A 3-year follow-up study of all-ceramic single and multiple crowns performed in a private practice: a prospective case series

OBJECTIVES: Zirconia-based prostheses are commonly used for aesthetic crown and fixed restorations, although follow-up data are limited, especially for implant-supported crowns. The aim of this study was to evaluate the threeyear clinical results of the installation of 463 zirconia core crowns by a general dental private practice. METHODS: This study followed 142 patients (69 men and 73 women; aged 28-82 years) who had received 248 single crowns (202 tooth-supported, 36 implant-supported) and 225 multiple units of up to six elements (81 toothsupported, 144 implant-supported). Clinical events, including fracture and loss of retention, secondary caries, and marginal integrity, were recorded. The overall failure rate was computed for the fractured and lost prostheses. Aesthetic, functional, and biological properties were rated, and patient satisfaction was investigated. RESULTS: During the three-year follow-up period, four patients were lost from the study (18 crowns, 4% of the total crowns). Three of the zirconia prostheses suffered fractures in more than three units (11 crowns; one- vs. three-year follow-up, p,0.05, Wilcoxon signed-rank test), and the cumulative prosthesis survival rate was 98.2%. Twelve units lost retention and were re-cemented, and no secondary caries of the abutment teeth were reported. The aesthetic, functional, and biological properties were generally well-rated, and there were no differences between tooth- and implant-supported crowns. The lowest scores were given regarding the anatomical form of the crowns, as some minor chipping was reported. Relatively low scores were also given for the periodontal response and the adjacent mucosa. Overall, patient satisfaction was high. CONCLUSIONS: At the three-year follow-up, the zirconia-core crowns appeared to be an effective clinical solution as they had favorable aesthetic and functional properties. Only the marginal fit of the prostheses should be improved upon

In Vitro and In Vivo Assessment of a New Workflow for the Acquisition of Mandibular Kinematics Based on Portable Tracking System with Passive Optical Reflective Markers

Clinical use of portable optical tracking system in dentistry could improve the analysis of mandibular movements for diagnostic and therapeutic purposes. A new workflow for the acquisition of mandibular kinematics was developed. Reproducibility of measurements was tested in vitro and intra- and inter-rater repeatability were assessed in vivo in healthy volunteers. Prescribed repeated movements (n = 10) in three perpendicular directions of the tracking-device coordinate system were performed. Measurement error and coefficient of variation (CV) among repetitions were determined. Mandibular kinematics of maximum opening, left and right laterality, protrusion and retrusion of five healthy subjects were recorded in separate sessions by three different operators. Obtained records were blindly examined by three observers. Intraclass correlation coefficient (ICC) was calculated to estimate inter-rater and intra-rater reliability. Maximum in vitro measurement error was 0.54 mm and CV = 0.02. Overall, excellent intra-rater reliability (ICC > 0.90) for each variable, general excellent intra-rater reliability (ICC = 1.00) for all variables, and good reliability (ICC > 0.75) for inter-rater tests were obtained. A lower score was obtained for retrusion with “moderate reliability” (ICC = 0.557) in the inter-rater tests. Excellent repeatability and reliability in optical tracking of primary movements were observed using the tested portable tracking device and the developed workflow

Longitudinal effects of rapid maxillary expansion on masticatory muscles activity

To investigate the modifications induced by rapid maxillary expansion (RME) on the electromyographic (EMG) activities of the anterior temporal and superficial masseter muscles, in patients without pre-treatment EMG alterations. Twenty-one patients with unilateral posterior cross-bite selected from the orthodontic department of the University of L?Aquila (Italy), were enrolled. There was no control group in this study since each subject acted as a control of her/himself. Two surface EMG recordings were taken: T0 (before RME) and at T1 (3 month after the end of expansion). To verify the neuromuscular equilibrium, the EMG activities of both right and left masseter and anterior temporal muscles were recorded during a test of maximum clench. EMG indexes were compared by paired Student?s t-test. In both occasions, all indices showed a good symmetry between the right and left side masticatory muscles. No statistically significant differences were found between the two recordings. In children without pre-treatment EMG alterations, no variations in standardized muscular activity after RME were found. The treatment did not alter the equilibrium of the masseter and temporal muscles

Effects of the functional orthopaedic therapy on masticatory muscles activity

The purpose of this study was to examine surface electromyographic (sEMG) activity of masticatory muscles before and after functional orthopaedic therapy with Sander appliance. Ten adolescents (5 girls, 5 boys) with an Angle Class II, division I malocclusion, 9-13 years old, were submitted to sEMG before and after functional orthopaedic therapy. To verify the neuromuscular equilibrium, the standardized EMG activities of right and left masseter and anterior temporal muscles were recorded during maximum voluntary clench, and analysed calculating: POC (index of the symmetric distribution of the muscular activity determined by the occlusion); TC (index of presence of mandibular torque) and Ac (index suggesting the position of occlusal barycentre). The total muscular activity was also calculated. Pre- and post- functional therapy data were compared with Wilcoxon Signed-Rank Test. Before treatment, all subjects had a good neuromuscular equilibrium, which was not altered by treatment. sEMG evaluations allow to quantify the impact of occlusion on masticatory muscle activity and to control that the functional orthopaedic therapy maintain a good muscular coordination

Electromyographic activity of sternocleidomastoid and masticatory muscles in patients with vestibular lesions

This study evaluated the electromyographic characteristics of masticatory and neck muscles in subjects with vestibular lesions. Surface electromyography of the masseter, temporalis and sternocleidomastoid muscles was performed in 19 patients with Ménière's disease, 12 patients with an acute peripheral vestibular lesion, and 19 control subjects matched for sex and age. During maximum voluntary clenching, patients with peripheral vestibular lesions had the highest co-contraction of the sternocleidomastoid muscle (analysis of covariance, p=0.02), the control subjects had the smallest values, and the patients with Ménière's disease had intermediate values. The control subjects had larger standardized muscle activities than the other patient groups (p=0.001). In conclusion, during maximum voluntary tooth clenching, patients with vestibular alterations have both more active neck muscles, and less active masticatory muscles than normal controls. Results underline the importance of a more inclusive craniocervical assessment of patients with vestibular lesions

Accuracy of automated 3D cephalometric landmarks by deep learning algorithms: systematic review and meta-analysis

Objectives The aim of the present systematic review and meta-analysis is to assess the accuracy of automated landmarking using deep learning in comparison with manual tracing for cephalometric analysis of 3D medical images. Methods PubMed/Medline, IEEE Xplore, Scopus and ArXiv electronic databases were searched. Selection criteria were: ex vivo and in vivo volumetric data images suitable for 3D landmarking (Problem), a minimum of five automated landmarking performed by deep learning method (Intervention), manual landmarking (Comparison), and mean accuracy, in mm, between manual and automated landmarking (Outcome). QUADAS-2 was adapted for quality analysis. Meta-analysis was performed on studies that reported as outcome mean values and standard deviation of the difference (error) between manual and automated landmarking. Linear regression plots were used to analyze correlations between mean accuracy and year of publication. Results The initial electronic screening yielded 252 papers published between 2020 and 2022. A total of 15 studies were included for the qualitative synthesis, whereas 11 studies were used for the meta-analysis. Overall random effect model revealed a mean value of 2.44 mm, with a high heterogeneity (I-2 = 98.13%, tau(2) = 1.018, p-value < 0.001); risk of bias was high due to the presence of issues for several domains per study. Meta-regression indicated a significant relation between mean error and year of publication (p value = 0.012). Conclusion Deep learning algorithms showed an excellent accuracy for automated 3D cephalometric landmarking. In the last two years promising algorithms have been developed and improvements in landmarks annotation accuracy have been done

The temporomandibular joint: from classical anatomy to modern functional assessments

The temporomandibular joint (TMJ) is a complex synovial articulation, made by the mandibular condyles and the squamous surface of temporal bones. The skeletal surfaces are highly incongruent and are separated by a fibrous disc, that reduces joint incongruence, increases joint stability, and allows mandibular movements with six degrees-of-freedom. In mammals, TMJ characteristics are so unique that are used to define the class Mammalia. TMJ development is strictly related to that of the middle ear, and it represents a complex modification of a phylogenetically older articulation found in non-mammalian vertebrates [1]. In particular, human TMJ possesses several differences from that of the other mammals, and animal models cannot be easily used to investigate its dynamic and kinematic characteristics. Several hypotheses have been proposed to describe TMJ movements and intra-articular force, but a major limitation lies in the difficulty in the actual assessment of condylar movements. Indeed, no current imaging system can provide a complete three-dimensional evaluation of TMJ motion: conventional radiographic images lack the third dimension and cannot inform about the behaviour of soft tissues; CT provides all three spatial planes but still cannot image the disc and related structures; magnetic resonance (MR), while providing adequate details of soft tissue structures, lacks the necessary dynamic information. Therefore, most of these studies are based on biomechanical models, where TMJ motion is recorded with three-dimensional motion analyzers, and mathematical and geometrical calculations provide the necessary background for the hypotheses about joint mechanical behaviour [2]

MRI of the TMJ and sEMG of masticatory muscles in patients with arthrogenous temporomandibular disorders: a correlation analysis

The aim of this study was to verify if patients with arthrogenous temporomandibular disorders (TMD) with different Magnetic Resonance Imaging (MRI) diagnoses had some objective differences in the surface electromyography (sEMG) characteristics of their masticatory muscles. Twenty-four TMD patients were categorized according to the RDC/TMD [1]; MRI classified patients with disk displacement (DD, mean age 22 years, SD 5; M/F: 3/6), and osteoarthrosis and/or disk displacement (OA, mean age 37 years, SD 10; M/F: 4/11). sEMG of the right and left masseter and anterior temporalis muscles was performed according to a standardized protocol, recording teeth clenching on either cotton rolls or occlusal surfaces [2]. EMG data were compared to those collected in control subjects of similar age and sex, and EMG z-scores were computed. The comparison of EMG z-scores and MRI scores between the 2 patient groups using the Mann-Whitney test was statistically significant (P < 0.05): the patients with OA had larger scores than the patients with only DD. The linear correlation analysis run between the EMG and the MRI scores found significant correlations in both patient groups. The EMG characteristics allowed to well differentiate patients with MRI diagnosis of DD or OA. The objective recording of the masticatory muscle function and dysfunction through sEMG can be a first simple and low cost diagnostic approach to TMD patients

Morphometric parameters for nasal septum deviation identification in CBCT data

Advances in the upper airway imaging allow to better evaluate and understand their morphology, pathology and mechanics [1]. In particular, Cone beam CT technology (CBCT), with its isotropic spatial resolution, undistorted images, X-ray lower radiation exposure, versatility and relatively low cost, takes over other imaging modalities [2]. The purpose of this study is to evaluate whether CBCT scans can be valuable tools for the extraction of quantitative parameters to confirm the deviation of the nasal septum in a specific patient. First, we assessed the difference in angle of septal deviation, calculated as proposed by Orhan et al., among a control group and a patient group [3]. Subsequently, we evaluated the percentage difference between the volume of the upper airways in the right side and left side of the nose in the same sample. The measurements were performed on 23 CBCT scans of Caucasian adult women, divided into 7 control subjects and 16 patients. The results demonstrate that there is a significant difference both in the deviation angle (p<0.05) and in the volume difference between healthy and patient subjects (p<0.001). Duplicate measurements of the deviation angle and the volume found no significant difference (p>0.05); random errors explained 0.77% (angle) and 0.99% (volume) of the sample variance. Paired Student’s t tests were used for comparisons. In particular, the volume difference appears to be less sensitive to the presence of isolated cartilaginous ridges that increase the angle of deviation even if the septum is not pathological. This makes it more suited to the identification of this pathology. The obtained outcomes are encouraging and it is advisable to continue the study on a larger sample