Clinical Oral Investigations

Harlos, Mauricio Marcelo; da Silva, Thiago Bezerra; Montagner, Pedro Giorgetti; Teixeira, Lucas Novaes; Gomes, Adriana Vanderley; Martinez, Elizabeth Ferreira

doi: 10.1007/s00784-022-04515-9pmid: 35511290

ObjectivesPneumatization of the maxillary sinus can make it difficult, if not impossible, to install osseointegrated implants, and undertake their eventual functional rehabilitation, which may ultimately require regenerative techniques to achieve. This randomized controlled study proposed conducting a histological evaluation of the behavior of different graft materials in wide maxillary sinuses, at a height of 8 to 10 mm from the alveolar ridge, combined with bone remnants less than 3mm.Materials and methodsThirty-six patients underwent a sinus elevation procedure through the lateral window. The sinuses were randomly filled with the following materials (n=12/group): group 1, xenogenic bone + autogenous bone (ratio 70:30, respectively); group 2, xenogenic bone + L-PRF; and group 3, xenogenic bone. At 8 months, bone biopsies of engrafted sites were harvested and analyzed histomorphometrically in order to quantify newly formed bone tissue.ResultsThe results showed a greater area of newly formed bone for G1, averaging 2678.37 (1116.40) μm2, compared with G2 at 984.87 (784.27) μm2, and G3 at 480.66 (384.76) μm2 (p < 0.05). Additionally, fewer xenogenic bone particles and a large amount of connective tissue were observed in G2.ConclusionsIn maxillary sinuses with large antral cavities, autogenous bone combined with xenogenic bone seems to demonstrate better graft remodeling and improve bone formation, compared with the addition of L-PRF.Clinical relevanceL-PRF produces few advantages regarding new bone formation in the wide maxillary sinuses.Trial registrationBrazilian Clinical Trials Registry (REBEC) number RBR-2pbbrvg.

Fonseca-Souza, Gabriela; de Oliveira, Luiza Becker; Wambier, Letícia Maira; Scariot, Rafaela; Feltrin-Souza, Juliana

doi: 10.1007/s00784-022-04540-8pmid: 35729285

ObjectiveTo evaluate the association between orofacial clefts (OFC) and tooth abnormalities (TA).MethodsWe searched PubMed, Scopus, Web of Science, Cochrane Library, LILACS, and BBO, and in the gray literature and selected observational studies that evaluated the association between TA and OFC. The risk of bias was analyzed using the Newcastle–Ottawa Scale. A random-effects meta-analysis was performed comparing the presence and absence of OFC, cleft type—cleft palate (CP) and cleft lip with or without palate (CL/P)—and cleft laterality—unilateral and bilateral. The certainty of evidence was evaluated using the GRADE approach.ResultsA total of 99 studies were included in the qualitative analysis, and 37 were included in the meta-analysis. Only four studies were classified as low risk of bias. Significant associations were observed between the presence of OFC and tooth agenesis (OR = 19.46; 95%CI = 4.99–75.96), supernumerary teeth (OR = 4.04; 95%CI = 1.26–12.99), developmental defects of enamel (OR = 3.15; 95%CI = 1.28–7.80), microdontia (OR = 15.57; 95%CI = 1.06–228.51), and taurodontism (OR = 1.74; 95%CI = 1.74–2.86). Individuals with CP had a lower frequency of supernumerary teeth (OR = 0.22; 95%CI = 0.08–0.64), peg-shaped tooth (OR = 0.31; 95%CI = 0.12–0.80), and morphological TA (OR = 0.13; 95%CI = 0.04–0.45) than individuals with CL/P. No TA was significantly associated with cleft laterality (p > 0.05). The quality of the evidence was very low in all analyses.ConclusionIndividuals with OFC had a higher frequency of TA than those without OFC. Individuals with CP had a lower frequency of TA than individuals with CL/P. No TA was associated to cleft laterality.Clinical relevanceHelp to identify the treatment needs of individuals affected by OFC, improving the services provided to this population.

Alves dos Santos, Guilherme Nilson; Faria-e-Silva, André Luis; Ribeiro, Vitor Luís; Pelozo, Laís Lima; Candemil, Amanda Pelegrin; Oliveira, Matheus L; Lopes-Olhê, Fabiane Carneiro; Mazzi-Chaves, Jardel Francisco; Sousa-Neto, Manoel Damião

doi:

Lahoud, Pierre; Jacobs, Reinhilde; Boisse, Philippe; EzEldeen, Mostafa; Ducret, Maxime; Richert, Raphael

doi: 10.1007/s00784-022-04572-0pmid: 35687196

The dental practice has largely evolved in the last 50 years following a better understanding of the biomechanical behaviour of teeth and its supporting structures, as well as developments in the fields of imaging and biomaterials. However, many patients still encounter treatment failures; this is related to the complex nature of evaluating the biomechanical aspects of each clinical situation due to the numerous patient-specific parameters, such as occlusion and root anatomy. In parallel, the advent of cone beam computed tomography enabled researchers in the field of odontology as well as clinicians to gather and model patient data with sufficient accuracy using image processing and finite element technologies. These developments gave rise to a new precision medicine concept that proposes to individually assess anatomical and biomechanical characteristics and adapt treatment options accordingly. While this approach is already applied in maxillofacial surgery, its implementation in dentistry is still restricted. However, recent advancements in artificial intelligence make it possible to automate several parts of the laborious modelling task, bringing such user-assisted decision-support tools closer to both clinicians and researchers. Therefore, the present narrative review aimed to present and discuss the current literature investigating patient-specific modelling in dentistry, its state-of-the-art applications, and research perspectives.

Gonzaga, Carla Castiglia; Garcia, Paula Pontes; Wambier, Letícia Maíra; Prochnow, Fernanda Harumi Oku; Madeira, Luciano; Cesar, Paulo Francisco

doi: 10.1007/s00784-022-04573-zpmid: 35660957

ObjectivesThis systematic review was performed to determine the main cause of technical failure of tooth-supported zirconia crowns and fixed partial dentures (FPDs), categorizing them as fracture/chipping or loss of retention/decementation.Materials and methodsElectronic and manual searches were performed for randomized clinical trials, prospective clinical trials, and prospective cohort studies that reported the technical failure rates of zirconia restorations. The Cochrane Collaboration risk-of-bias tool and Newcastle–Ottawa scale were used to assess the quality of the studies.ResultsFifty-two studies were included and most of them had unclear risk of bias. Considering all reported fractures/chipping, for veneered crowns with 1 to 3 years of follow-up, the relative risk (RR) of fracture in relation to loss or retention was 3.95 (95% CI 1.18–13.23; p = 0.03). For 4 to 6 years of follow-up, the RR was 5.44 (95% CI 1.41–20.92; p = 0.01). For veneered FPDs with 1 to 3 years of follow-up, the RR was 5.98 (95% CI 2.31–15.01; p = 0.0002). For 4 to 6 years of follow-up, the RR was 3.70 (95% CI 1.63–8.41; p = 0.002). For 7 years or more of follow-up, the RR was 3.45 (95% CI 1.84–6.46; p = 0.0001). When only framework fractures were considered, there were no significant differences for the RR in all follow-up periods (p > 0.05).ConclusionsHigher RR for fracture/chipping in relation to decementation for veneered zirconia crowns and FPDs at all follow-up times. For framework fractures, no difference was observed between the risk of failure of the restoration due to fracture or decementation.Clinical relevanceZirconia crowns and FPDs showed relatively high success and survival rates. However, considering the technical failures, there is approximately four times higher chance of fracture/chipping than loss of retention for both single and multi-unit tooth-supported veneered zirconia restorations.

Shi, Yijin; Wang, Yanling; Ge, Han; Diao, Pengfei; Song, Xiaomeng; Jiang, Hongbing; Wang, Dongmiao

doi: 10.1007/s00784-022-04482-1pmid: 35426001

ObjectiveThis retrospective study aimed to comprehensively delineate the epidemiological and 3-dimensional radiographic characteristics of non-third molar (non-M3) impacted teeth in a Chinese dental population.Material and methodsPatients with impacted teeth except for the third molar (ITEM3) were retrospectively screened via cone-beam CT images from 75,021 patients treated at our institution from June 2012 to December 2018. Demographic and clinical data of patients with ITEM3 were retrieved from medical records. CBCT coupled with 3-dimensional reconstruction was employed to characterize the radiographic features of ITEM3. Associations between these epidemiological, clinical, and radiographic features were further statistically analyzed.ResultsAmong 1975 eligible patients, 2467 ITEM3s were identified with a prevalence of 2.63% (1975/75,021). Females slightly outnumbered males with a ratio of 1.12:1. The majority of ITEM3 was single (1577, 79.85%) in the maxilla. The maxillary canine teeth were the most frequently impacted (52.45%), followed by maxillary incisors. The mesioangular position was the most common orientation (43.8%), followed by vertical and buccal-lingual orientations. The most frequently associated lesion was external root resorption of the adjacent tooth, which was significantly correlated with the morphology and position of the impacted tooth.ConclusionMost ITEM3 was single, mesioangular, found at maxillary canines, sometimes associated with diverse complications. Our data advance the current understanding of ITEM3 and offer insights into the management of this dental abnormality.Clinical relevanceThese findings are useful for clinicians to comprehensively understand the prevalence, radiographic features, and complications of non-M3 impacted teeth.

Kloukos, Dimitrios; Kalimeri, Eleni; Koukos, George; Stähli, Alexandra; Sculean, Anton; Katsaros, Christos

doi: 10.1007/s00784-022-04483-0pmid: 35503136

ObjectivesThe aim was to retrieve the threshold of gingival thickness (GT), where the attribute of gingival translucency through probe visibility was altered.MethodsIn 200 patients, the soft tissue thickness was evaluated at both central mandibular incisors using ultrasound quantification (USD). Additionally, probe visibility was determined using a standard periodontal probe (PB) (CPU 15 UNC, Hu-Friedy), inserted 1 mm deep into the gingival sulcus. Frequencies and relative frequencies were calculated. Repeatability analyses and receiver operating characteristics (ROC) were conducted to determine the USD cut-off point for probe visibility.ResultsRegression model indicated that the probe was not visible at a thickness of 0.82 mm for the mandibular left central incisor (95% CIs 0.77, 0.86) and became visible at a thickness of 0.69 mm (95% CIs 0.65, 0.72). The respective values for the mandibular right central incisor were 0.82 mm (95% CIs 0.77, 0.87) and 0.70 mm (0.68, 0.74). ROC analysis confirmed the retrieved regression results by indicating the best fitting balance for specificity and sensitivity at a thickness of 0.8 mm for both mandibular incisors.ConclusionsIn the frame of the current study, the data revealed that gingiva becomes non-transparent at a thickness of approximately 0.8 mm.Clinical relevanceProbe visibility at mandibular incisors for the discrimination between thin and thick soft tissues was correlated with a gingival thickness of 0.8 mm and a high repeatability.

Lari, Soma; Hiyari, Sarah; de Araújo Silva, Davi Neto; de Brito Bezerra, Beatriz; Ishii, Makiko; Monajemzadeh, Sepehr; Cui, Zhong-Kai; Tetradis, Sotirios; Lee, Min; Pirih, Flavia Q.

doi: 10.1007/s00784-022-04484-zpmid:

Pan, Yuhua; Yi, Sheng; Chen, Dong; Du, Xinya; Yao, Xinchen; He, Fei; Xiong, Fu

doi: 10.1007/s00784-022-04485-ypmid: 35641834

ObjectivesKDF1 is a recently identified gene related to tooth development, but it has been little studied. To date, only three cases have been reported in which KDF1 mutations are related to tooth development, including two ectodermal dysplasia cases accompanied by tooth loss and one non-syndromic case with tooth agenesis. However, no KDF1 mutations have been reported as associated with non-syndromic anodontia. Here, the aim was to investigate the genetic etiology of this condition and explore the functional role of a novel KDF1 mutation in a Chinese patient with non-syndromic anodontia.Materials and methodsPathogenic variants were identified by whole-exome and Sanger sequencing. Meanwhile, we conducted a literature review of the reported KDF1 mutations and performed an in vitro functional analysis of four anodontia-causing KDF1 mutations (one novel and three known).ResultsWe identified a novel de novo missense mutation (c.911 T > A, p.I304N) in the KDF1 gene in a Chinese patient with severe non-syndromic anodontia. In vitro functional studies showed altered mRNA and protein expression levels of the mutant KDF1.ConclusionsOur results are the first report of KDF1 missense mutation causing non-syndromic anodontia.Clinical relevanceThis study not only further supports the important role of KDF1 in non-syndromic congenital anodontia, but also expands the spectrum of KDF1 mutations and will contribute to the genetic diagnosis and counselling of families with anodontia.

Bagan, Jose; Martorell, Miguel; Cebrián, Jose L.; Rubert, Andrea; Bagán, Leticia; Mezquida, Carlos; Hervás, David

doi: 10.1007/s00784-022-04486-xpmid: 35474554

ObjectivesOur main purpose and research question were to analyze and quantify whether there were significant differences in the time to develop cancer among patients with oral leukoplakia (OL), comparing the more susceptible cases to those with the least susceptibility to malignancy.Materials and methodsWe followed 224 cases of OL after surgical or CO2 laser treatment for a mean time of 6.4 years. A Bayesian mixture cure model based on the Weibull distribution was used to model the relationship between our variables and cancer risk. In this model type, the population is considered a mixture of individuals who are susceptible or non-susceptible to developing cancer. The statistical model estimates the probability of cure (incidence model) and then infers the time to malignancy. The model was adjusted using the R-package INLA using default priors.ResultsHistology type (moderate or severe dysplasia) and tongue location showed hazard ratios (HR) of 3.19 (95% CI [1.05–8.59]) and 4.78 (95% CI [1.6–16.61]), respectively. Both variables increased the risk of malignant transformation, thus identifying a susceptible subpopulation with reduced time required to develop cancer, as with non-homogeneous leukoplakias. The median time for cancer development was 4 years and 5 months, with a minimum of 9 months after the diagnosis of OL and a maximum of 15 years and 2 months.ConclusionsSusceptible patients with non-homogeneous leukoplakia, dysplasia, or leukoplakia in the tongue develop cancer earlier than those with homogeneous OL and those without dysplasia.Clinical relevanceThe novel contribution of this research is that, until now, the time it took for oral leukoplakias to develop cancer based on whether they were homogeneous or non-homogeneous, and if they have or not epithelial dysplasia, had not been comparatively described and quantified. As a final result, the time to malignant transformation in non-homogeneous and dysplastic leukoplakias is significantly shorter.