Acute dental malocclusion associated with lateral pterygoid muscle partial tear: Case Report and literature review

BACKGROUND

The article presents a rare case of acute malocclusion produced by a unilateral partial tear of the lateral pterygoid muscle and an up-to-date literature review of the pathology.

CLINICAL PRESENTATION

A 37-year-old female was examined; her chief complaints were pain on the right side of the temporomandibular joint (TMJ) area and mastication impairment associated with major occlusal modifications and anterior open bite. After magnetic resonance imaging (MRI) and cone beam computed tomography (CBCT) of the TMJ and subsequent MRI for soft tissue, the final diagnosis was a partial right lateral pterygoid muscle tear.

CONCLUSION

The case shows the value of combined imaging in temporomandibular disorders (TMD) and the importance of soft tissue evaluation in addition to articular examination, as the primary pathology might lie outside the joint. The authors' review of the current literature did not hitherto reveal a similar case.

Zirconia-Reinforced Lithium Silicate Ceramic in Digital Dentistry: A Comprehensive Literature Review of Our Current Understanding

Zirconia-reinforced lithium silicate (ZLS) ceramic is a new innovative dental material with unique a chemical composition that is designed to combine harmoniously with the appropriate optical properties of lithium disilicate and the enhanced mechanical strength of zirconia. A thorough understanding of ZLS materials is essential for both clinicians and dental technicians. At present, the mechanical behavior and optical properties of the ZLS ceramic system have not been extensively researched, and there is still a lack of consensus regarding the fabrication process and clinical behavior of ZLS all-ceramic restorations. The aim of the present study was to present a selection of comprehensive information concerning zirconia-reinforced lithium silicate ceramics and their optical and mechanical properties, as well as to assess data regarding cementation procedures and clinical outcomes for ZLS all-ceramic restorations. Three electronic databases (PubMed, Web of Science, and the Cochrane Library) were used for the research by two independent reviewers. The search was limited to articles published in the English language, as well as clinical and in vitro studies of color and studies on mechanical behavior and the cementation procedures of ZLS restorations. The exclusion criteria comprised abstracts, questionnaire-based studies, case reports, literature reviews, and studies that were not available in English. Zirconia-reinforced lithium-silicate-based ceramic presents a unique and complex microstructure that increases mechanical resistance but decreases aesthetic appearance, especially its translucency, due to tetragonal zirconia content. A material's thickness, the color of the underlying tooth structure, and the resin cement shade are important factors that influence the final shade and aesthetic appearance of ZLS restorations. Mechanical properties, which are defined by the fracture toughness, flexural strength, elastic modulus, and hardness of ZLS ceramic are higher compared to feldspathic, lithium disilicate, and hybrid ceramics, as well as resin nanoceramics; however, they are lower than translucent or high-translucency zirconia. Acid etching, sandblasting, and laser etching represent the most used methods to prepare the ZLS restoration surfaces for proper bonding procedures.

Translucent Zirconia in Fixed Prosthodontics-An Integrative Overview

Over the past two decades, dental ceramics have experienced rapid advances in science and technology, becoming the fastest-growing field of dental materials. This review emphasizes the significant impact of translucent zirconia in fixed prosthodontics, merging aesthetics with strength, and highlights its versatility from single crowns to complex bridgework facilitated by digital manufacturing advancements. The unique light-conducting properties of translucent zirconia offer a natural dental appearance, though with considerations regarding strength trade-offs compared to its traditional, opaque counterpart. The analysis extends to the mechanical attributes of the material, noting its commendable fracture resistance and durability, even under simulated physiological conditions. Various zirconia types (3Y-TZP, 4Y-TZP, 5Y-TZP) display a range of strengths influenced by factors like yttria content and manufacturing processes. The study also explores adhesive strategies, underlining the importance of surface treatments and modern adhesives in achieving long-lasting bonds. In the realm of implant-supported restorations, translucent zirconia stands out for its precision, reliability, and aesthetic adaptability, proving suitable for comprehensive dental restorations. Despite its established benefits, the review calls for ongoing research to further refine the material's properties and adhesive protocols and to solidify its applicability through long-term clinical evaluations, ensuring its sustainable future in dental restorative applications.

Survival Rates of Glass versus Hybrid Ceramics in Partial Prosthetic Restorations: A Scoping Review with Emphasis on Adhesive Protocols

As dental practices and methodologies evolve, the emergence of novel materials adds complexity to clinical choices. While glass ceramics, particularly those based on lithium disilicate and leucite-reinforced variants, have been extensively researched and are well regarded for their attributes, hybrid ceramics remain relatively recent area of research that is less investigated. This review aims to evaluate the durability of glass and hybrid ceramics while assessing the role of various adhesive techniques on restoration longevity. Using a comprehensive search of PubMed and EMBASE, 84 articles from the past decade were found. Only eleven met the set criteria for analysis. The results underscore the urgent need for the extended monitoring of partial prosthetic restorations. The existing literature has significant gaps, hindering the attainment of dependable insights about these materials' long-term performance. For a clearer understanding of how different ceramic systems affect restoration survival rates, rigorous research involving more participants and uniform outcome documentation is vital.

Smile Design and Treatment Planning-Conventional versus Digital-A Pilot Study

INTRODUCTION

Several methods are currently available for providing a preview of the prosthodontic treatment, including computer simulations, 3D models, wax-ups, and mock-ups. The aim of this study is to compare the aesthetic aspects and assessment of conventional versus digital prefigurative methods.

METHODS

The study included 5 patients and 3 observers, for each of whom a wax-up was made in both the conventional and digital techniques. The analog method, which implied a mock-up molding with a silicone matrix of the wax-up, was compared to a digital workflow, which consisted of a mock-up milling from a digital design. The patient's clinical mock-ups were recorded with digital photographs and assessed for nine different criteria by three observers.

RESULTS

The analysis has shown a balanced assessment of the aesthetic criteria without any significant difference between the analog and digital prefigurative methods.

CONCLUSIONS

Between the two wax-ups (conventional and digital), there were some variations in smile and dental criteria; however, the obtained data were very similar. When it comes to the smile criteria, the general average grades of the mock-ups conducted using the conventional method are slightly higher than the ones using the digital technique.

Is Teledentistry a Method for Optimizing Dental Practice, Even in the Post-Pandemic Period? An Integrative Review

Background: For the past two and half years, dentists all across the world, along with their patients, have faced numerous challenges. In this context, the aim of this integrative review was to assess if dentists’ and patients’ attitudes regarding teledentistry (TD) have changed since the COVID-19 outbreak, and if the use of TD will continue to rise, even in the post-pandemic period; (2) Methods: A literature search was performed between August 2021 and January 2022. The PubMed, Scopus, and Science Direct databases were searched for articles published between 2012 and 2022 using a combination of the following Mesh terms: “COVID-19”, “pandemic”, “oral telemedicine”, “teledentistry”; (3) Results: Among the 52 included papers, nine papers were published between 2011 and 2019, and 43 articles were published after 2020 (12 were published in 2020, 29 papers were published in 2021, and two in 2022). Among the articles published before 2020, seven out of nine included papers were reviews, and two were original research. Among the 43 papers published after 2020, 18 were reviews and 25 original research. (4) Conclusions: Based on the results of this integrative review, there is clear evidence that the interest in teledentistry and teleassistance in the dental field has increased rapidly, especially in the context of the COVID-19 pandemic. Therefore, while dental practitioners should be encouraged to keep themselves updated about new technologies, patients should also be constantly informed about their options for receiving special oral health care.

Influence of Human Papillomavirus on Alveolar Bone and Orthodontic Treatment: Systematic Review and Case Report

Background: As the human papillomavirus (HPV) infections are detected in healthy oral mucosa as well as in oral lesions, dental practitioners have an important role in detecting any possible lesions that might be caused by this virus. Therefore, the aim of this study was to investigate the outcomes of orthodontic treatments and HPV infections and to report a rare case of ongoing orthodontic treatment superposed on an HPV infection. Methods: An electronic English literature research of the articles published between the years 2011–2021 was conducted between December 2021–February 2022, accessing PubMed, Web of Science, Embase, Scopus, and Google Scholar. The terms “HPV”, “orthodontics”, “orthodontic treatment”, “tooth movement”, “tooth mobility”, and “malocclusion” were searched. The following inclusion criteria were pursued: articles published in English language; studies reporting HPV infection in subjects with past or ongoing orthodontic treatment; and case reports of subjects with HPV and orthodontic treatment. Exclusion criteria were: articles in languages other than English, studies related to malignancies other than HPV and orthodontic treatment; and studies reporting patients with HPV and no orthodontic treatment. Results: Following the systematic review, which includes six papers, a case of orthodontic treatment superposed on a HPV infection is presented. Conclusion: Incumbent, postponed HPV infection on an ongoing orthodontic treatment might affect treatment outcome and patient compliance.

The Use of Laser Energy for Etching Enamel Surfaces in Dentistry-A Scoping Review

BACKGROUND

In dental practice, different situations require etching the enamel layer. Acid etching, the present golden standard, may be replaced by other methods, such as laser etching. The main focus of our scoping review is to assess the existent literature regarding the effectiveness of different types of lasers, to identify the main aspects studied so far, and to understand where new search strategies are needed.

METHODS

The search was conducted in several databases focusing on the laser etching of human definitive enamel. We included English language articles published between January 2000 and December 2021.

RESULTS

The 34 articles reviewed showed that hard lasers, Er:YAG, Er,Cr:YAG, may represent an alternative etching method on enamel surfaces. They create a fractured, irregular surface and open dentin tubules, highly suitable for adhesion but with a lower risk of cavity formation. Nd:YAG, CO₂, and Diode lasers do not help in creating sufficient shear bond strength. There is, however, evidence suggesting that microcracks in the enamel layer may appear after thermomechanical ablation using laser energy.

CONCLUSIONS

While the use of acid etching is still successfully used for enamel conditioning, some researchers have emphasized the role played by saliva in the enamel-remineralization process a few days after the procedure. In this context, laser energy can be used, especially for bonding ceramic brackets in the case of orthodontic treatments. However, as thermomechanical ablation can generate microcracks, further research is required in order to establish clear findings concerning the use of laser energy on enamel etching.

Incidence of Malocclusion among Young Patients with Gingival Recessions—A Cross-Sectional Observational Pilot Study

Background and Objectives: Dental occlusion and gingival recession have been studied over the past years especially because of the increasing incidence of occlusal interferences in young patients. The purpose of this pilot study is to investigate any association between occlusal dysfunctions and gingival recessions. Data on gingival phenotype and previous orthodontic treatment were also collected to assess any correlation with the presence of gingival recession. Materials and Methods: Forty systemically healthy subjects, without signs of periodontitis and with gingival recessions, were included in the study. The following parameters were determined: location and extent of the gingival recession, gingival phenotype and functional occlusion by means of observing and registering the occlusal contacts in maximum intercuspation position, protrusive and lateral guidance. Results: Premolars were mostly affected in cases of working-side interferences during lateral guidance (71.19% of the affected teeth during left and 75% during right mandibular movements). The chi-squared exact test applied for the analysis of contingency tables revealed statistically significant associations between excursive interferences during lateral guidance and anterior guidance and the presence of gingival recession on the involved group of teeth. Conclusions: The results suggest that most gingival recessions might be associated with working-side interferences, the highest number of gingival recessions being associated with active interferences during lateral guidance.

A survey on dental students’ perception regarding online learning during COVID-19 pandemic

Background and aims

This study aimed to assess the students’ opinion about the efficiency of online teaching and also about the methods and features to be implemented even after this pandemic period would pass.

Methods

A questionnaire was formulated in order to evaluate the students’ perception about the teaching methods used by the Faculty of Dentistry, which was distributed through email.

Results

The answers of 208 students were analyzed. There were 157 women and 51 men, 119 were from Cluj County, while 89 were from other Romanian counties; 102 of the students were in the 4^th year of study, while 62 were still in the preclinical years (1^st, 2^nd, 3^rd), and the rest of 44 of the subjects, were in the 5^th or 6^th year of study. 85.8% of the respondents were satisfied with the traditional lectures, 51.7% considered that online lectures were more useful than the traditional. 187 (88.6%) of the students were satisfied with the traditional practical activities, while 37 (16.1%) believed that online activities were more useful to them, 111 (52.6%), believed that they were able to communicate better with the teacher during the online lectures.

Conclusions

Overall positive responses were reported regarding the acceptability and usability of online learning. The students viewed online learning helpful as a supplement to their learning rather than a replacement for traditional teaching methods.

Vitamin D and Temporomandibular Disorders: What Do We Know So Far?

Background and aims. Vitamin D is synthesized in the skin with the aid of ultraviolet-B radiation, playing a variety of roles in the body. Temporomandibular disorders (TMDs) are a group of pathological conditions involving the temporomandibular joints as well as the masticatory muscles and othersurrounding tissues. In the present narrative review, we investigated the potential role of vitamin D in the etiology of temporomandibular disorders in order todetermine whether the current knowledge supports 25-hidroxyvitamin D (25-OHD) supplementation in temporomandibular disorders associated with insufficient or deficient levels of vitamin D. Methods. A literature research was performed in PubMed, Scopus, Science Direct, and Google Scholar databases, and a total of 10 articles were included for analysis. Results.Among the observational studies published to date, investigating the role for vitamin D in the etiology of TMDs, six of them suggest that there is a connection between the two aspects. In this context, patients suffering from TMD, with deficient levels of vitamin D (<30 ng/mL), are most likely to benefit from supplementation, whereas individuals with vitamin D level >50ng/mL probably have little benefit from supplementation.Conclusion.Vitamin D might be a safe, simple, and potentially beneficial way to prevent TMDs or to reduce pain; however, more randomized and placebo-controlled trials are required before any firm conclusions can be drawn.

Orthodontic Attachment Adhesion to Ceramic Surfaces

Ceramic materials are constantly evolving, achieving good functionality and aesthetics. Bonding to ceramics may be difficult because of high toxicity procedures and risk of surface damage. The review aims to answer several research questions: Is there a golden standard for bonding to ceramic? Are there adhesives or types of photopolymerization lamps that produce a higher bond strength on certain types of ceramics rather than others? Articles focusing on the bonding process of orthodontic attachments to ceramic surfaces searched in Pubmed, Medline and Embase, published between 1990 and 2018 were revised. Exclusions concerned bonding to non-ceramic surfaces, bonding to ceramic surfaces that are not destined for orthodontics or laser usage. Forty-nine articles that matched the inclusion criteria were researched. The following categories of original research articles were compared and discussed: metallic brackets bonding to ceramic surfaces, ceramic brackets to ceramic surfaces, bonding to new types of ceramics, such as zirconia, lithium disilicate, different photopolymerisation devices used on bonding to ceramics. Some types of adhesive may achieve minimal bond strength (6-8 MPa) even on glazed ceramic. Ceramic surface preparation may be done by sandblasting or hydrofluoric acid (60s application and 9.6%) with generally similar results. Studies rarely show any statistical difference and there are reduced number of samples in most studies. Ceramic brackets show better adhesion to ceramic surfaces and the same bonding protocol is advised. A higher bond strength may lead to ceramic surface. Few studies focus on newer types of ceramics; additional research is necessary. There is no clear evidence that a certain type of photopolymerization device produces higher shear bond strength values.

Temporomandibular dysfunction diagnosis by means of computerized axiography

Background and aims

The objective of this study was to evaluate the accuracy of the CADIAX Compact 2 axiograph in confirming the presumptive clinical diagnosis of temporomandibular dysfunction, established according to the muscular-articular clinical examination.

Methods

A retrospective analytical study was carried out on 50 patients, aged between 21 and 62 years, 31 women and 19 men. A clinical diagnosis was established after masticatory muscles, temporomandibular joints and mandibular border limit movements were assessed. During the same day a computerized axiography (Cadiax Compact 2, Gamma, Vienna, Austria) was performed in order to confirm the diagnosis.

Results

The study had a sensitivity of 100%, which means that the CADIAX device detected all clinically positive patients. On the other hand, the specificity of the study was 74%, representing the percentage of patients negatively diagnosed by CADIAX device out of the total number of patients clinically diagnosed as negative. The 88% accuracy shows the proportion in which the CADIAX device provides a diagnosis equal to the clinical one.

Conclusions

Of all the methods for investigating temporomandibular joint dysfunction, axiography is less invasive, does not irradiate the patient, it is relatively easy to use and it offers functional information about the TMJ function.

Dentists' perspectives on the reconstruction possibilities of a non-vital tooth

Background and aims

The decision-making process when restoring a non-vital tooth is influenced by multiple factors. This study aimed to survey the dentists’ preferences regarding cast post-and-core and fiber post techniques for the reconstruction of non-vital teeth and to identify a correlation between reconstruction technique and practitioners characteristics, or dental characteristics.

Methods

The survey instrument was a questionnaire, which included a general part with questions regarding the practitioner’s profile (gender, age, years of experience, pattern and location of practice, etc.) and the dental characteristics (anterior or posterior position of the tooth on the arch, the amount of dental remaining tissues, etc.) and a technical part, containing more specific questions regarding the manufacture and performance of root-coronal reconstructions.

Results

Among the surveyed practitioners (n=35), 69.7% use more often cast post-and-core reconstructions (CPR) while 30.3% choose fiber post reconstructions (FPR). No difference in the reconstruction type was observed regarding patient’s age (p=0.23) or gender (p=0.092). The para-function criterion was considered important by 8.23% of the participants. When deciding the type of the root-coronal reconstruction depending on the remaining dentine walls, CPRs are significantly more frequently used in posterior areas (p=0.043) or when para-functional habits exist (p=0.022).

Conclusion

Cast post-and-core represent the most frequently used type of reconstruction for non-vital teeth. Fiber post reconstructions are indicated in the aesthetic zone and when the amount of healthy remaining dental structure is higher.

Psycho-social impact of orthodontic treatment in Romanian teenagers and young adults

Background and aims

This survey evaluated the psycho-social impact of oral health on the quality of life in Romanian teenage and young adult orthodontic patients.

Methods

Of the 300 standard questionnaires distributed in four dental offices, 125 questionnaires were returned. Each questionnaire contained 110 items, focusing on aspects like patients’ satisfaction, self-confidence, school/work performances and aesthetic concern, in relation to oral health. The patients were 16–25 years of age and all were undergoing or had undergone orthodontic treatment in the previous two years. Data analysis was performed using the Statistical Package for the Social Science software (SPSS), version 19.0.

Results

57.90% of the orthodontic patients participating in this study were happy about their dental status, 56.52% declared themselves not shy because of their oral health issues, 52.33% considered themselves as attractive to other people, and 57.29% replied (awarding a score between 8 and 10) that they were confident when smiling. Regarding self-confidence and school/work performances, 58% of the participants declared they avoided speaking in public because of the aspect of their teeth and 47.42% considered that their school/work performances during the fix appliance therapy stayed the same as before appliance. Nevertheless, the self-perceived facial aspect improved during orthodontic treatment (64.74% of replies had scores between 8 and 10 during the treatment versus 24.67% before the treatment). Several correlations were found between aspects such as psycho-social and functional variables, physical self-evaluation, and oral health issues.

Conclusion

Patients’ satisfaction was improved during and after appliance therapy, for more than half of the participants. Self-confidence was low in relation to school/work performances; almost half of the patients reported stagnation in their school/work performances during the fix appliance therapy. However, more than 64% of the patients participating in this study were quite satisfied about their facial aspect during and after the orthodontic treatment. Thus, the common concerns of the patients anxious about their aspect during appliance therapy are not supported by the findings of this study.