Low-level laser therapy in the treatment of muscle-skelet pain in patients affected by temporo-mandibular disorders

Background

The purpose of the study is to evaluate the effectiveness of Low-Level Laser Therapy in reducing joint and muscle pain in patients with acute and chronic temporomandibular dysfunction.

Materials and methods

The study was conducted on a sample of 180 patients. The sample was divided into two groups according to the time of onset of the disease: acute TMD (<6 months) and chronic TMD (> 6 months). The treatment for all patients provided for the irradiation with Diode Laser Wiser Doctor Smile with tip plane wave at wavelength of 830 nm, continuous beam to 40nW diameter and radius of 6 mm. The irradiated areas were the joint area, temporal, masseter and pterygoid. The irradiation time for each zone was 60s.The protocol adopted consisted of two weekly treatment for six weeks. Pain assessment was performed using the Visual Analog Scale (VAS), in which different scores (s) depending accused of pain by the patient: s0 no pain, s1-3 mild pain, s4-6 moderate pain, s7-9 severe pain and s10 excessive pain. The pain monitoring was performed before treatment, after 15 days and after one month.

Results

The sample included 80 patients with acute TMD and 100 with chronic TMD. The sample belonging to acute TMD group before treatment, was distributed as follows: 0% in s0; 12,5% in s1-3; 31.3% in s4-6; 53.6% in s7-9 and 2.5% in s10. After 15 days the distribution was was as follows: 6.25% in s0; 47.5% in s1-3; 20% in s4-6; 26.3% in s7-9 and 0% in s10. After 30 days the sample was well distributed: 35% in s0; 45% in 1-3; 10% in s4-6; 10% in s7-9 and 0% in s10. The sample belonging to the chronic TMD group, at time zero, was as follows: 0% at s0; 48% in S1-3; 35% in s4-6; 15% in s7-9 and 2% in s10. After 15 days the distribution was: 29% in s0; 28% in S1-3; 33% in s4-6; 10% in s7-9 and 0% in s10. After 30 days the sample was well distributed: 45% in s0; 36% in S1-3; 15% in s4-6; 4% in s7-9 and 0% in s10.

Conclusions

The Low-Level-Laser-Therapy is a valuable tool that can significantly decrease the perception of pain in patients with temporomandibular joint dysfunction, acute and chronic.

Polysonographical evaluation in a case of moderate osas treated with mandibular advancement device

Background

The Obstructive Sleep Apnea Syndrome (OSAS) is a clinical picture characterized by partial or complete obstruction of the upper airway during sleep, associated with a reduction of oxygen saturation in the blood.The most common symptoms are: apnea sleep, snoring, headache, sleepiness, reduced concentration and memory, irritability, increased blood pressure and dry mouth.

Materials and methods

It was examinated a not-smoker man of 54 years that suffers of roncophaty. He did physical examination, rhinoscopyexam, faringoscopy, rhinofibrolaringoscopy, gnathological evaluation and polysomnographic examination performed with multichannel polygraphy (VitalNight). From the performed examinations, it has been diagnosed a moderate form of obstructive apnea sleep syndrome. He was treated with a mandibular advancement device and it was repeated the polysomnographic exam.

Results

Comparing the results of the polysonographic examination performed before and after the treatment, the patient's clinical picture clearly improved. It has shown a clear reduction of obstructive apneas, hypopneas and snoring.

Conclusions

The use of a mandibular advancement device is certainly a valuable aid in the treatment of moderate type OSAS. The quality of diurnal life is also improved as shown with Sleepness Epworth Scale.

Smart fusion vs. double scan: a comparison between two data-matching protocols for a computer guided implant planning

AIM

To make a comparison between two different approaches of data matching during the preparation of a computer guided implant planning.

MATERIAL AND METHODS

Electronic and manual literature searches were performed to collect information about the double-scan protocol and the smart fusion protocol. The two systems were then tested to identify or confirm their advantages and disadvantages.

RESULTS

The double scan protocol is a reliable and well-known process to obtain a fusion between the anatomical data (CBCT) and the prosthetic data (radiographic template). It is possible to use this protocol both in dentate and edentulous patients. The newly developed smart fusion technique offers the possibility to superimpose the anatomical data (CBCT) onto the prosthetic data (cast + wax-up scan) without the production of a radiographic template. This system is still being tested by the clinicians even though dental manufacturers already consider it as the best solution for the dentate patients selected for a static computer guided implant surgery.

CONCLUSIONS

Smart fusion protocol offers a reasonable time and cost reduction even though its application is limited to dentate patients. A noticeable drawback of the workflow is the matching step: often a manual intervention is necessary to obtain a correct alignment of the CBCT data with the lab scan of the cast. This issue is partially due to the use of non-volume stable materials during the preparation of the cast. Future improvements could be made by combining CBCT data with direct optical scans of patient dental arches in order to create the so-called 'virtual patient'.

Experimental protocol of dental procedures In patients with hereditary angioedema: the role of anxiety and the use of nitrogen oxide

Hereditary angioedema (HAE) is a rare disease, little known to the medical and dental community, but with a growing rate of hospitalization over the years. HAE is due to a deficit/dysfunction of C1 esterase inhibitor which leads to an increase in vascular permeability and the appearance of edemas widespread in all body areas. The airways are the most affected and laryngeal swelling, which can occur, it is dangerous for the patient's life, is also a sensitive spot in our daily practice, therefore, it is also important to be aware of all the signs of this disease. Episodes of HAE have no obvious cause, but it can be triggered by anxiety, invasive procedures and trauma. So this disease is a major problem in oral and maxillofacial surgery, ENT, endoscopy, emergency medicine and anesthesia because even simple procedures can cause laryngeal edema. The recommendations on the management of HAE include long- and short-term prophylaxis and treatment for acute attacks, however, the importance of anxiety control during the operating phases is undervalued. The present work suggests an experimental protocol for the surgery management of HAE patients with the help of nitrous oxide, with a brief review of the literature on this topic.

Full digital workflow for implant-prosthetic rehabilitations: a case report

OBJECTIVES

The aim of the present study was to describe a proof of concept digital workflow for the implant-prosthetic treatment in partially edentate patients and evaluate its clinical performance.

METHODS

A 55-year-old woman with a Kennedy class III bilateral edentulism in the mandible has been selected for a computer guided implantology according with the Smart Fusion® protocol (NobelBiocare, Kloten, Switzerland). After the template-guided implant placement, an immediate loading of the implants has been performed. QuickTemp conical temporary abutments were selected to deliver immediately prefabricated cement-retained provisionals. Two months after an impression was taken with an intraoral digital scanner (3Shape Trios3, Copenhagen, Denmark). The provisional restoration optical scanning was used to transfer the functionalized prosthetic contour to be duplicated into the definitive porcelain fused to zirconia restoration cemented on customized titanium abutments.

RESULTS

A satisfying esthetic and functional result has been achieved. No biological and mechanical complications were recorded.

CONCLUSIONS

The investigated fully digital implant-prosthetic protocol provided a smooth, complication free and time effective treatment alternative to the conventional workflow. Besides the fully digital workflow allowed the surgical and prosthetic decision making and the communication within the dental team and with the patient. Further improvements heading to a direct match between the intraoral scan and the CBCT are strongly advised in order to create the so-called virtual patient.

Statistical analysis of the frequency distribution of signs and symptoms of patients with temporomandibular disorders

The purpose of this text is to evaluate the distribution by sex and age of TMD patients and the frequency of pain on palpation of the lateral pterygoid muscle, pterygoid internal, sternocleidomastoid, masseter, temporal. The purpose is also to assess the existence of direct correlations between the articulating click and lateral deviation, the headache and tenderness of the temporal, the back pain and tenderness of the sternocleidomastoid, the postural disorders and difficulty finding the exact mating closing, the disorders related to previous dental procedures (large conservative reconstructions, rehabilitations fixed dentures and dental extractions) and tenderness to the temporal and masseter. 623 medical records, including 451 males and 175 females were randomly selected. It was statistically calculated the F/M ratio, age distribution and frequency of muscle tenderness to palpation through the relationship of positive feedback on the total sample multiplied by one hundred. The correlation between various disorders was calculated by estimating the Mantel-Haenszel common odds ratio. For each result it has been finally calculated the asymptotic level of significance.

Differences between warfarin and new oral anticoagulants in dental clinical practice

The oral anticoagulant therapy is used for the cure and the prevention of thromboembolic diseases. In the last fifty years the warfarin has been considered the oral anticoagulant of choice. However, its use is limited by a narrow therapeutic index and by a complex pharmacodynamics, which requires regular adjustments and monitoring of the dose. Recently, three new oral anticoagulant - dabigatran etexilato (direct thrombin inhibitor), rivaroxaban and apixaban (Xa factor direct inhibitor) - have been approved for use in europe. Increasing the number of patients taking these drugs, it is important that the dentist knows these new oral anticoagulants, their indications and methods of action, in particular for the management of patients, who require invasive treatments. With regard to the management of the patient threated with the new oral anticoagulants (NAO), there have been new significant changes in the procedure compared to the one followed by patients treated with warfarin. This led to the development of new guidelines that the dentist has to follow in order to ensure a safe and appropriate dental treatment and reduce any postoperative complications. The aim of this work is to evaluate the effectiveness of the new oral anticoagulants compared to warfarin, especially in terms of risks of bleeding events and intra and postoperative complications, in patients requiring multiple dental extractions.

Straight Versus Angulated Abutments on Tilted Implants in Immediate Fixed Rehabilitation of the Edentulous Mandible: A 3-Year Retrospective Comparative Study

PURPOSE

The aim of this study was to evaluate and compare the use of straight versus angulated abutments on tilted implants in the All-on-Four immediate function protocol.

MATERIALS AND METHODS

A total of 85 patients (36 men and 49 women; mean age 56.5 years) with edentulous mandibles were treated according to the All-on-Four concept using computer-guided implant placement. All patients received immediate interim prostheses screwed onto distal tilted implants by means of angulated (control group, n = 42) or straight abutments (test group, n = 43) and were followed for at least 3 years. Outcome considerations comprised implant and prosthetic survival and success rates, marginal bone level changes, patient satisfaction, and required clinical time. Student t test at a significance level of P < .05 was used to correlate the influence of the prosthetic protocol on marginal bone levels around the implants.

RESULTS

Overall implant survival rate was 98.21% for the control group and 98.83% for the test group. None of the 85 fixed prostheses were lost during the observation period (prosthetic survival rate of 100%). Statistically significant differences (P = .0068) in marginal bone loss were found between control and test groups. All patients were functionally and esthetically satisfied with their restorations. Required clinical time averaged 50 minutes for the control group and 30 minutes for the test group.

CONCLUSION

The described simplified and shortened surgical-prosthodontic protocol that avoids use of angulated abutments may be considered a reliable alternative to the traditional All-on-Four protocol.

Influence of the implant drill design and sequence on temperature changes during site preparation

PURPOSE

The purpose of this study was to compare bone temperature changes during implant drilling with two drill designs employed in three different drilling sequences.

MATERIALS AND METHODS

Two implant drill designs and three drilling sequences were evaluated in vitro using artificial bone cylinders. The evaluated drills were different only in the cutting-surface length (control, 16 mm; test, 4 mm). Three drilling sequences (control A, test B1, and test B2) were evaluated with and without irrigation. Temperatures were measured with thermocouple technology. The temperature changes generated by the final drill of each sequence were recorded as the experimental results and were subjected to the Student t test.

RESULTS

There were statistically significant differences in temperature changes when comparing the control group A with the test groups B1 (P = .001) and B2 (P = .01) during drilling without coolant. The mean temperature changes were 12.4°C, 6.5°C, and 13.7°C for groups A, B1, and B2, respectively. The Student t test showed statistically significant differences between temperature changes of the control group A and the test groups B1 (P < .01) and B2 (P < .05) during drilling with coolant. The mean temperature changes were 0.9°C, 0.7°C, and 1.9°C for groups A, B1, and B2, respectively.

CONCLUSION

Reduction in length of the cutting surface of the drill may limit frictional heat. Drills with the same length of cutting surface may induce lower bone temperature changes, when considering a preliminary drilling step with a pilot drill.

Monolithic Lithium Disilicate Full-Contour Crowns Bonded on CAD/CAM Zirconia Complete-Arch Implant Bridges With 3 to 5 Years of Follow-Up

This study was carried on to assess the clinical performance of a novel restorative concept consisting in single monolithic lithium disilicate full-contour crowns bonded on computer-aided design/computer-aided manufacturing (CAD/CAM) zirconia complete-arch implant bridges, to overcome the drawbacks related to the chipping of porcelain fused to zirconia restorations. Sixteen patients received 18 implant-supported hybrid screw-cement-retained complete-arch restorations, consisting of single monolithic lithium disilicate full-contour crowns bonded on CAD/CAM zirconia frameworks. The restorations were supported by 4-8 implants. All patients were followed up for at least 3 years on function (range 36 to 60 months, mean 49.3 months). Clinical controls were scheduled every 4 months. The outcomes were implant and prosthetic survival and success rates, any complications, patient satisfaction, and soft tissue parameters. No dropouts occurred. The overall implant and prosthesis survival rates were 100%. One of 18 restorations (1 of 236 dental units) showed a chip-off fracture of the veneering ceramic that was polished intraorally without any additional treatment, scoring a cumulative prosthetic success rate of 100%, according to the California Dental Association index. All patients were functionally and esthetically highly satisfied with their restorations. Successful soft tissue parameters were found around all implants. Single monolithic lithium disilicate full-contour crowns, bonded on CAD/CAM screw-retained complete-arch zirconia frameworks, showed favorable preliminary outcomes with medium-term follow-up. However, randomized controlled studies of this technique are required for further conclusive recommendations.

Immediate versus delayed positioning of dental implants in guided bone regeneration or onlay graft regenerated areas: a systematic review

The aim of this study was to compare success rates in immediate and delayed dental implant placement following guided bone regeneration or onlay bone block ridge augmentation. A systematic review of all studies on this topic was performed. For inclusion, studies had to involve at least five patients, report specific success criteria, and have a minimum follow-up period of 6 months. Studies reporting only the survival rate of implants were excluded. From 287 studies identified, 79 were screened and 13 were included in the analysis. Six studies provided data on simultaneous (immediate) positioning of implants, five studies on delayed positioning, and two studies provided data on both of these approaches. Success rates for implants placed using a simultaneous approach ranged from 61.5% to 100%; success rates for implants placed using a staged approach ranged from 75% to 98%. Even though the current review revealed that there are not many studies reporting data relevant to the analyzed topic, the data obtained suggest that the delayed positioning of implants should be considered more predictable than the immediate positioning. Studies presenting a control group and adopting standardized success criteria are required, and data from this review must be considered indicative.

Different implant impression techniques for edentulous patients treated with CAD/CAM complete-arch prostheses: a randomised controlled trial reporting data at 3 year post-loading

PURPOSE

To compare two different impression techniques for implants in totally edentulous patients.

MATERIALS AND METHODS

A total of 38 patients had impressions taken both using plaster and splinted vinyl polysiloxane (splinted-VPS). Two casts per patient were generated and allocated as test (plaster) and control (splinted-VPS) cast groups according to a randomised cross-over design. One of the two casts from each patient was randomly selected as master cast according to a parallelgroup design and used to fabricate the definitive prosthesis. Outcome measures were implant and prosthetic success rates, complications, marginal bone level (MBL) changes, patient satisfaction, chair time required to take the impressions, inter-implant discrepancy between the casts, sulcus bleeding index (SBI) and plaque score (PS).

RESULTS

In total, 76 impressions were taken in 38 patients. Two plaster impressions failed. Furthermore, 38 computer-aided design/computer-assisted manufacturing screw-retained complete-arch prostheses were fabricated onto the master cast (18 from plaster and 20 from splinted-VPS impressions) and the patients were followed up for 3 years after loading. No drop-out occurred and no implants or prostheses failed, accounting for a cumulative implant and prosthesis survival rate of 100% over the 3-year post-loading period. Plaster impressions yielded significantly greater patient satisfaction and shorter chair time. The discrepancy between the casts was 0.055 ± 0.067 mm (P = 0.931). Mixed model analysis revealed a significant main effect from both the implant number and the inter-implant distance, while no difference was found with regard to implant angulation. Five chip-off fractures of the porcelain veneer occurred in 5 of the 38 patients (3 in restorations fabricated onto the plaster cast group and 2 in the splinted-VPS cast group) with no effect from the type of impression on the prosthetic success rate (P = 0.331). However, all of the patients were functionally and aesthetically satisfied with their prostheses. Furthermore, mean MBL, SBI and PS showed no significant differences (P > 0.05) between the groups.

CONCLUSIONS

The clinical outcome of plaster impressions for completely edentulous patients was found to be the same as that for splinted-VPS impressions. The intraoral pre-scan resin framework try-in can be avoided. Plaster impressions may be less time consuming and thus more comfortable for the patient, but sometimes may have to be repeated due to fractures.

CONFLICT-OF-INTEREST STATEMENT

All materials used in this study were purchased by the authors and there were no commercial or institutional interests.

Unusual anchor pins placement and protocol deviations during computer-based implant placement in a patient with severe mandibular bone atrophy. A case report

The aim of the study was to describe an unusual method to stabilize the surgical template during the treatment of a severely resorbed edentulous mandible by means of computer-guided implant surgery. Pre-operative computer-based planning revealed the difficulty to stabilize the surgical template in a 67-year-old healthy woman. A deviation of the original NobelGuide™ protocol was performed to ensure the stability of the surgical template: four anchor pins were used to stabilize the surgical template, two in the buccal side of the anterior template and two unusual pins were placed in the lingual site. Four straight TiUnite® Nobel Biocare™ implants were then placed, according to a modified All-on-4™ concept procedure, to avoid graft procedures and to reduce the cumulative chair-side treatment time and costs. A temporary restoration was placed immediately after implant placement. Three months later a definitive, full acrylic restoration was delivered.

Success rate of dental implants inserted in horizontal and vertical guided bone regenerated areas: a systematic review

This study assessed the success rate of implants placed in horizontal and vertical guided bone regenerated areas. A systematic review was carried out of all prospective and retrospective studies, involving at least five consecutively treated patients, that analysed the success rate of implants placed simultaneously or as second surgery following ridge augmentation by means of a guided bone regeneration (GBR) technique. Studies reporting only the survival rate of implants and studies with a post-loading follow up less than 6 months were excluded. From 323 potentially relevant studies, 32 full text publications were screened and 8 were identified as fulfilling the inclusion criteria. The success rate of implants placed in GBR augmented ridges ranged from 61.5% to 100%; all studies, apart from three, reported a success rate higher than 90% (range 90-100%). The data obtained demonstrated that GBR is a predictable technique that allows the placement of implants in atrophic areas. Despite that, studies with well-defined implant success criteria after a longer follow-up are required.

Salivary miRNAome profiling uncovers epithelial and proliferative miRNAs with differential expression across dentition stages

Saliva's ability to mirror the internal physiological environment of an organism coupled with its facile accessibility makes it an attractive diagnostic medium. The finding of microRNAs (miRNAs) in saliva has expanded the field of biomarker discovery since these tiny non-coding RNAs affect various physiological processes and diseases. Few reports have linked miRNAs to tooth development and eruption, with none having studied this in humans. As a first initiative to describe miRNAs in saliva whose modulations may reflect developing and erupting teeth, we quantified the levels of 730 miRNAs in the saliva of children of varying dentition stages: edentulous (newborns), deciduous and permanent by megaplex stemloop reverse-transcription quantitative PCR. The three groups expressed 193, 181 and 192 miRNAs, respectively, where 125 miRNAs had consistent expression. The remaining miRNAs had inter-group variations from 5 to hundreds of fold, where most had either an increasing or decreasing trend in going from edentulous to deciduous to permanent. A literature survey of epithelial miRNAs found most were present in saliva. Moreover, many miRNAs with expression differences between groups had previously documented functions in proliferation, cell cycle, apoptosis and other cellular behaviours key to the dynamics of tooth morphogenesis. Lastly, miRNAs of the same family, such as the let-7 and miR-200 families, or transcribed from the same hairpin, had similar expression patterns. The results presented here should serve as a salivary miRNA dictionary for future studies in tooth development as well as in childhood diseases associated with modulations in saliva composition.

p63 in tooth development

Recent findings have shown that the development of teeth involves a complex sequence of molecular events in which the p53 family member p63 is involved. Indeed, mice lacking p63 do not have teeth and humans bearing mutations in p63 suffer developmental syndromes that affect tooth morphology and number. Several isoforms of p63 have been described: the use of two different promoters produces longer TAp63 isoforms, or shorter, 5' truncated isoforms known as ΔNp63. The 3' end of primary transcripts is then subject to alternative splicing resulting in three additional isoforms: alpha (α), beta (β) and gamma (γ). Tooth development relies mainly on the activity of the N-terminally truncated ΔNp63 isoforms. Here we review the experimental evidence for the involvement of ΔNp63 in tooth development through its ability to sustain the molecular signalling that orchestrates epithelial-mesenchymal interaction.

Rapid virological response as a predictor of sustained response in HCV-infected patients with persistently normal alanine aminotransferase levels: A multicenter study

Rapid virological response (RVR) is now considered the strongest predictor of sustained virological response (SVR) in patients with HCV undergoing antiviral treatment, and thus, shorter antiviral treatment for these patients has been suggested. However, no data exist on the predictive value of RVR in HCV carriers with normal ALT values. A total of 137 patients with persistently normal ALT treated with peginterferon alfa 2a and ribavirin were studied. Fifteen patients dropped out early because of side effects, and in 10 patients with HCV-1 treatment was discontinued because of lack of early virological response (EVR). RVR was observed in 68% of the patients (42% patients with HCV-1, 90% HCV-2 and 64% HCV-3). An end-of-treatment response was observed in 86% of the patients (68% HCV-1, 100% HCV-2 and 91% HCV-3). SVR was maintained in 91 patients (46% HCV-1, 97% HCV-2 and 82% HCV-3). Overall, 92% patients with rapid response did obtain HCV eradication vs only 38% of those without rapid response. HCV-1 patients with baseline HCV RNA <400×10(3) IU/mL were more likely to achieve RVR and SVR than those with higher HCV RNA levels. We conclude that patients with genotype 1 and normal ALT who achieve HCV RNA negativity at week 4 may have a higher probability of eradicating their infection. Because of the concomitant favourable demographic and virological features often found in this particular subset of patients, the duration of therapy in these people might be shortened in the case of RVR. Persistently normal alanine aminotransferase levels patients with genotype 2 or 3 have a high chance of achieving SVR, so retesting of HCV RNA during treatment may have no additional practical value in these subjects.

Comparison of different dose reduction system in computed tomography for orthodontic applications

TO CORRELATE DIFFERENT CT SYSTEM: MSCT (multislice computed tomography) with different acquisition parameters (100KV, 80KV), different reconstruction algorithm (ASIR) and CBCT (cone beam computed tomography) examination in terms of absorbed X-ray dose and diagnostic accuracy.80 KV protocols compared with 100 KV protocols resulted in reduced total radiation dose without relevant loss of diagnostic image information and quality. CBCT protocols compared with 80 KV MSCT protocols resulted in reduced total radiation dose but loss of diagnostic image information and quality although no so relevant.In addition the new system applies to equipment ASIR applicable on MSCT allows 50% of the dose without compromising image quality.

Comparison of fracture resistance of bonded glass fiber posts at different lengths

PURPOSE

To evaluate in vitro the fracture resistance of quartz fiber posts for three different dowel lengths.

METHODS

30 single-rooted human premolars with similar root length and diameter were endodontically treated and randomly divided into three experimental groups (n = 10) according to the post space depth created: (1) 5 mm; (2) 7 mm; (3) 9 mm. Quartz fiber posts (Endo Light post) were cemented using a dual cured resin cement with its adhesive system (Prime & Bond NT + Fluorocore 2). After 24 hours, specimens were embedded in acrylic resin and loaded under continuous compressive force at the extruding coronal part of the post (45-degree angle) to the long tooth axis (crosshead speed: 0.75 mm/minute). Forces at fracture (Newtons) were recorded. One-way ANOVA and Tukey tests were used for the statistical analysis (P < 0.05).

RESULTS

Mean strength values (SD) were: (1) 40.52 (3.14); (2) 41.68 (5.31); (3) 44.88 (6.77), respectively. No statistically significant differences were found among the groups.