Awareness of Dental Interns to Treat Pregnant Patients

BACKGROUND: Pregnancy causes major changes in maternal physiology and metabolism, which may lead to increased susceptibility to oral infection. AIM: Aim of this study is to assess the awareness of dental interns regarding the management of the dental needs of pregnant patients. METHODS: A cross-sectional questionnaire survey was conducted among 188 interns of a private dental college in Saudi Arabia. The questionnaire comprised of 14 knowledge-based questions regarding their training, awareness and practice management of the pregnant patient in dental clinics. Four questions to record and evaluate their training, the number of pregnant patients treated by them and their confidence level in the dental management of the pregnant patient. Excel spreadsheet was used for mathematical calculations. RESULTS: Almost 62% of our participants never treated a pregnant female during their training. About 65% of the interns knew using antibiotics, almost 55% have a clear idea of the safest NSAIDS, and 43% regarded local anaesthesia to be safe when used among pregnant females. Conversely, about 50% of the participants had no clear knowledge of the FDA category of drugs. Only 24% considered dental radiographs to be safe in pregnant patients. 57% thought to postpone the dental treatment in an acute active dental infection in expecting mothers. Results also showed a lack of confidence among interns to provide dental care to gestating female. CONCLUSION: On analysing the results, we found that there is a need to improve the knowledge, awareness and confidence levels among the interns who are the future dentists treating these patients

Evaluación de la falla del bracket en relación con diferentes factores en pacientes que reciben tratamiento ortodóntico integral: Un estudio de cohorte retrospectivo.

Objective: The aim of this study was to investigate loose brackets in relation to various related factors in orthodontic patients who had completed orthodontic treatment. Material and Methods: In this retrospective study, 738 medical records of patients who had undergone comprehensive orthodontic treatment and matched specific inclusion criteria were selected. Paired t-tests and ANOVA, along with the Mann-Whitney test and Kruskal–Wallis analyses were performed to compare the means of variables between selected subgroups. Results: Loose brackets were found most frequently on premolars, followed by incisors and then canines (p<0.01). Male and young patients were found to have a higher incidence of loose brackets compared to female and adult patients (p=0.044 and p<0.01, respectively). The highest correlation coefficient value was found between treatment duration and total number of loose brackets (0.393), which was statistically significant. Conclusions: The frequency of total number of loose brackets increased with younger age group. Premolar teeth were found to be the most commonly affected teeth, followed by incisors and canines. Mandibular teeth presented more loose brackets than maxillary.Objetivo: Fue investigar brackets sueltos en relación con varios factores relacionados en pacientes ortodónticos que habían completado el tratamiento de ortodoncia. Material y Métodos: En este estudio retrospectivo, se seleccionaron 738 registros médicos de pacientes que se habían sometido a un tratamiento ortodóntico integral y criterios de inclusión específicos coincidentes. Se realizaron pruebas t pareadas y ANOVA, junto con la prueba de Mann-Whitney y los análisis de Kruskal-Wallis para comparar las medias de las variables entre los subgrupos seleccionados. Resultados: Se encontraron corchetes sueltos con mayor frecuencia en los premolares, seguidos de incisivos y luego caninos (p<0.01). Se encontró que los pacientes masculinos y jóvenes tenían una mayor incidencia de corchetes sueltos en comparación con los pacientes femeninos y adultos (p=0.044 y p<0.01, respectivamente). El valor del coeficiente de correlación más alto se encontró entre la duración del tratamiento y el número total de corchetes sueltos (0.393), que fue estadísticamente significativo. Conclusiones: La frecuencia del número total de corchetes sueltos aumentó con el grupo de edad más joven. Los dientes premolares fueron los dientes más afectados, seguidos de los incisivos y los caninos. Los dientes mandibulares presentan más brackets sueltos que los maxilares

A comparison of Six Cone Beam Computed Tomography Systems for Image Quality and Detection of Simulated Canine Impaction-Induced External Root Resorption in Maxillary Lateral Incisors

status: Published onlin

Maxillary Canine Impaction and Adjacent Incisor Root Resorption

Maxillary canine impaction and root resorption of adjacent lateral incisors is a well-known and relatively common phenomenon in orthodontic practice. The risk of canine impaction and associated root resorption is relatively high in patients needing orthodontic treatment. Early diagnosisremains a critical problem, and there are no straightforward clinical clues concerning the treatment planning, prediction, or prevention as regards canine impaction and the associated root resorption of the adjacentlateral incisor. The introduction of CBCT in dentomaxillofacial radiology has created new diagnostic challenges, including some potential opportunities for evaluating the impacted canines. With this new technology, it was obligatory to investigate and determine if this new information provides another and better way of diagnostic approach, treatment planning, improved treatment outcome and early prediction. Consequently, the present thesis attempted to link the radiological observations to diagnostic, therapeutic and further preventive measures. The main objectives were to develop an improved diagnostic methodology that would enable optimal diagnosis, treatment, and early prediction. The diagnostic accuracy for the detection of simulated canine-induced external root resorption lesions in maxillary lateral incisors was compared between conventional panoramic radiographic imaging and CBCT systems in vitro. The results show that the performance of CBCT imaging was significantly better than that of panoramic radiography. After the CBCT had been proven to perform better than conventional 2D panoramic images, the question to be answered remained whether there is a difference between CBCT machines. Therefore, the subjective image quality of the different CBCT systems in vitro was determined. The results suggest that the CBCT radiographic method is moresensitive and that high image quality is important when trying to detect root resorption. There were no significant differences between the CBCT systems in the detection of root resorption. The findings of a previous in vitro study were confirmed in vivo: the results show that CBCT was a reliable diagnostic method for the localization of impacted canines and the detection of root resorption of adjacent lateral incisors. The treatment of impacted canines usually requires a multidisciplinary approachand is associated with prolonged treatment times, increased costs, complexity, and a risk of failure and complications. The diagnostic consequences of using 2D or 3D radiography may have a significant impact on therapeutic interventions. Therefore, this aspect was investigated by comparing the orthodontic treatment planning between conventional and CBCT-based planning. Similarly, the influence on pre-surgical treatment planningwas also studied. The findings of those studies show no statistically significant difference in treatment planning or in pre-surgical treatmentplanning between the use of conventional and CBCT sets. The only significant difference was related to the precise localization of impacted canine but had no effect in the treatment plans. However, a high confidencelevel was observed in CBCT treatment based planning. The influence of CBCT on the treatment methods used and treatment outcomes achieved for orthodontically treated patients was then investigated. No difference was found either in the number of treatment methods or treatment outcome. Inthe last part of this thesis, a method for early prediction and prevention of canine impaction and root resorption was explored. Early prediction based on radiographic factors might clinically stimulate the application of preventive measures. Therefore, a prediction model for root resorption on panoramic radiographs was constructed. The early prediction of root resorption might reduce complications before, during and/or after treatment because additional clinical measure can be taken. The prediction of root resorption was carried out on the basis of available panoramicradiographs because they are routinely present in orthodontic records. Furthermore, the diagnosis of root resorption based on panoramic radiographs is difficult, and the final prediction model for root resorption could be a helpful tool in justifying the need for additional CBCT examination. The purpose was to reduce the need for additional radiation exposure, certainly in cases where the probability of the presence of root resorption is low. Finally, the prediction model for canine impaction was established on the basis of CBCT with a high level of accuracy, which mayhelp orthodontists in identifying the probability of impaction, which, in turn, is helpful in defining the optimal intervention method.status: publishe

Effectiveness of Riboflavin and Rose Bengal Photosensitizer Modified Adhesive Resin for Orthodontic Bonding

This study aimed to evaluate the effect of riboflavin (RF) and Rose Bengal (RB) photosensitizer modified adhesive resin on the degree of conversion (DC), and antimicrobial capacity after bonded to tooth surface. Different concentrations of RB and RF were prepared by homogenization method. An ultraviolet light source A (UVA) (375 nm wavelength, 3 mW/cm2 power) was used for 30 min irradiation. FTIR was performed for control and test adhesives to analyze the DC. Antibacterial testing was performed using the MTT assay. Metal brackets were bonded using the modified adhesives and subjected for SEM examination. The surfaces of teeth and metal brackets were examined at ×10 magnification for assessing adhesive remnant index (ARI) after PDT, 24 h and thermocycling. For DC, control group, 0.1% RB and RF after PDT showed the highest value. SEM imaging indicated lowest growth of Streptococcus mutans over 0.5% of RB-PDT and RF-PDT as compared to the control group. The MTT assay outcomes reported that the activity of S. mutans substantially decreased with the addition of a high amount of either RB or RF (p < 0.01). Mean ARI scores showed a significant difference between all groups. This study concluded that 0.1% of either RB or RF after PDT can be used for bonding orthodontic brackets to the tooth surface with substantial antibacterial properties

Radiographic predictors for maxillary canine impaction

INTRODUCTION: The aims of this study were to compare 3-dimensional cone-beam computed tomography (CBCT) images of patients with unilaterally impacted canines and to determine the possible radiographic factors for prediction of maxillary canine impactions. METHODS: The sample consisted of 65 patients ranging in age from 9.6 to 13.8 years. The patients comprised 43 girls and 22 boys, with a mean age of 12.1 years and a median age of 12.2 years (±SD 1.23 years). Of the impacted maxillary canines, 32 were located on the right side and 33 on the left side. CBCT radiography was available for all patients. The diagnosis of a unilaterally impacted canine was determined from the patients' dental records as a unilateral failure of the canine to erupt at its appropriate site in the dental arch in contrast to normal eruption of the contralateral side. Radiographic follow-up assessment to identify unilateral impaction was performed for 1 year. The radiographic variables generated and the specific features investigated were collected with 3-dimensional CBCT imaging and compared between the impacted and the contralateral maxillary canines. RESULTS: Statistically significant differences were found between the impacted and nonimpacted canines. Based on these results, clinical relevance and correlations among the variables-canine rotation, canine crown position, canine cusp tip to the midline and to the occlusal plane, canine angle to the midline, and canine angle to the lateral incisor-were considered as variables in a multivariable prediction model. A prediction model using CBCT for canine impaction was established (area under the curve, 0.965; 95% confidence interval, 0.936 to 0.995). Canine crown position, canine cusp tip to the occlusal plane, and canine angulation to the lateral incisor were the relevant predictors in this model. CONCLUSIONS: Prediction of canine impaction based on CBCT was excellent. The probability of canine impaction obtained from the prediction model can help orthodontists to define the optimal intervention method.status: publishe

Minimally Invasive Resin-Bonded Inlay-Retained Cantilever Fixed Dental Prosthesis: A Clinical Report

This clinical report demonstrates the treatment of a healthy adult patient referred for prosthodontic treatment after orthodontic treatment with a resin-bonded inlay-retained cantilever fixed dental prosthesis (IRCFDP). The purpose of this report was to demonstrate the esthetic, functional, and conservative properties of a resin-bonded IRCFDP fabricated from monolithic zirconia which can be placed in posterior area in certain situations. Acceptable esthetics with a conservative and functional result were achieved by using a resin-bonded inlay-retained cantilever fixed dental prosthesis (IRCFDP). All laboratory and clinical procedures of this case report are described

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Comment on Limitation of a cross-sectional study. [Am J Orthod Dentofacial Orthop. 2015] Radiographic predictors for maxillary canine impaction. [Am J Orthod Dentofacial Orthop. 2015]status: publishe

Comparison of two cone beam computed tomographic systems versus panoramic imaging for localization of impacted maxillary canines and detection of root resorption

The diagnostic accuracy for the localization of impacted canines and the detection of canine-induced root resorption of maxillary incisors were compared between conventional radiographic procedures using one two-dimensional (2D) panoramic radiograph with that of two three-dimensional (3D) cone beam computed tomography (CBCT) scans. The clinical records of 60 consecutive patients who had impacted or ectopically erupting maxillary canines were identified from those seeking orthodontic treatment. For each case, two sets of radiographic information were obtained. The study sample was divided into two groups: group A (n = 30) included those for whom a dental pantomograph (DPT) and CBCT obtained with a 3D Accuitomo-XYZ Slice View Tomograph were available and group B (n = 30) who had a DPT and CBCT obtained with a Scanora. The DPT and CBCT images were subsequently analysed by 11 examiners. Statistical analysis included an evaluation of the agreement between observers based on the standard error of the measurement, kappa statistics and coefficient of concordance, as well as an assessment of the differences between 2D and 3D imaging employing Wilcoxon signed rank and McNemar tests. There was a highly significant difference between the 2D and 3D images in the width of the canine crown (P < 0.001) and in canine angulation to the occlusal plane. Moreover, there was a highly significant difference between the DPT and Scanora CBCT images in canine angulation to the midline (P < 0.001). There was also a significant difference between 2D and 3D images with respect to canine location (P = 0.0074 for group A and P = 0.0008 for group B). The presence or absence of root resorption of the lateral incisor was also significantly different in both groups (P = 0.0201 and P < 0.001 for groups A and B, respectively). Detection of central incisor root resorption was significantly different between the Accuitomo and DPT images (P = 0.045). There was also a significant difference in the severity of lateral incisor root resorption between the DPT and CBCT in both groups (P = 0.02). The results of this study suggest that CBCT is more sensitive than conventional radiography for both canine localization and identification of root resorption of adjacent teeth.status: publishe

Predictors of root resorption associated with maxillary canine impaction in panoramic images

Objectives: The aim was to identify a prediction model for root resorption (RR) caused by impacted canines based on radiographic variables assessed on 2D panoramic radiographs with the intention to reduce the need for additional cone beam computed tomography (CBCT) imaging. Materials and methods: Three hundred and six patients (188 female, 118 male; mean age, 14.7 years; standard deviation, 5.6; range, 8.4–47.2 years) were included in the study. In total, 406 impacted maxillary canines were studied, from 206 patients with unilateral impaction and from 100 patients with bilateral impaction. Initial 2D panoramic radiography was available, and 3D CBCT imaging was obtained upon clinical indication. The generated radiographic variables and specific features investigated were collected on 2D panoramic imaging and were correlated to the presence/absence of RR detected on CBCT. A validation sample consisting of 55 canines from 45 patients with maxillary canine impactions was collected to validate the outcome of the present study. Results: The incidence of RR of the adjacent teeth was 33.8%. A prediction model using panoramic images for the possible presence of RR was established [area under the curve (AUC) = 0.74, 95% confidence interval (CI): 0.69–0.79] and validated by applying leave-one-out cross-validation (AUC = 0.71, 95% CI: 0.66–0.77). For the subgroup of presence of severe RR the discriminative ability increased to 0.80. In this prediction model, patient gender, canine apex, vertical canine crown position, and canine magnification were the strongest predictors for RR. Conclusions: The final prediction model for RR based on available panoramic radiographs could be a helpful tool in justifying the need of additional CBCT examination.status: publishe