Oral, Volume 4, Issue 2 (June 2024) – 5 articles

Background: In low- and middle-income countries, oral health is frequently marginalized due to limited dental care access. This cross-sectional study assesses the outcomes of dental outreach camps in Zanzibar, Tanzania, organized in 2019 and 2023, to understand their impact on addressing local oral health needs over a four-year span. Methods: The study involved a thorough examination and analysis of clinical dental health data from both outreach camps. In 2019, 224 patients were examined, and in 2023, the number increased to 354. The assessment covered various dental health parameters, including dental caries, DMFT/dmft indices, enamel fluorosis, dental trauma, oral mucosa lesions, and non-carious tooth surface loss. Results: The analysis demonstrated a significant reduction in dental caries among adolescents and teens, decreasing from 62.5% in 2019 to 35.59% in 2023 (p < 0.0001). Similarly, the prevalence of teeth missing due to caries showed marked reductions from 40.2% to 9.04% in adolescents and teens (p < 0.0001) and from 25.89% to 11.86% among preschool and school-aged children (p = 0.004). Moreover, a significant change was observed in the Basic Erosive Wear Examination (BEWE) scores, with cases showing no erosive tooth wear (BEWE = 0) decreasing from 49.1% to 33.3% (p = 0.016), and cases with initial loss of enamel surface texture (BEWE = 1) increasing from 47.3% to 61% (p = 0.044). Conclusions: The outreach camps conducted in 2019 and 2023 showed tangible improvements in certain dental health metrics, particularly a reduction in dental caries and missing teeth due to caries among adolescents and teens. However, the uptick in non-carious tooth surface loss points to emerging dental health concerns. These results underline the importance of sustained and targeted dental health interventions to improve oral health outcomes in underserved communities such as Zanzibar. Full article

An anterior open bite is a dental malocclusion, the diagnosis of which is fundamental for its treatment. With the evolution of artificial intelligence, it is possible to treat it through the Invisalign G4 protocol, depending on the degree of severity. The aim of this study was to perform a systematic review, based on the PICO strategy, to evaluate the effectiveness of aligners and accessory devices in adult patients with anterior open bites. The search was carried out in the following databases for publications over the last ten years: PubMed, Web of Science, Cochrane Library, and LILACS. The inclusion criteria were clinical studies evaluating adults with anterior open bites (overbites < 0 mm) and orthodontic studies with aligners. The exclusion criteria were studies of cases with dentofacial deformities, previous orthodontic treatment, history of surgery/trauma, or systemic diseases that affect craniofacial growth, as well as animal studies, reviews, and clinical cases. The selection was carried out separately by two researchers. In the four databases, 108 articles were obtained. By reviewing the titles and abstracts and applying the exclusion criteria, 91 articles were eliminated. The seven resulting articles were submitted to the inclusion criteria, two of which were excluded due to their lack of patients presenting an open bite and the absence of aligner treatment. According to the PRISMA method, five studies were selected. The collected data showed an increase in overbites with the use of aligners. The bias assessment was performed with the ROBINS-I tool, indicating a moderate risk of bias. The included studies demonstrated the effectiveness of aligners in the treatment of adults with mild or moderate open bites; however, due to the lack of scientific evidence, it is necessary to carry out randomized studies with the same standardized variables. Full article

Endodontic treatments are performed to avoid extractions and maintain the natural dentition. Root canal treatments are undertaken to eliminate or prevent an infection within the root canal system. Chemical and mechanical root canal debridement are the main methods used in endodontics to remove necrotic tissue, microorganisms, and microbial byproducts from the canal. However, to date there is no objective method to clinically determine the proper root canal disinfection level and thus proceed with the obturation. Clinicians just rely on their experience and habits or can trust in empirical methods such as the insertion of paper cones inside the canal and then check their appearance after the removal. Even in the in vitro and ex vivo scientific studies there is no objective method to analyze and compare the efficacy of different endodontic chemo-mechanical techniques and materials. The most frequently used method is to visually analyze some areas with a scanning electron microscope (SEM), even if the resulting images are hardly quantifiable and could greatly vary according to the analyzed area. A new device to clinically test the cleanliness of a root canal and display the result in an objective score was recently developed. The device analyzes the luminescence generated by an enzyme cycling method that process the adenosine triphosphate (ATP), adenosine diphosphate (ADP) and adenosine monophosphate (AMP) present in organic residues. The aim of the present in vitro study was to test the efficacy and reliability of this novel device (Endocator) in a controlled in vitro environment, before using it in clinical practice. The device sensitivity was tested on 5 single canal resin blocks. Three consecutive sampling were executed by one operator for each block to test the device repeatability. Results were recorded according to Endoscore (ES) and relative light unit (RLU) scales. Descriptive analysis and comparison between the 5 resin blocks and the 3 consecutive sampling were performed. Only the comparison between the first and third measurements both for ES (p = 0.00115999) and RLU (p = 0.00532749) resulted significant. Endocator was able to determine small variations of canal contamination in a controlled laboratory environment, showing high sensitivity and repeatability. Full article

Scientific advances in biosensor technology are leading to the potential of wearable biosensors for salivary biomarker detection. This review aims to identify the current status of intraoral biosensor technology that can be used to monitor systemic diseases. A total of 11 studies were identified for inclusion, which included nine different devices, including modified mouthguards, retainers, toothbrushes, and dental floss. Out of the 11 studies, 8 studied continuous biomarker monitoring, and the remaining 3 were point-of-care applications. A total of seven biomarkers were studied, six of which investigated the intraoral detection of salivary glucose levels using glucose oxidase enzyme. All the sensors demonstrated excellent sensitivity (minimum R = 0.9928) and selectivity. The study designs were proof of concept, with five studies including in vivo components. We concluded that while there are established links between salivary biomarkers and systemic health, there is a lack of mature intraoral biosensor research. Refinement of biosensor design and data analysis is required to improve patient acceptability by promoting more discrete, real-time, low-cost, and wireless devices. Further research that utilises the biosensor technology in large controlled clinical trials will be required to confirm clinical applicability before intraoral biosensor technology can be integrated into routine health monitoring. Full article

Background: A range of psychosocial and aesthetic factors motivate patients to undergo orthodontic treatment. The appliance choice depends not only on the type of malocclusion, but also on the aesthetic and functional demands of the patients themselves. Nowadays, digital planning enables the manufacture of individualised and customised orthodontic appliances. However, the predictability of movements with aligner treatment has long been under discussion. This article illustrates, through a series of case reports, how a hybrid approach combining individualised aesthetic orthodontic appliances can improve the predictability of tooth movements, thereby providing additional tools for clinicians charged with choosing the best indicated and biomechanically advantageous technique. To this end, three patients with different malocclusions were treated via a hybrid approach involving clear aligners in the upper arch followed by lingual fixed appliances in the upper and lower arches. All patients were treated using ALIAS lingual PSL 0.018 × 0.018-inch slot brackets and in-house 3D-printed aligners. Findings: The hybrid approach combining aligners and fixed lingual appliances led to the successful resolution of all three complex cases in the series without prolonging treatment time. The superimpositions demonstrate the predictability of even traditionally difficult movements. In particular, the Alias PSL lingual system, used from the beginning, enabled good control of both the torque and inclination of the lower incisors. Conclusions: Combining clear aligners and fixed lingual appliances provides a highly efficient means of treating malocclusions aesthetically. In our cases, the aligners offset the lack of bite-plate effect from the lingual brackets and appliances, providing advantageous biomechanics for rotation correction and control of tip, torque and root movements. Understanding how to exploit the strengths of each appliance enables the clinician to treat adult patients efficaciously, efficiently and aesthetically. Full article