Quo vadis, esthetic dentistry? Part II: Composite resin overtreatment and social media appeal

OBJECTIVES

This article presents case reports highlighting over-treatments with resin composites, often misconceived as minimally invasive procedures.

CLINICAL CONSIDERATIONS

Tooth-colored restorative materials, such as ceramics and composites, have found widespread application to correct problems related to tooth color, shape, and alignment. When composite resin is used, these procedures can be done in a very conservative, cost-effective, and timely fashion. However, it is noteworthy that contemporary dental esthetic expectations are based on standards propagated by social media and other marketing and communications platforms. The abuse of and addiction to social media impacts can lead to unrealistic esthetic expectations and standards for both patients and dentists.

CONCLUSIONS

After a critical discussion on ceramic veneers published in part I of this 2-part series, this article directs attention towards what has become a trendy fashion, i.e., the use of direct composite resins as "non-prep" veneers in clinical situations that arguably required no restorative intervention at all. We further explore how social media influences the decision-making processes of both professionals and patients.

Prevalence of oral and maxillofacial lesions in children and adolescents at a regional Brazilian oral pathology service: a retrospective study and the relevant literature review

PURPOSE

This study assessed the prevalence of maxillofacial lesions in children, i.e., 0-9 years, and adolescents, i.e., 10-19 years, in a Brazilian Oral Pathology Service and compared results with available literature.

METHODS

Clinical and histopathological records from January 2007 to August 2020 were analysed and a literature review investigating maxillofacial lesions in paediatric populations was also performed.

RESULTS

Overall, "reactive salivary gland lesions" and "reactive connective tissue lesions" were the most prevalent group of soft tissue lesions, affecting children and adolescents equally. From these, mucocele and pyogenic granuloma were the most prevalent histological diagnoses, respectively, regardless of age. These findings were consistent with the 32 studies included. Considering intraosseous lesions, "odontogenic cysts" and "periapical inflammatory lesions" were the most prevalent groups, with no relevant differences between age groups, except for the odontogenic keratocyst, which was more prevalent in adolescents. Moreover, several odontogenic tumours, such as ameloblastic fibroma and odontogenic myxoma, were significantly more prevalent in children.

CONCLUSION

Most maxillofacial lesions presented a similar prevalence between children and adolescents. Reactive salivary gland lesions and reactive connective tissue lesions were the prevailing diagnostic categories, regardless of age. Some odontogenic tumours and the odontogenic keratocyst showed significantly different frequencies across these age groups.

AB1331 DIAGNOSTIC CAPABILITY OF ANESTHETIC INTRA-ARTICULAR INJECTIONS FOR FEMOROACETABULAR IMPINGEMENT

Background

Femoroacetabular impingement syndrome (FAIS) is a highly prevalent painful disorder that is considered a risk factor for hip osteoarthritis. Confirming that FAIS is the main cause of a pain is a hard task. There are patients who have the typical morphological alterations of FAIS, but are asymptomatic. FAIS morphologies can represent a major confounding factor in patients with undiagnosed rheumatic diseases. On the other hand, surgery can significantly improve quality of life of patients with FAIS. Anesthetic intra-articular injections might constitute viable alternatives for diagnosing FAIS.

Objectives

This systematic review aimed to answer the following question: “What is the diagnostic capability of anesthetic intra-articular hip injections for the assessment of FAIS?”.

Methods

This study was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement. Embase, CINAHL, LILACS, PubMed, SCOPUS, SPORTDiscuss, The Cochrane Library, and Web of Science databases were screened. All studies that assessed the diagnostic capability of anesthetic intra-articular hip injections for the assessment of FAIS were considered eligible. Study selection and data collection were performed by three independent reviewers. Risk of bias of the included studies was assessed through the QUADAS-2 tool.

Results

A total of 13 articles were selected for full-text reading, of which 5 were finally considered eligible and included for analysis [1-5]. A summary of the studies’ descriptive characteristics can be found in the Table 1. Overall judgment was “at risk of bias” for all included studies (Figure 1). More detailed information regarding bias assessment at QUADAS-2 is available in the Figure 1. From 5 included studies, only 2 [2,5] indicated that anesthetic intra-articular injections can be useful as diagnostic tools for FAIS.

Figure 1.Table 1.AuthorMean AgeN (Female)Injection ContentInjection GuidanceTime for pain assessment after injection (Way of assessment)Threshold to consider FAIS diagnosisReference StandardFindingsKivlan29.9 ± 10.472 (54)Lidocaine + bupivacaine + triamcinoloneFluoroscopy2 hours (provocative activities)Not establishedArthroscopyNo difference in pain relief after injection between individuals with and without FAIS (p=0.128)Kraeutler38.8 ± 14.2161 (120)Lidocaine + triamcinoloneNon-guided10 minutes (physical tests and provocative activities)>70% of pain relief after injectionSymptoms + physical tests + radiographyFAIS and dysplasia diagnosed in 76% of patients with >70% of pain relief after injection, and in 67% in patients presenting <70% (p=0.62)Chinzei36.7 ± 14.749 (27)LidocaineFluoroscopy2 weeks (uninformed)>50% of pain reliefArthroscopyNo significant association between pain relief intensity after injection and the presence of FAIS (p>0.05)Gao36 (16-65)78 (41)Lidocaine + betamethasoneUltrasound10 minutes and 1 week (routine tasks)> 50% of pain reliefArthroscopyResponse to injection is 91.7% accurate for detecting FAISPerdikakis33 (18-58)34 (20)RopivacaineFluoroscopy30 minutes (physical tests)UninformedArthroscopyResponse to injection presented 92% of PPV and 96,5% of accuracy for diagnosing FAIS, with NPV and sensitivity of 100%

Conclusion

Evidence regarding the diagnostic capability of anesthetic intra-articular hip injections for FAIS is sparse. In order to accurately answer our research question, future studies that use standardized and optimized protocols of injection and pain assessment after injection are still essential. Furthermore, the need to take into account the different biases surrounding diagnostic studies was highlighted in our study.

References

[1]N Chinzei et al., Eur J Orthop Surg Traumatol 30 (4), 737 (2020)

[2]G Gao et al., Arthroscopy 37 (1), 128 (2021)

[3]BR Kivlan et al., Arthroscopy 27 (5), 619 (2011)

[4]MJ Kraeutler et al., J Hip Preserv Surg 5 (3), 220 (2018)

[5]E Perdikakis et al., Hell J Radiol 6 (2), 6 (2021)

Disclosure of Interests

None declared

Effectiveness of marsupialisation and decompression on the reduction of cystic jaw lesions: a systematic review

In this study, we aimed to systematically review and critically appraise the available literature concerning the effectiveness of marsupialisation and decompression on the reduction of cystic jaw lesions. The 'Preferred Reporting Items for Systematic Reviews and Meta-Analysis' guidelines were followed and the study protocol was registered at the 'International Prospective Register of Systematic Reviews' (CRD42019116099). Six main databases were searched: Embase, LILACS, PubMed, Scopus, The Cochrane Library, and Web of Science. Searches were complemented with three grey literature sources: Google Scholar, ProQuest, and Open Grey. Any reduction measures, compared with preoperative status or other procedures, were considered. Risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Thirty-one studies were included, of which five were judged with low, 24 with moderate, and two with high risk of bias. Considering surgical approach, 20 studies assessed the decompression and 11 the marsupialisation technique. Most studies considered these techniques as preliminary treatments, followed by enucleation. From 1088 lesions found, most were odontogenic keratocysts (33.8%), followed by unicystic ameloblastomas (21.0%), dentigerous cysts (20.6%), and radicular cysts (8.4%). Large lesions and younger individuals frequently presented more favourable responses to treatment and anatomical location was not associated with lesion reduction overall. The intervention duration generally ranged between one to two years. In conclusion, marsupialisation and decompression were mostly considered as preliminary treatments, followed by enucleation. Lesion reduction was generally considered insufficient for these techniques to be used as definitive therapies, although benefits concerning the diminished invasiveness of the secondary surgery were often proposed.

[Chagas disease in a rural area of Northeast Brazil]

A serological and medical survey on Chagas disease was carried out between December 1997 and June 2000 in four villages of the semi-arid rural Northeast Brazil. The average human serological prevalence rate of 11.8% was strongly linked with age: 1.1% for people under 25, 13.7% for people aged of 26 to 49, 29.5% for people aged of 50+. The clinical form was indeterminate for 57% of the infected population, cardiac for 35%, digestive or mixed for 8%. The infected patients under 55 received at home an etiologic treatment with benznidazol. The survey confirms the drastic reduction of Trypanosoma cruzi transmission during the last decades, especially since 25 years. This situation is the result jointly of the antivectorial activities, improvement of education level and changes in the way of life. However Chagas disease is still a serious problem, especially for numerous middle-aged infected adults. The situation could be improved by increasing the serologic screening in the field as well as the counselling and the treatment of the patients.

Clinical and genetic heterogeneity in hereditary haemochromatosis: association between lymphocyte counts and expression of iron overload

To identify a new marker of expression of disease, independent of HFE genotype in patients with hereditary haemochromatosis (HHC), the total peripheral blood lymphocyte counts were analysed according to iron status in two groups of subjects with HFE mutations. The groups consisted of 38 homozygotes for C282Y, and 107 heterozygotes for the C282Y or compound heterozygotes for C282Y and H63D. For control purposes, total lymphocyte counts and iron status were also examined in 20 index patients with African dietary iron overload, a condition not associated with HFE mutations, and in 144 members of their families and communities. Mean lymphocyte numbers were lower in C282Y homozygous HHC index subjects with cirrhosis and higher iron stores than in those without cirrhosis and with lower iron burdens [(1.65 +/- 0.43) x 10(6)/mL vs. (2.27 +/- 0.49) x 10(6)/mL; p = 0.008]. Similarly, mean lymphocyte counts were significantly lower in C282Y heterozygotes and C282Y/H63D compound heterozygotes with iron overload and increased serum ferritin concentrations compared to those with normal serum ferritin concentrations (p < 0.05). Statistically significant negative correlations were found, in males, between lymphocyte counts and the total body iron stores, either in C282Y homozygous HHC patients (p = 0.031 in a multiple regression model dependent on age) and in C282Y heterozygotes or C282Y/H63D compound heterozygotes with iron overload (p = 0.029 in a simple linear model). In contrast, lymphocyte counts increased with increasing serum ferritin concentrations among the index subjects with African iron overload (r = 0.324, not statistically significant) and among the members of their families and communities (r = 0.170, p = 0.042). These results suggest that a lower peripheral blood lymphocyte count is associated with a greater degree of iron loading in HFE haemochromatosis but not in African iron overload, and they support the notion that the lymphocyte count may serve as a marker of a non-HFE gene that influences the clinical expression of HFE haemochromatosis.