Search Results (70)

Introduction: Digital planning and evolution of technology is allowing dentistry to be more efficient in time than before. In orthodontics the main purpose is to obtain fewer patient visits and to reduce the bonding time. For that, indirect bonding planned with CAD-CAM softwares is used to obtain a shorter treatment period, in general, and less chair-time. This waste of chair-time should also be reduced in other fields of dentistry such as endodontics, surgery, prosthodontics, and aesthetics. Methods: A total of 504 teeth were embedded into epoxy resin models mounted as a dental arch. Customized lingual multibracket appliances were bonded by a current adhesion protocol. After that, they were debonded, the polishing of cement remnants was performed with three different burs and two drills. The polishing time of each group was recorded by an iPhone 14 chronometer. Results: Descriptive and comparative statistical analyses were performed with the different study groups. Statistical differences (p < 0.005) between diamond bur and tungsten carbide and white stone burs and turbine were obtained, with the first being the slowest of them. Discussion: Enamel roughness was widely studied in orthodontics polishing protocol as the main variable for protocols establishment. However, in lingual orthodontics, due the difficulty of the access to the enamel surfaces, the protocol is not clear and efficiency should be considered. It was observed that the tungsten carbide bur is the safest bur. It was also recommended that a two-step protocol of polishing by tungsten carbide bur be followed by polishers. Conclusions: A tungsten carbide bur mounted in a turbine was the most efficient protocol for polishing after lingual bracket debonding. Full article

Dental anxiety is an intense and irrational fear of visiting the dentist or of undergoing dental procedures. Background/Objectives: The aim of this study was to investigate the prevalence of dental anxiety in children aged 6–11 years and to identify the importance of communication in reducing anxiety in pediatric patients. Methods: The research was conducted through a questionnaire administered to 101 students (55.4% girls and 44.6% boys), aged 6–11 years, from the North-West Region of Romania. The data collected included the age and gender of the subjects, their previous experiences with the dentist, the identification of factors that trigger anxiety, and the way in which patients perceive future dental visits. Results: This study found that for the majority of participants, a visit to the dentist does not represent a source of fear. Moreover, most children are eager to visit the dentist again. Gender and age did not have a significant effect on the prevalence of anxiety. Elements such as sitting in the dental chair, observing dental instruments, having the teeth examined with a mirror, and hearing the sounds produced by the instruments were identified as factors that may cause anxiety in pediatric patients. Conclusions: It was found that pediatric patients who have good communication with the practitioner display lower anxiety levels compared to those of others. Full article

Introduction: Dental professionals are susceptible to musculoskeletal disorders due to unphysiological postures during treatment, which can be mitigated by the choice of a work chair to improve ergonomic working posture. Methods: In this study, the influence of five different work chairs on the ergonomic risk assessment using RULA and the working behaviour of 22 right-handed dentists was investigated. To this end, dental treatment was simulated on a phantom head, with the body posture recorded using an inertial motion capture system. The resulting kinematic data were converted into a continuous RULA scheme, and statistical methods (Friedman test with Conover–Iman comparisons and statistical parametric mapping) were used to compare the chairs. The significance level was set at p ≤ 0.05. Results: The RULA analysis revealed no significant differences between the task chairs that were tested; however, it should be noted that all of the task chairs exhibited an increased ergonomic risk (RULA ≥ 5), which indicates an increased risk of musculoskeletal disorders. Significant multiple comparisons (SPM analysis) between the selected chairs of the relative occurrence of total joint angles were between Chair 1 vs. 5 (p ≤ 0.03 for shoulder left flexion–extension), Chair 2 vs. 4 (p ≤ 0.03 for shoulder right flexion–extension), Chair 1 vs. 3 (p ≤ 0.03 for trunk right flexion–extension, 0.04 for trunk lateral flexion and 0.05 for elbow left flexion–extension), Chair 3 vs. 4 (p ≤ 0.05 for shoulder left flexion–extension and 0.01 shoulder right flexion–extension), and between Chair 2 vs. 3 (p ≤ 0.05 for elbow left flexion–extension). Discussion: The study’s findings indicate that the selection of work chairs did not have a significant impact on the ergonomic risk, which remained consistently high across all the chairs. Nevertheless, the analysis of joint angles demonstrated that the Ghopec chair was more frequently associated with greater joint angles, with only a few significant deviations. However, it should be noted that these significant differences in joint angles occurred only sporadically, did not demonstrate a clear and consistent trend across all the chairs, and have no clinical impact. Overall, the results confirm that the working posture of the dentists has a potential risk of developing musculoskeletal disorders, while the ergonomic design of the work chairs plays a rather subordinate role. Full article

Dental professionals face an increased risk of exposure to biological fluids, aerosols, and droplets due to close patient contact, which heightens the risk of infectious diseases. Rubber dam, commonly used in dentistry, not only isolates treatment areas but also reduces aerosol and droplet dispersion. Accurate orthodontic bracket positioning is crucial for optimal treatment, and isolation techniques like rubber dam and traditional methods are essential for ensuring precise bracket placement and bonding. This study aims to compare the effects of rubber dam and traditional isolation techniques on orthodontic bracket positioning using 3D digital models, while also evaluating the impact of these methods on the patient’s chair time during the procedure. The study group (RDI—Rubber Dam Isolation) included individuals isolated with a rubber dam, while the control group (TI—Traditional Isolation) consisted of those isolated using retractors and cotton rolls. Digital models were taken from these groups before bracketing (BB) and after bracketing (AB). BB models were transferred to the Orthoanalyzer^TM program for virtual bracketing and a virtual bonding model (VB) was created. AB and VB models were superimposed in the GOM Inspect^TM program in order to determine the accuracy of the bracket positions. Linear measurements were taken along the X, Y, and Z axes, while angular measurements were recorded on the XY, XZ, and YZ planes. There was no significant difference in deviation values along the X-axis between the RDI and TI groups. In both groups, the lowest deviation values in linear measurements were found in the Z-axis, while the highest deviation values were found in the Y-axis. In the Y-axis, it was found that the deviation values were higher in the RDI group for tooth numbers 32 and 33, and in the Z-axis, the deviation values were higher in the RDI group for tooth numbers 34 and 44. In angular measurements, it was observed that in the XY plane, the deviation values in tooth number 35 were higher in the TI group. RDI proves to be an effective method for ensuring accurate bracket positioning in orthodontic procedures when compared to traditional isolation techniques. Especially considering infectious diseases, the use of RDI is considered appropriate. Full article

Objectives: This randomized clinical trial evaluated the microbiological efficacy and the ergonomic impact of three prototypes of a device to reduce aerosol dispersion during dental procedures. Methods: Sixty patients undergoing dental care using high-speed turbines and/or ultrasonic tips were randomly assigned to 4 groups (n = 15): CG: control group, with standard personal protective equipment (PPE); G1: PPE + acrylic device (AD) with aspiration; G2: PPE + AD without aspiration; and G3: PPE + polyvinyl chloride device. The device prototypes consisted of a rigid translucent acrylic structure (G1 and G2), or a rigid PVC tube structure surrounded by layers of translucent flexible PVC films (G3), adjusted to the dental chair, involving the patient’s head, neck and chest. The main outcome was the microbiological analysis (mean Δ of CFU at 10 different sites), and the secondary outcome was the ergonomic evaluation (questionnaire to dentists and patients). Results: The final sample comprised 59 participants (mean age 38.6 ± 11.4 years, 55.2% male). The overall mean time for dental procedures was 32.4 ± 16.9 min, with no differences between groups (p = 0.348). Microbiological analyses showed that the use of the device significantly reduced contamination in the light reflector (01.46 ± 4.43 ΔCFU in G2 vs. 19.25 ± 36.50 ΔCFU in CG; p = 0.028), apron (09.11 ± 12.05 ΔCFU in G3 vs. 21.14 ± 43.41 ΔCFU in GC; p = 0.044), and face shield (08.80 ± 32.70 ΔCFU in G1 vs. 56.78 ± 76.64 ΔCFU in the GC; p = 0.017). The device was well accepted by patients and increased the dentists‘ perception of safety and protection (p < 0.001), but significantly decreased ergonomics related to the clinical view, space, agility and access to the patient, and ease of performing procedures (p < 0.001). Conclusions: The tested device can be an additional tool for infection prevention and control in dentistry, not only during the COVID-19 pandemic, but also for the control of future infectious diseases and epidemics. Full article

Background/Objectives: This study aimed to compare the cost and time implications for implant-supported prosthesis comparing three digital impression techniques: digitization with an intraoral scanner, digitization of the conventional impression (without dental casts) and digitization of the stone models. Methods: To assess the time and cost of digital impression techniques on implants, time records on intraoral scans were consulted and three models were created with one, two and six implants to assess extraoral procedures time. Costs were evaluated based on material consumption, time expenditure and operator-related expenses. Time was recorded in three stages: (1) impression-taking, (2) model fabrication and (3) overall workflow completion. Statistical analysis was performed using ANOVA to compare cost and time differences across workflows. Results: Intraoral scanning presented a reduction in chair-side time between 4 and 20% when compared to extraoral techniques. For the three clinical situations evaluated, the intraoral scanning always presented the lowest cost. The extraoral digitization of impressions showed a reduction between 51.9% and 53.6% in laboratory time and between 3.5% and 7.6% in total cost compared to stone models digitization. Conclusions: The findings of this study indicate that intraoral scanning is a more cost-effective and time-efficient alternative to traditional impression methods, providing advantages in terms of reduced material use and shorter procedural durations. Full article

Computer-assisted preparation of porcelain laminate veneers (PLVs) using stereolithographic templates has been developed to enhance the accuracy of tooth preparation. However, the digital workflows involved in guided PLV preparation remain inconsistently defined across various practices. Therefore, this scoping review aimed to examine publications on computer-assisted PLV preparation to identify the key stage of digital workflows involved in designing and fabricating stereolithographic templates, as well as to highlight the limitations of various template designs. This scoping review aimed to identify publications on digital workflows for designing and fabricating stereolithographic templates in computer-assisted porcelain laminate veneer preparation. A systematic search on MEDLINE/PubMed, Web of Science and Scopus identified English-language articles published from 2014 to March 2024. Eligible articles focused on digitally designed and fabricated tooth reduction templates for porcelain laminate veneers, excluding conventional tooth preparation procedures for tooth reduction assessment. Seven clinical reports were included, demonstrating various 3D data acquisition techniques for virtual patient generation. All articles described virtual diagnostic wax-ups on digital casts, with two using a virtual articulator. Only five articles documented chair-side mock-ups with resin trial restorations to evaluate planned dental esthetics. Additionally, virtual tooth preparation prior to templates design was included in only four articles. The templates were designed using different software and ranged from simple designs with access windows to complex stacked templates with rotary instrument sleeved windows. Each template design had limitations affecting tooth reduction accuracy. All articles reported printing templates in clear acrylic resin using different technologies. In conclusion, the review highlights a lack of standardization in the digital workflow for designing stereolithographic templates for PLVs. Establishing a sound protocol for designing the tooth reduction templates is essential to ensure the accuracy and consistency of veneer preparation. Full article

This review aims to provide a comprehensive overview of the literature on the oral side effects caused by radiotherapy for head and neck cancers. Various treatments are examined to mitigate these sequelae, and a protocol is proposed for dentists and dental hygienists to manage oncological patients. A literature search was conducted to select relevant articles addressing the effects of radiotherapy treatments on the oral cavity, with a particular focus on the development of mucositis, candidiasis, changes in salivary pH, trismus, fibrosis, and alterations in the oral biofilm. PubMed and MedLine were used as search engines, with keyword combinations including: head and neck cancer, mucositis, candida, dental care, dental hygiene, epidemiology, oral microbiome, biofilm, trismus, fibrosis, and salivary pH. A total of 226 articles were identified, spanning the period from 1998 to 2023. Articles deemed inappropriate or in languages other than English or Italian were excluded. A management protocol for oncological patients was proposed, divided into two phases: home-based and professional. Despite the advancements in intensity-modulated radiation therapy, it is impossible to completely avoid damage to healthy tissues. Preventive education and counseling in the dental chair, ongoing motivation, and education about oral hygiene are crucial to combine a good therapeutic outcome with an improved quality of life for the patient. Full article

Background: Without mechanical cleaning, gingivitis can develop within three weeks. The first clinical sign is bleeding on positive probing. The accumulation of dental biofilm triggers an inflammatory gingival response. In the past decade, attention has focused mainly on interproximal areas and the use of customized interproximal toothbrushes. The aim of this study was to evaluate the effectiveness of individualized oral hygiene education and its role in dental disease prevention among patients with dental problems. Methods: Altogether, 102 patients, 38 males and 64 females, were included in the study. All patients were aged over 18 years. Before treatment, patients were clinically and radiologically examined, their full mouth plaque score (FMPS), full mouth bleeding score (FMBS), and bleeding on brushing (BOB) were recorded, and matrix-metalloproteinase-8 (MMP-8) was measured by using a chair-side MMP-8 measuring system. Patients in group A had gingivitis but no periodontal damage, and group B had periodontal damage. Patients in both groups were divided into four subgroups based on their toothbrushing habits and the oral health education they received. Three months after the initial examination, each patient was examined three more times (2, 4, and 12 weeks later). Results: It was concluded that subjects in groups A1 and B1 showed a significant reduction in BOB, MMP-8, FMBS, and FMPS levels after two weeks. Solo Prophylaxis (A1 and B1) remained a well-constructed protocol and caused the complete resolution of interdental inflammation after two weeks. Other subgroups achieved significant reductions only after 12 weeks. Conclusions: BOB and MMP-8 tests are valuable complements in preventive dentistry, and are able to detect potential pathological processes. The clinical relevance of BOB testing, in addition to FMBS, FMPS and gingival inflammation testing, can be demonstrated to patients, which may increase compliance. Full article

Background: The goal is to analyze the need for reinterventions under deep sedation to treat oral pathologies in a population of children with special health care needs (SHCNs) and healthy children who followed a prevention program and to study the influence of parental motivation and child collaboration on the need for reinterventions under deep sedation. Methods: A retrospective study was carried out in a private clinic in Cartagena (Murcia, Spain), with patients treated under deep sedation from 2006 to 2018, both years included, following the Strobe statement. Results: In this study with 230 children who were treated under deep sedation, 23.92% underwent two or more sedations. The mean time elapsed between the first and the second sedations was 21.64 ± 15.87 months, and the main cause for reinterventions was the occurrence of new pathologies. Significantly more pulp treatments were performed in the first sedation than in the second (p = 0.013) and in the third (p = 0.007). Healthy children required fewer reinterventions under deep sedation than children with special needs (6.42% vs. 39.67%). Similarly, patients who followed the preventive program and required some type of dental treatment were reoperated fewer times than those who did not follow the preventive program (35.8 vs. 50%); than “cooperative” children as opposed to “non-cooperative” (12.12% vs. 60.93%) and than patients with “motivated” parents as opposed to those with “non-motivated” parents (20.83% vs. 46.34%). A total of 50% of the children who participated in the preventive program became “cooperative”, and 100% were able to receive some treatment in the dental chair. Conclusions: Prevention programs, including motivational interviewing, are essential to improve children’s behavior in the dental chair and reduce the need for reinterventions under general anesthesia or deep sedation. Although patients with special needs do require more sedation during their lifetime due to their inability to cooperate, these programs are necessary for the maintenance of oral health status and for the early diagnosis of caries lesions. Pediatric dentists should implement a quarterly preventive program because it improves patient collaboration. It is essential to achieve the motivation of parents in the oral care of their children. Full article

This study aimed to compare several potential mouthrinse biomarkers for periodontitis including active matrix-metalloproteinase-8 (aMMP-8), total MMP-8, and other inflammatory biomarkers in diagnosing and monitoring the effects of nonsurgical periodontal therapy. Thirteen patients with stage III/IV periodontitis were recruited, along with thirteen periodontally and systemically healthy controls. These 13 patients were representative of the number of outpatients visiting any dentist in a single day. Full-mouth clinical periodontal parameters and biomarkers (the aMMP-8 point-of-care-test [POCT], total MMP-8, tissue inhibitor of MMPs (TIMP)-1, the aMMP-8 RFU activity assay, Myeloperoxidase, PMN elastase, calprotectin, and interleukin-6) were recorded at baseline and after nonsurgical therapy at 6 weeks. The aMMP-8 POCT was the most efficient and precise discriminator, with a cut-off of 20 ng/mL found to be optimal. Myeloperoxidase, MMP-8’s oxidative activator, was also efficient. Following closely in precision was the aMMP-8 RFU activity assay and PMN elastase. In contrast, the total MMP-8 assay and the other biomarkers were less efficient and precise in distinguishing patients with periodontitis from healthy controls. aMMP-8, MPO, and PMN elastase may form a proteolytic and pro-oxidative tissue destruction cascade in periodontitis, potentially representing a therapeutic target. The aMMP-8 chair-side test with a cut-off of 20 ng/mL was the most efficient and precise discriminator between periodontal health and disease. The aMMP-8 POC test can be effectively used by dental professionals in their dental practices in online and real-time diagnoses as well as in monitoring periodontal disease and educating and encouraging good oral practices among patients. Full article

Hemostasis disorders require particular attention in dental treatment. Dental implants are a very widespread and valid method for total rehabilitation. Flapless dental implant surgery is a minimally invasive treatment that allows the implants to be placed in the jaw bones with minimal surgical trauma. The aim of this study is to report the bleeding incidence in a group of patients with bleeding disorders treated with flapless implants. A total of 52 patients with bleeding disorders (46 in anticoagulant therapy; 4 with hemophilia; 2 with von Willebrandt disease) were treated with 188 flapless implant surgeries Anticoagulants were not discontinued. Patients with hemophilia and VWD were treated following specific protocols. Four late, easy to treat bleeding complications were reported (three mild bleeding, one ecchymosis). No additional sutures or other hemostatic measures were taken, no further infusions or transfusions were reported, and no severe bleeding complications requiring more than easy on-chair treatment, were reported. In conclusion, with adequate knowledge of the procedure and the pathology, dental implantology can be safely performed in patients with bleeding disorders. Full article

Background: The dreaded sensation of pain in the dental chair has a significant impact on children’s behavior. This study aimed to compare and contrast the perception of pain and patient behavior between the use of INJEX and the conventional syringe needle technique during pulpotomy among children. Methods: A randomized clinical trial was designed and conducted among pediatric dentistry patients aged 6–12 years old. Fifty-eight children were divided into two groups, conventional syringe needle and INJEX, using simple randomization method applying the sequentially numbered, opaque, sealed envelope method of allocation concealment. Anesthesia was administered to the groups as local infiltration by a single operator following routine behavior guidance techniques. After 3 min, pulpotomy was performed using the standard protocol. The Face, Legs, Activity, Cry, Consolability (FLACC) scale and Wong–Baker FACES Pain Rating Scale (WBS) were used to assess the intensity of pain, while the Frankl behavior rating scale (FBRS) was used to assess the children’s behavior. Results: During anesthesia, most of the participants in the INJEX group (median = 3) had higher FBRS scores compared with the conventional syringe needle group (median = 2), and the difference was very highly significant (p-value < 0.001). Analyzing the FLACC scores during local anesthesia administration revealed a high statistical significance (p-value < 0.01) across the two groups. A very high statistically significant difference (p-values < 0.001) with higher WBS scores for pain intensity was seen in the group using conventional syringe needles. Conclusions: INJEX administration significantly reduced the intensity of pain experienced by the children and helped maintain a positive attitude among them during pulpotomy. It provided a positive and comfortable experience for both the child and the practitioner. Therefore, it can serve as an excellent alternative to conventional needle anesthesia. Full article

Background: Preformed elastodontic appliances (EAs) have been described as safe, cost-effective, and easy-to-use devices for interceptive orthodontic treatment in growing patients. This study aimed to assess the knowledge and the attitude of dentists toward the use of EAs and to compare the behaviors of orthodontists (Os) with those of general dental practitioners (GDPs). Methods: An anonymous survey was distributed among dentists through social media. Twenty-two items were divided as follows: characteristics of respondents; general knowledge about EAs; section for EA-users; and section for EA non-users. Chi-squared tests were used to analyze differences in responses between groups. Results: Participants included 226 Os and 168 GDPs. The majority in both groups reported having adequate knowledge about EAs and utilizing them in their practice. GDPs usually use EAs to treat children during the early phase of growth, while Os also use EAs to address orthodontic problems in different stages of dentition, experiencing a chair time reduction compared with traditional appliances. Regarding EA non-users, GDPs seem not to find an application among their patients, whereas Os reported not having enough patient compliance during treatment. Conclusions: Although treatment with EAs is common among all dentists, differences exist between Os and GDPs in the awareness and application, as well as in the reasons provided for not using EAs. Full article

Dental professionals are exposed to significant unavoidable physical stress, and theoretical ergonomic recommendations for a sitting workplace are inapplicable in many dental activities. Work-related musculoskeletal disorders (WMSDs) represent a serious health problem among dental professionals (prevalence: 64–93%), showing involvement of 34–60% for the low back and 15–25% for the hips. Muscle stress; prolonged sitting; forward bending and twisting of the torso and head; unbalanced working postures with asymmetrical weight on the hips and uneven shoulders; and others are inevitable for dental professionals. Therefore, the approach for the prevention and treatment of WMSDs must be therapeutic and compensatory. This project was conceived to provide a Yoga protocol for dental professionals to prevent or treat WMSDs from a preventive medicine perspective, and it would represent a Yoga-based guideline for the self-cure and prevention of musculoskeletal problems. Methods: Specific Yoga positions (āsana, such as Virāsana, Virabhadrāsana, Garudāsana, Utkatāsana, Trikonāsana, Anuvittāsana, Chakrāsana, Uttanāsana, Pashimottanāsana) have been selected, elaborated on and adapted to be practiced in a dental office using a dental stool or the dental office walls or a dental unit chair. The protocol is specifically devised for dental professionals (dentists, dental hygienists and dental assistants) and targeted for the low back, hips and legs (including knees and ankles). The protocol includes Visranta Karaka Sthiti (supported positions) in sitting (Upavistha Sthiti) and standing (Utthistha Sthiti) positions, twisting/torsions (Parivrtta), flexions/forward bend positions (Pashima) and extensions/arching (Purva) for musculo-articular system decompression and mobilization. Results: Over 60 Yogāsana—specifically ideated for back detensioning and mobilization, lumbar lordosis restoration, trunk side elongation, hip release and leg stretches and decontraction—are shown and described. The paper provides a meticulous description for each position, including the detailed movement, recommendations and mistakes to avoid, and the breathing pattern (breath control) in all the breath-driven movements (āsana in vinyāsa). An exhaustive analysis of posture-related disorders affecting the lower body among dental professionals is reported, including low-back pain, hip pain and disorders, piriformis syndrome and quadratus femoris dysfunction (gluteal pain), iliopsoas syndrome, multifidus disorders, femoroacetabular and ischiofemoral impingement, spinopelvic mobility, lumbopelvic rhythm, impairment syndromes, lower crossed syndrome, leg pain, knee pain and ankle disorders. Conclusions: A detailed guideline of āsana for low-back decompression, hip joint destress, piriformis and gluteal muscle release, lumbar lordosis recovery and a spinopelvic mobility increase has been elaborated on. The designed Yogāsana protocol represents a powerful tool for dental professionals to provide relief to retracted stiff muscles and unbalanced musculoskeletal structures in the lower body. Full article