Dental Care and Education Facing Highly Transmissible SARS-CoV-2 Variants: Prospective Biosafety Setting: Prospective, Single-Arm, Single-Center Study

Comparing the accuracy of 3 different liquid crystal display printers for dental model printing

INTRODUCTION

This study aimed to evaluate the accuracy in terms of trueness and precision of 3 different liquid crystal display (LCD) printers with different cost levels.

METHODS

Three LCD 3-dimensional (3D) printers were categorized into tiers 1-3 on the basis of cost level. The printers' accuracies were assessed in terms of trueness and precision. For this research, 10 standard tessellation language (STL) reference files were used. For trueness, each STL file was printed once with each 3D printer. For precision, 1 randomly chosen STL file was printed 10 times with each 3D printer. After that, a model scanner was used to scan the models, and STL comparisons were performed using reverse engineering software. For the measurements regarding trueness and precision, the Friedman test was used.

RESULTS

There were significant differences among the 3 printers (P <0.05). The trueness and precision error were lower in models printed with a tier-1 printer than in the remaining 3D printers (P <0.05). The tier-2 and -3 printers presented very similar performance.

CONCLUSIONS

LCD 3D printers can be accurately used in orthodontics for model printing depending on the specific orthodontic use. The cost of a printer is relevant to the results only for the higher expense of the 3D printer in this study.

Changes in oral home care and smoking habits during COVID-19 pandemic: A cross-sectional study

OBJECTIVES

The coronavirus disease-19 (COVID-19) pandemic has caused disruption in the health behavior in many aspects of life. While hand hygiene was promoted as one of the precautionary measures to mitigate and contain COVID-19, oral health and smoking might have received less attention in the media campaigns. The aim of this study was to examine health behavioral changes in terms of oral home care habits, smoking, and perception of dental care during the COVID-19 pandemic.

MATERIAL AND METHODS

An online survey was designed to assess oral home care, smoking habits, and attitude toward dental services of participants aged 18 years and older. The data were collected between September and November 2021. The strength of association between changes in oral home care habits, smoking, and attitude toward invasive/long dental procedures and each variable was measured by χ2 analysis. Estimates of relative risk were also calculated for all variables. Predictors of avoiding dental procedures were estimated by a binary logistic regression.

RESULTS

A total of 532 participants, based in the United Arab Emirates, took part in this online survey with a response rate of 88.7%. The age of the participants ranged between 18 and 67 with mean age of 34.9 ± 9.0 years. The majority of the participants have adopted changes in their routine oral home care habits, with 82.1% of them changing the toothbrush more frequently. Participants who changed their oral home care habits were more likely to have received sufficient information on the importance of maintaining oral health. Likewise, the changes in smoking habits were significantly associated with receiving information on the relationship between smoking and the severity of the COVID-19 (p < 0.001).

CONCLUSIONS

The findings showed that positive behavior toward oral home care and smoking was noticed during the pandemic particularly when public receives sufficient and up-to-date information.

Visualization of droplets and aerosols in simulated dental treatments to clarify the effectiveness of oral suction devices

PURPOSE

The hazards of aerosols generated during dental treatments are poorly understood. This study aimed to establish visualization methods, discover conditions for droplets/aerosols generated in simulating dental treatments and identify the conditions for effective suction methods.

METHODS

The spreading area was evaluated via image analysis of the droplets/aerosols generated by a dental air turbine on a mannequin using a light emitting diode (LED) light source and high-speed camera. The effects of different bur types and treatment sites, reduction effect of intra-oral suction (IOS) and extra-oral suction (EOS) devices, and effect of EOS installation conditions were evaluated.

RESULTS

Regarding the bur types, a bud-shaped bur on the air turbine generated the most droplets/aerosols compared with round-shaped, round end-tapered, or needle-tapered burs. Regarding the treatment site, the area of droplets/aerosols produced by an air turbine from the palatal plane of the anterior maxillary teeth was significantly higher. The generated droplet/aerosol area was reduced by 92.1% by using IOS alone and 97.8% by combining IOS and EOS. EOS most effectively aspirated droplets/aerosols when placed close (10 cm) to the mouth in the vertical direction (0°).

CONCLUSIONS

The droplets/aerosols generated by an air turbine could be visualized using an LED light and a high-speed camera in simulating dental treatments. The bur shape and position of the dental air turbine considerably influenced droplet/aerosol diffusion. The combined use of IOS and EOS at a proper position (close and perpendicular to the mouth) facilitated effective diffusion prevention to protect the dental-care environment.

Parent's Attitudes toward Their Children's Oral Health Care during the COVID-19 Pandemic: A Cross-Sectional Study

Background

The COVID-19 pandemic has significantly impacted global health and presented challenges to maintaining oral health in children. Efficient management and prevention of oral diseases are therefore crucial in this population.

Aim

This cross-sectional study aimed to assess parents' self-reported oral and dental hygiene habits for their children during the COVID-19 pandemic.

Methods

A total of 256 parents of primary school children in Qazvin completed an online questionnaire containing demographic, general, and cardinal questions. The collected data were analyzed using SPSS 22 software, and accurate analytical tests were run to reach the results.

Results

The study found that 69.1% of parents and 87.1% of children brushed their teeth regularly during the pandemic. Additionally, 80.5% of parents monitored their children while brushing. While some parents expressed concerns about COVID-19 infection, parents from lower socioeconomic status reported a higher willingness to attend dental centers than those from more prosperous areas.

Conclusion

These findings suggest that parents' supervision and attitude toward oral health care significantly affect children's oral hygiene habits during the pandemic, possibly due to increased time spent together during lockdowns.

Artificial Intelligence Systems Assisting in the Assessment of the Course and Retention of Orthodontic Treatment

This scoping review examines the contemporary applications of advanced artificial intelligence (AI) software in orthodontics, focusing on its potential to improve daily working protocols, but also highlighting its limitations. The aim of the review was to evaluate the accuracy and efficiency of current AI-based systems compared to conventional methods in diagnosing, assessing the progress of patients' treatment and follow-up stability. The researchers used various online databases and identified diagnostic software and dental monitoring software as the most studied software in contemporary orthodontics. The former can accurately identify anatomical landmarks used for cephalometric analysis, while the latter enables orthodontists to thoroughly monitor each patient, determine specific desired outcomes, track progress, and warn of potential changes in pre-existing pathology. However, there is limited evidence to assess the stability of treatment outcomes and relapse detection. The study concludes that AI is an effective tool for managing orthodontic treatment from diagnosis to retention, benefiting both patients and clinicians. Patients find the software easy to use and feel better cared for, while clinicians can make diagnoses more easily and assess compliance and damage to braces or aligners more quickly and frequently.

Factors Associated with Epidemiological, Preventive and Health Care Knowledge of Dentists from North of the Peruvian Capital about COVID-19: A Cross-Sectional Study under a Predictive Model

Aim: In dental practice there is a high risk of contact with fluids that may contain SARS-CoV-2. Salivary secretions in the form of droplets are the main route of infection. The present study aimed to evaluate factors associated with epidemiological, preventive and health care knowledge of dentists from the north of the Peruvian capital about COVID-19. Materials and Methods: This analytical, observational, cross-sectional and prospective study evaluated 142 dental professionals from the Directorate of Integrated Health Networks (DIRIS) in the north of the Peruvian capital during June to August 2022. A validated questionnaire of 20 closed multiple-choice questions was used to measure the level of epidemiological, preventive and health care knowledge about COVID-19. A logit model was used to evaluate the influence of the following variables: age, sex, marital status, children, origin, university of origin, academic degree, work modality, work status and number of training courses. In addition, a predictive model was constructed with the causal variables considering a significance level of p < 0.05. Results: Epidemiological, preventive and health care knowledge about COVID-19 was fair in 17.6%, 34.5% and 57.7%, respectively. Likewise, all the variables analyzed were influential factors. It was observed that being single (OR = 0.05, CI: 0.01−0.26), having studied at a private university (OR = 0.09, CI: 0.023−0.38) and having received four to six trainings on COVID-19 related topics (OR = 0.02, CI: 0.002−0.238) were protective factors against fair knowledge. Conclusions: More than half of the dentists surveyed had fair knowledge about COVID-19. The factors that favored a good level of overall knowledge were: being single, having studied at a private university and having received 4 to 6 training courses on COVID-19-related topics. It is advisable that the competent authorities continue to educate dental professionals with training programs about infection control practices in accordance with the health care work they perform in their specialty. It will also be of utmost importance for the professional to be updated with reliable information accredited by the Centers for Disease Control and Prevention as well as the WHO.

Fabrication and In Vitro Characterization of Novel Hydroxyapatite Scaffolds 3D Printed Using Polyvinyl Alcohol as a Thermoplastic Binder

This paper presents a proof-of-concept study on the biocolonization of 3D-printed hydroxyapatite scaffolds with mesenchymal stem cells (MSCs). Three-dimensional (3D) printed biomimetic bone structure made of calcium deficient hydroxyapatite (CDHA) intended as a future bone graft was made from newly developed composite material for FDM printing. The biopolymer polyvinyl alcohol serves in this material as a thermoplastic binder for 3D molding of the printed object with a passive function and is completely removed during sintering. The study presents the material, the process of fused deposition modeling (FDM) of CDHA scaffolds, and its post-processing at three temperatures (1200, 1300, and 1400 °C), as well it evaluates the cytotoxicity and biocompatibility of scaffolds with MTT and LDH release assays after 14 days. The study also includes a morphological evaluation of cellular colonization with scanning electron microscopy (SEM) in two different filament orientations (rectilinear and gyroid). The results of the MTT assay showed that the tested material was not toxic, and cells were preserved in both orientations, with most cells present on the material fired at 1300 °C. Results of the LDH release assay showed a slight increase in LDH leakage from all samples. Visual evaluation of SEM confirmed the ideal post-processing temperature of the 3D-printed FDM framework for samples fired at 1300 °C and 1400 °C, with a porosity of 0.3 mm between filaments. In conclusion, the presented fabrication and colonization of CDHA scaffolds have great potential to be used in the tissue engineering of bones.

Smartphone-Based Facial Scanning as a Viable Tool for Facially Driven Orthodontics?

The current paradigm shift in orthodontic treatment planning is based on facially driven diagnostics. This requires an affordable, convenient, and non-invasive solution for face scanning. Therefore, utilization of smartphones' TrueDepth sensors is very tempting. TrueDepth refers to front-facing cameras with a dot projector in Apple devices that provide real-time depth data in addition to visual information. There are several applications that tout themselves as accurate solutions for 3D scanning of the face in dentistry. Their clinical accuracy has been uncertain. This study focuses on evaluating the accuracy of the Bellus3D Dental Pro app, which uses Apple's TrueDepth sensor. The app reconstructs a virtual, high-resolution version of the face, which is available for download as a 3D object. In this paper, sixty TrueDepth scans of the face were compared to sixty corresponding facial surfaces segmented from CBCT. Difference maps were created for each pair and evaluated in specific facial regions. The results confirmed statistically significant differences in some facial regions with amplitudes greater than 3 mm, suggesting that current technology has limited applicability for clinical use. The clinical utilization of facial scanning for orthodontic evaluation, which does not require accuracy in the lip region below 3 mm, can be considered.

Comparison in Terms of Accuracy between DLP and LCD Printing Technology for Dental Model Printing

Background: The aim of this study is to evaluate the accuracy of a Liquid Crystal Display (LCD) 3D printer compared to a Direct Light Processing (DLP) 3D printer for dental model printing. Methods: Two different printers in terms of 3D printing technology were used in this study. One was a DLP 3D printer and one an LCD 3D printer. The accuracy of the printers was evaluated in terms of trueness and precision. Ten STL reference files were used for this study. For trueness, each STL file was printed once with each 3D printer. For precision, one randomly chosen STL file was printed 10 times with each 3D printer. Afterward, the models were scanned with a model scanner, and reverse engineering software was used for the STL comparisons. Results: In terms of trueness, the comparison between the LCD 3D printer and DLP 3D printer was statistically significant, with a p-value = 0.004. For precision, the comparison between the LCD 3D printer and the DLP 3D printer was statistically significant, with a p-value = 0.011. Conclusions: The DLP 3D printer is more accurate in terms of dental model printing than the LCD 3D printer. However, both DLP and LCD printers can accurately be used to print dental models for the fabrication of orthodontic appliances.

Pierre Robin Sequence and 3D Printed Personalized Composite Appliances in Interdisciplinary Approach

This paper introduces a complex novel concept and methodology for the creation of personalized biomedical appliances 3D-printed from certified biocompatible photopolymer resin Dental LT Clear (V2). The explained workflow includes intraoral and CT scanning, patient virtualization, digital appliance design, additive manufacturing, and clinical application with evaluation of the appliance intended for patients with cranio-facial syndromes. The presented concept defines virtual 3D fusion of intraoral optical scan and segmented CT as sufficient and accurate data defining the 3D surface of the face, intraoral and airway morphology necessary for the 3D design of complex personalized intraoral and extraoral parts of the orthopedic appliance. A central aspect of the concept is a feasible utilization of composite resin for biomedical prototyping of the sequence of marginally different appliances necessary to keep the pace with the patient rapid growth. Affordability, noninvasiveness, and practicality of the appliance update process shall be highlighted. The methodology is demonstrated on a particular case of two-year-old infant with Pierre Robin sequence. Materialization by additive manufacturing of this photopolymer provides a highly durable and resistant-to-fracture two-part appliance similar to a Tübingen palatal plate, for example. The paper concludes with the viability of the described method and material upon interdisciplinary clinical evaluation of experts from departments of orthodontics and cleft anomalies, pediatric pneumology and phthisiology, and pediatric otorhinolaryngology.

Change in the Constricted Airway in Patients after Clear Aligner Treatment: A Retrospective Study

This retrospective study evaluated changes in the pharyngeal portion of the upper airway in patients with constricted and normal airways treated with clear aligners (Invisalign, Align). Additionally, we assessed the change of tongue position in the oral cavity from a lateral view. Evaluation was performed with specialized software (Invivo 6.0, Anatomage) on pretreatment and post-treatment pairs of cone beam computed tomography imaging (CBCT) data. The level of airway constriction, volume, cross-section minimal area and tongue profile were evaluated. Patients with malocclusion, with pair or initial and finishing CBCT and without significant weight change between the scans, treated with Invisalign clear aligners were distributed into two groups. Group A consisted of fifty-five patients with orthodontic malocclusion and constricted upper airway. Control group B consisted of thirty-one patients with orthodontic malocclusions without any airway constriction. In the group with airway constriction there was a statistically significant increase in volume during therapy (p < 0.001). The surface of the most constricted cross-section of the airway did not change significantly after treatment in any of the groups. The final tongue position was different from the initial position in 62.2% of all clear aligner treatments. The position of the smallest clearance of the airway in the pharynx was similar for both groups localized at the level of 2nd cervical vertebra.

Comparative Dissemination of Aerosol and Splatter Using Suction Device during Ultrasonic Scaling: A Pilot Study

Objective: This study compared the aerosol and splatter diameter and count numbers produced by a dental mouth prop with a suction holder device and a saliva ejector during ultrasonic scaling in a clinical setting. Methodology: Fluorescein dye was placed in the dental equipment irrigation reservoirs with a mannequin, and an ultrasonic scaler was employed. The procedures were performed three times per device. The upper and bottom board papers were placed on the laboratory platform. All processes used an ultrasonic scaler to generate aerosol and splatter. A dental mouth prop with a suction holder and a saliva ejector were also tested. Photographic analysis was used to examine the fluorescein samples, followed by image processing in Python and assessment of the diameter and count number. For device comparison, statistics were used with an independent t-test. Result: When using the dental mouth prop with a suction holder, the scaler produced aerosol particles that were maintained on the upper board paper (mean ± SD: 1080 ± 662 µm) compared to on the bottom board paper (1230 ± 1020 µm). When the saliva ejector was used, it was found that the diameter of the aerosol on the upper board paper was 900 ± 580 µm, and the diameter on the bottom board paper was 1000 ± 756 µm. Conclusion: There was a significant difference in the aerosol and splatter particle diameter and count number between the dental mouth prop with a suction holder and saliva ejector (p < 0.05). Furthermore, the results revealed that there was a statistically significant difference between the two groups on the upper and bottom board papers.

Where Is the Artificial Intelligence Applied in Dentistry? Systematic Review and Literature Analysis

This literature research had two main objectives. The first objective was to quantify how frequently artificial intelligence (AI) was utilized in dental literature from 2011 until 2021. The second objective was to distinguish the focus of such publications; in particular, dental field and topic. The main inclusion criterium was an original article or review in English focused on dental utilization of AI. All other types of publications or non-dental or non-AI-focused were excluded. The information sources were Web of Science, PubMed, Scopus, and Google Scholar, queried on 19 April 2022. The search string was “artificial intelligence” AND (dental OR dentistry OR tooth OR teeth OR dentofacial OR maxillofacial OR orofacial OR orthodontics OR endodontics OR periodontics OR prosthodontics). Following the removal of duplicates, all remaining publications were returned by searches and were screened by three independent operators to minimize the risk of bias. The analysis of 2011–2021 publications identified 4413 records, from which 1497 were finally selected and calculated according to the year of publication. The results confirmed a historically unprecedented boom in AI dental publications, with an average increase of 21.6% per year over the last decade and a 34.9% increase per year over the last 5 years. In the achievement of the second objective, qualitative assessment of dental AI publications since 2021 identified 1717 records, with 497 papers finally selected. The results of this assessment indicated the relative proportions of focal topics, as follows: radiology 26.36%, orthodontics 18.31%, general scope 17.10%, restorative 12.09%, surgery 11.87% and education 5.63%. The review confirms that the current use of artificial intelligence in dentistry is concentrated mainly around the evaluation of digital diagnostic methods, especially radiology; however, its implementation is expected to gradually penetrate all parts of the profession.