Dimensional Accuracy of Computer-Aided Design/Computer-Assisted Manufactured Orbital Prostheses

Purpose: The aim of this research was to assess the dimensional accuracy of orbital prostheses based on reversed images generated by computer-aided design/computer-assisted manufacturing (CAD/CAM) using computed tomography (CT) scans. Materials and Methods: CT scans of the faces of 15 adults, men and women older than 25 years of age not bearing any congenital or acquired craniofacial defects, were processed using CAD software to produce 30 reversed three-dimensional models of the orbital region. These models were then processed using the CAM system by means of selective laser sintering to generate surface prototypes of the volunteers` orbital regions. Two moulage impressions of the faces of each volunteer were taken to manufacture 15 pairs of casts. Orbital defects were created on the right or left side of each cast. The surface prototypes were adapted to the casts and then flasked to fabricate silicone prostheses. The establishment of anthropometric landmarks on the orbital region and facial midline allowed for the data collection of 31 linear measurements, used to assess the dimensional accuracy of the orbital prostheses and their location on the face. Results: The comparative analyses of the linear measurements taken from the orbital prostheses and the opposite sides that originated the surface prototypes demonstrated that the orbital prostheses presented similar vertical, transversal, and oblique dimensions, as well as similar depth. There was no transverse or oblique displacement of the prostheses. Conclusion: From a clinical perspective, the small differences observed after analyzing all 31 linear measurements did not indicate facial asymmetry. The dimensional accuracy of the orbital prostheses suggested that the CAD/CAM system assessed herein may be applicable for clinical purposes. Int J Prosthodont 2010;23:271-276.

Morphological assessment of dentine and cementum following apicectomy with Zekrya burs and Er:YAG laser associated with direct and indirect Nd:YAG laser irradiation

Objectives. This study aimed to assess the apical surface morphology of maxillary central incisors resected 3.0 mm from the tooth apex using Zekrya burs or Er:YAG laser, with or without subsequent direct Nd:YAG laser irradiation (apical and buccal surfaces) and indirect irradiation (palatal surface). Study design. Forty maxillary central incisors were instrumented and obturated. The roots were divided into 4 groups according to the root resection method (Zekrya bur or Er: YAG laser -1.8 W, 450 mJ, 4 Hz, 113 J/cm(2)) and further surface treatment (none or Nd: YAG laser -2.0 W, 100 mJ, 20 Hz, 124 J/cm(2)). The teeth were prepared for SEM analysis. Scores ranging from 1 to 4 were attributed to cut quality and morphological changes. The data were analyzed by the Kruskal-Wallis test and by Dunn`s test. Results. SEM images showed irregular surfaces on the apical portions resected with Zekrya burs, with smear layer and grooves in the resected dentine and slight gutta-percha displacement and plasticization. On the other hand, apicectomies carried out with Er: YAG laser showed morphological changes compatible with ablated dentine, with rough surfaces and craters. In spite of the presence of plasticized gutta-percha, with the presence of bubbles, an irregular adaptation of the filling material to the root walls was also observed. Direct Nd: YAG laser irradiation of the apical and buccal surfaces of the resected roots resulted in areas of resolidification and fusion in the dentine and cementum, with a vitrified aspect; indirect Nd: YAG laser irradiation of the palatal surfaces yielded a lower number of changes in the cementum, with irregular resolidification areas. Conclusions. There were no differences in terms of cut quality between the use of burs and Er: YAG laser or between the 2 surfaces (apical and buccal) treated with Nd: YAG laser with direct irradiation. However, morphological changes were significantly less frequent on surfaces submitted to indirect irradiation (palatal) when compared with those directly irradiated. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010; 109: e77-e82)

Evaluation of the lateral pterygoid muscle using magnetic resonance imaging

Objectives: The aims of this study were to evaluate the visibility of the lateral pterygoid muscle (LPM) in temporomandibular joint (TMJ) images obtained by MRI, using different projections and to compare image findings with clinical symptoms of patients with and without temporomandibular disorders (TMD). Methods: In this study, LPM images of 50 participants with and without TMDs were investigated by MRI. The images of the LPM in different projections of 100 TMJs from 35 participants (70 TMJs) with and 15 participants (30 TMJs) without clinical signs and symptoms of TMD were visible and analysed. Results: The oblique sagittal and axial images of the TMJ clearly showed the LPM. Hypertrophy (1.45%), atrophy (2.85%) and contracture (2.85%) were the abnormalities found in the LPM. TMD signs, such as hypermobility (11.4%), hypomobility (12.9%) and disc displacement (20.0%), could be seen in TMJ images. Related clinical symptoms, such as pain (71.4%), articular sounds (30.4%), bruxism (25.7%) and headache (22.9%), were observed. Conclusions: Patients with TMD can present with alterations in the LPM thickness. Patients without TMD also showed alterations, such as atrophy and contracture, in TMJ images. Recognition of alterations in the LPM will improve our understanding of clinical symptoms and pathophysiology of TMD, and may lead to a more specific diagnosis of these disorders. Dentomaxillofacial Radiology (2010) 39, 494-500. doi: 10.1259/dmfr/80928433

Comparison between multislice and cone-beam computerized tomography in the volumetric assessment of cleft palate

The aim of this study was to determine the applicability of multislice and cone-beam computerized tomography (CT) in the assessment of bone defects in patients with oral clefts. Bone defects were produced in 9 dry skulls to mimic oral clefts. All defects were modeled with wax. The skulls were submitted to multislice and cone-beam CT. Subsequently, physical measurements were obtained by the Archimedes principle of water displacement of wax models. The results demonstrated that multislice and cone-beam CT showed a high efficiency rate and were considered to be effective for volumetric assessment of bone defects. It was also observed that both CT modalities showed excellent results with high reliability in the study of the volume of bone defects, with no difference in performance between them. The clinical applicability of our research has shown these CT modalities to be immediate and direct, and they is important for the diagnosis and therapeutic process of patients with oral cleft. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011; 112: 249-257)

Tailoring of physical properties in highly filled experimental nanohybrid resin composites

Objectives. To assess the elastic modulus (EM), volumetric shrinkage (VS), and polymerization shrinkage stress (PSS) of experimental highly filled nanohybrid composites as a function of matrix composition, filler distribution, and density. Methods. One regular viscosity nanohybrid composite (Grandio, VOCO, Germany) and one flowable nanohybrid composite (Grandio Flow, VOCO) were tested as references along with six highly filled experimental nanohybrid composites (four Bis-GMA-based, one UDMA-based, and one Ormocer (R) -based). The experimental composites varied in filler size and density. EM values were obtained from the ""three-point bending"" load-displacement curve. VS was calculated with Archimedes` buoyancy principle. PSS was determined in 1-mm thick specimens placed between two (poly) methyl methacrylate rods (empty set = 6 mm) attached to an universal testing machine. Data were analyzed using oneway ANOVA, Tukey`s test (alpha = 0.05), and linear regression analyses. Results. The flowable composite exhibited the highest VS and PSS but lowest EM. The PSS was significantly lower with Ormocer. The EM was significantly higher among experimental composites with highest filler levels. No significant differences were found between all other experimental composites regarding VS and PSS. Filler density and size did not influence EM, VS, or PSS. Significance. Neither the filler configuration nor matrix composition in the investigated materials significantly influenced composite shrinkage and mechanical properties. The highest filled experimental composite seemed to increase EM by keeping VS and PSS low; however, matrix composition seemed to be the determinant factor for shrinkage and stress development. The Ormocer, with reduced PSS, deserves further investigation. Filler size and density did not influence the tested parameters. (C) 2011 Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

SH3BP2-encoding exons involved in cherubism are not associated with central giant cell granuloma

Central giant cell granuloma (CGCG) is a benign lesion with unpredictable biological behaviour ranging from a slow-growing asymptomatic swelling to an aggressive lesion associated with pain, bone and root resorption and also tooth displacement. The aetiology of the disease is unclear with controversies in the literature on whether it is mainly of reactional, inflammatory, infectious, neoplasic or genetic origin. To test the hypothesis that mutations in the SH3BP2 gene, as the principal cause of cherubism, are also responsible for, or at least associated with, giant cell lesions, 30 patients with CGCG were recruited for this study and subjected to analysis of germ line and/or somatic alterations. In the blood samples of nine patients, one codon alteration in exon 4 was found, but this alteration did not lead to changes at the amino acid level. In conclusion, if a primary genetic defect is the cause for CGCG it is either located in SH3BP2 gene exons not yet related to cherubism or in a different gene.

Long-term stability of Class II malocclusion treated with 2-and 4-premolar extraction protocols

Introduction: The objective of this study was to cephalometrically compare the stability of complete Class II malocclusion treatment with 2 or 4 premolar extractions after a mean period of 9.35 years. Methods: A sample of 57 records from patients with complete Class II malocclusion was selected and divided into 2 groups. Group 1 consisted of 30 patients with an initial mean age of 12.87 years treated with extraction of 2 maxillary premolars. Group 2 consisted of 27 patients with an initial mean age of 13.72 years treated with extraction of 4 premolars. T tests were used to compare the groups` initial cephalometric characteristics and posttreatment changes. Pearson correlation coefficients were calculated to determine the correlation between treatment and posttreatment dental-relationship changes. Results: During the posttreatment period, both groups had similar behavior, except that group 1 had a statistically greater maxillary forward displacement and a greater increase in the apical-base relationship than group 2. On the other hand, group 2 had a statistically greater molar-relationship relapse toward Class II. There were significant positive correlations between the amounts of treatment and posttreatment dentoalveolar-relationship changes. Conclusions: Treatment of complete Class II malocclusions with 2 maxillary premolar extractions or 4 premolar extractions had similar long-term posttreatment stability. (Am J Orthod Dentofacial Orthop 2009;136:154.e1-154.e10)

Stability and relapse of maxillary anterior crowding treatment in Class I and Class II Division 1 malocclusions

Introduction: The maxillary anterior teeth are the most important to facial esthetics because they are the first to show on a smile. Therefore, stability of the maxillary anterior teeth alignment is an important issue. The objective of this study was to compare the stability of maxillary anterior tooth alignment in Class I and Class II Division 1 malocclusions. Methods: The sample comprised dental casts of 70 patients with Class I and Class II Division 1 malocclusions and a minimum of 3 mm of maxillary anterior crowding measured by an irregularity index. The patients were treated with extractions and evaluated at pretreatment and posttreatment and at least 5 years after treatment. The sample was divided into 3 groups: group 1, Class I malocclusion treated with 4 first premolar extractions comprising 30 subjects, with an initial age of 13.16 years and 8.59 mm of initial maxillary irregularity; group 2, Class II malocclusion treated with 4 first premolar extractions comprising 20 subjects, with an initial age of 12.95 years and 11.10 mm of maxillary irregularity; and group 3, Class II malocclusion treated with 2 first maxillary premolar extractions comprising 20 subjects, with an initial age of 13.09 years and 9.68 mm of maxillary irregularity. Results: The decrease in the maxillary irregularity index was significantly greater in group 2 than in group 1 during treatment. The stability of maxillary anterior alignment was 88.12% over the long term; 77% of the linear displacement of the anatomic contact points tended to return to their original positions. Conclusions: Stability of maxillary anterior alignment between the 3 groups was similar. The stability of maxillary anterior alignment was high over the long term, but a high percentage of teeth tended to return to their original positions. (Am J Orthod Dentofacial Orthop 2011; 139: 768-74)

Comparison of the effects produced by headgear and pendulum appliances followed by fixed orthodontic treatment

This study compared the effects produced by two different molar distalizers, namely cervical headgear (CHG) and the intraoral pendulum appliance, associated with fixed orthodontic appliances. The headgear group comprised 30 patients (19 females, 11 males), with an initial age of 13.07 years [standard deviation (SD) = 1.3], treated with CHG and fixed orthodontic appliances for a mean period of 3.28 years, and the pendulum group 22 patients (15 females, 7 males), with initial age of 13.75 years (SD = 1.86), treated with the pendulum appliance followed by fixed orthodontic appliances for a mean period of 4.12 years. Lateral cephalograms were taken at the start (T1) and on completion (T2) of orthodontic treatment. The pendulum and CHG groups were similar as to initial age, severity of the Class II malocclusion, gender distribution, initial cephalometric characteristics, and initial and final treatment priority index (TPI). Only treatment time was not similar between the groups, with a need for annualization for data for the pendulum group. The data were compared with independent t-tests. There was significantly greater restriction of maxillary forward growth and improvement of the skeletal maxillomandibular relationship in the CHG group (P < 0.05). The maxillary molars were more mesially tipped and extruded and the mandibular molars more uprighted in the CHG group compared with the pendulum group (P < 0.05). There was more labial tipping of the mandibular incisors and greater overbite reduction in the pendulum group. The pendulum appliance produced only dentoalveolar effects, different from the CHG appliance, which restricted maxillary forward displacement, thus improving the skeletal maxillomandibular relationship.

Histological and molecular temporomandibular joint analyses after mandibular advancement surgery: study in minipigs

Objectives. The objective of this study was to elucidate the changes occurring in the temporomandibular joint (TMJ) after surgical mandibular advancement with different fixation techniques: bicortical screws (rigid fixation) and miniplates (semi-rigid fixation). Study design. Eighteen minipigs were equally and randomly divided into 3 groups: Group I (control), nonoperated animals; Group II, animals submitted to surgical advancement surgery and osteosynthesis by bicortical screws; and Group III, animals submitted to surgical advancement surgery and osteosynthesis by miniplates. Four months after the surgeries, the presence of interleukin (IL)-6 and IL-10 in synovial fluid samples was assessed in ELISA experiments. TMJs were histologically prepared. Results. Higher levels of IL-10 (P = .0436) were found for Group II. Descriptive histological analysis was compatible with the ELISA findings. Conclusions. Rigid fixation evokes more pronounced signs of bone remodeling in the TMJ, whereas malleable fixation promotes a more intense inflammatory activity. Therefore, rigid fixation seems to transmit a higher impact of postoperative masticatory forces to the TMJ.

Cephalometric evaluation of Class II malocclusion treatment with cervical headgear and mandibular fixed appliances

The present study aimed to evaluate the cephalometric changes in Class II patients treated exclusively with cervical headgear (CHG) in the maxillary arch and fixed appliances in the mandibular arch as compared with a control group. The sample comprised 82 lateral cephalograms obtained pre- (T1) and post- (T2) treatment/observation of 41 subjects, divided into two groups: group 1-25 Class II division 1 patients (20 females and five males), with a mean pre-treatment age of 10.4 years, treated for a mean period of 2.5 years and group 2-16 Class II untreated subjects (12 females and four males), with a mean initial age of 9.9 years, followed for a mean period of 2.2 years. Treatment changes between the groups were compared by means of t-tests. The results showed restriction of maxillary forward displacement and also a restriction in maxillary length growth, improvement in the maxillomandibular relationship, restriction of mandibular incisor vertical development, reduction in overjet and overbite, and improvement in molar relationship. It was concluded that this treatment protocol corrected the Class II malocclusion characteristics primarily through maxillary forward growth restriction.

Masticatory muscle activity during maximum voluntary clench in different research diagnostic criteria for temporomandibular disorders (RDC/TMD) groups

The research diagnostic criteria for temporomandibular disorders (RDC/TMD) are used for the classification of patients with temporomandibular disorders (TMD). Surface electromyography of the right and left masseter and temporalis muscles was performed during Maximum teeth clenching in 103 TMD patients subdivided according to the RDC/TMD into 3 non-overlapping groups: (a) 25 myogenous; (b) 61 arthrogenous; and (c) 17 psycogenous patients. Thirty-two control subjects matched for sex and age were also measured. During clenching, standardized total muscle activities (electromyographic potentials over time) significantly differed: 131.7 mu V/mu V s % in the normal subjects, 117.6 mu V/mu V s % in the myogenous patients, 105.3 mu V/mu V s % in the arthrogenous patients, 88.7 mu V/mu V s % in the psycogenous patients (p < 0.001, analysis of covariance). Symmetry in the temporalis muscles was larger in normal subjects (86.3%) and in myogenous patients (84.9%) than in arthrogenous (82.7%), and psycogenous patients (80.5%) (p=0.041). No differences were found for masseter muscle symmetry and torque coefficient (p>0.05). Surface electromyography of the masticatory muscles allowed an objective discrimination among different RDC/TMD subgroups. This evaluation could assist conventional clinical assessments. (C) 2007 Elsevier Ltd. All rights reserved.

Bond strength of AH Plus and Epiphany sealers on root dentine irradiated with 980 nm diode laser

Aim To evaluate the bond strength of AH Plus and Epiphany sealers to human root canal dentine irradiated with a 980 nm diode laser at different power and frequency parameters, using the push-out test. Methodology Sixty canine roots were sectioned below the cementoenamel junction to provide 4-mm-thick dentine discs that had their root canals prepared with a tapered bur and irrigated with sodium hypochlorite, ethylenediaminetetraacetic acid and distilled water. The specimens were assigned to five groups (n = 12): one control (no laser) and four experimental groups that were submitted to 980 nm diode laser irradiation at different power (1.5 and 3.0 W) and frequency (continuous wave and 100 Hz) parameters. Half of specimens in each group had their canals filled with AH Plus sealer and half with Epiphany. The push-out test was performed and data (MPa) were analysed statistically by ANOVA and Tukey`s test (P < 0.05). The specimens were split longitudinally and examined under SEM to assess the failure modes after sealer displacement. Results The specimens irradiated with the diode laser and filled with AH Plus had significantly higher bond strength values (8.69 +/- 2.44) than those irradiated and filled with Epiphany (3.28 +/- 1.58) and the nonirradiated controls (3.86 +/- 0.60). The specimens filled with Epiphany did not differ significantly to each other or to the control (1.75 +/- 0.69). There was a predominance of adhesive failures at Epiphany-dentine interface (77%) and mixed failures at AH Plus-dentine interface (67%). Conclusions The 980 nm diode laser irradiation of root canal dentine increased the bond strength of AH Plus sealer, but did not affect the adhesion of Epiphany sealer.