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Journal of Clinical Periodontology Jun 2022The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of... (Review)
Review
BACKGROUND
The recently published clinical practice guideline (CPG) for the treatment of periodontitis in stages I-III provided evidence-based recommendations for the treatment of periodontitis patients, defined according to the 2018 classification. Stage IV periodontitis shares the severity and complexity characteristics of stage III periodontitis, but includes the anatomical and functional sequelae of tooth and periodontal attachment loss (tooth flaring and drifting, bite collapse, etc.), which require additional interventions following completion of active periodontal therapy.
AIM
To develop an S3 Level CPG for the treatment of stage IV periodontitis, focusing on the implementation of inter-disciplinary treatment approaches required to treat/rehabilitate patients following associated sequelae and tooth loss.
MATERIALS AND METHODS
This S3 Level CPG was developed by the European Federation of Periodontology (EFP), following methodological guidance from the Association of Scientific Medical Societies in Germany and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process. A rigorous and transparent process included synthesis of relevant research in 13 specifically commissioned systematic reviews, evaluation of the quality and strength of evidence, the formulation of specific recommendations and a structured consensus process with leading experts and a broad base of stakeholders.
RESULTS
The S3 Level CPG for the treatment of stage IV periodontitis culminated in recommendations for different interventions, including orthodontic tooth movement, tooth splinting, occlusal adjustment, tooth- or implant-supported fixed or removable dental prostheses and supportive periodontal care. Prior to treatment planning, it is critically important to undertake a definitive and comprehensive diagnosis and case evaluation, obtain relevant patient information, and engage in frequent re-evaluations during and after treatment. The periodontal component of therapy should follow the CPG for the treatment of periodontitis in stages I-III.
CONCLUSIONS
The present S3 Level CPG informs clinical practice, health systems, policymakers and, indirectly, the public on the available and most effective modalities to treat patients with stage IV periodontitis and to maintain a healthy dentition over lifetime, according to the available evidence at the time of publication.
Topics: Delivery of Health Care; Humans; Periodontal Attachment Loss; Periodontics; Periodontitis; Tooth Loss
PubMed: 35688447
DOI: 10.1111/jcpe.13639 -
Journal of Clinical Periodontology Jun 2022To evaluate the efficacy of tooth splinting (TS) and occlusal adjustment (OA) compared to no TS or OA in patients with periodontitis exhibiting masticatory dysfunction. (Review)
Review
OBJECTIVE
To evaluate the efficacy of tooth splinting (TS) and occlusal adjustment (OA) compared to no TS or OA in patients with periodontitis exhibiting masticatory dysfunction.
MATERIAL
The primary outcome criterion was tooth loss (TL), and the secondary outcome parameters were change in probing pocket depth (PPD), change in clinical attachment level (CAL), tooth mobility (TM), and patient-reported outcome measures (PROMs). Literature search was performed on three electronic databases (from 01/1965 to 04/2021) and focused on clinical studies with at least 12 months follow-up.
RESULTS
From a total of 1515 publications, 51 articles were identified for full-text reading, of which 2 retrospective case series on TS with low risk of bias and 1 randomized and 2 prospective studies on OA with unclear risk of bias were included. For TS, synthesis of data showed that in 72 patients, 26 out of 311 teeth (weighted mean incidence of TL 8.4%) and 156 out of 1541 teeth with no TS (weighted mean incidence of TL 10.1%) were lost over 2 years following non-surgical periodontal therapy. The randomized controlled clinical trial (RCT) indicated CAL gain for teeth with OA compared to no OA. For the effect of OA on TL, PPD, and TM, heterogeneous data were retrieved from the included studies.
CONCLUSIONS
Within the limitations of this review and based on a low level of evidence, it is concluded that TS does not improve survival of mobile teeth in patients with advanced periodontitis. OA on teeth with mobility and/or premature contacts may lead to improved CAL, while the effect of OA on the remaining periodontal parameters remains unclear.
Topics: Humans; Occlusal Adjustment; Periodontitis; Randomized Controlled Trials as Topic; Tooth Loss; Tooth Mobility
PubMed: 34854115
DOI: 10.1111/jcpe.13563 -
European Journal of Dentistry Jul 2023This study aimed to evaluate the effectiveness of conventional occlusal analysis in contrast with digital occlusal analysis in natural dentition. Occlusal analysis...
This study aimed to evaluate the effectiveness of conventional occlusal analysis in contrast with digital occlusal analysis in natural dentition. Occlusal analysis allows the identification of normal and abnormal occlusal contact points that alter the craniomandibular cervical system. We searched for articles with keywords [[dental occlusion]], [[natural dentition]], [[occlusal adjustment]], [[Immediate Complete Anterior Guidance Development]] [[mastication]], [[bite force]], [[premature contact]], [[occlusal balance]] [[articulating paper]]], [[spray]], [[Occlusal contacts]], and [[bite strength]]. They were considered observational , odds ratio and case control studies. We found 189 items. After evaluating the abstracts and full texts of the articles, 10 papers met the inclusion criteria. It was found that occlusal analysis allows the identification of the relationship between poor occlusion and the sensitivity of the teeth due to occlusal trauma, which is also related to temporomandibular joint pain in dynamic occlusion. The contacts of greater strength were observed in nonfunctional cusps, 48%, without ruling out the functional cusps, 24%. Despite being the universal method of occlusal control to date, the use of joint paper, remains subjective compared to the digital occlusal control device. Posture is considered directly related to occlusal trauma and temporomandibular disorders; without proper occlusal analysis, a clear diagnosis of the patient's joint condition cannot be obtained. Digital occlusal analysis is more objective than traditional occlusal analysis.
PubMed: 36252609
DOI: 10.1055/s-0042-1755626 -
Journal of Dentistry Jan 2023To investigate the impact of the occlusal contact situation and occlusal adjustment on wear, roughness, and fracture force of molar crowns.
OBJECTIVES
To investigate the impact of the occlusal contact situation and occlusal adjustment on wear, roughness, and fracture force of molar crowns.
MATERIALS AND METHODS
CAD/CAM crowns (lower right first molar, n = 64; 4 groups à 8, 3Y-TZP zirconia and resin composite) and corresponding antagonists (upper right first molar; 3Y-TZP zirconia) were manufactured. Crowns were constructed according to two principles of occlusion (group "T": Peter K. Thomas' "point-centric" cusp-to-fossa tripodization concept, with 15 contact points; group "RA" Sigurd P. Ramfjord and Major M. Ash, "freedom in centric" concept with four contacts). On one half of the crowns, occlusal adjustment was performed (groups "T adjusted" and "RA adjusted"). All crowns underwent combined thermal cycling (TC) and mechanical loading (ML) (ML: 1.2 × 10 cycles, 50 N, 2 Hz, mouth opening 1 mm; TC: 2 × 3000 cycles, 5/55°C). Wear area and depth of each contact point on the occlusal surfaces of crowns and antagonists were determined using a digital microscope. Surface roughness (R, R) was measured in and besides (reference) the worn area (3D laser-scanning microscope). Fracture force of the crowns was determined (statistics: Levene-test, one-way-ANOVA; Bonferroni-post-hoc-test; between-subjects effects, Pearson correlation, α=0.05).
RESULTS
The resin composite crowns yielded significantly higher mean values for wear area and depth (p < 0.001) and lower fracture forces (p < 0.001). Resin composite surfaces showed increased roughness after TCML while zirconia exhibited smoothened surfaces. The occlusal design significantly impacted wear depth (p = 0.012) and fracture force (p < 0.001). Resin composite crowns with fewer contact points (group RA) showed more wear and lower fracture force. Adjusted resin composite crowns showed increased wear areas and depths (p = 0.009-0.013). For zirconia crowns, the adjustment impacted wear area (p = 0.013), wear depth (p = 0.008), and fracture force (p = 0.006), with adjusted zirconia crowns exhibiting more wear and lower maximum forces until fracture. Zirconia wear depth was also impacted by the occlusal design (p = 0.012). Antagonistic wear was influenced by the restorative material, the occlusal contact pattern, and the adjustment.
CONCLUSIONS
The investigated materials show strongly varying performances with zirconia being significantly influenced by the adjustment, while for resin composites, contact design and adjustment had a major impact.
CLINICAL RELEVANCE
The results show the necessity of adapting occlusal design and adjustment in order to improve roughness, wear, and stability of zirconia and resin composite crowns.
Topics: Humans; Dental Porcelain; Occlusal Adjustment; Materials Testing; Crowns; Zirconium; Composite Resins; Computer-Aided Design
PubMed: 36403693
DOI: 10.1016/j.jdent.2022.104364 -
Oral Health & Preventive Dentistry Jun 2023This review aimed to highlight the aetiology and risk factors of food impaction along with the treatment in each case. (Review)
Review
PURPOSE
This review aimed to highlight the aetiology and risk factors of food impaction along with the treatment in each case.
MATERIALS AND METHODS
A search was conducted in PubMed from 1947 to March 28, 2023. The search terms utilised included (food impaction) OR (interdental impaction). No filter was applied. Articles related to the classification, aetiology, treatment, and associated factors of food impaction in dentistry and published in English or with an abstract in English were selected.
RESULTS
A total of 72 articles were included in the review, which revealed the variety and complexity of aetiological factors and treatment of food impaction in dentistry, as well as the heterogeneity of previous studies. Based on the aetiology, different treatment plans and management should be considered.
CONCLUSION
This review indicated the need to identify the pathology of food impaction before treatment. Considering the causal factors of food impaction - including proximal contact loss, occlusal disharmony, morphological deformity, positional abnormality, and interdental papillae loss - different management approaches such as restoration, occlusal adjustment, orthodontic, nonsurgical or surgical treatment could be applied. Further clinical and experimental research is warranted to address the prevention and treatment of food impaction in dentistry.
Topics: Humans; Gingiva; Dentistry
PubMed: 37345582
DOI: 10.3290/j.ohpd.b4172837 -
Frontiers in Bioengineering and... 2021In dental research, bite force has become an important curative effect evaluation index for tooth restoration, periodontal treatment, and orthodontic treatment. Bite... (Review)
Review
In dental research, bite force has become an important curative effect evaluation index for tooth restoration, periodontal treatment, and orthodontic treatment. Bite force is an important parameter to evaluate the efficacy of the masticatory system. Physicians obtain the therapeutic basis for occlusal adjustment by measuring the bite force and the dynamic changes in occlusal contact at different stages of treatment and objectively evaluate the therapeutic effect. At present, many devices are used to record the bite force. Most of these devices use force transducers to detect bite force, such as strain gauge transducers, piezoresistive transducers, piezoelectric transducers, optical fiber transducers, and pressure-sensitive films. This article summarizes the various equipment used to record bite force, related materials and the characteristics of this equipment. It provides a reference for physicians to make choices during the clinical process and at the same time provides a basis for the development of new occlusal force measurement materials.
PubMed: 33898409
DOI: 10.3389/fbioe.2021.665081 -
International Journal of Computerized... Nov 2023To evaluate the accuracy and reproducibility of real and virtual occlusal contact points in implant-supported, fixed complete dentures.
AIM
To evaluate the accuracy and reproducibility of real and virtual occlusal contact points in implant-supported, fixed complete dentures.
MATERIALS AND METHODS
The study included 19 participants using mandibular interim complete-arch fixed prosthesis supported by 3 or 4 implants as opposed to conventional removable complete dentures. At installation, an examiner installed the prostheses and verified the occlusal contact points through 2 methods: recording the real contact points with carbon paper (RC) followed by occlusal photography and intraoral scanning (VC) to record the virtual contact points to obtain a screen print of the software. Then, the two images were randomized to determine the order to be inserted into Microsoft PowerPoint for blind and paired evaluation. The independent variables consisted of the distribution of occlusal contacts points (qualification through pre-defined scores based on the position of the contact points on the surfaces of the teeth) and the reproducibility of the methods by verifying the number of occlusal points. For this, a descriptive analysis was used to evaluate the distribution of occlusal contacts points and the Wilcoxon test for the reproducibility of the occlusal contact points between the methods (p<0.05).
RESULTS
The methods had 100% and 73.6% real and virtual occlusal contact points, respectively, which is considered clinically excellent. There was no significant difference regarding the reproducibility of the methods by the number of occlusal contact points (RC: x̅13.32; VC: x̅13.68; p=0.715).
CONCLUSION
The use of the tested intraoral scanner can be an easy and fast tool for studying and mapping the occlusion, and storing data for future treatment, with the conventional method being the preferred method for performing the occlusal adjustment.
PubMed: 37947209
DOI: 10.3290/j.ijcd.b4626921 -
Journal of Dentistry Jan 2023This prospective crossover clinical trial aimed to compare the complete-digital and -analog workflows in terms of occlusal adjustment of 3-unit tooth-supported fixed... (Clinical Trial)
Clinical Trial
AIM
This prospective crossover clinical trial aimed to compare the complete-digital and -analog workflows in terms of occlusal adjustment of 3-unit tooth-supported fixed dental prostheses, operator, and patient preferences.
MATERIALS AND METHOD
This study included twelve patients receiving fourteen 3-unit posterior FDPs. 2 FDPs were made for each restoration site: one fabricated in complete-digital workflow comprising intraoral scan with static bite registration (Trios 3) and a monolithic zirconia FDP (test); the other fabricated in complete-analog workflow comprising conventional impression/face-bow transfer and a porcelain-fused-to-metal FDP (control). The FDPs (n=28) were intraorally/provisionally fixed, and quadrant-like intraoral scans were taken for every FDP before & after their occlusal adjustments. Pre- and post-adjustment scans of each FDP were then superimposed using best-fit alignment (GOM Inspect) to measure the volumetric occlusal adjustment amount (mm) (3Matic) (Mann Whitney U, α=0.05). The patient and operator experience for digital and analog workflows were evaluated using visual analog scales (Wilcoxon test, α=0.05).
RESULTS
Mean occlusal adjustments were 7.63 mm [±7.02] and 25.95 mm [±39.61] for test and control groups, respectively. The volumetric adjustment difference was clinically noticeable but not significant (P=0.12). The impression and digital workflow adjustment were perceived more favorably by both operator (P=0.003, P=0.046, respectively) and the patients (P=0.003, P=0.002, respectively).
CONCLUSIONS
Within the limitations of this clinical study, the complete digital workflow with digital static bite-registration provided high occlusal accuracy for short-span tooth-supported FDPs. In addition, the patient and operator preferences significantly favored the digital workflow.
CLINICAL SIGNIFICANCE
Complete-digital workflow employing intraoral scanning and model-free fabrication of monolithic-Zr short-span tooth-supported FDPs offers an effective treatment modality with sufficient occlusal accuracy. Therefore complete-digital workflow is a valid alternative for complete-analog workflow comprising conventional impression, face-bow transfer, and use of a semi-adjustable articulator.
Topics: Humans; Computer-Aided Design; Dental Prosthesis Design; Occlusal Adjustment; Prospective Studies; Workflow; Zirconium; Cross-Over Studies
PubMed: 36403691
DOI: 10.1016/j.jdent.2022.104365 -
Clinical Oral Investigations Jul 2021To evaluate the precision of aligner (Invisalign®) treatment with the current material (SmartTrack®) in achieving expansion or contraction of the maxilla and occlusal...
OBJECTIVES
To evaluate the precision of aligner (Invisalign®) treatment with the current material (SmartTrack®) in achieving expansion or contraction of the maxilla and occlusal contacts as simulated in the proprietary planning software (ClinCheck®, CC).
MATERIALS AND METHODS
Thirty patients thus treated were retrospectively evaluated. Four maxillary models were analyzed per patient: a pretreatment model, a scan-based CC model, a posttreatment clinical model, and a CC model reflecting the treatment outcome as initially simulated. Thirteen transverse parameters were measured on each model separately by two investigators. Occlusal contacts were also analyzed.
RESULTS
The measuring method was validated by both investigators arriving at similar results for the effectiveness by which the simulated treatment goals had been clinically achieved. Significant differences (p < 0.05; Wilcoxon signed-rank test) were observed for transfer precision from the casts to the planning software and between the simulated and clinical outcomes. Intense occlusal contacts in the simulations materialized less common (≈ 2%) than ideal contacts (≈ 60%) in the clinical outcomes.
CONCLUSIONS
The effectiveness of achieving the simulated transverse goals was 45% and was generally not found to be better with SmartTrack® than with the previously used Ex30® material. Out of 100 simulated occlusal contacts, 40 will never materialize, and achieving around 60 will adequately ensure a clinically favorable contact pattern.
CLINICAL RELEVANCE
With the caveat that any overcorrection will to some extent reduce the precision, it seems perfectly possible to make deliberate use of overcorrection in current aligner therapies for transverse maxillary expansion or contraction.
Topics: Humans; Malocclusion; Maxilla; Occlusal Adjustment; Orthodontic Appliances, Removable; Palatal Expansion Technique; Retrospective Studies
PubMed: 33474622
DOI: 10.1007/s00784-021-03780-4 -
BDJ Open May 2023To measure the required clinical time and volume of occlusal adjustment when the maxillary cast is positioned in a virtual articulator using one of three methods:...
OBJECTIVE
To measure the required clinical time and volume of occlusal adjustment when the maxillary cast is positioned in a virtual articulator using one of three methods: digitization of a facebow-mounted mechanical articulator (group A), virtual Bonwill triangle (group B) or a 3D face scan (group F).
MATERIALS AND METHODS
In this randomized, triple-blind, crossover trial; 11 participants were enrolled. Every participant had one molar indicated for a single crown restoration. Three crowns were designed and milled for every participant molar totaling 33 crowns. Each of the three crowns was fabricated with the participant's casts virtually mounted utilizing a different method. An impression was taken of the crown in place before occlusal adjustment. The occlusal adjustment was then performed and timed with the three crowns in the different groups. After the occlusal adjustment, an impression of the adjusted crown was taken. The pre-adjustment and post-adjustment impressions were digitally superimposed and the volume difference was measured. The Kruskal-Wallis test was used to compare the groups.
RESULTS
Group A showed the shortest mean adjustment time (3:44.59 ± 3:39.07) followed by group F (4:30.09 ± 2:01.50) and group B (4:35.30 ± 2:32.33). The mean adjustment volume for group A was (28 ± 19.1 mm) followed by group F (30.5 ± 18.8 mm) and group B (40.6 ± 29.5 mm). Different virtual mounting methods had no statistically significant effect on adjustment time (P-value = 0.538) or adjustment volume (P-value = 0.490).
CONCLUSIONS
A simplified approach in virtual articulator mounting appears to be justified in the construction of a single full-coverage prosthesis. Added labor, time and cost of more elaborate virtual mounting methods seem to be counterproductive.
PubMed: 37164989
DOI: 10.1038/s41405-023-00146-8