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The Journal of Prosthetic Dentistry Jun 2024When using conventional methods, centric occlusion (CO) can be determined on conventional gypsum casts that are mounted in an analog articulator at centric relation...
When using conventional methods, centric occlusion (CO) can be determined on conventional gypsum casts that are mounted in an analog articulator at centric relation (CR). In the digital environment, intraoral scanners (IOSs) can be used to record maxillary and mandibular scans articulated in CR. However, a digital protocol to locate the CO on articulated intraoral digital scans at CR by using computer-aided design (CAD) programs is needed. The present manuscript describes a straightforward technique to record CR by combining an IOS and a Kois deprogrammer. Afterwards, the acquired digital data are imported into a CAD program to locate CO. The technique includes a complete digital protocol to locate CO by using 3 different CAD programs: open-access non-dental, open-access dental, and dental CAD program.
PubMed: 38834391
DOI: 10.1016/j.prosdent.2024.05.002 -
BDJ Open Jun 2024Dental implantation has emerged as an efficient substitute for missing teeth, which is essential for restoring oral function and aesthetics. Compared to traditional...
INTRODUCTION
Dental implantation has emerged as an efficient substitute for missing teeth, which is essential for restoring oral function and aesthetics. Compared to traditional denture repair approaches, dental implants offer better stability and sustainability. The position, angle, and depth of dental implants are crucial factors for their long-term success and necessitate high-precision operation and technical support.
METHOD
We propose an integrated dual-arm high-precision oral implant surgery navigation positioning system and a corresponding control strategy. Compared with traditional implant robots, the integrated dual-arm design greatly shortens the preparation time before surgery and simplifies the operation process. We propose a novel control flow and module for the proposed structure, including an Occluded Target Tracking Module (OTTM) for occlusion tracking, a Planting Plan Development Module (PPDM) for generating implant plans, and a Path Formulation Module (PFM) for controlling the movement path of the two robot arms.
RESULT
Under the coordinated control of the aforementioned modules, the robot achieved excellent accuracy in clinical trials. The average angular error and entry point error for five patients who underwent implant surgery using the proposed robot were 2.1° and 0.39 mm, respectively.
CONCLUSION
In essence, our study introduces an integrated dual-arm high-precision navigation system for oral implant surgery, resolving issues like lengthy preoperative preparation and static surgical planning. Clinical results confirm its efficacy, emphasizing its accuracy and precision in guiding oral implant procedures.
PubMed: 38830840
DOI: 10.1038/s41405-024-00231-6 -
The Journal of Oral Implantology Jun 2024The purpose of the present study was to evaluate the Morse effect of different internal tapered implant-abutment connections (ITCs) using a pullout test. Implants with...
The purpose of the present study was to evaluate the Morse effect of different internal tapered implant-abutment connections (ITCs) using a pullout test. Implants with different ITCs were selected: Short (Bicon, USA), G1; Novo Colosso (Medens, Brazil), G2; Epkut (SIN, Brazil), G3; Strong SW (SIN, Brazil), G4; Flash (Conexão, Brazil), G5 and Bone Level (Straumann, Switzerland), G6. The respective CAD files were loaded into the analysis software to measure each ITC's taper angle and implant-abutment contact area. Six implants from each group were embedded in acrylic resin blocks, and the respective universal abutments were fixed using a mallet (G1) or by applying 20 Ncm of torque (G2 to G6). After ten minutes, each abutment's retention screw was removed, and the force necessary for abutment rupture was recorded using a universal testing machine at a crosshead speed of 0.5 mm/min. The groups were compared using a one-way ANOVA and Tukey's test. Spearman's correlation was used to check the correlation of the taper angle and contacting area with the pullout strength. G1, a no-screw abutment with a 3° taper, and G2, a 10°tapered abutment tightened by 20 Ncm, presented the highest pullout strength (p<.05). The increased taper angle of G4, compared to G3, reduced the Morse effect despite their similar implant-abutment contacting areas (p<0.05). The G5 and G6 abutments loosened after screw removal and did not exhibit pullout resistance. The closer the tapered angle (r=-.958) and the higher the implant-abutment contact area (r=.880), the higher the pullout strength (p<.001). Within the limits of this study, the Morse effect is different among tapered implant-abutment connections. The closer the tapered angle and the higher the interface area, the higher the Morse effect between the abutment and the implant.
PubMed: 38826061
DOI: 10.1563/aaid-joi-D-24-00039 -
BMC Oral Health Jun 2024Immature teeth with necrotic pulps present multiple challenges to clinicians. In such cases, regenerative endodontic procedures (REPs) may be a favorable strategy....
BACKGROUND
Immature teeth with necrotic pulps present multiple challenges to clinicians. In such cases, regenerative endodontic procedures (REPs) may be a favorable strategy. Cells, biomaterial scaffolds, and signaling molecules are three key elements of REPs. Autologous human dental pulp cells (hDPCs) play an important role in pulp regeneration. In addition, autologous platelet concentrates (APCs) have recently been demonstrated as effective biomaterial scaffolds in regenerative dentistry, whereas the latest generation of APCs-concentrated growth factor (CGF), especially liquid phase CGF (LPCGF)-has rarely been reported in REPs.
CASE PRESENTATION
A 31-year-old woman presented to our clinic with the chief complaint of occlusion discomfort in the left mandibular posterior region for the past 5 years. Tooth #35 showed no pulp vitality and had a periodontal lesion, and radiographic examination revealed that the tooth exhibited extensive periapical radiolucency with an immature apex and thin dentin walls. REP was implemented via transplantation of autologous hDPCs with the aid of LPCGF. The periodontal lesion was managed with simultaneous periodontal surgery. After the treatment, the tooth was free of any clinical symptoms and showed positive results in thermal and electric pulp tests at 6- and 12-month follow-ups. At 12-month follow-up, radiographic evidence and three-dimensional models, which were reconstructed using Mimics software based on cone-beam computed tomography, synergistically confirmed bone augmentation and continued root development, indicating complete disappearance of the periapical radiolucency, slight lengthening of the root, evident thickening of the canal walls, and closure of the apex.
CONCLUSION
hDPCs combined with LPCGF represents an innovative and effective strategy for cell-based regenerative endodontics.
Topics: Humans; Female; Adult; Dental Pulp; Regenerative Endodontics; Dental Pulp Necrosis; Cell Transplantation; Transplantation, Autologous
PubMed: 38824565
DOI: 10.1186/s12903-024-04410-7 -
World Neurosurgery May 2024The optimal management and procedural strategy for tandem occlusion (TO) in acute ischemic stroke are still unclear, as is the long-term outcome of these patients. The...
OBJECTIVE
The optimal management and procedural strategy for tandem occlusion (TO) in acute ischemic stroke are still unclear, as is the long-term outcome of these patients. The aim of this study was to evaluate predictors of good functional outcome in patients with TO through the analysis of demographics, clinical, and radiological data with a 1-year follow-up.
METHODS
We collected data on 100 patients with TO who underwent revascularization treatments in our comprehensive stroke center. We divided patients into 2 groups: those with good functional outcome, defined as a modified Rankin Scale 0-2, and those with poor functional outcome, defined as a modified Rankin Scale 3-6 at 3, 6, and 12-month follow-up. Moreover, we investigated which variables were able to influence mortality.
RESULTS
At multivariate analysis, endovascular treatment with mechanical thrombectomy combined with emergent cervical carotid artery stenting was an independent predictor of good functional outcome at 6 and 12 months (adjusted odds ratio [aOR] 4.3, confidence interval [CI] 1.49-12.31, P = 0.007) (aOR 3.5, CI 1.25-9.61, P = 0.017) and was associated with a lower rate of mortality at 3 and 6 months follow-up (aOR 0.14, CI 0.04-0.57, P = 0.006 and aOR 0.296, CI 0.97-0.902, P = 0.032, respectively). Furthermore, smoking habit was associated with a better outcome at 3-month follow-up (aOR 10.7, CI 2.2-51.6, P = 0.003) but not at 6- and 12-month.
CONCLUSIONS
Our research, conducted in a small sample size of patients with acute ischemic stroke due to TO of anterior circulation, found that acute stent placement seems to be safe, improving clinical outcome, and it is associated with low rate of mortality at long-term follow-up.
PubMed: 38823443
DOI: 10.1016/j.wneu.2024.05.120 -
World Journal of Emergency Surgery :... May 2024Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to control massive hemorrhages. Although there is no consensus on the efficacy of REBOA,... (Observational Study)
Observational Study
BACKGROUND
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been used to control massive hemorrhages. Although there is no consensus on the efficacy of REBOA, it remains an option as a bridging therapy in non-trauma centers where trauma surgeons are not available. To better understand the current landscape of REBOA application, we examined changes in its usage, target population, and treatment outcomes in Japan, where immediate hemostasis procedures sometimes cannot be performed.
METHODS
This retrospective observational study used the Japan Trauma Data Bank data. All cases in which REBOA was performed between January 2004 and December 2021 were included. The primary outcome was the in-hospital mortality rate. We analyzed mortality trends over time according to the number of cases, number of centers, severity of injury, and overall and subgroup mortality associated with REBOA usage. We performed a logistic analysis of mortality trends over time, adjusting for probability of survival based on the trauma and injury severity score.
RESULTS
Overall, 2557 patients were treated with REBOA and were deemed eligible for inclusion. The median age of the participants was 55 years, and male patients constituted 65.3% of the study population. Blunt trauma accounted for approximately 93.0% of the cases. The number of cases and facilities that used REBOA increased until 2019. While the injury severity score and revised trauma score did not change throughout the observation period, the hospital mortality rate decreased from 91.3 to 50.9%. The REBOA group without severe head or spine injuries showed greater improvement in mortality than the all-patient group using REBOA and all-trauma patient group. The greatest improvement in mortality was observed in patients with systolic blood pressure ≥ 80 mmHg. The adjusted odds ratios for hospital mortality steadily declined, even after adjusting for the probability of survival.
CONCLUSIONS
While there was no significant change in patient severity, mortality of patients treated with REBOA decreased over time. Further research is required to determine the reasons for these improvements in trauma care.
Topics: Humans; Balloon Occlusion; Japan; Male; Female; Retrospective Studies; Middle Aged; Resuscitation; Injury Severity Score; Adult; Endovascular Procedures; Aged; Hospital Mortality; Aorta; Wounds and Injuries; Hemorrhage
PubMed: 38822409
DOI: 10.1186/s13017-024-00548-5 -
International Journal of Oral and... May 2024The surgery-first approach (SFA) orthognathic surgery can be beneficial due to reduced overall treatment time and earlier profile improvement. The objective of this...
The surgery-first approach (SFA) orthognathic surgery can be beneficial due to reduced overall treatment time and earlier profile improvement. The objective of this study was to utilize deep learning to predict the treatment modality of SFA or the orthodontics-first approach (OFA) in orthognathic surgery patients and assess its clinical accuracy. A supervised deep learning model using three convolutional neural networks (CNNs) was trained based on lateral cephalograms and occlusal views of 3D dental model scans from 228 skeletal Class III malocclusion patients (114 treated by SFA and 114 by OFA). An ablation study of five groups (lateral cephalogram only, mandible image only, maxilla image only, maxilla and mandible images, and all data combined) was conducted to assess the influence of each input type. The results showed the average validation accuracy, precision, recall, F1 score, and AUROC for the five folds were 0.978, 0.980, 0.980, 0.980, and 0.998 ; the average testing results for the five folds were 0.906, 0.986, 0.828, 0.892, and 0.952. The lateral cephalogram only group had the least accuracy, while the maxilla image only group had the best accuracy. Deep learning provides a novel method for an accelerated workflow, automated assisted decision-making, and personalized treatment planning.
PubMed: 38821731
DOI: 10.1016/j.ijom.2024.05.003 -
Cureus Apr 2024Aim Balanced function of the orofacial muscles is important for normal occlusion and dentition; however, patients with malocclusion often present with myofunctional...
Aim Balanced function of the orofacial muscles is important for normal occlusion and dentition; however, patients with malocclusion often present with myofunctional disorder (MFD). Myofunctional therapy (MFT) has received much attention as a method for reducing MFD. Moreover, prefabricated functional appliances (PFAs) have been developed as a method to eliminate abnormal muscle pressure and guide the tongue into the correct position. However, PFAs have disadvantages, such as poor intraoral retention, limited usage time due to discomfort and poor patient compliance, and changes in the axis of the mandibular anterior teeth. Therefore, this study aimed to develop a new custom-made splint-type orthodontic appliance with CAD/CAM technology. Moreover, we evaluated the characteristics of the appliance and conducted functional tests to determine the effects of the appliance on the orofacial muscles and the discomfort associated with its use. Materials and methods Twenty-five volunteers (nine females and 16 males; mean age 28.4 ± 3.4 years) with normal swallowing function were included in the study. Lip-closing strength (LCS), electromyogram during swallowing, oxygen saturation, and pulse rate were measured and compared when the appliance was not worn and when it was worn. In addition, tongue habits were evaluated, and the maximum tongue pressure was measured when the appliance was not worn. The subjects were asked to answer a questionnaire using a numerical rating scale (NRS) regarding discomfort when wearing the appliance. The evaluation items were swallowing difficulty, speaking difficulty, and breathlessness, which were rated on an 11-point scale ranging from 0 to 10. Statistical tests were conducted using IBM SPSS version 28.0.1 (IBM, Armonk, NY, USA) with the Shapiro-Wilk and Levene's test, followed by the Wilcoxon signed rank sum test. The significance level was set at α = 0.05. The measurement error for each measurement item was evaluated using an intraclass correlation coefficient. Results A new custom-made splint-type orthodontic appliance was fabricated for each subject. The fit and retention of the appliance in the mouth were good when fitted, and a comparison of the functional test measurements of 25 subjects with and without the appliance showed that the LCS decreased significantly (p<0.05) before and after wearing the appliance. However, no statistically significant differences were found for the other items. The Mann-Whitney U test regarding the effects of sex, previous orthodontic treatment, or MFT, and oral habits did not statistically significantly influence the effects of wearing the device. In the NRS results, "difficulty swallowing" was observed in half of the subjects, "difficulty breathing" was rarely observed, and "difficulty speaking" was observed in all subjects. Conclusions A novel custom-made splint-type orthodontic appliance was designed and fabricated using digital workflow and 3D printing technology. This appliance was designed to correct oral habits and was made from a new material classified as a class II medical appliance according to the international harmonized classification.
PubMed: 38807807
DOI: 10.7759/cureus.59228 -
American Journal of Orthodontics and... May 2024The purpose of this study was to investigate the longitudinal psychosocial effects of changes in malocclusion from adolescence to adulthood on oral health-related...
INTRODUCTION
The purpose of this study was to investigate the longitudinal psychosocial effects of changes in malocclusion from adolescence to adulthood on oral health-related quality of life (OHRQOL), self-rated dental appearance, and overall life satisfaction.
METHODS
The Dunedin Multidisciplinary Health and Development Study is a longitudinal birth cohort study of 1037 children born at Queen Mary Hospital, Dunedin, New Zealand, between April 1, 1972 and March 31, 1973. Data on their health and development, including dental examinations, has since been collected periodically. Malocclusion severity was measured using the Dental Aesthetic Index in participants aged 15 and 45 years (data collected at age 18 years was supplemented for data missing at age 15 years). Other data collected included clinically assessed oral health (dental caries and periodontal disease experience) and self-rated dental appearance, OHRQOL, life satisfaction, and personality traits.
RESULTS
Malocclusion data were available for 868 participants in adolescence and 834 aged 45 years. For those with a severe handicapping malocclusion at 15 years old, 46.6% who received orthodontic treatment transitioned to a resolved (ie, mild-moderate) malocclusion when aged 45 years, whereas only 16.2% of those who did not receive orthodontic treatment made that transition. A transition to a worse malocclusion was associated with impacts on OHRQOL when aged 45 years in the subdomains of functional limitation, psychological discomfort, and physical disability as well as worse self-ratings of dental appearance, and these findings were held after adjusting for potential confounders. Malocclusion was not associated with overall life satisfaction.
CONCLUSIONS
Maintenance of acceptable occlusion after orthodontic treatment requires a strong emphasis on achieving and maintaining excellent dental health and avoiding chronic oral conditions such as dental caries and tooth loss. The long-term benefits of orthodontic treatment may diminish by midlife unless good dental health is maintained. Orthodontists have the responsibility to raise awareness among their patients on how to maintain good oral health after orthodontic treatment.
PubMed: 38804994
DOI: 10.1016/j.ajodo.2024.04.013 -
Clinical Case Reports Jun 2024This article describes a successful case of auto-transplantation of a mandibular third molar to replace a non-restorable second molar, highlighting the efficacy of this...
KEY CLINICAL MESSAGE
This article describes a successful case of auto-transplantation of a mandibular third molar to replace a non-restorable second molar, highlighting the efficacy of this procedure in restoring function with factors like asepsis, surgical technique, and postoperative care contributing to the success.
ABSTRACT
This case report describes successful auto-transplantation of a mandibular third molar to replace a non-restorable second molar in a 66-year-old patient. The procedure involved atraumatic extraction, repositioning, and stabilization of the donor tooth, followed by postoperative care and 1-year follow-up. The favorable outcome highlights the potential of mature third molar transplantation as an effective approach for replacement of missing or non-restorable permanent molar teeth to restore esthetics and function. The success of the procedure was attributed to factors such as asepsis, atraumatic surgical technique, preservation of the periodontal ligament (PDL) vitality, minimal extraoral time, optimal occlusion, and adequate fixation. At the 1-year follow-up, the patient was asymptomatic with stable occlusion, highlighting the optimal efficacy of the procedure.
PubMed: 38799524
DOI: 10.1002/ccr3.8911