephone interview).

Methods

Patients with chronic periodontitis (n = 83, 54% females and 46% males, mean age 49.1 ± 9.5 years) completed the OHIP-49 using two modes of administration (manual self-complete and telephone interview) in a randomly assigned order, with a minimum washout period of 2 weeks between modes, both episodes occurring prior to any periodontal treatment being provided. To assess convergent validity, after each mode of administration, the patients were additionally asked a global question about their oral health-related quality of life (OHRQoL).

Results

Median OHIP-49 scores recorded by manual self-complete (median 36 [IQR = 20–70]) were significantly higher than those recorded by telephone interview (median 27 [IQR = 11–61]) (p < 0.01). The global question was well correlated to the OHIP domains, but did not reveal any evidence of an order effect such as was seen with OHIP-49 itself (which showed a higher impact on OHRQoL during the first administration in either mode).

Conclusions

The mode of administration (manual-self complete versus telephone interview) did substantially influence the OHIP-49 scores in patients with chronic periodontitis. The OHRQoL differed between the two modes of administration, with significantly higher scores (indicating poorer OHRQoL) when the questionnaire was manually self-completed.

Clinical significance

The mode of administration of quality of life questionnaires such as OHIP-49 could potentially affect the outcome scores derived. This study investigated whether there is a difference in outcome scores if OHIP-49 is delivered via manual self-complete or by telephone interview in patients with chronic periodontitis. We found that there was a significant difference between the two modes: manual self-completion by the patients yielded significantly higher scores than completion by telephone interview. It is therefore important to be consistent in the mode of completion of OHIP-49, as mixing modes could introduce additional error into clinical studies that utilise this instrument.     

Does rapid maxillary expansion affect the eruption of upper third molars?

OBJECTIVE: To test the hypothesis that there is no difference in the movement of the upper third molars between rapid maxillary expansion (RME) and non-RME patients. MATERIALS AND METHODS: This study was performed on 30 patients divided into two groups. The study group included 20 patients who had maxillary narrowness and bilateral maxillary third molars and who had undergone RME application. The control group of 10 patients had a bilateral crossbite, had bilateral maxillary third molars, and did not receive orthodontic treatment. The records included lateral and frontal cephalometric films and maxillary plaster models. In the study group, records were taken before expansion (T1), after expansion (T2), and at the retention period (T3). T2 records were not taken in the control group because this period was too short to observe any changes. Friedman tests were used to observe within groups, and the Mann-Whitney U-test was used to see the differences between groups on films and casts. RESULTS: Frontal films showed that vertical eruption occurred after the retention period in the RME cases. Cephalometric films revealed that the angular eruption occurred immediately after expansion. However, the results were not significant with respect to the control group. CONCLUSION: The hypothesis was rejected. Rapid maxillary expansion affects maxillary third molar movement during and after the RME procedure. RME may indicate upper third molar eruption, but the final position of third molar was not different compared to the normal growth pattern.     

Does the procedure of arthrography affect the range of movement in patients with locking of the temporomandibular joint?

The aim of this study was to investigate whether arthrography itself altered the range of mandibular movements, in a group of patients with locking of the temporomandibular joint (TMJ). The clinical records of a series of 161 patients who were diagnosed with locking of the TMJ were retrospectively analysed. Mouth opening had improved in 57 out of 161 patients (35%). Twenty-three patients (14%) had improved by 5 mm or less. Nineteen patients (11%) had improved by more than 5 mm but less than 10 mm, whereas 15 patients (9%) had improved by more than 10 mm. Of the patients who experienced an improved mouth opening, only nine (15%) had improved from their pre-arthrography restricted maximum opening to beyond the lower limit of normal. This suggests that the injection of contrast medium had an effect on the range of vertical opening in patients with displacement of the disc without reduction.     

Does ambient light affect the accuracy and scanning time of intraoral scans?

Statement of problemIntraoral scanners (IOSs) are based on light-optical imaging methods. However, little is known about whether the ambient light in dental practices influences the accuracy and scanning time of the IOS.PurposeThe purpose of this in vitro study was to investigate the influence of different illuminations on the accuracy of 4-unit and complete-arch scans of 6 IOSs. In addition, the required scanning time was evaluated.Material and methodsA reference structure was attached to the first premolars (P) and second molars (M) in both quadrants (L/R) of a maxillary model. The resulting measured distances were M1-P1, M2-P2, P1-P2, and M1-M2. The investigation included 6 IOSs: TRIOS 3 (TRI), Cerec Omnicam (OC), iTero Element (ITE), CS 3600 (CS), Planmeca Emerald (EME), and GC Aadva (AAD). With each IOS, 17 scans at different illuminances (100, 500, 1000, and 5000 lux) were performed (N = 408). The precision and trueness for all distances were determined, and the scanning time was recorded. For statistical analyses, the Levene tests (precision) and 1-way analysis of variance with the post hoc Tukey honestly significant difference and Games-Howell tests (trueness) were calculated.ResultsIlluminance significantly influenced the trueness of 4-unit scans for OC, EME, and AAD. TRI, OC, ITE, and CS demonstrated comparable results. AAD (>96 ±22 μm; 1000 lux) and EME (>248 ±88 μm; 500 lux) revealed greater deviations. For complete-arch scans, illuminance did not influence TRI and AAD, but significant variations were detected for ITE, CS, EME, and AAD. The least deviations were achieved with TRI and OC. The scanning time was extended for all IOSs except ITE at more than 500 lux. The shortest scanning times with OC and EME were recorded at 100 lux; with TRI, CS, and AAD at 500 lux; and with ITE at both 100 and 5000 lux. At all illuminances, the fastest scans were obtained with TRI.ConclusionsAmbient light was found to influence the accuracy and scanning time of IOSs. This influence varies depending on the device. For 4-unit scans, the effect was not clinically relevant, but for complete-arch scans, accuracy and scanning time can be improved with appropriate lighting.     

Does the use of soft or hard splints affect the short-term outcome of temporomandibular joint arthrocentesis?

Arthrocentesis is an effective treatment modality for temporomandibular joint (TMJ) disc displacement without reduction (DDw/oR), especially in patients who do not respond to non-surgical methods, and is nowadays regarded as a first-line treatment. Soft and hard stabilizing splints have also been used to treat TMJ disorders, but no data are available regarding the use of splints following arthrocentesis. The aim of this study was to compare the effect of the use of soft or hard stabilizing splints versus no appliance following TMJ arthrocentesis on the prognosis of the treatment. Forty-five patients with DDw/oR were included in the study. Pain was measured on a visual analog scale, and maximal mouth openings, lateral jaw movements and tenderness were recorded before arthrocentesis. Following arthrocentesis hard splints were fabricated for 22 patients, soft splints for 9 patients, and 14 patients without any splint served as controls. All the measurements were repeated 1 day, 1 month, 3 months and 6 months after arthrocentesis. Improvement in mouth opening was significant as well as decrease in pain in all groups regardless of the use of splints (P<0.05). Arthrocentesis alone is a successful procedure in the treatment of DDw/oR; the use of splints as an additional therapy does not affect the short-term prognosis.     

Does orthodontic treatment affect patients' quality of life?

The oral-facial region is usually an area of significant concern for the individual because it draws the most attention from other people in interpersonal interactions and is the primary source of vocal, physical, and emotional communication. As a result, patients who seek orthodontic treatment are concerned with improving their appearance and social acceptance, often more than they are with improving their oral function or health. Enhancing these aspects of quality of life is an important motive for undergoing orthodontic treatment. Regardless of age, patients' and their parents' or caregivers' expectations about improvements in oral function, esthetics, social acceptance, and body image are important for both general dentists and orthodontists to consider when advising patients about these procedures and during the treatment process. This review of research on the impact of conventional and surgical orthodontics on quality of life examines the association between oral health-related quality of life and severity and type of malocclusion, as well as the impact of treatment and patient characteristics on quality of life. The article will emphasize the importance of clinicians' having a clear understanding, before initiating treatment, of their patients' quality of life and their expectations about improvements in specific domains of quality of life.     

Does the acidity of self-etching primers affect bond strength and surface morphology of enamel?

PURPOSE: This study examined the ultrastructure and microtensile bond strengths (TBS) of self-etching (with different acidity) and conventional adhesive systems bonded to unground enamel. MATERIALS AND METHODS: Resin composite (Filtek Z250) buildups were bonded to unground enamel surfaces of third molars after adhesive application with the following materials: Clearfil SE Bond (CSE); Optibond Solo Plus Self-Etch (OP); Tyrian Self Priming Etching (TY), and the controls Scotchbond Multi-Purpose Plus (SBMP) and Single Bond (SB). Six teeth were assigned to each material. After storage in waterfor 24 h at 37 degrees C, the bonded specimens were sectioned into beams of approximately 0.8 mm2 and subsequently subjected to microTBS testing at a crosshead speed of 0.5 mm/min. The average values were subjected to one-way ANOVA (alpha = 0.05). The effect of surface conditioning of each material was observed under scanning electron microscopy (SEM). RESULTS: The highest resin-enamel bond strength was observed for SBMP (22.7 +/- 5.2) and SB (26.7 +/- 5.2 MPa). The lowest mean bond strengths were 10.9 +/- 3.2 and 7.8 +/- 1.5 MPa for TY and OP, respectively. CSE showed an intermediate performance (18.7 +/- 4.6 MPa). An overall increase in porosity was evident along the entire enamel surface treated with the self-etching primers; however, no selective demineralization similar to that with 35% phosphoric acid was observed. CONCLUSION: The highest bond strength means and the more retentive etching pattern were observed for the two-step etch-and-rinse adhesives. Among the self-etching systems studied, Clearfil SE Bond should be preferred.     

Does the thickness of the resin cement affect the bond strength of a fiber post to the root dentin?

This study aimed to evaluate the influence of cement thickness on the bond strength of a fiber-reinforced composite (FRC) post system to the root dentin. Eighteen single-rooted human teeth were decoronated (length: 16 mm), the canals were prepared, and the specimens were randomly allocated to 2 groups (n = 9): group 1 (low cement thickness), in which size 3 FRC posts were cemented using adhesive plus resin cement; and group 2 (high cement thickness), in which size 1 FRC posts were cemented as in group 1. Specimens were sectioned, producing 5 samples (thickness: 1.5 mm). For cement thickness evaluation, photographs of the samples were taken using an optical microscope, and the images were analyzed. Each sample was tested in push-out, and data were statistically analyzed. Bond strengths of groups 1 and 2 did not show significant differences (P = .558), but the cement thicknesses for these groups were significantly different (P < .0001). The increase in cement thickness did not significantly affect the bond strength (r2 = 0.1389, P= .936). Increased cement thickness surrounding the FRC post did not impair the bond strength.     

Does the presence of an occlusal indicator product affect the contact forces between full dentitions?

Studies have explored occlusal marking interpretation, repeatability and accuracy. But, when an occlusion detection product is interposed between teeth, direct tooth–tooth occlusal contact relationships are replaced by tooth‐material‐tooth structures. Thus, the marks cannot reflect the original contacts. This has been shown for single tooth pair contacts. The purpose of this laboratory study was to similarly examine full dentitions. A dentiform was set into Class I centric occlusion with the mandible supported by a load cell. The maxillary arch was guided by precision slides. As the weighted (~52 N) upper assembly was lowered onto and raised off the mandibular arch, the loads on the mandible were measured. With and without (control) occlusal marking material, the steps were as follows: (cleaning – control 1 – material 1) … (cleaning – control 6 – material 6). The six materials were as follows: Accufilm I and II, Rudischhauser Thick and Thin, Hanel Articulating Silk and T‐Scan. Then, the six sets of (cleaning – control – material) measurements were repeated with the mandibular assembly shifted, in turn, by 0·1 mm in the Anterior, Posterior, Right and Left directions. The five (Centric and four 0·1 mm shifted) occlusal relationships produced grossly different tooth–tooth (control) load profiles. And, in general, these controls were affected, in different ways, by the marking products. Among the five conventional products, the Rudischhausers fared the worst and the electronic T‐Scan was an extreme outlier. Thus, in general, popular occlusal detection products alter the occlusal contact forces, and therefore, their markings cannot characterise the actual occlusion.