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BMC Oral Health Jul 2023Establishing the level of surgical difficulty pre-operatively is an essential step in ensuring correct treatment planning. This study set out to determine whether the... (Observational Study)
Observational Study
BACKGROUND
Establishing the level of surgical difficulty pre-operatively is an essential step in ensuring correct treatment planning. This study set out to determine whether the knowledge and experience acquired by dentists who had received different levels of training influenced, firstly, the perceived levels of difficulty of a variety of cases of mandibular third molar (MTM) extraction and, secondly, the perceived difficulty deriving from a series of factors (patient-related factors, anatomical and radiographic factors, operative factors).
METHODS
This cross-sectional, descriptive, observational study took the form of a survey. Using a visual analog scale (VAS), participants evaluated both the perceived difficulty of 30 cases of MTM extraction described by means of digital panoramic radiographs and the perceived difficulty deriving from a series of factors conditioning MTM extraction. The results underwent statistical analysis with SPSS Statistics 28.0 software. Non-parametric tests (Mann Whitney test for independent samples and the Kruskal-Wallis test) were applied.
RESULTS
A total of 389 surveys were available for analysis. Dental practioners with no surgical training saw the intervention as presenting greater difficulty. Professionals with postgraduate training in oral surgery considered patient-related factors more important than operative factors, in contrast to dentists who had not received oral surgery training.
CONCLUSIONS
Dental training has a signficant influence on the perceived difficulty of MTM extraction and also affects opinions about which factors have greater or lesser influence on surgical difficulty.
Topics: Humans; Molar, Third; Cross-Sectional Studies; Tooth Extraction; Surveys and Questionnaires; Research Design; Mandible; Tooth, Impacted
PubMed: 37452399
DOI: 10.1186/s12903-023-03131-7 -
BMC Oral Health Oct 2023The extraction of impacted mandibular third molars might cause large bone defects in the distal area of second molars. A new strategy was innovatively employed here... (Randomized Controlled Trial)
Randomized Controlled Trial
A novel concentrated growth factor (CGF) and bio-oss based strategy for second molar protection after impacted mandibular third molar extraction: a randomized controlled clinical study.
BACKGROUND
The extraction of impacted mandibular third molars might cause large bone defects in the distal area of second molars. A new strategy was innovatively employed here combining autologous bone, Bio-Oss, concentrated growth factors (CGF) gel and CGF membrane for bone repair, and the present study aimed at exploring safety as well as short- and long-term efficacy of this new protocol clinically.
MATERIALS AND METHODS
A total of 66 participants were enrolled in this randomized single-blind clinical trial, and randomly allocated to control group (only blood clots), test A group (autogenous bone, Bio-Oss with barrier membrane) and test B group (autogenous bone, Bio-Oss, CGF gel with CGF membrane). The postoperative outcomes including PoSSe scale, periodontal probing depth (PD), degree of gingival recession and computed tomography measurements were assessed at 3rd, 6th, 12th month. A p-value < 0.05 was considered statistically significant.
RESULTS
In PoSSe scale, no significant difference was observed except a significant alleviation of early-stage pain perception in test B group (p < 0.05). Also, test B group exhibited better effect on periodontal healing and gingival recession reduction after 6 months (p < 0.05). Both two test groups showed more new bone formation than the control group (p < 0.05). It is noteworthy that the bone repair of test B group was significantly better than that of test A at 3rd and 6th month (p < 0.05), yet no difference was observed at 12th month (p > 0.05).
CONCLUSION
Both two test groups could achieve stable long-term efficacy on bone defect repair. The use of CGF gel and CGF membrane could accelerate early-stage bone repair, alleviate short-term pain after surgery, reduce long-term probing depth and relieve economic cost for patients. This new bone repair protocol is worthy of promoting by clinicians.
TRIAL REGISTRATION
This study was registered with the identification number ChiCTR2300068466 on 20/02/2023 at Chinese Clinical Trial Registry. Also, it was ethically approved from the institutional ethics committee at the Tongren Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China (No:2023-010-01), and has been conducted in accordance to the guidelines of the declaration of Helsinki. Written informed consent was obtained from all participants in the study.
Topics: Humans; Molar, Third; Gingival Recession; Single-Blind Method; Tooth Extraction; China; Molar; Tooth, Impacted; Mandible; Intercellular Signaling Peptides and Proteins
PubMed: 37828455
DOI: 10.1186/s12903-023-03411-2 -
Journal of Orthodontics Mar 2024The primary aim of this study was to provide a review of the types and frequency of orthodontic brackets, molar bands and orthodontic auxiliaries used for patients... (Review)
Review
OBJECTIVE
The primary aim of this study was to provide a review of the types and frequency of orthodontic brackets, molar bands and orthodontic auxiliaries used for patients undergoing orthognathic surgery. The secondary aim was to evaluate the risk of failure of these items during orthognathic surgery.
METHODS
From three Dutch hospitals, 124 adult patients were included in this prospective cohort study. Five independent researchers collected the data during surgery using a specifically created data extraction form. The type of surgery, surgeon, orthodontist and type of orthodontic bracket, molar band or auxiliary were noted for each tooth. To evaluate their failure risk, the following variables were noted: failure and site; and type and cause of failure.
RESULTS
Stainless-steel brackets were the most frequently (75.8%) used bracket type seen in patients undergoing orthognathic surgery. Ceramic brackets were seen in 24.2% of the cases and were only applied in the anterior region. Molar bands were present in 58.9% of the patients and mostly with bands on the first molars in combination with bonded tubes on the second molars. In 32.2% of all cases, one or more failures were noted. One-third of all failures were described as detachment of the molar tube on the most posterior molar. Kobayashi ligatures and powerpins showed the highest risk of failure (odds ratio [OR] 3.70, 95% confidence interval [CI] = 1.91-7.15). No significant difference in failure rate was found between stainless-steel brackets, molar bands (OR 0.34, 95% CI = 0.08-1.43) and ceramic brackets (OR 0.44, 95% CI = 0.14-1.45).
CONCLUSION
Stainless-steel brackets, ceramic brackets, molar bands and surgical hooks are suitable for orthognathic cases. Kobayashi ligatures and powerpins had a significantly higher risk of failure so are not recommended for temporary intraoperative maxillomandibular fixation (TIO-MMF).
Topics: Adult; Humans; Orthognathic Surgery; Orthodontic Brackets; Prospective Studies; Molar; Steel; Orthodontic Wires; Stainless Steel; Orthodontic Appliance Design
PubMed: 37462079
DOI: 10.1177/14653125231186825 -
Journal of Clinical Periodontology May 2024This systematic review and meta-analysis aimed to determine the survival of periodontally treated molars during maintenance care and identify the risk factors associated... (Meta-Analysis)
Meta-Analysis Review
AIM
This systematic review and meta-analysis aimed to determine the survival of periodontally treated molars during maintenance care and identify the risk factors associated with molar loss among patients with periodontitis who received professional periodontal therapy and maintenance.
MATERIALS AND METHODS
Longitudinal studies with a minimum follow-up duration of 5 years published until 28 August 2023 were retrieved from the following databases: the Cochrane Library, Embase, MEDLINE and Web of Science. All included studies reported data on molar retention. Meta-analysis was performed using Review Manager 5.4. A modified version of the Newcastle-Ottawa Scale was used to evaluate the study quality. Statistical results of analyses of the overall survival rate and molar loss are presented as estimated standardized mean differences, whereas the results of the analyses of risk factors are presented as risk ratios with 95% confidence intervals (95% CIs).
RESULTS
From among the 1323 potentially eligible reports, 41 studies (5584 patients, 29,908 molars retained at the beginning of maintenance therapy, mean follow-up duration of 14.7 years) were included. The pooled survival rate of the molars during maintenance therapy was 82% (95% CI: 80%-84%). The average loss of molars was 0.05 per patient per year (95% CI: 0.04-0.06) among the patients receiving long-term periodontal maintenance (PM) therapy. Fifteen factors were examined in this meta-analysis. Six patient-related factors (older age, lack of compliance, smoking, bruxism, diabetes and lack of private insurance) and five tooth-related factors (maxillary location, high probing pocket depth, furcation involvement, higher mobility and lack of pulpal vitality) were identified as risk factors for molar loss during maintenance therapy.
CONCLUSIONS
The findings of the present study suggest that the long-term retention of periodontally compromised molars can be achieved. The average number of molars lost per decade was <1 among the patients receiving long-term PM therapy. Older age, noncompliance, smoking, bruxism, diabetes, lack of private insurance coverage, maxillary location, furcation involvement, higher mobility, increase in the probing pocket depth and loss of pulpal vitality are strong risk factors for the long-term prognosis of molars.
Topics: Humans; Retrospective Studies; Bruxism; Tooth Loss; Molar; Furcation Defects; Diabetes Mellitus
PubMed: 38317331
DOI: 10.1111/jcpe.13951 -
Journal of Dentistry Oct 2023This study aimed to verify the non-inferiority of Endocem MTA Premixed and Well-Root PT, compared with ProRoot MTA in the pulpotomy of primary molars. In addition, we... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
This study aimed to verify the non-inferiority of Endocem MTA Premixed and Well-Root PT, compared with ProRoot MTA in the pulpotomy of primary molars. In addition, we tried to determine the factors that affect the prognosis of pulpotomy in primary molars.
METHODS
This randomized clinical trial enrolled 158 molars of 52 children; 153 teeth were finally included and divided into three groups: ProRoot MTA (n = 50), Endocem MTA Premixed (n = 53), and Well-Root PT (n = 50). Clinical and radiographic follow-up was performed at 3, 6, and 12 months postoperatively and at the last visit post-treatment. Data were analyzed using the Fisher's exact test, Cox regression analysis, and the Kaplan-Meier survival curve method.
RESULTS
The success rates in the ProRoot MTA, Endocem MTA Premixed, and Well-Root PT were 92, 84.9 and 82%, respectively. The cumulative survival rates did not differ significantly among the materials. Among the investigated variables, only ΔF and ΔF max significantly affected the success rates. In the multivariate survival tree model, significant unfavorable survival was observed when the ΔF value was -14.4 or less (hazard ratio, 7.56; P = 0.0295).
CONCLUSIONS
Considering the clinical effectiveness of Endocem MTA Premixed and Well-Root PT and the operational convenience as a premixed type, they can be used as advantageous materials in the pulpotomy of primary molars in pediatric patients. The QLF method is a useful diagnostic method that can establish treatment plans and determine the prognosis of pulpotomy based on the ΔF value in primary molars.
CLINICAL SIGNIFICANCE
Endocem MTA Premixed and Well-Root PT can confer high success rates and are non-inferior to ProRoot MTA in pulpotomy for primary molars. We also showed that QLF technology can be applied to predict the success/failure and prognosis of pulpotomies in primary molars.
Topics: Humans; Child; Pulpotomy; Dental Cementum; Calcium Compounds; Molar
PubMed: 37660882
DOI: 10.1016/j.jdent.2023.104684 -
L' Orthodontie Francaise Nov 2023Delayed evolution of second molars is a rare phenomenon with an estimated prevalence in the mandible of 0 to 2.3%. Many etiologies have been proposed to explain these...
INTRODUCTION
Delayed evolution of second molars is a rare phenomenon with an estimated prevalence in the mandible of 0 to 2.3%. Many etiologies have been proposed to explain these inclusions, among which the reduction of arch perimeter, distalization of first molar, mesio-angulated position of the second molar. However, the presence and position of the third molar does not seem to be a risk factor for this inclusion.
MATERIALS AND METHODS
Several therapeutics options with surgical management have been proposed in the literature; surgical repositioning, surgical release of the crown more or less associated with orthodontic treatment, and sometimes avulsion of the second molar to allow the third molar development. There is no recommendation on this subject, the literature describing mostly retrospective studies and case reports.
CONCLUSION
This article presents the different therapeutic options in the treatment of second molar inclusions.
Topics: Humans; Retrospective Studies; Molar; Tooth, Impacted; Molar, Third; Clonal Hematopoiesis
PubMed: 37930339
DOI: 10.1684/orthodfr.2023.140 -
Progress in Orthodontics Oct 2023This study aims to investigate the biomechanical effects of anchorage reinforcement using clear aligners (CAs) with microimplants during molar distalization. And also...
INTRODUCTION
This study aims to investigate the biomechanical effects of anchorage reinforcement using clear aligners (CAs) with microimplants during molar distalization. And also explores potential clinical strategies for enhancing anchorage in the sequential distalization process.
METHODS
Finite element models were established to simulate the CAs, microimplants, upper dentition, periodontal ligament (PDL), and alveolar bone. In group set I, the 2nd molars underwent a distal movement of 0.25 mm in group set II, the 1st molars were distalized by 0.25 mm after the 2nd molars had been placed to a target position. Each group set consisted of three models: Model A served as the control model, Model B simulated the use of microimplants attached to the aligner through precision cuts, and Model C simulated the use of microimplants attached by buttons. Models B and C were subjected to a series of traction forces. We analyzed the effective contribution ratios of molar distalization, PDL hydrostatic stress, and von Mises stress of alveolar bone.
RESULTS
The distalization of the 2nd molars accounted for a mere 52.86% of the 0.25-mm step distance without any reinforcement of anchorage. The remaining percentage was attributed to the mesial movement of anchorage teeth and other undesired movements. Models B and C exhibited an increased effective contribution ratio of molar distalization and a decreased loss of anchorage. However, there was a slight increase in the undesired movement of molar tipping and rotation. In group set II, the 2nd molar displayed a phenomenon of mesial relapse due to the reciprocal force produced by the 1st molar distalization. Moreover, the efficacy of molar distalization in terms of contribution ratio was found to be positively correlated with the magnitude of force applied. In cases where stronger anchorage reinforcement is required, precision cuts is the superior method.
CONCLUSIONS
The utilization of microimplants in conjunction with CAs can facilitate the effective contribution ratio of molar distalization. However, it is important to note that complete elimination of anchorage loss is not achievable. To mitigate undesired movement, careful planning of anchorage preparation and overcorrection is recommended.
Topics: Humans; Finite Element Analysis; Maxilla; Molar; Rotation; Orthodontic Appliances, Removable; Tooth Movement Techniques
PubMed: 37806991
DOI: 10.1186/s40510-023-00485-0 -
BMC Oral Health Nov 2023The treatment of young permanent first molars with extensive carious tissue loss may often require restoration with preformed crowns. This study compared the clinical... (Randomized Controlled Trial)
Randomized Controlled Trial
Clinical and radiographic performance of preformed zirconia crowns and stainless-steel crowns in permanent first molars: 18-month results of a prospective, randomized trial.
BACKGROUND
The treatment of young permanent first molars with extensive carious tissue loss may often require restoration with preformed crowns. This study compared the clinical and radiographic performance of stainless-steel crowns (SSCs) and preformed zirconia crowns (ZCs).
METHODS
Forty-eight molar incisor hypomineralisation (MIH)- or caries-affected permanent molars in 20 healthy patients between 6-13-year-old were randomly divided into ZC and SSC groups (n = 24 teeth/group) in a split-mouth design. The oral hygiene levels of patients were assessed using Greene and Vermillion simplified oral hygiene index (OHI-S). Plaque accumulation and gingival health were evaluated using the Silness&Löe plaque index (PI) and Löe&Silness gingival index (GI), respectively. Clinical retention, marginal extension level, marginal adaptation of crowns and wear of the antagonist teeth were assessed at baseline, 1, 6, 12 and 18 months. The radiological assessments for evaluating the marginal adaptation of crowns and periapical pathology of crowned teeth were performed at 6 and 12 months. The data were analyzed using Kaplan-Meier analysis, Mann-Whitney U test, and two-way ANOVA.
RESULTS
A total of forty teeth in 17 children were evaluated for 18 months. ZCs had significantly lower gingival and plaque index values than teeth restored with SSCs during all evaluation periods (p < 0.05). Neither crown type resulted in clinically-detectable wear on opposing dentition or periapical pathology. One ZC was lost at 13 months, while all SSCs survived in function clinically. The cumulative survival rates of ZCs and SSCs were 95.2% and 100% respectively.
CONCLUSIONS
Both ZCs and SSCs showed high clinical retention rates in young permanent molars. ZCs had lower plaque accumulation and better gingival health than SSCs, which were consistently associated with mild gingival inflammation.
CLINICAL TRIAL REGISTRATION NUMBER
NCT05049694.
Topics: Child; Humans; Adolescent; Tooth, Deciduous; Prospective Studies; Dental Restoration, Permanent; Stainless Steel; Dental Restoration Failure; Molar; Dental Plaque; Crowns
PubMed: 37924021
DOI: 10.1186/s12903-023-03501-1 -
Progress in Orthodontics Dec 2023In the present study, the effects of distalizations of one and two molars with different step distances and attachment designs have been analyzed.
BACKGROUND
In the present study, the effects of distalizations of one and two molars with different step distances and attachment designs have been analyzed.
METHODS
A 3D finite element analysis model has been developed in order to determine the tendency of tooth displacement and stress distribution with clear aligner treatment.
RESULTS
Under the condition of single-molar distalization, when the step distance was set to 0.25 mm, the total displacement was 0.086 mm for central incisors, 0.080 mm for lateral incisors, 0.084 mm for canines, 0.102 mm for the first premolar and 0.076 mm for the second premolar. The von Mises stress of roots and the principal stress of the periodontal ligament was slightly lower than in the control group when the step distance was set to 0.130 mm. Under the condition of two-molar distalization, when the step distance was set to 0.130 mm, the total displacements for central incisors, lateral incisors and canines as well as both the first and second maxillary molars were basically the same as with a distance of 0.250 mm for one-molar distalization. In addition, when the step distance was 0.130 mm with two-molar distalization, the rotation center of the first and second molar was closer to the apex of the root indicating that the smaller step distance led to more bodily movement during the two-molar distalization. However, displacement tendencies of the first molar and the second molar were basically the same whether horizontal or vertical rectangular attachments were added.
CONCLUSIONS
A step distance of moving two molars to 0.130 mm can achieve the same reaction force on the anterior teeth as moving one molar 0.250 mm without effects on horizontal or vertical rectangular attachments.
CLINICAL RELEVANCE
Our results provide a theoretical basis and guidance for simultaneously moving two molars backward in clinical practice using a clear aligner.
Topics: Humans; Finite Element Analysis; Molar; Malocclusion; Maxilla; Orthodontic Appliances, Removable; Tooth Movement Techniques
PubMed: 38044352
DOI: 10.1186/s40510-023-00493-0 -
European Journal of Orthodontics Jan 2024Agenesis of third molar agenesis has a higher incidence than other tooth development anomalies. Previous research identified a potential correlation between third molar... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Agenesis of third molar agenesis has a higher incidence than other tooth development anomalies. Previous research identified a potential correlation between third molar agenesis and specific craniofacial morphology; however, no systematic review and meta-analysis on this topic currently exists.
OBJECTIVE
The objective of this systematic review and meta-analysis was to evaluate the association between third molar agenesis and craniofacial sagittal and vertical morphology.
SEARCH METHODS
An electronic search was conducted on PubMed, Embase, Web of Science, and the Cochrane Library without restrictions on publication year or language; this was supplemented by the manual retrieval of relevant literature.
SELECTION CRITERIA
Cross-sectional studies that compared craniofacial morphology using angular and linear measurements obtained from lateral cephalography between patients with third molar agenesis and those without were included.
DATA COLLECTION AND ANALYSIS
The quality assessment of the enrolled articles was evaluated by the Joanna Briggs Institute critical appraisal tool. Meta-analysis and sensitivity analysis were performed by Review Manager software (The Cochrane Collaborative, version 5.4, Cochrane IMS).
RESULTS
A total of seven studies were included. Meta-analysis demonstrated that the ANB (mean differences (MD) = -0.75, 95% CI: -1.31 to -0.19, P < 0.01), palate length (ANS-PNS, MD = -1.68, 95% CI: -2.24 to -1.11, P < 0.01), and mandibular length (Go-Pog, MD = -0.36, 95% CI: -0.59 to -0.13, P < 0.01) were smaller in patients with third molar agenesis. With regard to vertical craniofacial morphology, the mandibular plane angle (MP-FH; MD = -1.88, 95% CI: -3.45 to -0.31, P = 0.02), gonial angle (gonial angle; MD = -1.73, 95% CI: -2.69 to -0.77, P < 0.01) and lower face height (lower face heigh angle; MD = -1.36, 95% CI: -1.94 to -0.77, P < 0.01) were smaller in patients with third molar agenesis, indicating a flatter or brachyfacial skeletal pattern.
CONCLUSIONS
The results of this study suggest that third molar agenesis maybe associated with a reduced maxillary length and a flatter mandible. However, these findings need to be interpreted with caution due to inconsistencies in the certainty of evidence.
CLINICAL TRIAL REGISTRATION
PROSPERO (CRD42023448226).
Topics: Humans; Molar, Third; Cross-Sectional Studies; Maxilla; Mandible; Palate
PubMed: 38168816
DOI: 10.1093/ejo/cjad081