Total Face Approach (TFA) 3D Cephalometry and Superimposition in Orthognathic Surgery: Evaluation of the Vertical Dimensions in a Consecutive Series

Retrospective evaluation of the morphometric properties of intact maxillary sinus using cone-beam computed tomography for sex estimation in an Indian population

Background

Sex estimation is crucial to forensic examinations. In order to estimate sex, intact bones are used if the majority of bones are severely deformed and recovered in fragments. This study aims to analyze sexual dimorphism in intact maxillary sinuses using CBCT scanning to evaluate morphometric properties for sex identification.

Methods

A total of 318 subjects, consisting of 159 males and 159 females, aged between 20 and 60 years without sinus pathology were included in this diagnostic, retrospective cross-sectional study. Bilateral measurements of the volume, height, width, and length of the maxillary sinuses were obtained and compared to evaluate the differences between sexes. Subsequently, a descriptive analysis using mean and standard deviation was performed, followed by a comparison between sexes with a p-value being less than 0.05 and Student's t-test. Finally, a discriminant analysis was performed separately for the right and left maxillary sinuses.

Results

Males and females showed statistically significant variations in the length, width, and volume of the maxillary sinuses. Specifically, on the right side, males had longer maxillary sinuses than females (t = 5.6203, p < 0.0001). Meanwhile, on the left side, females had wider maxillary sinuses than males (t = 8.621, plt0.0001). In addition, males had greater volumes of maxillary sinuses on the right (t = 6.373, p < 0.0001) and left (t = 3.091, p < 0.0001) sides than females. The results of the discriminant analysis showed that the left width parameter had the highest accuracy of sex estimation (74.21%), followed by the Right Length (70.07%) and left volume (66.66%) parameters. The left height parameter had the lowest accuracy of sex estimation (49.37%).

Conclusion

In forensic odontology, the volume of maxillary sinus can serve as a valid radiographic indicator of sex estimation.

Effect of premolar extraction and anchorage type for orthodontic space closure on upper airway dimensions and position of hyoid bone in adults: a retrospective cephalometric assessment

Background

This study aimed to assess the effect of premolar extraction and anchorage type for orthodontic space closure on upper airway dimensions and position of hyoid bone in adults by cephalometric assessment.

Methods

This retrospective study was conducted on 142 cephalograms of patients who underwent orthodontic treatment with premolar extraction in four groups of (I) 40 class I patients with bimaxillary protrusion and maximum anchorage, (II) 40 class I patients with moderate crowding and anchorage, (III) 40 class II patients with maximum anchorage, and (IV) 22 skeletal class III patients with maximum anchorage. The dimensions of the nasopharynx, velopharynx, oropharynx, and hypopharynx, and hyoid bone position were assessed on pre- and postoperative lateral cephalograms using AudaxCeph v6.1.4.3951 software. Data were analyzed by the Chi-square test, paired t-test, and Pearson's correlation test (alpha = 0.05).

Results

A significant reduction in oropharyngeal, velopharyngeal, and hypopharyngeal airway dimensions was noted in groups I, III, and IV (P < 0.001), which was correlated with the magnitude of retraction of upper and lower incisors (r = 0.6 - 0.8). In group II, a significant increase was observed in oropharyngeal and velopharyngeal dimensions (P < 0.001). A significant increase in nasopharyngeal dimensions occurred in all groups (P < 0.001). Also, in groups I and III, the position of hyoid bone changed downwards and backwards, which was correlated with reduction in airway dimensions (r = 0.4 - 0.6).

Conclusion

According to the present results, extraction orthodontic treatment affects upper airway dimensions and hyoid bone position. Maximum anchorage decreases airway dimensions while moderate anchorage increases airway dimensions.

Acquisition of Precision and Reliability of Modalities for Facial Reconstruction and Aesthetic Surgery: A Systematic Review

The foundation of reconstructive and cosmetic surgery is a confluence of advanced technologies, plethora of procedures, inventive modifications, and planned strategies. In surgical planning, the most crucial steps for treating a patient are evaluating the facial morphometry and recognizing the deviations from the baseline values of facial parameters. Various imaging and non-imaging modalities and sub-modalities contribute to diagnosis, treatment planning, and follow-up care. These techniques are an important milestone of pre-, peri-, and postoperative care in facial reconstruction. The current research aims to comprehensively explain imaging and non-imaging technologies encompassing both innovative and traditional approaches in facial reconstruction. PubMed, Scopus, and Web of Science were searched from 1990 to 2022, and systematic review was conducted in accordance with the PRISMA recommendations. Undoubtedly, various factors impact the selection of facial analysis acquisition approaches and their prospective. The surgical team must understand such modalities' potential for diagnosis and treatment. The evolution of three-dimensional imaging has been fueled because of the need for devices with high speed, small size, and several functions. Automation with more efficiency and precision is the way of the future for three-dimensional imaging. Stereophotogrammetry can clearly quantify the field of facial analysis. All the publications under consideration came to the same conclusion: Canfield's Vectra three-dimensional imaging devices can provide accurate, repeatable stereophotogrammetric pictures. Although a few minor mistakes were recorded, most examined devices are deemed reliable and accurate tools for Plastic surgeons.

Midpalatal Suture Maturation Stage in 10- to 25-Year-Olds Using Cone-Beam Computed Tomography-A Cross-Sectional Study

In this study, we aimed to evaluate the frequency of midpalatal maturational stages in a Chilean urban sample of adolescents, post-adolescents and young adults, associated with chronological age and sex, by assessing CBCT scan images. Tomographic images in axial sections of the midpalatal sutures from 116 adolescents and young adults (61 females and 55 males, 10-25 years old) were classified according to their morphologic characteristics in five maturational stages (A, B, C, D and E), as proposed by Angelieri et al. The sample was divided into three groups: adolescents, post-adolescents and young adults. Three previously calibrated examiners (radiologist, orthodontist and general dentist) analyzed and classified the images. Stages A, B and C were considered to be an open midpalatal suture, and D and E were considered to be a partially or totally closed midpalatal suture. The most frequent stage of maturation was D (37.9%), followed by C (24%) and E (19.6%). The possibility of finding closed midpalatal sutures in individuals of 10 to 15 years was 58.4%, and in subjects aged 16 to 20 and 21 to 25 years, it was 51.7% and 61.7%, respectively. In males, Stages D and E were present in 45.4%; for females, this prevalence was 68.8%. Individual assessment of the midpalatal suture in each patient is of crucial importance before making the clinical decision of which is the best maxillary expansion method. Due to the extensive calibration and training required, it is advisable to always request a report from a radiologist. Individual evaluation with 3D imaging is recommended because of the great variability observed in the ossification of midpalatal sutures in adolescents, post-adolescents and young adults.

Anterior Upper Teeth Golden Proportion Analysis with Millimetric Templates: An Invention Developed at Londrina State University

In order to achieve aesthetic and harmonious smile results, the use of anterior upper teeth golden proportion concepts represents reliable and scientific based guidelines. However, measuring, recording and analysing teeth and smiles biometric values proves to be a clinical and laboratory routine chalenge, once it is time consuming and demands additional especific math calculus or formulas. The aim of this paper is present an invention, “anterior upper teeth golden proportion millimetric templates,” a set of instruments fabricated in order to achieve precise and fast millimetric measures, once they present predefined geometrical drawings and diagrams. Currently, when planning aesthetic tooth size modifications treatments, tools are used as pachymeters, dry edge compass, or some softwares. Most of times this strategy relies on professional expertise and intuiton, which shows to be limitating factors with the need of trial-and-error training and an accurate critical and artistic sense. Unfortunately, this is not inherent to all professionals, especially undergraduate dental school students. Thus, the templates bring differentials and advantages, being versatile and convenient, allowing countless clinical and laboratory uses, even over a cellphone or a computer screen. An excellent diagnostic aid providing ideal teeth proportions and positioning, increasing the chances of success in dental treatment planning.

Relationship between Posterior Permanent Dentition Pattern and Radiographic Changes of the Mandibular Condyle

This study assessed the relationship between posterior permanent dentition and radiographic changes of the mandibular condyle. This descriptive, cross-sectional study was conducted on 300 panoramic radiographs of patients over 40 years of age (188 females and 112 males). Panoramic radiographs were evaluated for condylar changes such as flattening, subcortical sclerosis, subcortical cyst, erosion, osteophytes, and generalized sclerosis. Presence of muscle pain and temporomandibular joint (TMJ) pain and sounds, and history of TMJ trauma were also assessed. The occlusal scheme of posterior teeth was analyzed according to the Eichner's index. The frequency of condylar changes was calculated in the right and left sides, and their association with posterior permanent dentition was analyzed by the Chi-square test (alpha = 0.05). The frequency of flattening, muscle pain, TMJ sounds, and erosion was 11.7%, 9.7%, 5.7%, and 3.7% in the right side, respectively. The frequency of flattening, muscle pain, erosion, and subcortical cyst was 12%, 9.3%, 5%, and 5% in the left side, respectively. The frequency of bilateral muscle pain, flattening, TMJ sounds, and TMJ pain was 18%, 16.7%, 11.7%, and 9.3%, respectively. Cases with TMJ trauma, generalized sclerosis, and osteophytes were few. According to the Eichner's index, most patients with condylar changes had classes A and B, and a smaller percentage had class C. No significant difference was noted between healthy individuals and those with condylar changes regarding dentition patterns. No relationship existed between condylar changes and posterior permanent dentition pattern.

Modeling and Simulating an Orthodontic System Using Virtual Methods

Cone beam computed tomography (CBCT) is a modern imaging technique that uses X-rays to investigate the structures of the dento-maxillary apparatus and obtain detailed images of those structures. The aim of this study was to determine a functional mathematical model able to evaluate the elastic force intensity on each bracket and tube type element and the ways in which those components act on the orthodontic system being used. To analyze a real orthodontic system, we studied the case of a 13-year-old female patient. To transfer geometric information from tomographic images, we used the InVesalius software. This software can generate three-dimensional reconstructions based on sequences and files in the DICOM format and was purchased from CBCT equipment. We analyzed and processed the geometries of the converted tissues in InVesalius using the Geomagic software. After using the Geomagic software, we exported the resulting model to the SolidWorks software used in computer-aided design. In this software, the model is transformed into a virtual solid. After making the geometric model, we analyzed the model using the Ansys Workbench software, which incorporates finite element analysis techniques. Following the simulations, we obtained result maps, which showed the complete mechanical behavior of the analyzed structures.

Clinical Use of Aligners Associated with Nuvola® OP System for Transverse Maxillary Deficiency: A Retrospective Study on 100 Patients

Introduction: Aligners represent a common treatment for orthodontic patients thanks to their countless advantages including aesthetics, comfort, and oral hygiene maintenance; at the same time, they are associated with a reduced number of visits and a low incidence of complications. Although aligners have undergone considerable improvements over time, to date they have limitations in resolving the most serious malocclusions related to transverse maxillary deficiency. The aim of the present study was to retrospectively evaluate an orthodontic protocol (the Nuvola® OP System) which associates a morpho-functional corrector (to be used for 30 min/day) with the aligner, allowing for the treatment of cases that would be difficult or unpredictable with aligners alone. Methods: Linear measurements were taken on STL files of 100 patients. In 77 patients between 18 and 55 years (mean 28.6 ± 16.2 (standard deviation) years), 3D superimpositions of the maxilla obtained from intraoral scans before and after treatment were performed in order to evaluate the degree of maxillary expansion. The normality of the data distribution was tested. The pre- and post-treatment data were compared using a paired t-test with a 5% significance level. After treatment, a questionnaire was proposed to assess patients’ degree of satisfaction and compliance. Results: A statistically significant difference (p < 0.05) for each distance evaluated was found. The maximum expansion was obtained at the first molar level (2.35 ± 1.64 mm). Of the subjects who completed the questionnaire, 96% were satisfied and 90% were able to perform the protocol without difficulty for the required duration. Conclusions: A significant expansion of the maxillary arch as well as a high degree of patient satisfaction and compliance were observed with the Nuvola® OP System. Further studies are needed in order to clinically evaluate the relative contribution of the aligners and morpho-functional device to the obtained expansion.

A Comparison of Lower Dental Arch Changes Using Two Types of Space Regainers: A Removable Appliance with a Distalizing Screw and a Fixed Double-Banded Appliance

Aim

The aim of this study was to compare lower dental arch changes using two types of space regainers, including a removable appliance with a distalizing screw and a fixed double-banded appliance.

Methods and Materials

In this case-control study, the study sample was comprised of thirty-eight children with mixed dentitions, all of whom had unilateral space deficiency due to premature loss of the second deciduous molar in the mandibular arch. Patients were treated with either a removable appliance with a distalizing screw or a fixed double-banded space regainer (DBSR) (n = 19). Pre- and posttreatment dental casts and lateral cephalograms of patients were evaluated to compare the effects of the two space-regaining devices on the mandibular dental arch. The data were analyzed using paired and independent t-tests.

Results

Available space, molar angle, IMPA, and the first molar distance to the mandibular plane and symphysis increased significantly in both groups (P < 0.001). The mean amount of IMPA changes was significantly greater in the distalizing screw group than in the DBSR group (P < 0.05). But, there were no statistically significant differences between the mean changes of available space, molar angle, and the first molar distance to the mandibular plane and symphysis in the distalizing screw and the DBSR group (P < 0.05). The DBSR group's treatment time was significantly shorter (P < 0.001).

Conclusion

The removable device with a distalizing screw and the DBSR were both able to regain mild-to-moderate unilateral space loss, achieving an increase in molar angle, IMPA, and molar extrusion. However, treatment time with the DBSR was shorter and with less incisor tipping as a side effect.

Transverse Analysis of Maxilla and Mandible in Adults with Normal Occlusion: A Cone Beam Computed Tomography Study

Objectives: To study the transverse widths of maxilla and mandible and their relationship with the inclination of first molars. Materials and Methods: Fifty-six untreated adults (12 males, 44 females) with normal occlusion were included. On each Cone Beam Computed Tomography (CBCT) image of the subject, inter-buccal and inter-lingual bone widths were measured at the levels of hard palate, alveolar crest and furcation of the first molars, and maxillomandibular width differentials were calculated. In addition, the buccolingual inclination of each first molar was measured and its correlation with the maxillomandibular width differential was tested. Results: At the furcation level of the first molar, the maxillary inter-buccal bone width was more than the mandibular inter-buccal bone width by 1.1 ± 4.5 mm for males and 1.6 ± 2.9 mm for females; the mandibular inter-lingual bone width was more than the maxillary inter-lingual bone width by 1.3 ± 3.6 mm for males and 0.3 ± 3.2 mm for females. For females, there was a negative correlation between the maxillomandibular inter-lingual bone differential and maxillary first molar buccal inclination (p < 0.05), and a positive correlation between the maxillomandibular inter-lingual bone differential and mandibular first molar lingual inclination (p < 0.05). Conclusions: This is a randomized clinical study on transverse analysis of maxilla and mandible in adults with normal occlusion using CBCTs. On average: (1) At the furcation level of the first molars, the maxillary inter-buccal bone width was slightly wider than mandibular inter-buccal bone width; whereas the mandibular inter-lingual bone width was slightly wider than maxillary inter-lingual bone width; (2) A statistically significant correlation existed between the maxillomandibular transverse skeletal differentials and molar inclinations.

Changes in Facial Profile after Modified Anterior Maxillary Subapical Osteotomy

(1) Background: This study explored the effects of modified anterior maxillary subapical osteotomy (AMSO) on facial profile changes in patients with bimaxillary protrusion. (2) Methods: Cephalograms of patients were collected preoperatively and over 2 months postoperatively. The following landmarks were recorded: pronasale (Prn), subnasale (Sn), labrale superius (Ls), anterior nasal spine (ANS), and incisor superius (Is). The following distances and angles were measured: ANS-Prn, ANS-Sn, ANS-Ls, Is-Sn, Is-Ls, SNA angle, and nasolabial (NLA) angle. (3) Results: Is and ANS were significantly retracted by 7.3 and 2.3 mm, respectively. Soft tissue landmarks (Prn, Sn, and Ls) were significantly retracted (1.2, 1.6, 4.4 mm, respectively). Postoperative changes in soft/hard tissue ratios were 0.54, 0.72, 0.31, and 0.60 for Prn/ANS, Sn/ANS, ANS/Is, and Ls/Is, respectively. The NLA angle was increased significantly by 7.1°. (4) Conclusions: The horizontal soft/hard tissue ratios of Sn/Is, ANS/Is, and Ls/Is were 0.22, 0.31, and 0.60, respectively. The NLA angle was increased significantly by 7.1°. The modified AMSO provides an increased blood supply, allows for direct vision, and results in fewer complications than other AMSO methods.

Applications and Clinical Behavior of BioHPP in Prosthetic Dentistry: A Short Review

(1) Background: BioHPP® (Bredent, UK) is a partially crystalline poly ether ether ketone (PEEK) that is strengthened using ceramic. PEEK and its various formulations represent a very interesting alternative, and has been in-depth with its literature in recent years; (2) Methods: A PubMed and Scopus search for the term “BioHPP” yielded 73 results and 42 articles which were included in this short review. Considering the scarce literature on the subject, each article was considered in this review; (3) Results: the articles analyzed are very recent, all published in the last 5 years. Their clinical evaluation of BioHPP® highlights many positive aspects, and few articles have highlighted critical issues in its multiple clinical applications; (4) Conclusions: this material is not only extremely interesting for the future, but possesses characteristics suitable for clinical application today, for endocrowns, small adhesive bridges, temporary prostheses and for immediate loads on implant restorations. The excellent aesthetics and the possibility of simple reprocessing of the restorations made with this material invite its clinical application.

Evaluation of Electromyographic Activity of Masticatory Muscles in Adults with Posterior Crossbite

Introduction

There is evidence that patients with posterior crossbite (PXB) have neuromuscular changes in the masticatory muscles. However, up to the present time, the relationship among these changes on the electromyographic activity of the masticatory muscles is still unclear.

Objective

To systematic review the available literature on the electromyographic activity of masticatory muscles in adults with PXB.

Methods

Between August 22 and September 9, 2020, we searched the following seven electronic databases: PubMed, EMBASE, Web of Science, Cochrane Library, SciELO, LILACS, and Scopus. No restrictions were applied regarding the language and year of publication. This systematic review was registered in the Prospective Register of Systematic Reviews (PROSPERO - CRD42020205057) database and conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. After data selection and extraction, the methodological quality of the selected studies was conducted independently by two reviewers, using two different evaluation tools.

Results

6957 records were initially located after the search process. In the end, eight papers were selected. Most studies were classified as having average to low methodological quality and moderate to high risk of bias. Based on the available evidence, adult patients with PXB have electromyographic activity changes in the masticatory muscles when compared with individuals without PXB. Moreover, adult patients with unilateral posterior crossbite (UPXB) have asymmetrical electromyographic activity when the crossbite side is compared with the noncrossbite side.

Conclusion

Despite the lack of studies with high methodological quality, electromyographic evaluation of masticatory muscles should be considered in the diagnosis and in the orthodontic treatment plan of patients with PXB. Prospective studies with a higher sample size and follow-up time, conducted using a rigorous scientific methodology, are necessary to reach a more reliable conclusion.

Anatomical Positions of Mesially/Horizontally Impacted Mandibular Third Molars are Significant Predictors for Distal Caries in Adjacent Second Molars

Background

Prevalence of distal caries in mandibular second molars (M2Ms) and its relationship with impacted condition of the adjacent mandibular third molars (M3Ms) have been reported in some studies. The results, however, were ambiguous because of including all impaction types and using univariate analysis for statistics.

Aim

This study aimed to determine anatomical features of mesially/horizontally impacted mandibular third molars (M3Ms) that could predict distal caries in the adjacent mandibular second molars (M2Ms) using multivariable analysis.

Materials and Methods

The study sample consisted of 300 digital panoramic radiographs of patients who underwent impacted M3Ms extraction. Two independent researchers collected the following variables from 446 pairs of M2M-M3M: sex, age, status of distal caries in M2Ms, mesial angulation, and Pell–Gregory classification of M3Ms.

Results

The prevalence of distal caries was 50.67%. Multivariable Firth's logistic regression analysis showed that age (β = 0.066, 95% CI = 0.023–0.113), mesial angulation (<30°: β = −1.205, 95% CI = −1.955 to −0.499; >70°: β = −0.730, 95% CI = −1.184 to −0.282), vertical position (level B: β = 2.275; 95% CI = 0.015–7.175; level A: β = 3.008; 95% CI = 0.755–7.905), and horizontal position (level II: β = 1.515; 95% CI = 0.444–2.874; level I: β = 1.423; 95% CI = 0.283–2.825) were significant variables after adjusting for sex in the final model for predicting distal caries (p < 0.05).

Conclusions

In conclusion, anatomical positions of impacted M3Ms, such as mesial angulation and Pell–Gregory classification were significant predictors of distal caries in M2Ms.

Age Estimation in Children by the Measurement of Open Apices in Teeth: A Study in the Western Indian Population

In forensic sphere and clinical dentistry, age estimation is a topic of utmost importance. Various techniques are employed in children to determine age; however, dental development has proven to be an appropriate method because of its low variability. Cameriere's method is a widely accepted method of age estimation in children, which is carried out by measuring the projections of open apices and also the heights of developing permanent teeth seen on panoramic radiographs. The aim of this study is to establish a new formula for age estimation in the Western Indian population by measuring the open apices of mandibular teeth using Cameriere's European formula. For this study, we included 311 panoramic radiographs of healthy children living in Western India (Maharashtra, Gujarat, and Goa) aged 4–15 years which were analysed by two independent researchers. Seven left permanent mandibular teeth were assessed for length and width of open apices. Dental maturity was evaluated using measurements of the left seven permanent mandibular teeth (x_i = A_i/L_i, i = 1,…, 7), the sum of the normalized open apices (s), and the number (N0) of teeth with complete root formation. A linear relationship between open apices, N0, age, and other factors was evaluated with the aid of a stepwise multiple regression model. A stepwise linear regression showed that all parameters, gender, s, N0, and x₅, were significantly associated with age (R = 85%). No statistically significant difference was found between the predicted and actual chronological age of children in the age group of 4–13 years using the regression equation for the Western Indian population. The present research suggests that the new regression formula developed will be more accurate for age assessment in the Western Indian population.

Survival and Success Rates of Monolithic Zirconia Restorations Supported by Teeth and Implants in Bruxer versus Non-Bruxer Patients: A Retrospective Study

The aim of this study was to assess retrospectively the survival and success rates of monolithic zirconia restorations supported by teeth and implants in bruxer versus non-bruxer patients. Methods: A total of 15 bruxer and 25 non-bruxer patients attended the recall appointment. The bruxer group (mean age of 61.2 ± 13.3 years and follow-up of 58.7 ± 16.8 months) were treated with 331 monolithic zirconia restorations, while the non-bruxer group, with a comparable mean age and follow-up time, were treated with 306 monolithic zirconia restorations. Clinical data were retrieved from the patients' files. At the recall appointment, all supporting teeth and implants were examined for biological and technical complications, and the restorations were evaluated using modified California Dental Association (CDA) criteria. Data were statistically analyzed using survival analysis methods. A significance level of p < 0.05 was used. A total of 31 versus 27 biologic and technical complications were recorded in the bruxer and non-bruxer groups, respectively. No significant differences were found between the two groups regarding overall complications and survival rate. Regarding the type of complication, a significantly higher rate of veneered porcelain chipping (p = 0.045) was observed in the bruxer group. With regard to biological complications, the only complications that exhibited a borderline, although not significant, difference were three fractured teeth exclusively in the bruxer group (p = 0.051), which were replaced with implant-supported restorations. Within the limitations of this study, we conclude that there were no significant differences in the overall survival and success rates of the monolithic zirconia restorations in bruxer versus non-bruxer patients, although veneered zirconia restorations and single tooth abutments exhibited a higher rate of complications in the bruxer group.

Modern Approaches and Innovations on Methods and Imaging Protocols of the Maxillofacial District

In recent years, improvements in imaging techniques have profoundly changed the diagnosis of pathologies of the maxillofacial district [...].

Dental Curriculum's Continuing Improvement in the North American and Gulf Cooperation Council (GCC) Education Systems

Background:

Dynamic oral health care needs, alongside a diverse demographic of patients, presents a challenge to dental clinicians as they strive to resolve the ever-increasing demand for quality oral care service. Claims have arisen that the most appropriate way of speeding up the slow change in adopting innovations within the dental practice is by updating dentists' knowledge and skills through improving the undergraduate students' curriculum.

Objective:

This review compares the dental curriculum's continuing improvement processes between the North American and Gulf Cooperation Council (GCC) countries.

Methods:

The process of analysis consisted of identifying, examining, and interpreting patterns and themes within textual data, and then determining how each of these help answer the research questions.

Results:

Efforts to implement the dental curriculum's continuous improvement processes in the North American and GCC countries are evident, but the significant barriers for the dental curriculum's continuing improvement among the North American countries include the consequences of a compressed four-year curriculum, reliance on professional regulations, insufficient focus on patient perceptions, and the lack of a more theoretically robust approach to self-reflection. Conversely, amongst the GCC countries, the available literature states that the most significant factors hindering the dental curriculum's continuing improvement include deficient leadership attributes and low research productivity.

Conclusion:

The North American and GCC regions will benefit from the new dental curriculum and result in producing more competent dental practitioners, with improved leadership and patient-centered care. However, it has been observed that the dental curriculum’s continuous improvement processes are adopted slowly, particularly among the GCC countries.

Ultrasound Imaging in Dentistry: A Literature Overview

(1) Background: the frequency with which diagnostic tests are prescribed with exposure to ionizing radiation, a cause of biological damage, has been studied, and with much more attention, patients are subjected to these diagnostic tests for diagnosis and follow-up. This review aimed, given the recent developments of this technology, to evaluate the possible use of ultrasound in different branches of dentistry. The possibility of applying ionizing-radiation-free diagnostic exams in dentistry, overcoming the limits of this application, has led scientific research in this area to obtain interesting results that bode well for the future. (2) Methods: a search for articles on the application of ultrasounds in dentistry was performed using the PubMed electronic database. (3) Results: only 32 studies were included, and these clearly stated that this examination is widely usable and in great progress. (4) Conclusions: regarding the modern application techniques of this diagnostic test, it is essential to consider technological evolution as an objective to reduce the damage and side effects of necessary diagnostic tests. The use of ultrasound in dentistry can represent a valid radiation-free alternative, in certain contexts, to the other most used exams.