Summary The purpose of our review was to synthesize the existing literature about the prevalence of adenoid hypertrophy in children and adolescents confirmed by the reference standard – the ...nasoendoscopy. Six electronic databases and grey literature were searched. Studies were included if they reported the prevalence of adenoid hypertrophy confirmed via nasoendoscopy. Studies involving participants with associated comorbidities, fully diagnosed sleep apnea in their sample were excluded. The MAStARI tool assessed the potential risk of bias (RoB) among the studies, while the GRADE approach determined the level of evidence. A total of 5,248 patients were included. Seventeen studies were included in the meta-analysis showing an adenoid hypertrophy prevalence of 49.70% (CI: 39.92 to 59.50). The studies were then divided into 3 groups based on the RoB and patient selection method. The adenoid hypertrophy prevalence for Groups 1, 2 and 3 were 42.18% (CI: 34.93 to 49.60; n=2,794), 70.02% (CI: 40.102 to 92.690; n=538) and 34.46% (CI: 10.507 to 63.742; n=1,446) respectively. High heterogeneity between the studies was found. The GRADE approach classified the quality of evidence as moderate. In a randomized representative population, the prevalence of adenoid hypertrophy was 34.46%; however, in convenience samples the prevalence ranged from 42-70%.
The current methods to image alveolar bone in humans include intraoral 2D radiography and cone-beam computed tomography (CBCT). However, these methods expose the subject to ionizing radiation. ...Therefore, ultrasound imaging has been investigated as an alternative technique, as it is both non-invasive and free from ionizing radiation. In order to assess the validity and reliability of ultrasonography in visualizing alveolar bone, a systematic review was conducted comparing ultrasound imaging to CBCT for examination of the alveolar bone level.
Seven databases were searched. Studies addressing examination of alveolar bone level via CBCT and ultrasound were selected. Risk of bias under Cochrane guidelines was used as a methodological quality assessment tool.
All the four included studies were ex vivo studies that used porcine or human cadaver samples. The alveolar bone level was measured by the distance from the alveolar bone crest to certain landmarks such as cemento-enamel junction or gingival margin. The risk of bias was found as low. The mean difference between ultrasound and CBCT measurements ranged from 0.07 mm to 0.68 mm, equivalent to 1.6% - 8.8%.
There is currently preliminary evidence to support the use of ultrasonography as compared to CBCT for the examination of alveolar bone level. Further studies comparing ultrasound to gold standard methods would be necessary to help validate the accuracy of ultrasonography as a diagnostic technique in periodontal imaging.
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DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Complications after adenotonsillectomy (AT) in children have been extensively studied, but differences between children with and without obstructive sleep apnea (OSA) have not been systematically ...reported. Our objective was to identify the most frequent complications after AT, and evaluate if differences between children with and without OSA exist.
Several electronic databases were searched. A partial gray literature search was undertaken by using Google Scholar. Experts were consulted to identify any missing publications. Studies assessing complications after AT in otherwise healthy children were included. One author collected the required information from the selected articles. A second author crosschecked the collected information and confirmed its accuracy. Most of the selected studies collected information from medical charts.
A total of 1254 studies were initially identified. Only 23 articles remained after a 2-step selection process. The most frequent complication was respiratory compromise (9.4%), followed by secondary hemorrhage (2.6%). Four studies compared postoperative complications in children with and without OSA, and revealed that children with OSA have nearly 5 times more respiratory complications after AT than children without OSA (odds ratio = 4.90; 95% confidence interval: 2.38-10.10). In contrast, children with OSA are less likely to have postoperative bleeding when compared with children without OSA (odds ratio = 0.41; 95% confidence interval: 0.23-0.74).
The most frequent early complications after AT are respiratory compromise and secondary hemorrhage. Based on the current limited evidence, children with OSA appear to have more respiratory complications. Conversely, hemorrhage appears to be more frequent in children without OSA.
Introduction Our objective was to identify factors associated with orthodontic treatment satisfaction of patients and their caregivers, when applicable. Methods MEDLINE via Ovid, PubMed, EBM Reviews ...and EMBASE via OVIDSP, LILACS, Web of Science, and Google Scholar were searched electronically. Reference lists of included articles were also screened for potential relevant studies missed during the electronic searches. Studies evaluating the satisfaction levels of patients or caregivers after orthodontic treatment were considered. Methodologic quality of the included studies was assessed using a modified Newcastle-Ottawa scale. Results Eighteen studies satisfied the inclusion criteria, representing 2891 patients and 464 parents. The risk of bias was moderate in 13 and low in 4 of the included articles. The studies used different questionnaires and timings to assess postorthodontic treatment satisfaction. Based on the available limited evidence, satisfaction was associated with perceived esthetic outcomes, psychological benefits, and quality of care. The latter was specifically linked to dentist-staff-patient interactions. Dissatisfaction was associated with treatment duration, pain levels and discomfort, and the use of retention appliances. When both assessments were available, the patient's and the parent's satisfaction levels were strongly correlated. Conclusions Based on the limited available evidence with moderate risk of bias, we identified factors that appear to be more commonly associated with a high or low level of satisfaction. Consideration of these factors could be important for practitioners attempting to set realistic expectations of their patients and caregivers regarding orthodontic treatment outcomes.
The purpose of this systematic review was to evaluate the potential use of dental imaging assessment of trabecular bone structure in the maxillomandibular complex as an adjuvant screening tool to ...identify systemic disorders. Five electronic databases and grey literature were searched. Studies were included if they investigated subjects with altered trabecular bone determined by dental radiographs. The QUADAS‐2 assessed the risk of bias (RoB) among the studies, while the GRADE determined the strength of evidence. A total of 14 studies that included 1,466 individuals were considered eligible for the qualitative analysis. All studies presented an overall low RoB and low concern regarding applicability. Systemic disorders such as osteoporosis, osteogenesis imperfecta, diabetes, and primary hyperparathyroidism, with their respective control groups, were analyzed among the included studies. Osteoporosis was the condition presenting the most significant results, and 72% of the studies detected changes in the maxillomandibular trabecular bone structure. Studies exploring diabetic edentulous patients found less dense trabecular bone pattern (p < 0.05). In summary, periapical and panoramic radiographs, computed tomography, and cone beam computed tomography imaging could be considered useful for the assessment of the mandibular trabecular bone structure of patients affected by osteoporosis and patients with diabetes.
Summary The overall validity of biomarkers in the diagnosis of obstructive sleep apnea (OSA) remains unclear. We conducted a scoping review to provide assessments of biomarkers characteristics in the ...context of obstructive sleep apnea (OSA) and to identify gaps in the literature. A scoping review of studies in humans without age restriction that evaluated the potential diagnostic value of biological markers (blood, exhaled breath condensate, salivary, and urinary) in the OSA diagnosis was undertaken. Retained articles were those focused on the identification of biomarkers in subjects with OSA, the latter being confirmed with a full overnight or home-based polysomnography (PSG). Search strategies for six different databases were developed. The methodology of selected studies was classified using an adaptation of the evidence quality criteria from the American Academy of Pediatrics. Additionally the biomarkers were classified according to their potential clinical application. We identified 572 relevant studies, of which 117 met the inclusion criteria. Eighty-two studies were conducted in adults, 34 studies involved children, and one study had a sample composed of both adults and children. Most of the studies evaluated blood biomarkers. Potential diagnostic biomarkers were found in nine pediatric studies and in 58 adults studies. Only nine studies reported sensitivity and specificity, which varied substantially from 43% to 100%, and from 45% to 100%, respectively. Studies in adults have focused on the investigation of IL-6, TNF-α and hsCRP. There was no specific biomarker that was tested by a majority of authors in pediatric studies, and combinatorial urine biomarker approaches have shown preliminary promising results. In adults IL-6 and IL-10 seem to have a favorable potential to become a good biomarker to identify OSA.
When educators adopt flipped learning in their courses, online sources are assigned for students to study prior to class, and then the class period is devoted to face‐to‐face (F2F) interactions. The ...aims of this systematic review were to evaluate published research on the effectiveness of flipped learning for dental students' learning and on dental students' perceptions of the model and to report the results based on the first two phases of Kirkpatrick's model: reaction and learning. A systematic review based on the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis Protocols (PRISMA‐P) was performed. Articles in which the objective was to determine the effectiveness of students' learning or students' perceptions of flipped learning in both dental and advanced dental education were collected. The Risk of Bias of the included studies was assessed using the MINORS Grading of Recommendations Assessment, Development, and Evaluation (GRADE) Summary of Findings table. The authors screened the title and of 650 studies; after application of inclusion criteria, eight articles remained for analysis. In those studies, a total of 572 dental students were participants. The effectiveness of flipped learning and conventional lectures was compared in five of the eight studies; three of the studies compared students' perceptions of flipped learning and the conventional format; and four of the studies assessed students' perceptions of flipped learning without comparison to another methodology. The findings suggest that flipped learning was an effective way to deliver knowledge in these eight studies. Time flexibility was a particular asset found in this review since flipped learning allowed each student to assimilate the educational material at her or his own pace.
To evaluate short- and long-term mandibular dental arch changes in patients treated with a lip bumper during the mixed dentition followed by fixed appliances, compared with a matched control sample.
...Dental casts and lateral cephalograms obtained from 31 consecutively treated patients before (T0) and after (T1) lip bumper, after fixed appliances (T2), and a minimum of 3 years after fixed appliances (T3) were analyzed. The control group was matched as closely as possible. Arch width, arch perimeter, arch length, and incisor proclination were evaluated. Repeated measures ANOVA was used to analyze changes in measurements over all four time points between treatment and control groups.
Arch widths and crowding were always significantly different except at T2-T1. At T1-T0, only crowding decreased 3.2 mm while intercanine, interpremolar, and intermolar widths increased by 3.8, 3.3, and 3.9 mm, respectively. Changes at T3-T2 showed a significant decrease of 2.1 mm for crowding and an increase of 3.5, 2.9, 2.7, and 0.8 mm for intercanine, interpremolar, and intermolar widths and arch perimeter, respectively. Finally, at T3-T0, the reduction in crowding of 5.03 mm was significant and clinically important in the treated group. The differences between intercanine, interpremolar, and intermolar widths were also significant (2.1, 3.8, and 3.6 mm, respectively). All those differences favored the treated group.
Mandibular dental arch dimensions were significantly changed after lip bumper treatment. At follow-up, all arch widths were slightly decreased, generating an increase of 0.4 mm in crowding, considered clinically irrelevant. Overall changes remained stable after an average 6.3-year follow-up.
The purpose of this systematic review is to evaluate the diagnostic value of biological markers (exhaled breath condensate, blood, salivary and urinary) in the diagnosis of OSA in comparison to the ...gold standard of nocturnal PSG.
Studies that differentiated OSA from controls based on PSG results, without age restriction, were eligible for inclusion. The sample of selected studies could include studies in obese patients and with known cardiac disease. A detailed individual search strategy for each of the following bibliographic databases was developed: Cochrane, EMBASE, MEDLINE, PubMed, and LILACS. The references cited in these articles were also crosschecked and a partial grey literature search was undertaken using Google Scholar. The methodology of selected studies was evaluated using the 14-item Quality Assessment Tool for Diagnostic Accuracy Studies.
After a two-step selection process, nine articles were identified and subjected to qualitative and quantitative analyses. Among them, only one study conducted in children and one in adults found biomarkers that exhibit sufficiently satisfactory diagnostic accuracy that enables application as a diagnostic method for OSA.
Kallikrein-1, uromodulin, urocotin-3, and orosomucoid-1 when combined have enough accuracy to be an OSA diagnostic test in children. IL-6 and IL-10 plasma levels have potential to be good biomarkers in identifying or excluding the presence of OSA in adults.
Abstract Introduction Investigating the vertical root fracture (VRF) pathway under different clinical scenarios may help to diagnose this condition properly. We aimed to determine the capability and ...intrareliability of VRF pathway detection through cone-beam computed tomographic (CBCT) imaging as well as analyze the influence of different intracanal and crown materials. Methods VRFs were mechanically induced in 30 teeth, and 4 clinical situations were reproduced in vitro : no filling, gutta-percha, post, and metal crown. A Prexion (San Mateo, CA) 3-dimensional tomographic device was used to generate 104 CBCT scans. The VRF pathway was determined by using landmarks in the Avizo software (Version 8.1; FEI Visualization Sciences Group, Burlington, MA) by 1 observer repeated 3 times. Analysis of variance and post hoc tests were applied to compare groups. Results Intrareliability demonstrated an excellent agreement (intraclass correlation coefficient mean = 0.93). Descriptive analysis showed that the fracture line measurement was smaller in the post and metal crown groups than in the no-filling and gutta-percha groups. The 1-way analysis of variance test found statistically significant differences among the groups measurements. The Bonferroni correction showed statistically significant differences related to the no-filling and gutta-percha groups versus the post and metal crown groups. Conclusions The VRF pathway can be accurately detected in a nonfilled tooth using limited field of view CBCT imaging. The presence of gutta-percha generated a low beam hardening artifact that did not hinder the VRF extent. The presence of an intracanal gold post made the fracture line appear smaller than it really was in the sagittal images; in the axial images, a VRF was only detected when the apical third was involved. The presence of a metal crown did not generate additional artifacts on the root surface compared to the intracanal gold post by itself.
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