Endodontic treatment in the conditions of type I dentinal dysplasia: features and applicability of practical approaches
Background. Endodontic therapy within dentinal dysplasia conditions represents an overly complex clinical domain that integrates both diagnostic challenges and technical limitations. Understanding these challenges is essential for optimizing treatment strategies, preventing iatrogenic complications, and improving long-term outcomes in affected patients. Objective. To assess and systematize practical diagnostic, technical and treatment considerations that potentially may optimize endodontic procedures provided within the conditions of dentinal dysplasia, and stratify evidence-based impact of such considerations taking into account their origin within the pool of available literature data. Materials and Methods. Comprehensive literature review was based upon broad search strategy, which was adopted to maximize sensitivity and inclusiveness. The primary database used for the search was PubMed with the use of Medical Subject Headings (MeSH), while to enhance coverage and minimize the risk of missing pertinent articles not yet indexed or published in lower-impact outlets, supplementary searches were also performed via the Google Scholar platform. Results. Following the exclusion of non-relevant records, duplicates, and articles that, upon content analysis, were determined to be unrelated to the defined research aim, final study cohort was refined to 10 publications, all of which consisted exclusively of case reports. Analysis of available evidence demonstrated substantial heterogeneity in the reported outcomes of endodontic treatment among patients affected by dentinal dysplasia. Overall, the evidence demonstrates temporal transition from consistently poor outcomes with conventional methods, through a period dominated by extractions and restorative strategies, to the emergence of guided endodontics as the potential reliably successful modality for the management of dentinal dysplasia. Nevertheless, the majority of published cases reported high rates of treatment failure. Conclusion. Provided analysis revealed that endodontic treatment of teeth with signs of dentinal dysplasia represents significant clinical challenges related with difficulties to identify root canal orifices, obtain apical patency, retain anatomically-driven trajectory of instrumentation and prevent complications linked with unreasonable loss of dentine structure, perforations, ledges and instruments fracture. Conventional instrumentation approaches, which previously have been applied for the teeth with obliterations and curvatures, while also for management of ledges, may serve as first line treatment options, considering their conservative nature. Conflict of Interest Author does not have any potential conflict of interests that may influence the decision to publish this article. Funding No funding was received to assist in preparation and conduction of this research, as well as in composition of this article.
Copyright (c) 2024 The Author(s) https://creativecommons.org/licenses/by/4.0/
Is tooth form a major criterion during correction of anterior esthetic-functional disharmony? Case report of complex prosthetic-driven surgery-including approach
Background. Retainment of biologically-argumented relationship between surrounding periodontium and teeth restored with different kinds of prosthetic restorations is highly important predictive factor for long-termed clinical and functional success of complex dental rehabilitation, especially in cases when treatment is focused on the corrections of present anterior esthetic-functional disharmony. Objective. To represent possibilities of complex prosthetic-driven surgery-including approach applied for the treatment of esthetic-functional disharmony, while using tooth form as major criterion for successful outcome planning. Case report. This clinical case describes a prosthetically driven rehabilitation approach integrating digital planning, provisional restorations, and bone recontouring surgery to achieve optimal esthetic and functional outcomes. Comprehensive diagnostics encompassed cone-beam computed tomography (CBCT), intraoral scanning, and standardized smile photographic protocol to evaluate hard and soft tissue parameters. Surgical intervention involved gingivectomy, ostectomy, and osteoplasty performed according to the contours predetermined by the provisional restorations, ensuring a prosthetically-driven approach for the hard tissue modification. Laboratory-fabricated provisional restorations were utilized to establish a new reference of cemento-enamel junction (CEJ), which served as a critical guide for subsequent bone management procedures. Definitive zirconia restorations were fabricated based on the digital design files of the provisional restorations, ensuring precise transfer of the planned teeth morphology. During one-year follow-up patient demonstrated stable esthetic outcomes, healthy periodontal conditions, and functional occlusal relationships. This case underscores the effectiveness of digitally guided planning combined with close interdisciplinary collaboration among the prosthodontist, oral surgeon, and dental technician in managing complex anterior rehabilitations. Pivotal component contributing to treatment success was the reproduction of new CEJ on the provisional restorations in conjunction with a vertical preparation technique, which facilitated controlled soft tissue adaptation and long-term stability. Conclusion. Integration of advanced digital workflows with biologically-oriented preparation techniques enables to provide precise control over gingival zenith positioning and supports prosthetically-driven surgical strategies in complex anterior esthetic-functional rehabilitations. Provisional restorations are pivotal for shaping the emergence profile and guiding soft tissue maturation, while the use of multilayer zirconia frameworks and digital impression protocols ensures optimal biocompatibility, accuracy, and marginal integrity. Present case report highlights that the synergy between digital planning, meticulous provisionalization, and close clinician–laboratory collaboration is a critical determinant of long-term stability, esthetic harmony, and patient satisfaction. Ethical aspects Authors confirm that they have followed all relevant ethical norms and requirements during the treatment described within present case report and preparation of present manuscript. Authors obtained full patient’s agreement regarding publication of following case report, and such was approved by corresponding consent form signed by the patient personally. No information in present case report may disclose any personal data about the patient, which further may be used for patient’s personal identification. Any information related to patient’s identity disclosure was either deleted or anonymized within present case report. Authors confirm that they have followed CARE guidelines while preparing present case report with intention for further publication. Conflict of Interest Author does not have any potential conflict of interests that may influence the decision to publish this article. Funding No funding was received to assist in preparation and conduction of this research, as well as in composition of this article.
Case report on immediate replacement for maxillary posterior teeth with fixed implant-borne restorations: need – opportunity – feasibility of avoiding conventional sinus floor elevation
Background. Development of present implant-borne prosthetic rehabilitation approaches focused on the possibility to obtain the most patient-centered outcomes considering not only functional and esthetic criteria, but also time- and cost-beneficial results. Objective. To represent potential for simultaneous usage of multiple adaptive treatment modalities, including transcrestal sinus floor elevation, angled implant positioning, implant placement within the pterygoid process and intraoral welding, in case of immediate replacement of maxillary posterior teeth with implant-borne fixed restorations. Case report. 50-year-old male patient referred to dental clinic complaining on bilateral aedentia within the distal regions of maxilla and signs of excessive tooth wear in the projection of frontal mandibular teeth. Intraoral scanning procedure helped to agree plan of proposed complex dental rehabilitation with the patient, and later intraoral scanning results were coupled with CBCT data to plan surgical stage of future interventions through specialized software. During the planning stage implant scan bodies were uploaded from the virtual library and positioned on the virtual model following obtained digital treatment plan. Such approach helped to initiate provisional dentures manufacturing within dental lab even before any surgical intervention was provided. Provisional implant-borne dentures were reinforced with the partial titanium bars disconnected from each other in the area of the pontics during modelling stage, but connected later within oral cavity by welding procedure. Considering the need for realization of immediate implant loading protocol to decrease overall treatment duration, it was decided to position needed number of implants avoiding sinus floor elevation through lateral window approach. Taking this into account dental implant in the projection of tooth 1.5 was positioned in adaptive angled positions following sinus wall projection. The lack of space within the left maxillary region did not allow us to choose the same treatment tactics in this area, so it was decided to place the implant in area of missing tooth 2.5, while providing transcrestal sinus floor elevation position before. Placement of dental implant in the projection of tooth 2.7 was provided into the pterygoid process of the sphenoid bone, considering the need in achievement of corresponding primary stability for the immediate loading approach. All implant were placed by using surgical guides manufactured with 3D printing technology within dental clinic conditions. Conclusion. Need for avoidance of conventional sinus floor elevation procedure through lateral window access may be interpreted as prerequisite condition for the realization of immediate implant loading protocol in cases of bilateral aedentia at the distal regions of maxilla. Digital planning expands possibilities for effective complex dental rehabilitation and supports reduction of overall treatment duration, nevertheless, such requires sufficient knowledge and experience for correct performance within intricated clinical conditions. Ethical aspects Authors confirm that they have followed all relevant ethical norms and requirements during the treatment described within present case report and preparation of present manuscript. Authors obtained full patient’s agreement regarding publication of following case report, and such was approved by corresponding consent form signed by the patient personally. No information in present case report may disclose any personal data about the patient, which further may be used for patient’s personal identification. Any information related to patient’s identity disclosure was either deleted or anonymized within present case report. Authors confirm that they have followed CARE guidelines while preparing present case report with intention for further publication. Conflict of Interest Author does not have any potential conflict of interests that may influence the decision to publish this article. Funding No funding was received to assist in preparation and conduction of this research, as well as in composition of this article.
Immediate dentoalveolar restoration of hopeless endodontically-treated maxillary central incisor compromised with trauma in anamnesis
Background. Realization of immediate dentoalveolar restoration approach in the projection of maxillary frontal region considered to be one of the hardest one, taking into account role of not only long-term functional but esthetic parameters that dictate success of end result. Case report described below represents successful complex approach of using immediate dentoalveolar restoration after applied conservative treatment modalities have been failed, while also blending such with mini-invasive veneering of contralateral tooth to obtain the most acceptable esthetic outcome. Objective. To present effectiveness of immediate dentoalveolar restoration approach in case of replacing hopeless central incisor compromised by trauma factor in anamnesis, while following the most conservative treatment plan. Case report. Female patient 29 years of age referred to clinical dentist with the chief complaint of tooth 2.1 unesthetic appearance. Patient complained on grayish color of tooth in general and occurrence of pink staining along cervical margin on the vestibula side, which she has noticed during last several months. Considering trauma fact in anamnesis, pink discoloration, clinically visualized defect in tooth structure and CBCT-identified defect inside the tooth crown and root, assumption of traumatic cervical invasive resorption was made. Two weeks after controlled extrusion was started intracanal post got totally extruded from tooth root, while tooth itself remained at its primary position. Considering young age of the patient, relatively favorable adjacent tissue conditions and personal consent of the patient it was agreed to provide future treatment with implant placement and screw-retained implant-borne crown following immediate dentoalveolar restoration protocol of intervention. Ten weeks after primary surgical intervention secondary soft tissue augmentation was provided and new provisional crown with modified and adaptive coronal contour was manufactured. To prevent any color mismatching it was decided to cover adjacent teeth with ceramic veneer. Such approach also optimizes possibilities to obtain full harmony in form between two adjacent incisors if one of them is restored by implant-borne crown. Conclusion. The immediate dentoalveolar restoration technique epitomizes a patient-centered therapeutic approach, wherein the dental practitioner is required to execute the atraumatic extraction of the pathological tooth, subsequently place a dental implant, augment both hard and soft tissues in the peri-implant area, and install a provisional restoration, thereby achieving a predictable functional and aesthetic result within a singular visit. Further interventions, such as soft tissue grafting or the veneering of adjacent natural teeth, may be conducted subsequently to enhance the aesthetic appearance of the smile, particularly when immediate dentoalveolar restoration is performed on the anterior maxillary dentition. Given the intricate nature of the procedures involved in immediate dentoalveolar restoration, it is imperative that these interventions be carried out by a highly skilled dentist to ensure the attainment of the most reliable outcomes. Ethical aspects Authors confirm that they have followed all relevant ethical norms and requirements during the treatment described within present case report and preparation of present manuscript. Authors obtained full patient’s agreement regarding publication of following case report, and such was approved by corresponding consent form signed by the patient personally. No information in present case report may disclose any personal data about the patient, which further may be used for patient’s personal identification. Any information related to patient’s identity disclosure was either deleted or anonymized within present case report. Authors confirm that they have followed CARE guidelines while preparing present case report with intention for further publication. Conflict of Interest Author does not have any potential conflict of interests that may influence the decision to publish this article. Funding No funding was received to assist in preparation and conduction of this research, as well as in composition of this article.
Case report of using partially epithelialized connective tissue graft for peri-implant soft tissue augmentation simultaneously with dental implant placement
Background. The novelty of present case report is related to the fact that it represents achievement of successful results of dental implant-borne rehabilitation in means of forming appropriate pink esthetic profile and sufficient peri-implant soft tissue stability while using for such purpose partially epithelized connective tissue flap simultaneously with delayed implant placement procedure, which to the knowledge of authors have been described in the specialized literature before only in scarce manner. Objective. To demonstrate clinical option of using partially epithelialized connective tissue graft for peri-implant soft tissue augmentation simultaneously with dental implant placement procedure to enhance peri-implant esthetic profile and optimize soft-tissue stability for further prosthetic rehabilitation. Case report. Patient 46 years old patient referred to the dental clinic with complaints regarding condition of mandibular fixed denture, which he was using already for 9 years. Also, patient informed dentist that he wants to improve his chewing ability by restoring edentulous distal regions of mandible with implant-borne fixed dentures. Patient previous denture was gently deattached from mandibular abutment teeth while not altering periodontal conditions of any of them during procedure. All the targeted and periodontal treatment was provided based on clinical need. Tissue level implants were placed at the projection of teeth 4.5-4.6 and 3.6-3.7 due to the conventional implant placement protocol. To compensate soft tissue collapse within the implant placement region it was decided to augment such with partially epithelialized connective tissue graft. Graft was shaped, prepared and partially de-epithelialized to overcome issue of volume excess using standard technique. Partially epithelialized connective tissue graft was positioned carefully with the manner of the epithelial portion covering dental implant part, while connective tissue portion was facing inner surface of separated flap, and was covered by a flap. Modified horizontal mattress sutures were used to secure connective tissue graft at the place while retaining its primarily established positions and guaranteeing tension-free flap closure around installed healing abutments. Results of final rehabilitation outcomes with satisfactory appearance of the soft tissue condition around fixed prosthetic construction were achieved at the end of the treatment. Conclusion. Partially epithelized connective tissue graft combines features of both connective tissue graft, which makes it suitable for mucosa thickness gain, and free gingival graft, whin in turn helps to increase width of keratinized gingiva. Such universal properties make it suitable candidate for the usage simultaneously with implant placement to enhance peri-implant esthetic profile and optimize surrounding soft-tissue stability for further prosthetic rehabilitation. Ethical aspects Authors confirm that they have followed all relevant ethical norms and requirements during the treatment described within present case report and preparation of present manuscript. Authors obtained full patient’s agreement regarding publication of following case report, and such was approved by corresponding consent form signed by the patient personally. No information in present case report may disclose any personal data about the patient, which further may be used for patient’s personal identification. Any information related to patient’s identity disclosure was either deleted or anonymized within present case report. Authors confirm that they have followed CARE guidelines while preparing present case report with intention for further publication. Conflict of Interest Author does not have any potential conflict of interests that may influence the decision to publish this article. Funding No funding was received to assist in preparation and conduction of this research, as well as in composition of this article.
Impact of an oxygen-releasing agents and supportive hygienic aids on the periodontal pocket microbiota during the treatment of patients with stage III-IV periodontitis: clinico-microbiological study
Background. Taking into account that oxygen-releasing agents are relatively new in the periodontal practice it seems to be clinically relevant to validate how such may impact the results of classical periodontal treatment approaches, if latter are modified by the additional use of active oxygen-containing substances as local therapy modality. Moreover, effect of oxygen-releasing substances used in periodontology needs to be quantified not only through the changes of clinical criteria, but also through the changes of microbiological parameters registered with the precise laboratorial approach. Objective. To provide comparative quantitative assessment of periodontal pocket microbiota changes among patients with III-IV stages of periodontitis after modification of standard scaling and root planning approaches by application of oxygen-releasing gel with supportive hygienic aids and compare effect of such with chlorhexidine-containing agents. Material and Methods. Patients with III-IV stages of periodontitis were randomly allocated either to control (20 subjects) or study group (20 subjects). Independently of group allocation all patients underwent basic non-surgical periodontal treatment according to the EFP protocols (subgingival instrumentation). Patients within control group additionally to the basic non-surgical periodontal treatment received post-instrumentational application of chlorhexidine gel into the periodontal pockets immediately after cleaning. Patients within study group additionally to the basic non-surgical periodontal treatment received post-instrumentational application of an oxygen-releasing gel, which was applied immediately after subgingival instrumentation into the periodontal pockets. The microbiological assessment of the periodontal pocket biotope was performed using the PeriodontScreen Real-time PCR test. Samples for the study were collected at different time points: before treatment, two weeks after treatment, and two months after treatment. Results. Two months after treatment Aggregatibacter actinomycetemcomitans reappeared, although in smaller quantities, in 90% of patients in the control group, however, in the study group, among patients in whom Aggregatibacter actinomycetemcomitans was not detected after two weeks, it remained undetectable even after two months. Overall, Aggregatibacter actinomycetemcomitans was identified in only 20% of the patients in the second group after two months. No significant difference in the average quantitative levels of Porphyromonas gingivalis and Porphyromonas endodontalis between two groups were observed at different time points (p > 0.05). Conclusions. Considering limitations of present study, provided analysis of the obtained data revealed that oxygen-based preparations exhibit antibacterial properties no less effective than chlorhexidine-based preparations, which allows to recommend such as additional treatment modalities for local application and home hygiene aid during complex treatment of patients with periodontitis. Taking into account registered detection levels changes after provided treatment it may also be assumed that oxygen-releasing gel demonstrated the most pronounced antibacterial properties against such pathogens as Aggregatibacter actinomycetemcomitans and Treponema denticola, particularly in 2 months long monitoring. Conflict of Interest Authors do not have any potential conflict of interests that may influence the decision to publish this article. Funding No funding was received to assist in preparation and conduction of this research, as well as in composition of this article.
Modification of surgical and positioning splint for orthognathic surgical treatment of facial asymmetry
Present short communication demonstrates innovative approach for surgical and positioning splint modification, which could improve accuracy of orthognathic surgery during facial asymmetry treatment. Usage of traditionally designed splint leads to the orientation of the midline based just on visual control, which inevitably associated with some level of maxilla deviation. It was proposed to design splint with mutually perpendicular planes in its’ frontal part at the specialized software. Such approach helps to align vertical plane of the splint with the midline vertical facial plane, while horizontal component could be aligned with the horizontal one accordingly. Proposed approach was approbated in five different clinical cases of facial asymmetry treated by orthognathic surgery. In all analyzed cases dental midline aligned perfectly with the planned one, in two cases the midline sagittal plane deviations (from ANS to PNS) resulted to be less than 2°. The horizontal occlusal plane deviations were considered clinically non-significant. Modification of the surgical splint for jaws positioning in orthognathic surgery treatment enables possibilities to check and control position of maxilla regarding reference facial planes intraoperatively, which in turn increases the accuracy of bone fragments placement and assure high precision of orthognathic surgery for asymmetric cases.
Copyright (c) 2023 The Author(s) https://creativecommons.org/licenses/by/4.0/
Evidences From Systematic Reviews Regarding Miniscrew-Assisted Rapid Palatal Expansion (MARPE) Approach In Orthodontics
Background. Miniscrew-assisted rapid palatal expansion (MARPE) has been considered as relatively novel and effective method of orthodontic treatment, but the discussion is still ongoing regarding effectiveness of MARPE for different age population groups, while also in comparison with surgically assisted rapid palatal expansion or conventional rapid maxillary expansions, since evidences available for MARPE is mostly of insufficient quality. Objective. To collect and represent evidences of MARPE treatment outcomes in orthodontics based on the data available within systematic reviews. Materials and Methods. Search was provided via PubMed Central, Web of Science and Scopus databases, while also within Cochrane Library. Only systematic reviews written in English were considered for analysis. Primary outcomes such as success rate (percentage of cases, where required maxillary width was achieved) and maxillary expansion rate in means of midpalatal split, dental intermolar width, skeletal and dentoalveolar expansion, palatal suture opening, palatal width measured in millimeters or percentage were tabulated and analyzed. Secondary outcomes were presented in descriptive manner Results. Overall 12 systematic reviews were enrolled into study group of targeted publications. Among these 12 systematic reviews primary outcomes were extracted from 8 of them, while rest 4 systematic reviews were used for analysis of secondary outcomes. Succes rate of MARPE varied in the range of 82.8-100%, while intermolar width increase after MARPE treatment – in the range of 4.79-6.55 mm. Conclusion. Considering data available within systematic reviews MARPE approach seems to be reliable orthodontic treatment option, which help to gain significant increase for skeletal and dental intermolar width among patients with maxillary transverse deficiency. Such treatment strategy provides better results than conventional rapid maxillary expansion and lesser periodontal negative consequences compare to surgical-assisted rapid palatal expansion, even though quality of data supporting these statements are insufficient and debatable.
Role of endodontic treatment related signs for the forensic odontology practice considering real-life quality of comparable radiographs
Background. Real life quality of periapical radiographic images widely varies, while also periapical radiographs not always have been taken at the same angulation, especially in multirooted tooth cases, which in turn potentially may limit the value of obtained information received during endodontic treatment for the further comparative dental identification. Objective. To objectify possibility of using real-life quality periapical radiographs obtained during endodontic treatment for the comparative dental identification. Materials and Methods. Research was organized in the form of cross-sectional hospital-based study. Copies of ten pairs of selected radiographs were distributed for the Set 1 (simulation of ante-mortem images), which contained 10 radiographs of before root canal treatment, and Set 2 (simulation of post-mortem images), which contained 10 radiographs of after endodontic interventions. Set 1 and Set 2 images were randomized, and structured via Google Form, and five teaching assistants from the Department of Restorative Dentistry were asked to match the images through provided Google Form. Results. The range of 50-80% correct pre- and post-treatment images matching levels were registered among five operators. The mean correct matching level reached 68.0 ± 7.2%. Experience within endodontics seems to be valuable regressor regarding outcome performance (p < 0.05), while additional Radiology specialization did not significantly improved performance level for matching pre- and post-treatment images (p > 0.05). Operator graded 5 out of 10 images pair as relatively easy to match, 2 images – as moderately difficult to match, and 3 images – as hard to match (Fig. 3), while their agreement on the obtained above-mentioned scores reached 0.8. Conclusion. Significance of endodontics within forensic odontology field in most cases dictated by using the results of periapical radiology as evidences of ante-mortem origin, while also considering the fact of root canal morphology uniqueness and individualized endodontic treatment pattern consistency both ante- and post-mortem even under the influence of various disturbing factors. On the other hand identification role of endodontic signs may be diminished within the absence of proper quality radiographs, or when such were provided at critically different angulations, while also when endodontic-related evidences could not be supported by dental records.
Diagnostic criteria for odontogenic sinusitis: narrative review of relevant literature data
Background. Specific tendency could be observed regarding increasing number of odontogenic sinusitis related publications within decades between 1990 and 2019, but even with upgrowing pool of literature data regarding odontogenic sinusitis evidences reported within it remains of low quality. Also, it should be noted that yet no evidence-based consensus decision have been made regarding strict diagnostic criteria of maxillary odontogenic sinusitis. Objective. To systematize relevant data regarding odontogenic maxillary sinusitis diagnostic criteria based on available guidelines, consensus reports, CBCT-based and clinical researches. Materials and Methods. Study was provided in the form of retrospective literature review. Seach of publications related with the objective of the research was held within PubMed Central database (https://www.ncbi.nlm.nih.gov/pmc/) by applying Mesh-terms combinations. Articles included into study group were processed due to the following categories of content-analysis: signs and symptoms which may be used to prove odontogenic origin of maxillary sinusitis; diagnostic significance of different manifestations which may be used to prove odontogenic origin of maxillary sinusitis; approaches which should be followed to provide correct diagnostics of odontogenic maxillary sinusitis. Results. Out of 15 targeted publications, which formed study group, 2 were represented in the form of systematic review, 1 – in the form of online-survey study, 6 – in the form of literature/comprehensive/state-of-art review, 4 – in the form of retrospective study, 1 – in the form of international multidisciplinary consensus statement, 1 – in the form of experimental imaging study. Considering only one available international multidisciplinary consensus statement regarding odontogenic sinusitis diagnosis next approach should be followed in mentioned order for correct diagnostics of such pathology: 1) suspect odontogenic maxillary sinusitis; 2) confirm sinusitis; 3) confirm odontogenic pathology. Conclusion. Tomographical methods of examination are more accurate for the odontogenic maxillary sinusitis diagnostics, nevertheless if multidisciplinary diagnostic approach (endoscopy, tomography and clinical examination) is possible for realization it should be held as a primary diagnostic strategy. Cases of asymptomatic maxillary odontogenic sinusitis, while also symptomatic ones developing without background of recent dental treatment, may also be observed in clinical practice, and thus should be correctly diagnosed for appropriate treatment planning.
Regenerative endodontics: vary of scaffolds and its benefits for pediatric dentistry
Background. Regenerative Endodontic Procedures deliver a suitable environment to promote natural regeneration/repair with a functional pulp–dentin wall and apical closure. However, REPs have a number of features that can complicate their implementation, especially for children. One of them is scaffold formation. Objective. To describe alternative scaffold formation options for pulp revitalization and compare their effectiveness and describe possible causes of periapical tissues not bleeding during endodontic regenerative procedures. Materials and methods. A comprehensive search strategy was done through PubMed and Cochrane Library databases by using MESH terms equivalent to the keywords. Review articles for the last 5 years were selected according to the keywords with exclusion criteria. Results. According to the search criteria and keywords, 801 articles were obtained, after applying the exclusion criteria, 11 ones that met the selection requirements were left. Conclusions. The main method of scaffold obtaining is the blood clot formation. However, if it is not possible to make the periapical tissues bleed for clot formation, then the use of platelet-enriched autologous plasma or platelet-rich fibrin is recommended. This technique has proven to be as effective as the main one. It can prevent painfulness caused by bleeding provoking for blood clot formation.
Artificial intelligence in endodontics: relevant trends and practical perspectives
Background. Overall pool of studies regarding artificial intelligence (AI) implementation in dentistry is increasing every year, while possibilities for using AI methods within everyday endodontic practice is still quite confined and not always enough affirmed. Objective. To systematize and depict principal data regarding use of virtual artificial intelligence for various endodontic-related clinical purposes. Materials and Methods. Targeted literature search was provided within National Center for Biotechnology Information databases using pre-specified Mesh-terms algorithm. The following information was extracted from each publication during content analysis: diagnostic and treatment planning aspects of endodontic practice for which AI methods could be applied; accuracy levels registered for AI models used for different endodontic-related purposes; limitations of using AI within endodontic practice. Results. AI features could be used in endodontic practice for the following reasons: analysis of root canal morphology, identification of root fractures, verification of periapical lesions, estimation of root canal working length, root canal treatment planning, prediction of pain development during post-treatment period, predication of endodontic interventions success. The most prevalently used artificial intelligence methods for different endodontic diagnostic and treatment planning objectives were the following: convolutional neural network, artificial neurons network, case-based reasoning, deep learning, machine learning, neuro-fuzzy inference system, probabilistic neural network. Conclusion. Main advantage of using AI models in endodontic practice associated with improvement of diagnostic accuracy within reduced amount of time needed for X-ray images and clinical data analysis. AI application for apical foramen detection and working length determination demonstrates the highest level of accuracy compared to AI performance for other clinically related objectives in endodontics.
Copyright (c) 2023 The Author(s) http://creativecommons.org/licenses/by/4.0/
Improvement of self-performed oral hygiene among patients with braces and micro-implants: approbation of specifically designed plaque-controlled regime
Background. Braces and micro-implants may serve as retention points for the dental plaque under the condition of insufficient everyday oral care, thus compromising oral hygiene level of orthodontic patients. Objective. The assess changes of oral hygiene among orthodontic patients with braces and micro-implants during the use of adapted specifically-designed plaque-controlled regime of self-performed oral hygiene measures. Material and Methods. Study group was formed out of 30 patients aged 18 to 50 years, who were planned to undergo orthodontic treatment with brace system and micro-implant. During the first month of orthodontic treatment patients used a toothbrush with thin bristles, during the second month – V-toothbrush, and during the third month – a two-row and monobundle toothbrush. The interdental hygiene was provided by the size-adjusted toothbrushes. Clinical assessment was provided with the use of hygienic indices (O’Leary, Green-Vermillion and Turesky). Results. At the period of first month after orthodontic treatment initiation O’Leary index increased abruptly to 52.6±6.4%, which stands for unsatisfactory oral hygiene level. Values of Turesky and Green-Vermillion indices increased twofold after orthodontic appliance attachment, and after first month of treatment their values were 1.98±0.31, and 2.12±0.34 points, respectively; while after third month of treatment – 0.99±0.1 and 1.19±0.14, respectively. Conclusions. Oral hygiene conditions were deteriorated among all patients, compared to the pre-treatment situation, which was caused by orthodontic appliances fixation. Oral hygiene of the patients with fixed orthodontic appliances should include usage of two-row toothbrush, which most efficiently clean the plaque above and under the brace arch; and a mono-bundle toothbrush for additional cleaning around brace locks, in gingival area, and around micro-implants.
Advantages of using micro-implant during camouflaged treatment of the non-growing Class III malocclusion: case report with in-detail discussion
Background. Camouflaged orthodontic treatment as a possible rehabilitation algorithm may be proposed for the Class III malocclusion patients without remaining growth potential. Objective. To discuss clinically significant aspects of providing camouflaged orthodontic treatment for the non-growing Class III malocclusion with the usage of temporary-anchorage devices based on presented clinical case. Materials and Methods. Primary cohort of the publications related with the camouflaged treatment of the non-growing Class III malocclusion was formed through the literature search within PubMed database using MESH-terms and the analogical keywords within Google Scholar search engine. Results. In present case report it was possible to achieve pleasant facial profile, and Class I occlusion with normal anterior-posterior relationships in patient with initial Class III malocclusion. The mandible arch length deficiency was corrected within the mandibular dentition, and normal alignment was achieved without altering the arch form and width parameter due to the use of Class III elastics and micro-implants as absolute anchorage. Systematized advantages of using skeletal anchorage for Class III orthodontic treatment include following: minimized drawback of dental-based anchorage, possibility for greater maxillary advancement, maximization of skeletal effect and minimization of clockwise mandible rotation, forming conditions for elastics wear during whole day with possibility to employ smaller traction forces, while minimizing risk of unwanted changes in any craniofacial structures. Conclusion. Camouflaged orthodontic correction is a reliable treatment option for Class III malocclusion patients without remaining growth potential. Micro-implants as skeletal anchorage devices represent reliable opportunity for camouflaged orthodontic treatment of Class III malocclusion patients and changes the need in orthognathic surgery.
Dental implants survival rates among ectodermal dysplasia patients: aggregation and synthesis of literature data
Background. Consensus statements of several international congresses and conferences include option of using dental implants as a potentially effective treatment alternative for ectodermal dysplasia patients. So far ectodermal dysplasia seems to be the most common disorder which arguments need for using dental implants among growing patients Objective. To assess survival rates of dental implants placed among patients with ectodermal dysplasia based on previous literature data. Materials and Methods. Bibliographic search of publications potentially related with the objective of present study was held through PubMed database (https://pubmed.ncbi.nlm.nih.gov/), while also via Google Scholar (https://scholar.google.com/) search engine to increase the probability for identification of corresponding scientific articles. Data extraction was provided in selective manner in terms to collect specific rates of dental implants survival observed among ectodermal dysplasia patients. Results. Provided analysis revealed that in the majority of studies approximated conventional implants survival rate exceeds 90% for the first five years. Due to the data extracted from systematic reviews implants survival rates among ectodermal dysplasia patients varied in the range of 35.7-98.7%; due to the data extracted from retrospective studies – in the range of 35.7-98.7%; due to the data extracted from prospective studies – in the range of 76-100%; due to the data extracted from critical review of literature – in the range of 88.5-97.6%. Conclusion. Provided analysis revealed that dental implants remain reliable treatment option for patients with ectodermal dysplasia. Placement of dental implants among pediatric patients with ectodermal dysplasia characterized with decreased survival rates compare to intraosseous fixtures placed among adult ED patients. Use of mini-implants helps to overcome some complications and shortcomings related with placement of conventional implants among patients with confirmed ectodermal dysplasia diagnosis.
Copyright (c) 2023 The Author(s) http://creativecommons.org/licenses/
Prevalence of delayed tooth eruption of permanent maxillary anterior teeth among Ukrainian children: retrospective radiographic study using CBCT data
Background. Tooth eruption is a complex, multi-staged, and well-regulated biological and age specific process that can be affected and influenced by many systemic and local factors. The deviation more than ±2SD from the established norm of tooth eruption terms, while also taking account racial, ethnic, and gender factors, is important for the clinician. Objective. To estimate the prevalence of delayed tooth eruption (DTE) of permanent maxillary anterior teeth among Ukrainian children sample and to investigate the epidemiology distribution of delayed eruption cases according to their causes based on CBCT data. Materials and Methods. Cone Beam Computed Tomography (CBCT) data sets of 684 children (304 boys and 380 girls) aged 7–14 years old, who previously have sought for orthodontic diagnostics in Central Laboratory Diagnosis of the Head (CLDH), were collected and examined to detect any delayed eruption of the permanent maxillary anterior teeth. Signs of delayed eruption were identified considering tooth developmental stages, relationships between the chronologic age and dental developmental age, eruption sequence. Results. The total prevalence of delayed tooth eruption of permanent maxillary anterior teeth among the 684 children was 42.84%. 293 children (155 boys and 138 girls) had at least one impacted or retained tooth. The maxillary canines the most frequently demonstrated signs of delayed eruption and compiled 30.7% of all examined cases and 71.67% of all delayed eruption cases, followed by the lateral incisors of the maxilla – 6.58% and 15.36% respectively, and the central incisors – 5.56% and 12.97% respectively. Loss of space in dental arch and the ectopic eruption pathway were the most causative factor of delayed eruption of permanent maxillary anterior teeth. Conclusions. Delayed tooth eruption of permanent maxillary anterior teeth is frequently seen in everyday orthodontic practice and requires a multidisciplinary approach of diagnostics to avoid many treatment-related complications. CBCT data is essential for timely diagnostics of DTE and primary for the causative factors identification in order to provide optimal and effective management plan for each patient.
New analysis and classiŢcation of Angle’s class II malocclusion varieties during the mixed dentition period
Introduction: It is well known that Angle's class II malocclusion is the most common of all occlusal pathology. The prevalence of this malocclusion among children remains at 35-43% and tends to increase. Class II malocclusion negatively affects not only the functions of chewing, swallowing, breathing and speech, but also life in general, especially for children and adolescents. An analysis of modern scientific papers shows that variability of class II malocclusion is insufficiently covered in published classifications. Objectives: To develop a classification of Angle's class II malocclusion forms based on the determination of angular and linear cephalometric parameters for children aged 7 to 12 years old and to analyze of their prevalence in Ukraine. Material and Methods: 138 lateral cephalometric radiographs of children aged 7 to 12 years old with Angle's class II malocclusion were selected. Cephalometric analysis by Perillo-ID method was performed on all 138 radiographs. 68 lateral cephalometric radiographs were selected for further study. Results: Cephalometric analysis by Perillo-ID method on 68 lateral cephalograms in children aged 7-12 years old showed a wide range of variability forms of Angle's class II malocclusion. The results of 7 angular and 4 linear parameters allowed to create a classification of Angle's class II malocclusion forms and sizes, taking into consideration the position of the lower jaw in children during the mixed dentition period. Conclusions: Authors modified Perillo's cephalometric analysis, which allowed to create a detailed classification of Angle's class II malocclusion forms for children during the mixed dentition period. The new classification will allow to clearly differentiate the etiology of malocclusion, to differentiate the true mandible underdevelopment from its retroposition or rotation.
Copyright (c) 2022 The Author(s) http://creativecommons.org/licenses/by/4.0/
Clinical experience for Porphyromonas gingivalis detection in the cerebrospinal ţuid of patients with inţammatory diseases of the central nervous system and periodontitis
Background. Porphyromonas. gingivalis is one of the most aggressive periodontopathogens causing periodontitis. Present scientific evidence proves the possibility of the influence of P.gingivalis on the pathogenesis of inflammatory diseases of the central nervous system. Objective. To verify frequency of P.gingivalis detection within the cerebrospinal fluid of patients affected by various types of CNS inflammatory diseases. Material and Methods. Cerebrospinal fluid of 36 patients, aged 18 to 79 years, with various infectious diseases of the central nervous system was analyzed during two years of study. Real-time PCR technique was used for P.gingivalis detection. Results: 13 patients out of 36 demonstrated the presence of P.gingivalis within cerebrospinal fluid. 4 of them were diagnosed with meningoencephalitis, 3 patients had fever of unknown origin, at that one of them had Parkinson's disease, 3 patients had acute disseminated unspecified demyelination, 1 had multiple sclerosis, 1 had unspecified cerebrovascular disease. 77% of the total number of patients in whom P.gingivalis was detected in the cerebrospinal fluid, also were diagnosed with periodontitis. Conclusions: Based on the data obtained, it can be assumed that P.gingivalis plays a significant role in the pathogenesis of inflammatory diseases of the central nervous system. Sanitation of the oral cavity and timely treatment of periodontal diseases can significantly reduce the incidence of inflammatory diseases of the central nervous system.
Copyright (c) 2022 The Author(s) https://creativecommons.org/licenses/by/4.0/
Treatment options for dens in dente: state-of-art literature review
Background. Dens in dente represents developmental anomaly of tooth structure, characterized with different depth of invagination lined with either enamel or cementum, and associated with different clinical and roentgenological features. Objective. To methodize available treatment options for dens invaginatus in systematic manner and analyze suitability of such for different clinical scenarios. Materials and Methods. Aggregation of data regarding treatment options for dens invaginatus cases was provided through literature search within Pubmed Central and PubMed databases. Literature review was provided in accordance to the available guidelines. Results. Provided literature review helped to establish four main strategies of treating teeth with present dens invaginatus anomaly: 1) preventive treatment (with no endodontic intervention); 2) preventive treatment (with endodontic intervention only in invaginated canal); 3) treatment of dens invaginatus-associated complications (with endodontic treatment of original and invaginated canals); 4) complex treatment of dens invaginatus-associated complications, which includes not only root canal treatment, but also periodontal treatment and other potential treatment options, such as extraction. Conclusion. Dens invaginatus represents several clinical challenges during the treatment related with type of structural anomaly due to the Oehlers classiŢcation, variability of its conŢguration, depth of invagination and its localization within coronal or root portion of tooth, proximity to the pulp and pretreatment pulp and periodontium vitality conditions, while also with periapical status in means of apex size and thickness of root residual walls.
Clinical aspects of tooth autotransplantation and post-endodontic restoration of autrotransplanted tooth: case-based literature review
Introduction. Tooth autotransplantation allows to maintain a vital status of periodontal ligament, which supports the preservation of the alveolar bone volume, better conservation of the interdental papilla and the possibility of dental movement through orthodontic forces. It has been shown that longevity and prognosis of autotransplanted teeth are comparable with those of dental implants. Objective. To discuss major practically-oriented aspects regarding tooth autotransplantation operation including further post-endodontic restoration based on presented clinical case. Materials and Methods. A bibliographic search was conducted in April 2022 by the using MESH terms equivalent to the keywords “tooth” and “autotransplantation” within the Cochrane Library and PubMed database with the aim to identify publications related with practical aspects of tooth autotransplantation presented in clinical case. Data extraction during content-analysis of selected publications was provided selectively in terms to represent the most practically valuable information regarding tooth autotransplantation operation, principles of tooth autotransplantation surgery and further post-endodontic restoration of autotransplanted tooth taking into account aspects highlighted in present clinical case. Results. Due to the provided literature review it was highlighted that success rate of tooth autotransplantation is highly inţuenced by such factors as the stage of root development, morphology of the tooth, selected surgical procedure, time of extraoral exposure of donor tooth, shape of the recipient socket, vascularity of the recipient site, and the vitality of the periodontal ligament cells, impact of which was considered during presented clinical case. Conclusions. Present clinical case report with accompanied literature review arguments the clinical perspective of tooth autotransplantation procedure as valuable treatment option, and highlights major practically-oriented aspects regarding tooth autotransplantation operation including further post-endodontic restoration of donor tooth. Synergy of tooth autotransplantation and post-endodontic restoration protocols in the hands of an experienced doctor who is ready to carefully follow the scientiŢc evidence-based protocol associated with successful outcome of provided treatment.
Demirjian’s dental age estimation accuracy among Ukrainian. Transcarpathian children sample: pilot study
Background. Number of forensic methods have been proposed for dental age estimation, while parameter of dental age itself is demonstrating a high level of correspondence with chronological age. Analysis of available literature revealed deŢciency of studies regarding applicability of using Demirjian’s age estimation technique among Ukrainian samples for forensic purpose. Objective. To evaluate accuracy of original Demirjian’s dental age estimation method amongsamp le of Ukrainian Transcarpathian children. Materials and Methods. Study was organized as retrospective by the design based on the analysis of 276 digital panoramic X-ray images obtained from the patients of University Dental Clinic aged 6.0-15.99 years old. Dental age estimation was held by the originally proposed Demirjian’s technique. Results. Dental age estimation using Demirjian’s technique provoked overestimation effect on 0.43 years among patients aged 6.0-6.99 years, on 0.49 years among patients aged 7.0-7.99 years, on 0.47 years among patients aged 8.0-8.99 years, on 0.55 years among patients aged 9.0-9.99 years, on 0.51 years among patients aged 10.0-10.99 years, on 0.55 years among patients aged 11.0-11.99 years, on 0.44 years among patients aged 12.0-12.99 years, on 0.45 years among patients aged 13.0-13.99 years, on 0.54 years among patients aged 14.0-14.99 years, on 0.58 years among patients aged 15.0-15.99 years. Conclusion. Demirjian’s dental age estimation technique may be used for forensic purposes among population of children from Ukrainian Transcarpathia, if accuracy of other available dental age estimation methods would not be validated till the moment of needed forensic investigation.
Tooth autotransplantation: review of the relevant procedural aspects for the clinical success
Background. Tooth autotransplantation may be considered as valuable treatment option to overcome adverse effects of tooth loss and prevent implant-related complications. The essence of such manipulation based on removing targeted (donor) tooth from its present location with its further placement at some other tooth position within the oral cavity of the same patient in the least traumatic way. Objective. To systematize and analyze relevant procedural aspects of tooth autotransplantation associated with its’ clinical success. Materials and Methods. A comprehensive search strategy was realized through databases PubMed (https://pubmed.ncbi.nlm.nih.gov/) and Cochrane Library (https://www.cochranelibrary.com/), and also via Google Scholar (https://scholar.google.com/) search engine to expand possibilities for targeted publications identification. Primary extraction of the targeted studies was provided by their title and abstract. The criteria for eligibility included publications with described original practical and theoretical aspects regarding tooth autotransplantation procedure, while publications with repetitive information or non-sufficiently argumented/non evidence based statements were excluded from further analysis. Results. The final number of eligible studies for analysis was 82 publications with adequate reporting of outcomes associated with present research objective. Out of this number 8 were presented in the form of systematic reviews, 3 in the form of literature reviews, while all others were presented in forms of case reports, case series, protocols, recommendations, follow-ups, experimental and clinical studies. Conclusion. Correct surgical manipulations, which should be as atraumatic as possible to preserve the periodontal ligament of the transplanted tooth, is a key of autotransplantation successful outcome. The success of the treatment is also related with the stage of root development. In cases of transplanting the teeth with complete root development endodontic treatment should be performed approximately in 2 weeks after primary intervention.