Oral Soft Tissue Grafting

The presence of healthy soft tissue at the tooth and implant interface correlates to long-term success and stability in function and esthetics. Grafting procedures utilizing various techniques can be performed during any stage of the implant or restorative therapy. Materials of autogenous, allogeneic, and xenogeneic sources are available for oral soft tissue grafting. This article describes the classifications of soft tissue defects, treatment modalities, and materials used to enhance soft tissue quality and quantity and to achieve optimal esthetics and function around teeth and implants.

Hypophosphatasia in adolescents and adults: overview of diagnosis and treatment

This article provides an overview of the current knowledge on hypophosphatasia-a rare genetic disease of very variable presentation and severity-with a special focus on adolescents and adults. It summarizes the available information on the many known mutations of tissue-nonspecific alkaline phosphatase (TNSALP), the epidemiology and clinical presentation of the disease in adolescents and adults, and the essential diagnostic clues. The last section reviews the therapeutic approaches, including recent reports on enzyme replacement therapy (EnzRT).

Bite force data suggests relationship between acrodont tooth implantation and strong bite force

Extant and extinct reptiles exhibit numerous combinations of tooth implantation and attachment. Tooth implantation ranges from those possessing roots and lying within a socket (thecodonty), to teeth lying against the lingual wall of the jawbone (pleurodonty), to teeth without roots or sockets that are attached to the apex of the marginal jawbones (acrodonty). Attachment may be ligamentous (gomphosis) or via fusion (ankylosis). Generally speaking, adaptative reasonings are proposed as an underlying driver for evolutionary changes in some forms of tooth implantation and attachment. However, a substantiated adaptive hypothesis is lacking for the state of acrodont ankylosis that is seen in several lineages of Lepidosauria, a clade that is plesiomorphically pleurodont. The convergent evolution of acrodont ankylosis in several clades of lepidosaurs suggests a selective pressure shaped the evolution of the trait. We hypothesize that acrodont ankylosis as seen in Acrodonta and Sphenodon punctatus, is an adaptation either resulting from or allowing for a stronger bite force. We analyzed bite force data gathered from the literature to show that those taxa possessing acrodont dentition possess a stronger bite force on average than those taxa with pleurodont dentition. Dietary specialists with pleurodont dentition may also possess relatively high bite forces, though body size may also play a role in their ability to bite hard. Furthermore, our results have implications for the evolution of acrodont ankylosis and potential behaviors related to strong bite force that influenced the evolution of acrodonty within Acrodonta and Rhynchocephalia.

Teeth resorption at cement - enamel junction (CEJ) - Microscopy analysis

The cement - enamel junction (CEJ) gains a growing interest in clinical dentistry, due to an increasing number of idiopathic tooth resorption leading to the inevitable loss of permanent dentition. Therefore, in this research study, we investigated healthy and under resorption teeth to verify junctions' morphology in relation to the resorption process, its initiation, and propagation. Using light and scanning electron microscopy we examined the three types of CEJ: 1) coronal cementum, 2) abutment) and 3) the gap between cementum and enamel. With energy-dispersive X-ray spectroscopy (EDX) we analyzed the Ca and P concentration along the CEJ border. The study indicated the strict correlation between the gap junction and tooth resorption, due to the dentine exposure to the oral environment.

Recent directions in the solid-state NMR study of synthetic and natural calcium phosphates

Materials containing a calcium phosphate component have been the subject of much interest to NMR spectroscopists, especially in view of understanding the structure and properties of mineralized tissues like bone and teeth, and of developing synthetic biomaterials for bone regeneration. Here, we present a selection of recent developments in their structural characterization using advanced solid state NMR experiments, highlighting the level of insight which can now be accessed.

Equine saliva components during mastication, and in vivo pH changes in the oral biofilm of sound and carious tooth surfaces after sucrose exposure

Background

The role of saliva composition and dietary sugar in development of infundibular caries in equine cheek teeth is not fully understood. This study analysed electrolyte and urea concentrations in saliva in relation to different forage and measured pH changes after sucrose application in vivo in sound and carious cheek teeth.

Results

Forage type had no effect on the equine saliva electrolyte concentrations, which varied considerably both intra- and inter-individually. Chewing resulted in increased values for all electrolytes except bicarbonate. Compared with stimulated human saliva, horse saliva after mastication, contained higher amounts of potassium, calcium and bicarbonate, and less phosphate. The in vivo pH measurements showed a lower resting pH and a more pronounced pH drop after sucrose application in carious teeth compared to sound teeth.

Conclusions

No large differences were found between the composition of equine saliva and human saliva. A more pronounced acidogenicity was found for the carious than sound teeth. Thus, the caries process in equine cheek teeth seems to follow the same pattern as in human teeth, caused by acid production by oral microorganisms after sugar consumption.

Magnetic Resonance Imaging of Hard Tissues and Hard Tissue Engineered Bio-substitutes

Magnetic resonance imaging (MRI) is a non-invasive diagnostic imaging tool based on the detection of protons into the tissues. This imaging technique is remarkable because of high spatial resolution, strong soft tissue contrast and specificity, and good depth penetration. However, MR imaging of hard tissues, such as bone and teeth, remains challenging due to low proton content in such tissues as well as to very short transverse relaxation times (T₂). To overcome these issues, new MRI techniques, such as sweep imaging with Fourier transformation (SWIFT), ultrashort echo time (UTE) imaging, and zero echo time (ZTE) imaging, have been developed for hard tissues imaging with promising results reported. Within this article, MRI techniques developed for the detection of hard tissues, such as bone and dental tissues, have been reviewed. The main goal was thus to give a comprehensive overview on the corresponding (pre-) clinical applications and on the potential future directions with such techniques applied. In addition, a section dedicated to MR imaging of novel biomaterials developed for hard tissue applications was given as well.

The petrous bone: Ideal substrate in legal medicine?

Over the last few years, palaeogenomic studies of the petrous bone (the densest part of the temporal bone) have shown that it is a source of DNA in both larger quantities and of better quality than other bones. This dense bone around the otic capsule has therefore been called the choice substrate in palaeogenomics. Because the practice of forensic genetics responds to different imperatives, we implemented a study aimed at (i) understanding how and why the petrous bone is an advantageous substrate in ancient DNA studies and (ii) establishing whether it is advantageous in forensic STR typing. We selected 50 individual skeletal remains and extracted DNA from one tooth and one petrous bone from each. We then amplified 24 STR markers commonly used in forensic identification and compared the quality of that amplification using the RFU intensities of the signal as read on the STR profiles. We also performed histological analyses to compare (i) the microscopic structure of a petrous bone and of a tooth and (ii) the microscopic structure of fresh petrous bone and of an archaeological or forensic sample. We show that the RFU intensities read on STR profiles are systematically higher in experiments using DNA extracted from petrous bones rather than teeth. For this reason, we were more likely to obtain a complete STR profile from petrous bone material, increasing the chance of identification in a forensic setting. Histological analyses revealed peculiar microstructural characteristics (tissue organization), unique to the petrous bone, that might explain the good preservation of DNA in that substrate. Therefore, it appears that despite the necessity of analysing longer fragments in forensic STR typing compared to NGS palaeogenomics, the use of petrous bones in forensic genetics could prove valuable, especially in cases involving infants, toothless individuals or very degraded skeletal remains.

The level of two trace elements in carious, non-carious, primary, and permanent teeth

Purpose

The boron and fluoride mainly accumulate in the bones and teeth of the human body. The purpose of this study is to determine boron or fluoride levels in the whole tooth, to evaluate the correlation between their levels and to compare these levels in primary/permanent, carious, and non-carious groups.

Materials and methods

The boron and fluoride levels of thirty-six teeth, separated such as primary carious (n=9) and non-carious (n=9), permanent carious (n=9) and non-carious (n=9), were determined by ICP-MS and ion-selective electrode, respectively.

Results

While boron levels were between 0.001 and 5.88 ppm, the fluoride levels were between 21.24 and 449.22 ppm. The boron level of non-carious teeth was higher than those of carious teeth in primary and permanent tooth groups. However, this difference was not statistically significant (p>0.05). The fluoride level of non-carious teeth was higher than those of carious teeth in primary (p=0.062) and permanent teeth groups (p=0.046). Negative correlation, found between boron and fluoride in all groups, was significant only in non-carious teeth group (r=-0.488, p=0.040).

Conclusion

The results of our study proved the importance of fluoride as a protective factor for dental caries once more. The boron levels in non-carious teeth were also higher than carious teeth. However, it was not significant. Moreover, there was negative correlation between teeth boron and fluoride levels. Therefore, it is necessary to conduct more detailed studies on the tooth boron level and its relation with caries formation and with fluoride levels.

Effects of self-assessed chewing ability, tooth loss and serum albumin on mortality in 80-year-old individuals: a 20-year follow-up study

Background

The association between dental status and mortality in community-dwelling older adults has been documented by several studies. The aim of this study was to analyze the contribution of self-assessed chewing ability, number of remaining teeth and serum albumin levels to mortality and the interactions between the three factors.

Methods

A 20-year follow-up study was conducted with 666 subjects aged 80 years (from 1996 to 2017) who resided in the 8 areas served by one health center in Iwate Prefecture. Health check-ups including physical fitness measurements were conducted at a meeting place or gymnasium. Medical interview and blood sampling were conducted by physician. Oral examination was examined by dentist. The number of remaining teeth, serum albumin levels, and self-assessed chewing ability were used as predictors of mortality.

Results

Among the 608 subjects (233 men and 375 women) included in this study, only 12 subjects (1.97%) survived after 20 years of follow-up. For men, dental status and serum levels of albumin were significantly associated with mortality. The hazard ratios of self-assessed chewing ability calculated by item response theory analysis and the inability to chew at least one food adjusted for serum albumin and tooth conditions were statistically significant in men. When adjusted by health status evaluated by blood tests, self-assessed chewing ability was statistically significant in men. According to path analysis, self-assessed chewing ability and serum albumin independently affected mortality in men.

Conclusion

Masticatory dysfunction may be an important risk factor for mortality in men, even though it was self-assessed. Retaining chewing ability might be a useful predictor of longevity in older male adults.

Brain abscesses and intracranial empyema due to dental pathogens: Case series

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Cerebral infection is rare but life-threatening disease.

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Dental origin for brain abscesses or intra cranial empyema is very rarely reported in the literature.

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Infected maxillary teeth are probably involved in contiguous spread of the infection to the brain.

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There is currently no guidelines in oral surgery to manage patients with cerebral infection from dental origin.

Introduction

Spontaneous brain abscess and intracranial empyema are rare but life-threatening diseases. They can result from potential complications of oral chronic infections. Given the similarity between most of the germs commonly found both in cerebral abscess and in oral cavity and its anatomic proximity, the oral cavity represents a major source of cerebral infections.

Presentation of cases

We report here a series of seven cases of intracranial abscesses and empyema due to dental pathogens that occurred in the neurosurgery department of our institute. Five of those seven cases were then cared in the oral surgery department of our institute.

Discussion

Bacteriological examination of the brain abscesses identified an oral commensal bacterium belonging to streptococci group in six patients (85.7%) and Porphyromonas Gingivalis, a pathogen oral germ involved in periodontal diseases in the seventh patient. For all patients examined, oral status and oral health were poor or moderate with the presence of dental caries, missing teeth and abundant dental plaque. Except the oral cavity, no other front door or infectious site were found.

Conclusion

This rare series of cases highlights the importance of systematically explore the oral cavity in presence of intracranial infection and to radically eradicate the potential infectious foci.

Quaternary ammonium silane, calcium and phosphorus-loaded PLGA submicron particles against Enterococcus faecalis infection of teeth: An in vitro and in vivo study

Refractory root canal infection of human teeth is the primary cause of dental treatment failure. Enterococcus faecalis is the major cause of refractory root canal infection. In the present study, poly(D,L-lactic-co-glycolide) (PLGA) submicron particles were used as carriers to deliver an antimicrobial quaternary ammonium silane (code-named K21) as well as calcium and phosphorus elements. The release profiles, antibacterial ability against E. faecalis, extent of infiltration into dentinal tubules, biocompatibility and in vitro mineralization potential of the particles were investigated. In addition, the antimicrobial effects of the particles against E. faecalis infection were evaluated in vivo in the teeth of beagle dogs. The encapsulated components were released from the PLGA particles in a sustained-release manner. The particles also displayed good biocompatibility, in vitro mineralization ability and antibacterial activity against E. faecalis. The particles could be driven into dentinal tubules of dentin slices by ultrasonic activation and inhibited E. faecalis colonization. In the root canals of beagle dogs, PLGA submicron particles loaded with K21, calcium and phosphorus demonstrated strong preventive effects against E. faecalis infection. The system may be developed into a new intracanal disinfectant for root canal treatment.

Teeth as Potential New Tools to Measure Early-Life Adversity and Subsequent Mental Health Risk: An Interdisciplinary Review and Conceptual Model

Early-life adversity affects nearly half of all youths in the United States and is a known risk factor for psychiatric disorders across the life course. One strategy to prevent mental illness may be to target interventions toward children who are exposed to adversity, particularly during sensitive periods when these adversities may have even more enduring effects. However, a major obstacle impeding progress in this area is the lack of tools to reliably and validly measure the existence and timing of early-life adversity. In this review, we summarize empirical work across dentistry, anthropology, and archaeology on human tooth development and discuss how teeth preserve a time-resolved record of our life experiences. Specifically, we articulate how teeth have been examined in these fields as biological fossils in which the history of an individual's early-life experiences is permanently imprinted; this area of research is related to, but distinct from, studies of oral health. We then integrate these insights with knowledge about the role of psychosocial adversity in shaping psychopathology risk to present a working conceptual model, which proposes that teeth may be an understudied yet suggestive new tool to identify individuals at risk for mental health problems following early-life psychosocial stress exposure. We end by presenting a research agenda and discussion of future directions for rigorously testing this possibility and with a call to action for interdisciplinary research to meet the urgent need for new biomarkers of adversity and psychiatric outcomes.

Edge chipping test in dentistry: A comprehensive review

OBJECTIVE

Literature on edge chipping test applied to dental materials and structures has been systematically reviewed with regard to the evaluation methods and parameters used.

DATA

A systematic search of the literature retrieved 3484 relevant studies. After removing duplicates, 1848 records were screened by titles and abstracts and 1797 were excluded; 51 papers were assessed full text for eligibility. Twenty papers were included in this study and they were organized according to the dental materials and structures tested as follows: 2 studies on human tooth, 9 on dental ceramics, 5 on polymer-based composites, and 4 studies evaluated both ceramic and polymer-based materials.

SOURCES

MEDLINE/PubMed, Scopus and Web of Science databases were searched up to June 2019 without restriction on date and language.

STUDY SELECTION

In vitro studies using edge chipping test on dental materials and structures were included.

CONCLUSIONS

Different methods have been used for edge chipping test, regardless of reported parameters. There is significant evidence that edge chipping test is a relevant approach to predict chipping behavior of dental materials and tooth tissues because chips produced from most edge chipping studies are similar to clinically reported chipping failures.

Dentition, nutritional status and adequacy of dietary intake in treatment naïve head and neck cancer patients

OBJECTIVES

To examine the relationship of reduced numbers of occluding teeth and dietary intake (DI), nutrition impact symptoms (NIS), and weight loss (WL) in head and neck cancer (HNC) patients.

METHODS

As a part of the standard of care, treatment-naïve HNC patients (n = 104) completed dental evaluation (number of teeth, total anterior/posterior occlusal teeth, Eichner Index (EI) classification), WL, DI questionnaire and HNC Symptom Checklist©. Descriptive statistics (Kruskal-Wallis, Fisher-exact, χ² tests) and (uni-) multi-variable logistic regression.

RESULTS

Overall, 42, 45 and 13% of patients were in EI-class A, B and C with a median of 8, 3, and 0 total posterior occlusal teeth. EI-class B/C patients were older, more likely to have impaired DI (OR = 3.88; 95%CI:1.63-9.26; P = 0.002) and reported interference with DI by 11 NIS (p < 0.05). DI was, however, reported as unimpaired in 77, 49 and 39% of patients in EI-class A, B and C, respectively. The subset of EI-class B/C patients with impaired DI, had more NIS interference with DI (P < 0.05; difficulty chewing, pain, early satiety, lack of energy); EI-class C patients additionally had dry mouth, thick saliva and dysphagia (P < 0.05). In logistic regression, EI-classes B/C patients with reduced (vs unimpaired) DI were more likely to have ≥5% WL (OR = 10.1; 95%CI:2.0-50.0), higher NIS interference (range OR 4.3-10.7).

CONCLUSIONS

More than half of these HNC patients had reduced numbers of occlusal teeth or were edentulous. EI-class B/C patients did not necessarily have impaired DI, however the combination of EI-class B/C and a constellation of NIS, associated with reduced DI.

CLINICAL SIGNIFICANCE

Treatment naïve head and neck cancer (HNC) patients with reduced occlusal and masticatory performance (Eichner Index B/C) and reduced dietary intake are at high risk for weight loss. Identifying HNC patients at risk may improve their oral health, dietary intake and reduce their risk of weight loss.

Application of Trace Elemental Profile of Known Teeth for Sex and Age Estimation of Ajnala Skeletal Remains: a Forensic Anthropological Cross-Validation Study

Teeth store crucial information needed for medical, environmental, genomics, public health, and forensic anthropological research work. The prolonged forensic utility of teeth is ensured by their extended postmortem longevity as they can resist almost all sorts of chemical, biological, and physical degradations or destructions. The main aim of the present investigation was to utilize the discriminant functions and regression equations generated from the elemental profile of known teeth for estimating sex and age of unknown human skeletal remains excavated from an abandoned well at Ajnala (Amritsar, India). The written records mentioned that 282 Indian mutineer soldiers were killed in July 1857, their cadavers were dumped in the disused well, and then a religious structure was built over the periphery of the said well. These human remains, along with some contextual items, were excavated non-scientifically in April 2014. Preliminary results obtained from application of different forensic anthropological techniques like stable isotope, pulp-tooth area ratio, and mtDNA analyses have indicated that these remains belonged to adult males. In present study, the elemental concentrations of 100 mandibular molars of known age and sex were estimated from wavelength-dispersive X-ray fluorescence spectrophotometer (WD-XRF) analyzer. The statistical equations so generated from elemental concentrations of known teeth were applied to estimate the probable age and the sex of unknown mandibular teeth (N = 100) collected from Ajnala skeletal assemblage. The elements Pb and As were detected in ancient teeth only whereas the detection of elements like Ba, Se, and Te was limited to modern teeth samples only. When the statistical equations so generated were applied to elemental concentrations of Ajnala teeth, it was found that 96% teeth belonged to adult males and the remaining ones were classified to be that of females. Though sexual differences were observed in concentrations of majority of elements, statistically significant differences were found in elemental concentrations of very few teeth. Age estimates of unknown teeth were found in the age ranges of 19 to 48 years. Thus, the trace elemental analysis results supported the written records that the victims were adult males. The cross-validated application of elemental profiles of known teeth for establishing the identity of unknown teeth is the first forensic anthropological study reported from India. Though the obtained accuracy levels were not found within acceptable forensic threshold limits, the present study results may guide future researches involving human hard tissues. It may be concluded that trace elemental concentrations of teeth may be influenced by the factors like age and sex of an individual and thus cannot be used for accurate and reliable forensic sex or age estimations. Dental trace elemental composition can be used as a forensic tool only if used in conjunction with other morphological or molecular analysis of the unknown dental remains.

Lithium and Boron in Calcified Tissues of Vicuna and Their Relation to Chronic Exposure by Water Ingestion in The Andean Lithium Triangle

Vicuna is a wild, endangered species of Andean camelid living in the hyperarid Andean plateau. In the central part of the plateau, the Lithium Triangle defines a zone with lithium-rich salt pans. Brine pools naturally form within the salt pans, and the adaptation strategy of vicuna consists of drinking from brine pools. Together with reporting the first chemical data on vicuna bones and teeth, we analyzed lithium, boron, and arsenic in water and brines, with the aim of assessing their relation to chronic exposure by water ingestion. We collected and analyzed bones of vicuna specimens lying in an Andean salt pan, together with brine and water samples. Brine and water samples are highly saline and contain large amounts of lithium, boron, and arsenic. Lithium (13.50-40 mg kg^-1 ) and boron (40-46.80 mg kg^-1 ), but not arsenic, were found in the vicuna bones and teeth. Based on our results and on previously reported data on human tissues in the Andes, we conducted statistical assessments of the relationships between lithium and boron in body tissues and water samples, and discuss their environmental significance in the context of the Lithium Triangle. Environ Toxicol Chem 2019;39:200-209. © 2019 SETAC.

Association between tooth loss and hypertension among older Chinese adults: a community-based study

Background

The purpose of the study is to examine the association between tooth loss and hypertension among older community residents in urban China.

Methods

This study included 3677 participants aged ≥50 years from the Shanghai Aging Study. We determined the number of teeth missing from questionnaires. Hypertension was defined as the mean of two measurements of systolic blood pressure (SBP) (140 mmHg or higher), diastolic blood pressure (DBP) (90 mmHg or higher) or physician-diagnosed hypertension confirmed from medical records. A multivariable logistic regression model was used to investigate the association between tooth loss and hypertension.

Results

The average number of missing teeth among study participants was 9.67. Among them, participants with hypertension had lost an average of 10.88 teeth, significantly higher than those without hypertension (8.95) (p < 0.0001). After adjusting for covariates (socio-demographic characteristics, health behaviors and other chronic conditions), teeth lost (15 or more) was significantly associated with grade III hypertension, with OR = 1.55(95% CI 1.09–2.20).

Conclusions

Significant tooth loss maybe associated with severe hypertension among older Chinese adults. Prevention of tooth loss is important to the overall health of this population.

Evaluation of the reliability of human teeth matrix used as a biomarker for fluoride environmental pollution

Environmental contamination by heavy metals has been a matter of great concern in many countries for several decades. Human exposure to such elements may cause adverse health effects and young children are particularly at risk. Many matrixes have been used for determination of metal exposure levels. Hard tissues such as teeth and bones have some advantages compared to other matrix. Dental tissues are considered to be suitable for long-term metal exposure due to their stability, resistance to physical and chemical degradation and their good preservation over time. Several studies have analyzed the teeth of animals for assessment the relationship between increased fluoride exposure and dental fluorosis, however few studies have been conducted on human teeth. Thus, the aim of the present study was to assess the reliability of human teeth matrix used as a biomarker for fluoride environmental pollution in Tunisia, and to evaluate the relationship with place of residence, age, dental caries and sex. Teeth samples (n=123) were collected from individuals living in Gafsa (fluoride-polluted area which inhabitants are to a great extent exposed to heavy metals) and Tunis (non polluted area). Samples were analyzed using a potentiometric method. The fluoride concentration was found to be significantly higher in teeth from Gafsa samples than those from Tunis. Their control levels were respectively 6793.1μg/g and 1068.8μg/g. The results indicate that there is a clear relation between fluoride concentration and residence of living. An increased level of dental fluorosis in fluoridated communities has been used to evaluate historical chronic exposure to fluoride in these communities, despite constant fluoride levels in the drinking-water. The fluoride concentration was also observed to be significantly increased in polluted area with age and in carious teeth whereas, no significant difference was observed for sex. Our study confirms well that human teeth used as a bioindicator for environmental pollution provide good chronological information on exposure, and highlighted the risks incurred by consumers living in such polluted area.

Possible applications of reflected UV photography in forensic odontology: Food for thought

Usually, in forensic sciences, ultraviolet (UV) light is used to induce fluorescence on many samples to identify and evaluate proofs (ex. fibers, gunshot residue, biologic fluids, pigments, inks and fingerprints) and different wavelength are used to better enhance the material characteristics. On the contrary, the potential use of absorbed and reflected UV has not been deeply investigated, especially in forensic odontology. The aim of this study is to evaluate the forensic potential of dental materials UV absorption and reflection and to investigate if different dental tissues and materials interact in different ways with UV radiation. A digital camera modified so to be UV sensible only and a modified flashlight were used to produce images of absorbed/reflected UV radiation of different dental materials. First results show the promising potentials of the technique in detecting dental composite resin materials, in enhancing image contrast between dentin and enamel, in enhancing enamel infractions and in possible age estimation future applications.

Self-insertion of Foreign Objects in Teeth

Introduction

Self-insertion of foreign objects in teeth is a common occurrence in children facing dental problems in an attempt to alleviate irritation, drainage, or other symptoms from teeth. However, this could lead to the development of infection and may worsen the condition if not intervened at an early stage. The removal of such objects and the preservation of involved teeth pose a challenge and, in some cases, the tooth must be extracted to resolve the infection.

Aims and objectives

The aim of this article is to report cases of foreign object insertion and discuss the related consequences, thereby, stressing the importance of regular dental visits and maintenance of oral hygiene so as to minimize dental neglect.

Case Studies

The article discusses four case reports of children in the age group 2–14 year old who reported with self- inserted foreign objects in their teeth.

Discussion

Regular dental visits and timely dental management can help reduce the complications associated with such incidents. Ultrasonic instruments, the Masserann kit, periapical surgery and various other techniques have been recommended by the authors for successful removal of foreign objects from the pulp chamber and the canal.

How to cite this article

Lakhani B, Garg S, et al. Self-insertion of Foreign Objects in Teeth. Int J Clin Pediatr Dent 2019;12(2):145–149.

Factors predictive of the intensity of local anesthesia in mandibular third-molar surgery: A cross-sectional study

INTRODUCTION

Primarily, the intensity of local anesthesia (LA) in mandibular third-molar (M3) surgery is governed directly by lipid solubility of the local anesthetic drug and indirectly by other physical characteristics. However, a patient's demographic, anthropometric, behavioral, and surgical factors may affect these physical characteristics and, therefore, indirectly influence the clinical actions of the local anesthetic drug used. The aim of this study was to investigate patients' demographic, anthropometric, behavioral, and surgical variables that may predict for the intensity of LA in mandibular M3 surgery among healthy adult patients.

MATERIAL AND METHODS

This cross-sectional study included 141 patients with unilateral mandibular M3 teeth indicated for surgical extraction under LA. Patients' demographic, anthropometric, behavioral, and surgical potential predictor variables were recorded. Lidocaine (2%) with epinephrine (1:100,000) was administered to provide block anesthesia for mandibular M3 surgery. The overall intra-operative pain (intensity of LA) was the outcome variable and was evaluated by the patient after surgery, using a visual analogue scale (VAS). Data were analyzed using univariate analysis and multivariate regression analysis.

RESULTS

The final study population comprised 126 participants: 80 women and 46 men (mean age±SD=29.2±12.3 year). With multivariate regression analysis, age, smoking quantity, and "amount of local anesthetic used" were the only significant (P<0.001) predictors of the intensity of LA in mandibular M3 surgery.

CONCLUSIONS

This study suggested that an increase in age, smoking quantity and "amount of local anesthetic used" would predict an increase in the intensity of LA in mandibular M3 surgery.

The relation between dental age and cervical vertebral maturation in orthodontic patients aged 8 to 16 years: A cross-sectional study

OBJECTIVE

This study aimed to assess the relation between the dental age of seven left mandibular teeth determined by the Demirjian's method and skeletal age determined by the Baccetti's method.

MATERIALS AND METHODS

This cross-sectional study evaluated 600 patients aged between 8-16 years, who were selected from those presenting to Orthodontics Department of Hamadan dental school and private orthodontic offices. The patients had good-quality panoramic radiographs and lateral cephalograms taken within 2 months of each other. Skeletal age was determined according to the cervical vertebral maturation (CVM) on lateral cephalograms. The dental age of seven left mandibular teeth was determined using the Demirjian's method. Data were analysed by the Spearman's and Pearson's correlation coefficients via SPSS 16.

RESULTS

CVM had significant correlations with dental age (0.780) and chronological age (0.792). Accordingly, the strongest correlation was noted between CVM and the developmental stage of second molars in both males and females. In males, the highest correlation between dental age and chronological age was in CS5 stage (0.724) while, in females, the highest correlation between dental age and chronological age was in CS4 stage (0.651).

CONCLUSION

Considering the correlation between skeletal age and dental calcification, dental age, especially the developmental stage of mandibular second molars, based on panoramic radiographs, can be served as a primary diagnostic tool for determining the skeletal maturity stage of patients.

Three-dimensional geometric morphometric analysis of tooth shape in hypodontia: II size variation

The study aimed to evaluate differences in tooth size between patients with hypodontia and those with normal complement of permanent teeth using three-dimensional geometric morphometric analysis. The number of anatomical landmarks was recorded on the clinical crown of the permanent teeth on three-dimensional scanned study models of hypodontia and in control subjects. The study sample comprised 120 patients with hypodontia (mild, moderate, severe) and 40 controls matched for age and sex. Tooth size differences were tested statistically using multivariate statistics. Size variation was for the most part found to be significant, especially when the control subjects were compared with the hypodontia groups. The explained variance among group membership was generally larger in the anterior and premolar region than in the molar region Sexual dimorphism was found less in the anterior region than in the posterior region; therefore, the sexes were pooled more often for teeth in the anterior region. Quantitative measurement of tooth size in patients with hypodontia may enhance the multidisciplinary management of these patients.

A proposed terminology for the dentition of gomphodont cynodonts and dental morphology in Diademodontidae and Trirachodontidae

Gomphodont cynodonts were close relatives of mammals and one of the Mesozoic lineages of cynodont therapsids that became extinct at the end of the Triassic. Gomphodonts were omnivorous to herbivorous animals characterized by labiolingually expanded postcanines, which allowed tooth-to-tooth occlusion. The morphology of the upper and lower postcanines presents important means of distinguishing among major lineages within Gomphodontia, that is, Diademodontidae, Trirachodontidae, and Traversodontidae, but the dentition of most Diademodontidae and Trirachodontidae remain poorly documented. Here, we present a comprehensive description of the dentition of each diademodontid and trirachodontid species, as well as detailed illustrations of each dental unit, after firsthand examination of material and 3D reconstructions of postcanine teeth. Based on dental morphology, Trirachodon berryi and “Trirachodon kannemeyeri,” considered as separate taxa by some authors are here interpreted as representing different ontogenetic stages of the same species. Likewise, Sinognathus and Beishanodon, thought to belong to non-cynognathian cynodonts and traversodontids by some authors, are referred to Trirachodontidae and Gomphodontia based on dental characters, respectively. Finally, we propose a standardized list of terms and abbreviations for incisors, canines, and postcanines anatomical entities, with the goal of facilitating future descriptions and communication between researchers studying the gomphodont dentition.