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Objectives To evaluate overall image quality and visibility of anatomic structures on low-dose cone beam computed tomography (CBCT) scans and the effect of a noise reduction filter for assessment of the anterior maxilla. Methods We obtained 48 CBCT volumes on eight skull-phantoms using six protocols: two clinical default protocols [standard definition (SD) and high definition (HD)] and four low-dose protocols, two with a noise reduction filter [ultra-low-dose with high definition (ULDHD) and ultra-low-dose (ULD)] and two without [low-dose with high definition (LDHD) and low-dose (LD)]. Overall image quality and visibility of eight anatomic structures were assessed by five observers and statistically analyzed using the Wilcoxon signed rank test. Intra- and interobserver agreement was measured using Cohen's weighted kappa. Results HD provided higher overall image quality than diagnostically required; LD scored lower than diagnostically acceptable. ULDHD, ULD, and LDHD were acceptable. For anatomic structures, ULDHD and ULD were acceptable. LDHD and LD showed significantly inferior visibility for one and four structures, respectively. Mean values of intra- and interobserver agreement were 0.395-0.547 and 0.350 -0.370, respectively. Conclusions ULDHD, ULD, and LDHD may be recommended for assessment of impacted maxillary canines. The noise reduction filter affects image quality positively only at low exposure.

Objective: To investigate how cone beam computed tomography (CBCT) affects the therapeutic planning of impacted maxillary canines. Study Design: A total of 132 impacted canines from 89 pediatric patients were collected from 3 specialist clinics in Stockholm, Sweden. An interdisciplinary therapy planning team consisting of 5 dental specialists evaluated each case and chose their preferred treatment alternative, initially without and later with CBCT images, to decide whether CBCT was justified for therapy planning. Predefined variables measurable using only 2-dimensional (2D) assessments were analyzed using stepwise logistic regression analyses. Results: The CBCT was considered indicated in 47% of the cases. Additional information from CBCT led to a treatment decision change in 9.8%. Significant 2D predictors for CBCT justification were horizontal canine angulation compared with vertical angulation (odds ratio [OR] = 10.9), extraction strategy involvement (OR = 6.7), and buccally positioned canines compared with palatal (OR = 5.3), central (OR = 25.0), and distal or uncertain positions (OR = 7.7). Conclusions: The benefit-risk assessment of CBCT for impacted canines may be reinforced by performing and applying justification decisions for CBCT acquisition at the therapeutic thinking level. If preliminary treatment planning motivates further in-depth investigation of either root status or tooth location, a CBCT is indicated. publishedVersion

Objectives The present study evaluated the effect of rapid maxillary expansion (RME) on the morphology of the upper airway (UA) by calculating cross-sectional areas and volumes and comparing the effect in patients with a normal-sized adenoid with the effect in patients with an enlarged adenoid. Study design: Seventeen patients met the inclusion criteria. We constructed 3D models of the UA on cone-beam computed tomography images to calculate cross-sectional areas and volumes at the levels of the nasopharyngeal, retropalatal, and retroglossal airways. Patients were divided into two groups: group 1 was comprised of patients with an adenoidal nasopharyngeal (AN) ratio < 0.6 and group 2 with an AN ratio ≥ 0.6. Paired samples t-tests assessed any area and volumetric changes of the UA after RME. Changes in degree of nasal obstruction, calculated as the AN ratio, was then compared for the two groups. An independent samples t-test compared volumetric changes in the nasopharynx between the two groups before and after RME. Results Changes in cross-sectional areas and volumes of the UA due to RME were not significant. The effects of RME on AN ratio (11 % vs 0 %) and nasopharyngeal volume (36.8 % vs 5.97%) were somewhat larger in group 2 patients who had adenoid-associated nasal obstruction compared with group 1 patients with a normal-sized adenoid; however, the differences were not significant. Conclusions After RME, the patients with an enlarged adenoid had more increases in nasopharyngeal volume compared with those with normal adenoid, despite there was no significant difference.

Dysregulated growth factor receptor pathways, RNA modifications, and metabolism each promote tumor heterogeneity. Here, we demonstrate that platelet-derived growth factor (PDGF) signaling induced N6-methyladenosine (m(6)A) accumulation in glioblastoma (GBM) stem cells (GSCs) to regulate mitophagy. PDGF ligands stimulated early growth response 1 (EGR1) transcription to induce Methyltransferase-Like 3 (METTL3) to promote GSC proliferation and self-renewal. Targeting the PDGF-METTL3 axis inhibited mitophagy by regulating m(6)A modification of optineurin (OPTN). Forced OPTN expression phenocopied PDGF inhibition and OPTN levels portend longer survival of GBM patients, suggesting a tumor suppressive role for OPTN. Pharmacologic targeting of METTL3 augmented anti-tumor efficacy of PDGF receptor (PDGFR) and mitophagy inhibitors in vitro and in vivo. Collectively, we define PDGF signaling as upstream of oncogenic m(6)A regulation driving tumor metabolism to promote cancer stem cell maintenance, highlighting PDGF-METTL3-OPTN signaling as a GBM therapeutic target.

The aim of the study was to estimate and to compare effective doses in the elbow region resulting from four different x-ray imaging modalities. Absorbed organ doses were measured using 11 metal oxide field effect transistor (MOSFET) dosimeters that were placed in a custom-made anthropomorphic elbow RANDO phantom. Examinations were performed using Shimadzu FH-21 HR radiography device, Siemens Sensation Open 24-slice MSCT-device, NewTom 5G CBCT device, and Planmed Verity CBCT device, and the effective doses were calculated according to ICRP 103 recommendations. The effective dose for the conventional radiographic device was 1.5 mu Sv. The effective dose for the NewTom 5G CBCT ranged between 2.0 and 6.7 mu Sv, for the Planmed Verity CBCT device 2.6 mu Sv and for the Siemens Sensation MSCT device 37.4 mu Sv. Compared with conventional 2D radiography, this study demonstrated a 1.4-4.6 fold increase in effective dose for CBCT and 25-fold dose for standard MSCT protocols. When compared with 3D CBCT protocols, the study showed a 6-19 fold increase in effective dose using a standard MSCT protocol. CBCT devices offer a feasible low-dose alternative for elbow 3D imaging when compared to MSCT.

Background Preterm birth has been shown to cause various long-term health issues. Children who were born preterm have also been observed to have more dental behaviour management problems (DBMP) during dental examinations and treatment than children born full term. It is known that dental radiographic examinations can be uncomfortable and cause anxiety in paediatric patients. Thus, our aims were to retrospectively compare dental care related examinations and treatments carried out in three different age intervals (3–6 years, 7–12 years, and 13–19 years) among preterm- and full-term born children and adolescents. Methods The present study included 311 patient files: 122 very preterm–born and 33 extremely preterm–born children and adolescents ( Results Extremely preterm–born children missed significantly more dental appointments and presented with more DBMP during dental examinations and treatment than full term–born children in the 3–6-year age group; the same was observed for the very preterm–born in the 7–12-year age group. No significant differences in DBMP during bitewing and periapical examinations or in number of bitewing, periapical and panoramic radiographs occurred between the groups in any age interval. Conclusion Preterm–born children and adolescents may need more flexibility in booking and receive reminders for scheduled visits with the general dental team. Due to the non-significant differences in dental care related oral examinations and treatments, the same dental care service may be applied to the preterm- and full-term born children and adolescents.

Background Children and adolescents with juvenile idiopathic arthritis (JIA) may suffer pain from temporomandibular disorder (TMD). Still, routines for the assessment of temporomandibular joint (TMJ) pain in health and dental care are lacking. The aims of this study were to examine the prevalence of TMD in children and adolescents with JIA compared to their healthy peers and to investigate potential associations between JIA and TMD. Methods This comparative cross-sectional study is part of a longitudinal multicentre study performed during 2015–2020, including 228 children and adolescents aged 4–16 years with a diagnosis of JIA according to the ILAR criteria. This particular substudy draws on a subset of data from the first study visit, including assessments of TMD as part of a broader oral health examination. Children and adolescents with JIA were matched with healthy controls according to gender, age, and centre site. Five calibrated examiners performed the clinical oral examinations according to a standardised protocol, including shortened versions of the diagnostic criteria for TMD (DC/TMD) and the TMJaw Recommendations for Clinical TMJ Assessment in Patients Diagnosed with JIA. Symptoms were recorded and followed by a clinical examination assessing the masticatory muscles and TMJs. Results In our cohort of 221 participants with JIA and 221 healthy controls, 88 (39.8%) participants with JIA and 25 (11.3%) healthy controls presented with TMD based on symptoms and clinical signs. Painful TMD during the last 30 days was reported in 59 (26.7%) participants with JIA vs. 10 (5.0%) of the healthy controls (p Conclusion Symptoms and clinical signs of TMD were seen in approximately half of the JIA patients compared to about one fourth of their healthy peers. Painful palpation to masticatory muscles and decreased vertical unassisted jaw movement were more frequent in participants with JIA than among healthy controls and should be part of both medical and dental routine examinations in patients with JIA.

Objectives To develop and evaluate an educational web-based programme for temporomandibular joint (TMJ) assessment using cone-beam computed tomography (CBCT). Methods A web-based educational programme was designed for TMJ assessment using CBCT images. Fifteen CBCT cases of the TMJ (three-dimensional reconstructed volumes) and an assessment module based on image analysis criteria in the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) were added to the programme. Thirty-six undergraduate dental students were invited to test the programme by assessing all cases twice: before and after 2 months of training. Participants submitted written subjective evaluations of the programme. Results The web-based programme can be accessed on Malmo University webpage (www.cbct-tmj.mau.se). Despite limited CBCT learning in their undergraduate training and not using the programme in the 2-month interval, the students were able to correctly diagnose 80% of the cases at the second assessment. Their diagnoses, however, did not differ significantly from the first assessment. Overall, the students were satisfied with the programme and considered it user-friendly. Conclusion The web-based educational programme that was developed in the present study and tested by dental students could be a useful educational tool for TMJ assessment using CBCT.

Background Few studies have investigated oral health-related quality of life (OHRQoL) in young individuals with juvenile idiopathic arthritis (JIA). Aims were to investigate whether OHRQoL differs between children and adolescents with JIA compared to controls without JIA, while adjusting for socio-demographic-, behavioral- and oral health-related covariates. Furthermore, to explore whether socio-behavioral and oral health-related covariates of OHRQoL vary according to group affiliation and finally, specifically for individuals with JIA, to investigate whether disease-specific features associate with OHRQoL. We hypothesized that participants with JIA have poorer OHRQoL compared to participants without JIA. Methods In this comparative cross-sectional study participants with JIA (n = 224) were matched to controls without JIA (n = 224). OHRQoL was assessed according to Early Childhood Oral Health Impact Scale (ECOHIS) (4–11-years-olds) and the child version of Oral Impacts on Daily Performances (Child-OIDP) (12–16-years-olds). JIA-specific characteristics were assessed by pediatric rheumatologists and socio-demographic, behavioral and self-reported oral health information collected by questionnaires. Index teeth were examined for caries by calibrated dentists. Multiple variable analyses were performed using logistic regression, reporting odds ratio (OR) and 95% confidence interval (CI). Two-way interactions were tested between group affiliation and the socio-behavioral- and oral health-related variables on the respective outcome variables. Results In total, 96 participants with JIA and 98 controls were evaluated according to ECOHIS, corresponding numbers for Child-OIDP was 125 and 124. Group affiliation was not associated with impaired ECOHIS or Child-OIDP in adjusted analyses (OR = 1.95, 95% CI 0.94–4.04 and OR = 0.99, 95% CI 0.46–2.17, respectively). Female adolescents with JIA were more likely than males to report oral impacts according to Child-OIDP. Continued activity or flare was found to adversely affect Child-OIDP, also self-reported outcome measures in JIA associated with Child-OIDP. Conclusions This study did not provide consistent evidence to confirm the hypothesis that children and adolescents with JIA are more likely to have impaired OHRQoL compared to their peers without JIA. However, female adolescents with JIA were more likely than males to report impacts on OHRQoL. Furthermore, within the JIA group, adolescents with continued disease activity, flare or reporting pain, physical disability, had higher risk than their counterparts of impaired OHRQoL.

Background Children and adolescents with juvenile idiopathic arthritis (JIA) may suffer from temporomandibular disorder (TMD). Due to this, imaging diagnosis is crucial in JIA with non-symptomatic TM joint (TMJ) involvement. The aim of the study was to examine the association between clinical TMD signs/symptoms and cone-beam computed tomography (CBCT) findings of TMJ structural deformities in children and adolescents with JIA. Methods This cross-sectional study is part of a longitudinal prospective multi-centre study performed from 2015–2020, including 228 children and adolescents aged 4–16 years diagnosed with JIA, according to the International League of Associations for Rheumatology (ILAR). For this sub-study, we included the Bergen cohort of 72 patients (32 female, median age 13.1 years, median duration of JIA 4.5 years). Clinical TMD signs/symptoms were registered as pain on palpation, pain on jaw movement, and combined pain of those two. The severity of TMJ deformity was classified as sound (no deformity), mild, or moderate/severe according to the radiographic findings of CBCT. Results Of 72 patients, 21 (29.2%) had pain on palpation at and around the lateral pole, while 41 (56.9%) had TMJ pain upon jaw movement and 26 (36.1%) had pain from both. Of 141 TMJs, 18.4% had mild and 14.2% had moderate/severe structural deformities visible on CBCT. CBCT findings were not significantly associated with either the pain on palpation or the pain on jaw movement. A significant difference was found between structural deformities in CBCT and the combined pain outcome (pain at both palpation and movement) for both TMJs for the persistent oligoarticular subtype (p = 0.031). Conclusions There was no association between painful TMD and CBCT imaging features of the TMJ in patients with JIA, but the oligoarticular subtype of JIA, there was a significant difference associated with TMJ pain and structural CBCT deformities.

To query the experience of oral surgeons concerning referral routines and preferences for radiographic imaging modality before surgical removal of mandibular third molars and investigate factors that influence imaging modality preferences.Members of the Swedish Association of Oral and Maxillofacial Surgeons (n = 280) were invited to participate in a web-based digital survey concerning their experiences and use of three imaging modalities in pre-surgical assessment of mandibular third molar removal. The survey comprised multiple-choice questions and four cases depicted in images; respondents reported whether they would supplement the cases with other images and, if so, from which modality.The response rate was 64%. Panoramic radiographs were most commonly used in pre-surgical planning (response options: always or often), significant difference between professions (p = 0.039), and considered to facilitate treatment planning (87%), as was CBCT (82%); for 51%, CBCT reduced post-operative complications. Preferred modality for localizing the mandibular canal was fairly evenly distributed and for non-complex case, significant difference between subgroups of OMFS surgeons was found (p = 0.003) as to preference for intraoral radiographs.A majority of respondents received a report within 2 weeks of their referral for CBCT and would read the report and view the images before surgery. Image modality preference differed depending on case complexity, with a greater perceived need for CBCT. Profession and practical experience affected choice.Choice of imaging modality in mandibular third molar assessment is also important from dose delivery and social economy standpoints.

OBJECTIVES: This study aimed to identify potential clinical and radiological predictors associated with the outcome of discectomies. METHODS: In this retrospective observational study, the material comprised preoperative CBCT images and medical records of 62 patients with disc derangement disorders, who had undergone discectomy because of disc displacement with reduction (DDwR), disc displacement without reduction (DDwoR), systemic arthritis (SA), or joint hypermobility. Clinical and radiographic variables were analysed in relation to success rate determined by subjective, objective and combined outcomes. RESULTS: The success odds ratio was 11 times higher in patients with painful DDwR versus that of SA (p = 0.03), and even 25.9 times higher when considering solely objective outcome (p = 0.03). In the absence of subchondral pseudocyst, there were 5.2 times higher odds to have a successful subjective outcome (p = 0.04). Extensive bone apposition on the temporal joint component indicated a 9.3 times higher likelihood of a failed objective outcome (p = 0.04). CONCLUSIONS: There is a significant higher risk for combined outcome failure for the diagnosis SA involving the TMJ compared with DDwR. Predictors of importance based on CBCT findings related to the objective outcome failure were extensive bone apposition on the temporal joint component and condylar subchondral pseudocysts for the subjective outcome failure. ispartof: ORAL DISEASES vol:28 issue:8 pages:2185-2193 ispartof: location:Denmark status: published

Background Adenoid hypertrophy among orthodontic patients may be detected in lateral cephalograms. The study investigates the aerodynamic characteristics within the upper airway (UA) by means of computational fluid dynamics (CFD) simulation. Furthermore, airflow features are compared between subgroups according to the adenoidal nasopharyngeal (AN) ratios. Methods This retrospective study included thirty-five patients aged 9–15 years having both lateral cephalogram and cone beam computed tomography (CBCT) imaging that covered the UA region. The cases were divided into two subgroups according to the AN ratios measured on the lateral cephalograms: Group 1 with an AN ratio ms), maximum wall shear stress (Pws), and minimum wall static pressure (Pw). Results The maximum Vms exhibits nearly 30% increases in Group 2 at both inspiration (p = 0.013) and expiration (p = 0.045) compared to Group 1. For the other aerodynamic parameters such as ΔP, the maximum Pws, and minimum Pw, no significant difference is found between the two groups. Conclusions The maximum Vms seems to be the most sensitive aerodynamic parameter for the groups of cases. An AN ratio of more than 0.6 measured on a lateral cephalogram may associate with a noticeably increased maximum Vms, which could assist clinicians in estimating the airflow features in the UA.

Objectives: This retrospective observational study aimed to evaluate the diagnostic accuracy of two-dimensional radiographs on canine-induced root resorption (CIRR) in lateral incisors and identify predictors of CIRR in patients with impacted maxillary canines (IMC). Methods: Ninety-nine patients aged 9–17 years, with 156 IMCs, were included in the study. All had CBCT-volumes and two-dimensional radiographs consisting of at least one panoramic radiograph. Two radiologists jointly viewed all cases twice. First, radiographic features related to the IMC and possible CIRR were recorded from two-dimensional radiographs. Then, CIRR was determined from CBCT and according to position and extension classified as mild, moderate and severe. Results: CIRRs was detected in 80% of lateral incisors (mild: 45%; moderate: 44%; severe: 11%). The sensitivity was generally low at mild and moderate cut-offs (29 and 29%), and somewhat higher for severe (50%). Corresponding specificities were 48%, 63% and 68%. Canine cusp-tip superimposing the lateral incisor’s middle third and root/crown ratio >1 was positively associated with mild CIRR, with an odds ratio (OR) of 3.8 and 6.7, respectively. In addition, the root development stage was positively associated with moderate/severe CIRR when the canine root was nearly or fully developed (OR = 3.1). Conclusions: The diagnostic accuracy of two-dimensional radiographs was inadequate for detecting CIRR amongst patients referred for CBCT examinations. Based on our results, none of the suggested two-dimensional radiographic features could predict moderate/severe CIRR except for root development stage. IMC in a later stage of root development seems to be associated with a higher risk of moderate/severe CIRR.

Background The effect of rapid maxillary expansion (RME) on the upper airway (UA) has been studied earlier but without a consistent conclusion. This study aims to evaluate the outcome of RME on the UA function in terms of aerodynamic characteristics by applying a computational fluid dynamics (CFD) simulation. Methods This retrospective cohort study consists of seventeen cases with two consecutive CBCT scans obtained before (T0) and after (T1) RME. Patients were divided into two groups with respect to patency of the nasopharyngeal airway as expressed in the adenoidal nasopharyngeal ratio (AN): group 1 was comprised of patients with an AN ratio ms), and maximum wall shear stress (Pws) were compared by paired t-test and Wilcoxon test according to the normality test at T0 and T1. Results The aerodynamic characteristics in UA revealed no statistically significant difference after RME. The maximum Vms (m/s) decreased from 2.79 to 2.28 at expiration after RME (P = 0.057). Conclusion The aerodynamic characteristics were not significantly changed after RME. Further CFD studies with more cases are warranted.

Background Optimal utilization of dental caries data is crucial in epidemiological research of individuals with juvenile idiopathic arthritis (JIA). The aims were to: explore whether caries is more prevalent among children and adolescents with JIA compared to controls; examine presence of caries according to JIA group, socio-behavioral and intraoral characteristics, and the extent to which surface-specific caries varies between and within individuals; assess whether surface-specific caries varies according to JIA group and dentition; and investigate whether disease-specific clinical features of JIA are associated with presence of caries. Methods In this comparative cross-sectional study, calibrated dentists examined index teeth (primary 2. molars, 1. permanent molars) of 4–16-year-olds with JIA (n = 219) and matched controls (n = 224), using a detailed caries diagnosis system (including enamel caries). JIA-specific characteristics were assessed by pediatric rheumatologists and socio-behavioral information collected by questionnaires. Multilevel mixed-effect logistic regressions reporting odds ratios (OR) with 95% confidence interval (CI) were applied (caries at surface level as outcome variable). Potential confounders were adjusted for, and the effect of dependency of surface-specific caries data was estimated by calculating intra-class correlation coefficients (ICC). Results At individual level, no significant difference in caries prevalence was found between individuals with JIA and controls, regardless of inclusion of enamel caries. Proportion of enamel lesions exceeded dentine lesions. JIA was not associated with presence of caries, but in both groups, low maternal educational level was associated with presence of caries (OR: 2.07, 95% CI: 1.24–3.46). Occlusal and mesial surfaces, compared to buccal surfaces, had generally higher OR according to presence of caries than distal and lingual surfaces (ICC = 0.56). Surface-specific caries in the permanent dentition differed significantly according to group affiliation. Some JIA disease-specific variables were suggested to associate with presence of caries. Conclusions No overall difference in caries prevalence between individuals with JIA and controls was observed, but for both groups, low maternal educational level and tooth surface associated with presence of caries. Associations between JIA disease-specific variables and presence of caries cannot be excluded. Due to predominance of enamel lesions, the potential of preventative dental strategies is considerable.

Rationale: Some diseases contribute to hypopituitarism without clinical manifestations and the glucocorticoid therapy may unveil central diabetes insipidus. The condition is rare and usually causes problems for clinical physicians. Patient concerns: A 59-year-old woman presented to our hospital due to facial numbness and persistent eyelid heaviness. Diagnosis: Physical examination and cerebrospinal fluid examination supported a diagnosis of Guillain–Barré syndrome. Magnetic resonance imaging showed an empty sella. Hormone test indicated hypopituitarism. Interventions: The patient received intravenous immunoglobulin and glucocorticoid. Central diabetes insipidus appeared after 20 days. Subsequently, the patient was prescribed 1-desamino-8-D-arginine vasopressin and prednisone. Outcomes: During 6 months’ follow-up, the patient's urine output was gradually reduced to normal level. Lessons: This case indicated that hypopituitarism may be caused by an empty sella and be masked by adrenal insufficiency. Central diabetes insipidus may present after glucocorticoid therapy.

Objective: Evaluation of cone beam CT (CBCT) examination with a low-dose scanning protocol for assessment of the temporomandibular joint (TMJ). Methods: 34 adult patients referred for CBCT imaging of the TMJ underwent two examinations with two scanning protocols, a manufacturer-recommended protocol (default) and a low-dose protocol where the tube current was reduced to 20% of the default protocol. Three image stacks were reconstructed: default protocol, low-dose protocol, and processed (using a noise reduction algorithm) low-dose protocol. Four radiologists evaluated the images. The Sign test was used to evaluate visibility of TMJ anatomic structures and image quality. Receiver operating characteristic analyzes were performed to assess the diagnostic accuracy. κ values were used to evaluate intraobserver agreement. Results: With the low-dose and processed protocols, visibility of the TMJ anatomical structures and overall image quality were comparable to the default protocol. No significant differences in radiographic findings were found for the two low-dose protocols compared to the default protocol. The area under the curves (Az) averaged for the low-dose and processed protocols, according to all observers, were 0.931 and 0.941, respectively. Intraobserver agreement was good to very good. Conclusion: For the CBCT unit used in this study, the low-dose CBCT protocol for TMJ examination was diagnostically comparable to the manufacturer-recommended protocol, but delivered a five times lower radiation dose. There is an urgent need to evaluate protocols for CBCT examinations of TMJ in order to optimize them for a radiation dose as low as diagnostically acceptable (the as low as diagnostically acceptable principle recommended by NCRP). publishedVersion

Background Observational studies examining the association between oral health and juvenile idiopathic arthritis (JIA) among children and adolescents have reported inconsistent findings. The aims of this systematic review and meta-analysis were to ascertain a potential difference in oral health and oral health-related quality of life (OHRQoL) among children and adolescents with JIA and healthy peers, and to assess the association of prevalence of oral diseases/conditions, temporomandibular disorders (TMD), including temporomandibular joint (TMJ) diseases, in relation to activity and severity of JIA. Method Medline Ovid, Embase, CINAHL, SweMed+ and Cochrane Library were searched up to 25 November 2018. All articles published in English, German and Scandinavian languages focusing on children and adolescents with JIA and without JIA in relation to oral health measures, were considered. Two authors independently evaluated observational studies for inclusion. The study quality was assessed using modified Newcastle Ottawa Scale. Meta-analysis was performed for studies focusing on dental caries as an outcome. Results Nineteen articles met the inclusion criteria, covering a range of oral diseases/conditions and OHRQoL. Eighteen studies had cross-sectional design. No mean difference of dmft/DMFT indices (decayed/missed/filled teeth) was observed between the JIA - and healthy group. None of the oral health measures including dental erosive wear, enamel defects, dental maturation and OHRQoL, indicated better oral health among children and adolescents with JIA compared to healthy group. However, periodontal conditions and TMD were more predominant among children and adolescents with JIA compared to healthy peers. Conclusions Based on the cross-sectional studies, periodontal diseases and TMD were found to be more frequent in children and adolescents with JIA compared to healthy peers. Furthermore, more high-quality studies with large sample size are needed before we infer any concrete conclusion regarding the association between the prevalence of oral and TMJ diseases or oral conditions in relation to activity and severity of JIA.

Targeted therapy of hepatocellular carcinoma (HCC) is essential for improved therapies. Therefore, identification of key targets specifically to HCC is an urgent requirement. Herein, an iTRAQ quantitative proteomic approach was employed to identify differentially expressed proteins in HCC tumor tissues. Of the upregulated tumor-related proteins, minichromosome maintenance 2 (MCM2), a DNA replication licensing factor, was one of the most significantly altered proteins, and its overexpression was confirmed using tissue microarray. Clinicopathological analysis of multiple cohorts of HCC patients indicated that overexpression of MCM2 was validated in 89.8% tumor tissues and strongly correlated with clinical stage. Furthermore, siRNA-mediated repression of MCM2 expression resulted in significant suppression of the HepG2 cell cycle and proliferation through the cyclin D-dependent kinases (CDKs) 2/7 pathway. Finally, the first small molecule-based MCM2-targeted NIR-II probe CH1055-MCM2 was concisely generated and subsequently evaluated in mice bearing HepG2 xenografts. The excellent imaging properties such as good tumor uptake and high tumor contrast and specificity were achieved in the small animal models. This analytical strategy can determine novel accessible targets of HCC useful for imaging and therapy.

The objective of the present study was to assess and compare the effective doses in the wrist region resulting from conventional radiography device, multislice computed tomography (MSCT) device and two cone beam computed tomography (CBCT) devices using MOSFET dosemeters and a custom made anthropomorphic RANDO phantom according to the ICRP 103 recommendation. The effective dose for the conventional radiography was 1.0 μSv. The effective doses for the NewTom 5 G CBCT ranged between 0.7 μSv and 1.6 μSv, for the Planmed Verity CBCT 2.4 μSv and for the MSCT 8.6 μSv. When compared with the effective dose for AP- and LAT projections of a conventional radiographic device, this study showed an 8.6- fold effective dose for standard MSCT protocol and between 0.7 and 2.4-fold effective dose for standard CBCT protocols. When compared to the MSCT device, the CBCT devices offer a 3D view of the wrist at significantly lower effective doses.

Objective To evaluate the influence of clinical pathways in the hospitals using the Traditional Chinese Medicine in treatment of stroke in terms of postoperative complications, length of stay (LOS), costs incurred during hospitalization, compared with standard medical care. Methods Medline, Embase, China National Knowledge Infrastructure (CNKI) platforms, Wanfang databases and the Cochrane Central Register of Controlled Trials were searched. The search was performed up to August 2014. Each study was assessed independently by two reviewers. The assessment of methodological quality of the included studies was based on the Methodological index for non-randomized studies standard. Meta-analyses were performed using RevMan software, version 5.0. Results Six studies met the study inclusion criteria and were included in the Meta-analysis for a total sample of 710 patients. The aggregate overall results showed that shorter length of stay in the clinical pathway group was observed during hospital stay was associated with the use of the clinical pathways. No significant differences were found in other effects. Conclusion Regardless the possible limitations, our findings show that clinical pathways can significantly reduce LOS. Although there is no clear evidence that clinical pathways can reduce hospital costs, but the cost of hospitalization path group for each included study were lower than the control group.

Objectives The aim of this study was to evaluate the reliability of bitewing and panoramic radiographs in marginal bone level measurements in terms of inter- and intra-observer agreement. Methods Fifty paired bitewing and panoramic images were used. Eight observers measured marginal bone level at the mesial and distal surfaces of tooth 25 and tooth 35. Thus, in total 100 radiographs of 400 measurements were obtained for each observer. To evaluate intra-observer agreement, three observers re-evaluated the radiographs after a minimum of 1 month. Intra-class correlation coefficient (ICC) was applied to evaluate the inter- and intra-observer agreement. The t test was applied to assess possible difference in measurement between bitewing and panoramic radiographs. Results The mean ICC value of inter-observer agreement was 0.85 for bitewing and 0.66 for panoramic radiographs. The mean intra-observer agreement was 0.92 and 0.76 for bitewing and panoramic radiographs, respectively. There was no statistically significant difference between bitewing and panoramic radiographs in measurements of marginal bone level on maxillary tooth 25, whereas a statistically significant difference was found between the two image modalities on mandible tooth 35. Conclusion Bitewing examination should be the choice of image modality for assessment of marginal bone level at premolar region due to good to excellent reliability and low radiation dose. However if a panoramic radiograph already exists, a rough estimation of marginal bone level at premolar region is clinically acceptable bearing in mind that the bone height of the mandible premolar region might be overestimated as compared to bitewing radiograph. publishedVersion

Genetic drivers of cancer can be dysregulated through epigenetic modifications of DNA. Although the critical role of DNA 5-methylcytosine (5mC) inthe regulation of transcription is recognized, the functions of other non-canonical DNA modifications remain obscure. Here, we report the identification of novel N6-methyladenine (N6-mA) DNA modifications in human tissues and implicate this epigenetic mark in human disease, specifically thehighly malignant brain cancer glioblastoma. Glioblastoma markedly upregulated N6-mA levels, which co-localized with heterochromatic histone modifications, predominantly H3K9me3. N6-mA levels were dynamically regulated by the DNA demethylase ALKBH1, depletion of which led to transcriptional silencing of oncogenic pathways through decreasing chromatin accessibility. Targeting the N6-mA regulator ALKBH1 in patient-derived human glioblastoma models inhibited tumor cell proliferation and extended the survival of tumor-bearing mice, supporting this novel DNA modificationas a potential therapeutic target for glioblastoma. Collectively, our results uncover a novel epigenetic node in cancer through the DNA modification N6-mA.

ObjectivesThe aims of this study were to evaluate the subjective image quality and reliability of two digital sensors. In addition, the image quality of the two sensors evaluated by specialists and general dentists were compared.Methods:30 intraoral bitewings from five patients were included in the study, 15 were exposed with a Dixi sensor (CCD-based) and 15 with a ProSensor (CMOS-based) using modified parallel technique. Three radiologists and three general dentists evaluated the images in pair. A five-point scale was used to register the image quality. Visual grading characteristics (VGC) analysis was performed to compare the image quality and the observer agreement was assessed in terms of intra class correlation co-efficient.ResultsNo statistically significant difference was found on image quality between the sensors. The average scores of the observer agreement were moderate with an average of 0.66 and an interval of 0.30 to 0.87, suggesting that there was a large variation on preference of image quality. However, there was a statistically significant difference in terms of the area under the VGC- curves between the specialist group and the general dentist group ( p = 0.043), in which the specialist group tended to favor the ProSensor.ConclusionsSubjective image quality of the two intraoral sensors were comparable when evaluated by both general and oral radiologists. However, the radiologists seemed to prefer the ProSensor to the Dixi as compared to general dentists. Inter- observer conformance showed a large variation on the preference of the image quality.

Background Autologous grafting, despite some disadvantages, is still considered the gold standard for reconstruction of maxillofacial bone defects. The aim of this study was to evaluate bone regeneration using bone marrow-derived mesenchymal stromal cells (MSCs) in a clinical trial, a less invasive approach than autologous bone grafting. This comprehensive clinical trial included subjects with severe mandibular ridge resorption. Methods The study included 11 subjects aged 52–79 years with severe mandibular ridge resorption. Bone marrow cells were aspirated from the posterior iliac crest and plastic adherent cells were expanded in culture medium containing human platelet lysate. The MSCs and biphasic calcium phosphate granules as scaffolds were inserted subperiosteally onto the resorbed alveolar ridge. After 4–6 months of healing, new bone formation was assessed clinically and radiographically, as were safety and feasibility. Bone at the implant site was biopsied for micro-computed topography and histological analyses and dental implants were placed in the newly regenerated bone. Functional outcomes and patient satisfaction were assessed after 12 months. Results The bone marrow cells, expanded in vitro and inserted into the defect together with biphasic calcium phosphate granules, induced significant new bone formation. The regenerated bone volume was adequate for dental implant installation. Healing was uneventful, without adverse events. The patients were satisfied with the esthetic and functional outcomes. No side effects were observed. Conclusions The results of this comprehensive clinical trial in human subjects confirm that MSCs can successfully induce significant formation of new bone, with no untoward sequelae. Hence, this novel augmentation procedure warrants further investigation and may form the basis of a valid treatment protocol, challenging the current gold standard. Trial registration EudraCT, 2012-003139-50. Registered on 21 August 2013. ClinicalTrials.gov, NCT 02751125. Registered on 26 April 2016.

Objectives: The primary aim was to evaluate the effective dose for a full size panoramic image and nine different panoramic protocols using collimation. The secondary aim was to estimate possible reduction of effective dose in clinical situations. Methods: Effective dose, according to International Commission on Radiological Protection 2007 was determined for a full size panoramic image and nine different panoramic protocols applying collimation on an anthropomorphic Rando phantom, using metal-oxide semiconductor field-effect transistor dosemeters. The collimation protocols were chosen based on common diagnostic questions. 10 exposures were made for each protocol using a Planmeca ProMax® 2D (Helsinki, Finland). The mean effective doses were calculated according to clinical default exposure settings and compared for all protocols. A retrospective analysis of 252 referrals to a specialist clinic in dentomaxillofacial radiology assessed usability and dose reduction applying nine different collimation protocols, based on possible collimation of panoramic images. Dose reduction was calculated applying collimation feature in comparison to constant use of full size panoramic imaging. Referrals were categorized according to indication for radiographic examination. Results: Effective dose of a full size panoramic radiograph was 17.6 µSv at 8 mA and 66 kV. The dose reduction for the collimated images compared to a full size panoramic radiograph ranged from 4.5 to 86.9%. Potential total dose reduction in the studied sample was 35% if collimation feature had been applied. In four out of five of the referrals, collimation was possible and in 61% of the referrals the indication for radiographic examination was restricted to the dental alveolar region, reducing the dose by 40.3% compared with a full size panoramic image. Conclusions: Since the effective dose may be reduced without losing diagnostic information in the area of interest, collimation feature of panoramic imaging should be routinely applied when the diagnostic task allows.

To evaluate the ultra-low dose scanning protocols of a newly developed CBCT for pre-implant radiographic assessment.A total number of 32 CBCT scans were exposed at 90 kV using ProMax 3D's standard (GS) and three ultra-low dose scanning protocols: high, mid and low definition (UL-HD, UL-MD and UL-LD) on eight human dry skulls with simulated soft tissue. The mAs values and the voxel size were 96mAs/200 µm, 28mAs/150 µm, 22.4mAs/200 µm and 7.5mAs/400 µm for scanning protocols GS, UL-HD, UL-MD and UL-LD, respectively. The overall image quality and the precision of anatomical landmarks were assessed on a 4-rank ordinal scale by seven observers. Logistic regression analysis and post-hoc Scheffé test were applied to analyse possible differences in image quality and recognition of the anatomical structures for the three ultra-low dose protocols, compared with the standard protocol. Additionally, observers performed bone quality assessment and bone quantity measurement at 96 predefined 2D cross-sectional images. A Pearson Chi-square test and a paired t-test were used to analyse assessed bone quality and quantity using the four scanning protocols respectively.For the CBCT unit, ProMax 3D, UL-LD was not diagnostically acceptable for pre-implant assessment, whereas the UL-HD and UL-MD were diagnostically acceptable regarding overall image quality, visibility of most anatomical structures and bone quality assessment. However, to recognise the border of mandibular canal and the border of maxillary sinus, standard protocol may be indicated for some cases. No statistically significant differences in bone height measurement were found when applying standard protocol and the three ultra-low dose protocols.Low-dose scanning protocols may be applied for pre-implant radiographic assessment, although image quality can be hampered if the radiation exposure is too low and the voxel size too large.

Introduction In this study, we aimed to evaluate the adenoidal nasopharyngeal ratio (ANR) on lateral cephalograms by assessing upper airway volumes using cone-beam computed tomography (CBCT) images as the validation method. Methods Fifty-five patients were included in the study, and it was essential that the lateral cephalograms and CBCT images taken at their examinations were not more than 1 week apart. There were 32 subjects in group A (age ≤15 years) and 23 subjects in group B (age >15 years). The ANR was measured on the lateral cephalograms. The area and volumetric measurements of the nasopharynx and the total upper airway were obtained from CBCT images. Repeated measurements of the ANR and airway volume were performed on 10 subjects by 2 observers. Results Group A had a higher correlation (r = −0.78) between the ANR and the nasopharynx volume than did group B (r = −0.57). The ANR had a weak correlation with the total upper airway volume (group A, r = −0.48; group B, r = −0.32). Both measurements made on lateral cephalograms and CBCT were highly reproducible in terms of intraobserver and interobserver agreement. Conclusions Based on our results, the measurement of the ANR on lateral cephalograms can be used as an initial screening method to estimate the nasopharynx volumes of younger patients (age ≤15 years).

Chronic hepatitis B virus (HBV) infection has been considered as the major cause of hepatocellular carcinoma (HCC). Hepatitis B virus X protein (HBx) has been reported to be oncogenic. The underlying mechanisms of HBV-related HCC are not fully understood, and the role played by the HBx protein in HBV induced carcinogenesis remains controversial. CDC42, a member of the Rho GTPase family, has been reported to be overexpressed in several different cancers, including HBV-related HCC. However, the specific role of CDC42 in HCC development remains unclear. Here, we investigated the cellular mechanisms by which CDC42 was responsible for the higher proliferation of HuH-7 cells mediated by HBx. We found that the expression level of CDC42 and its activity were significantly increased in HuH-7-HBx cells. The deficiency of CDC42 using the CRISPR/Cas9 system and inhibition by specific inhibitor CASIN led to the reduction of HBx-mediated proliferation. Furthermore, we observed that IQ Motif Containing GTPase Activating Protein 1 (IQGAP1), the downstream mediator of the CDC42 pathway, might be involved in the carcinogenesis induced by HBx. Therefore, the HBx/CDC42/IQGAP1 signaling pathway may potentially play an important role in HBx-mediated carcinogenesis.

Chronic hepatitis B virus (HBV) infection is partly responsible for hepatitis, fatty liver disease and hepatocellular carcinoma (HCC). HBV core protein (HBc), encoded by the HBV genome, may play a significant role in HBV life cycle. However, the function of HBc in the occurrence and development of liver disease is still unclear. To investigate the underlying mechanisms, HBc-transfected HCC cells were characterized by multi-omics analyses. Combining proteomics and metabolomics analyses, our results showed that HBc promoted the expression of metabolic enzymes and the secretion of metabolites in HCC cells. In addition, glycolysis and amino acid metabolism were significantly up-regulated by HBc. Moreover, Max-like protein X (MLX) might be recruited and enriched by HBc in the nucleus to regulate glycolysis pathways. This study provides further insights into the function of HBc in the molecular pathogenesis of HBV-induced diseases and indicates that metabolic reprogramming appears to be a hallmark of HBc transfection.

OBJECTIVES: To compare the radiation dose to children examined for impacted canines, using two-dimensional (2D) examinations (panoramic and periapical radiographs) and cone beam CT (CBCT). METHODS: Organ doses were determined using an anthropomorphic 10-year-old child phantom. Two CBCT devices, a ProMax3D and a NewTom5G, were examined using thermoluminescent dosimeters. For the panoramic radiograph, a Promax device was used and for periapical radiographs, a Prostyle device with a ProSensor digital sensor was used. Both the panoramic and the intraoral devices were examined using Gafchromic-QR2 dosimetric film placed between the phantom slices. RESULTS: ProMax3D and NewTom5G resulted in an effective dose of 88 µSv and 170 µSv respectively. A panoramic radiograph resulted in an effective dose of 4.1 µSv, while a periapical radiograph resulted in an effective dose of 0.6 µSv and 0.7 µSv using a maxillary lateral projection and central maxillary incisor projection respectively. CONCLUSIONS: The effective dose from CBCT ranged from 140 times higher dose (NewTom5G compared to two periapical radiographs) to 15 times higher dose (ProMax3D compared to three periapical and one panoramic radiograph) than a 2D examination.

The aim of this study was to evaluate the performance of the automatic exposure control (AEC) in an intraoral digital system.Three series of radiographs were captured with the activated AEC on seven dry mandibles adhered to different thicknesses of Plexiglas((R)), which represented soft tissue. Exposure times required for each radiograph of the specimens were analysed as functions of the added Plexiglas thickness. Differences in mean grey levels between pairs of the three images obtained from the same specimen were analysed by employing the subtraction technique. Additionally, four radiographs of all seven mandibles were manually exposed with one layer of Plexiglas, which employed one and two steps below and above the registered automatic exposure time. Six observers evaluated the series of radiographs exposed with one layer of Plexiglas in a random order. The observers were instructed to classify the quality of the diagnostic images as unacceptable, acceptable or excellent.The results demonstrated a good correlation between the exposure times determined by AEC and Plexiglas thickness (r = 0.85). Mean grey level values for subtraction images obtained from radiographs exposed with different thickness of Plexiglas with activated AEC indicated that almost identical radiographs were obtained, regardless of the Plexiglas thickness. The subjective observer evaluation of the most satisfactory radiographic image quality as a function of exposure time demonstrated that the highest scores were for radiographs exposed with the AEC function activated.The AEC function may accurately determine the appropriate exposure times related to object thickness, providing radiographs with satisfactory image quality, and may thus be advantageous in clinical radiographic work.

Objective The objective of this study was to compare detection of approximal caries in vitro by black-and-white and color-coded digital radiographs. Study design The material comprised 2 groups of tooth sample. One group consisted of 40 premolars mounted in groups of 3 or 4 and the other group included 90 premolars mounted in groups of 5. Radiographs, respectively exposed with the Dixi and the Digora Optime digital radiographic systems, were color-coded using specially designed software. Seven observers in each of 2 centers subjectively evaluated one series of black-and-white and color-coded radiographs. The teeth were subsequently sectioned for histological determination of the lesions. ROC analyses were performed. Differences between the area under the ROC curves for the digital black-and-white and the color-coded radiographs were analyzed by ANOVA. Results There were no significant differences between the black-and-white and the color-coded radiographs in detection of approximal caries. Conclusion Color-coded digital radiographs may be used as an alternative to digital black-and-white radiographs.

The aims of this in vitro study were 2-fold: 1) to evaluate two fluorescence methods (DIAGNOdent and QLF (quantitative light-induced fluorescence)) for quantification of white spot lesions adjacent to fixed orthodontic appliances; and 2) to determine the inter-observer agreement of the DIAGNOdent and QLF methods for quantification of incipient enamel lesions adjacent to fixed orthodontic appliances. Forty-one premolar teeth with visually sound smooth surfaces or visually white spot enamel lesions were included in the study. Orthodontic brackets were fixed adjacent to the lesions, thus simulating the position of fixed appliances during orthodontic treatment. All teeth were measured using both the DIAGNOdent and QLF methods. Of the 41 teeth, 20 smooth surfaces were randomly selected and analyzed by 4 operators using both DIAGNOdent and QLF. The teeth were sectioned into 300-microm-thick slices using a water-cooled diamond saw and the slices manually ground to 80-100 microm thickness. Histopathology and transverse microradiography were performed to provide the gold standards for verification of lesion depth and mineral loss, respectively. The Spearman rank correlation coefficients between lesion depth determined by histopathology and the DIAGNOdent and QLF were 0.76 and 0.82, respectively, whereas the Pearson correlation coefficients between mineral loss and the two methods were 0.64 and 0.84, respectively. Inter-observer agreement was found to be 0.80 and 0.93 for DIAGNOdent and QLF, respectively. In conclusion, QLF may be a suitable method for quantifying incipient carious lesions adjacent to fixed orthodontic appliances.

Two digital image processing methods, correction for X-ray attenuation and correction for attenuation and visual response, have been developed. The aim of the present study was to compare digital radiographs before and after correction for attenuation and correction for attenuation and visual response by means of a perceptibility curve test.Radiographs were exposed of an aluminium test object containing holes ranging from 0.03 mm to 0.30 mm with increments of 0.03 mm. Fourteen radiographs were exposed with the Dixi system (Planmeca Oy, Helsinki, Finland) and twelve radiographs were exposed with the F1 iOX system (Fimet Oy, Monninkylä, Finland) from low to high exposures covering the full exposure ranges of the systems. Radiographs obtained from the Dixi and F1 iOX systems were 12 bit and 8 bit images, respectively. Original radiographs were then processed for correction for attenuation and correction for attenuation and visual response. Thus, two series of radiographs were created. Ten viewers evaluated all the radiographs in the same random order under the same viewing conditions. The object detail having the lowest perceptible contrast was recorded for each observer. Perceptibility curves were plotted according to the mean of observer data.The perceptibility curves for processed radiographs obtained with the F1 iOX system are higher than those for originals in the exposure range up to the peak, where the curves are basically the same. For radiographs exposed with the Dixi system, perceptibility curves for processed radiographs are higher than those for originals for all exposures. Perceptibility curves show that for 8 bit radiographs obtained from the F1 iOX system, the contrast threshold was increased in processed radiographs up to the peak, while for 12 bit radiographs obtained with the Dixi system, the contrast threshold was increased in processed radiographs for all exposures. When comparisons were made between radiographs corrected for attenuation and corrected for attenuation and visual response, basically no differences were found.Radiographs processed for correction for attenuation and correction for attenuation and visual response may improve perception, especially for 12 bit originals.

Objective: To evaluate if digital compensation for exponential attenuation and the characteristics of the human visual system improves the diagnosis of approximal caries from digital radiographs. Material and methods: Forty premolar teeth were mounted in plaster blocks. Radiographs of the teeth were exposed with the Dixi digital intraoral system employing a Prostyle Intra dental X-ray unit (Planmeca Oy, Helsinki, Finland). Thirteen radiographs were then processed to compensate for the exponential attenuation and for the characteristic of the human visual system using equations presented in the paper. Ten observers were asked to diagnose approximal caries in all radiographs. ROC analyses were performed. The teeth were subsequently sectioned for histological validation of the lesions. The areas under ROC curves of original and processed radiographs were compared and analysed using Wilcoxon’s signedranks test. Results: There were significant diagnostic diAerences between the two types of radiographs (all lesions P=0.005, enamel P=0.028, and dentine P=0.050). Conclusion: Digital radiographs processed to compensate for exponential attenuation and the characteristics of the human visual system significantly improves the diagnosis of approximal caries in vitro. Dentomaxillofacial Radiology (2002) 31, 113‐116. DOI: 10.1038/sj/dmfr/4600675

The aims of this study were to investigate the anti-inflammatory effect and the effect on bone regeneration of hyaluronan in surgical and non-surgical groups.In each of 15 individuals, 2 teeth with defects of similar character and magnitude in the upper or lower jaw were chosen. There were at least 2 teeth between the test and the control sites. In the surgical group, a bioabsorbable membrane was used for both test and control sites, and hyaluronan was placed in the intrabony pocket of the test site. In the non-surgical group, the periodontal pockets were scaled and hyaluronan was administered 3 times with an interval of 1 week in the test pockets. Alveolar bone height and bone healing patterns were analyzed using digital intraoral radiographs. Measurements of bone height were performed in the original digital black-and-white radiographs to obtain quantitative data on bone gain or loss. Bone healing patterns were studied with color-coded radiographs, using specially designed software in a personal computer with subsequent combinations of radiographs. Gingival crevicular fluid immunoglobulin (Ig)G, C3, and prostaglandin E2 (PGE2) responses; periodontal probing depth; bleeding on probing; and the presence of plaque were studied to evaluate the anti-inflammatory effect. Data were obtained at baseline before treatment, and at 2 weeks, and 1, 3, 6, and 12 months after treatment.For the surgical treatments, bone height was increased in the test group treated with hyaluronan (mean value 2.2%, corresponding to an average increase of approximately 0.5 mm) and reduced in the control group (mean value -1.8%, corresponding to an average decrease of approximately - 0.4 mm) (P0.05) after 12 months. For the non-surgical treatments, bone height was reduced by a mean value of -1.1% (corresponding to an average decrease of approximately -0.25 mm) in the test group treated with hyaluronan and -3.3% (corresponding to an average decrease of approximately -0.75 mm) in the control group after 12 months (N.S.). According to the digital color-coded radiographs, the test sites in the surgical and non-surgical groups showed apposition of bone minerals. Immune responses showed no differences during the 12 months studied for the surgical and non-surgical sites. Mean periodontal probing depths were reduced between 2.5 mm and 4.1 mm in the surgical and non-surgical groups.The observed difference in bone height between test and control sites in the surgical group after 12 months was less than 1 mm, which was only detectable on radiographs. No statistical difference was found on radiographs in the non-surgical group, where a decrease in bone height was found for both groups after scaling. Probing depth reduction after the surgical treatment, as well as after scaling and root planing, was as expected. Hyaluronan in contact with bone and soft tissues had no influence on the immune system in this study. Further studies are needed to determine the extent to which hyaluronan can lead to clinically significant healing of periodontal lesions.

To compare the sensitometric properties and accuracy in the diagnosis of approximal caries of two E-speed (Ektaspeed Plus and EV 57) and two D-speed (Ultra-speed and DV 57) films.Speed and contrast for the four films were determined following 30 exposures for each film. Base plus fog density was measured on unexposed films and the increase was studied over a 18-month period. Seventy-five extracted premolars with known pathology were radiographed under standardized conditions and the radiographs assessed by nine observers for approximal caries. Receiver Operating Characteristic (ROC) curve technique was used to analyse the diagnostic accuracy.The sensitometric analysis showed that the Ektaspeed Plus film had the highest speed of the four films. At a density of 1.0 it was 2.28 times faster than Ultra-speed. The contrast of Ektaspeed Plus was comparable with that of the other films and base plus fog density plateaued at 0.4 ten months before expiry date. There were no statistically significant differences in diagnostic accuracy for white spot lesions between the four films. For cavitations there was a significant difference between EV 57 and DV 57 and Ektaspeed Plus (P = 0.005) but not between Ultra-speed and Ektaspeed Plus nor between Ultra-speed and EV 57 and DV 57.Ektaspeed Plus film is comparable with D-speed and a conventional E-speed film. Since it is at present the fastest available dental film it should be recommended for general dental practice.

The objective was to investigate diagnostic performance on approximal caries detection among Swedish and Chinese dental students using analogue and digital radiographs in vitro. Additionally, to compare the diagnostic accuracy of two image modalities for approximal caries detection. 46 extracted premolars and molars were mounted in blocks and exposed with two intra-oral systems, one CCD based digital radiographs and one with conventional films. 10 Swedish and 10 Chinese senior dental students diagnosed the approximal sites of the teeth exposed with the digital and analogue images. A 5 point diagnosis confidence scale was applied for caries registration for all the observers. Subsequently, the teeth were sectioned and histo-pathologically analyzed in order to obtain a gold standard. The data were analyzed in terms of receiver operating characteristic (ROC) curves for evaluation of diagnostic accuracy of the two radiographic methods and for the two groups of students for enamel and dentinal caries detection, respectively. The area under the ROC curve was significantly higher for dentinal caries detection compared with enamel caries detection for both Chinese and Swedish students and for both imaging modalities (p0.001). The present results indicated that the students' ability for enamel caries detection on approximal surfaces was poor. Neither between the two student groups (p=0.15-0.64) nor between the two image modalities (p=0.34-0.91) a statistically significant difference in detecting approximal caries was found.The two different intra-oral x-ray systems were equally accurate. Chinese and Swedish students showed similar outcomes in their performance for approximal caries detection.

BackgroundStudies have suggested the chemopreventive effects of flavonoids on carcinogenesis. Yet numbers of epidemiologic studies assessing dietary flavonoids and breast cancer risk have yielded inconsistent results. The association between flavonoids, flavonoid subclasses (flavonols, flavan-3-ols, etc.) and the risk of breast cancer lacks systematic analysis.ObjectiveWe aimed to examine the association between flavonoids, each flavonoid subclass (except isoflavones) and the risk of breast cancer by conducting a meta-analysis.DesignWe searched for all relevant studies with a prospective cohort or case-control study design published before July 1(st), 2012, using Cochrane library, MEDLINE, EMBASE and PUBMED. Summary relative risks (RR) were calculated using fixed- or random-effects models. All analyses were performed using STATA version 10.0.ResultsTwelve studies were included, involving 9 513 cases and 181 906 controls, six of which were prospective cohort studies, and six were case-control studies. We calculated the summary RRs of breast cancer risk for the highest vs lowest categories of each flavonoid subclass respectively. The risk of breast cancer significantly decreased in women with high intake of flavonols (RR=0.88, 95% CI 0.80-0.98) and flavones (RR=0.83, 95% CI: 0.76-0.91) compared with that in those with low intake of flavonols and flavones. However, no significant association of flavan-3-ols (RR=0.93, 95% CI: 0.84-1.02), flavanones (summary RR=0.95, 95% CI: 0.88-1.03), anthocyanins (summary RR=0.97, 95% CI: 0.87-1.08) or total flavonoids (summary RR=0.98, 95% CI: 0.86-1.12) intake with breast cancer risk was observed. Furthermore, summary RRs of 3 case-control studies stratified by menopausal status suggested flavonols, flavones or flavan-3-ols intake is associated with a significant reduced risk of breast cancer in post-menopausal while not in pre-menopausal women.ConclusionsThe present study suggests the intake of flavonols and flavones, but not other flavonoid subclasses or total flavonoids, is associated with a decreased risk of breast cancer, especially among post-menopausal women.

A new generation of the laser fluorescence device, DIAGNOdent, for caries detection and quantification has been introduced recently. It is the DIAGNOdent pen. The aim of this study was to compare the validity and reliability of both laser-based devices, DIAGNOdent and the DIAGNOdent pen, in quantifying smooth surface caries.The material comprised a sample of 52 premolar teeth extracted on orthodontic indication. The teeth were visually sound or had various stages of non-cavitated carious lesions on smooth surfaces. All teeth were photographed and measured with both DIAGNOdent and the DIAGNOdent pen by two examiners independently. The teeth were then sectioned into 300-microm slices and analysed under a microscope for verification of lesion depth. Histopathological analyses were performed by two observers to assess lesion depth, which was classified into five categories ranging from sound to dentinal caries. Reliability and validity of the two devices were evaluated in terms of intra-class coefficients and Spearman rank correlation coefficient, respectively. The relation between measurements performed by DIAGNOdent and the DIAGNOdent pen was analyzed using Pearson's correlation coefficient.Both DIAGNOdent and the DIAGNOdent pen had excellent intra-observer agreement and acceptable inter-observer agreement. The correlation with histology for DIAGNOdent and the DIAGNOdent pen ranged between 0.47 and 0.57, although the correlation between DIAGNOdent and the DIAGNOdent pen was high.In this in vitro study, the new laser fluorescence device, the DIAGNOdent pen, showed similar reliability and validity at quantification of smooth surface caries compared to the conventional DIAGNOdent device. Agreement between DIAGNOdent and the DIAGNOdent pen was excellent.

The aims of this study were to evaluate the effect of two caries-preventive programs, and to apply the laser fluorescence method, DIAGNOdent, for longitudinal quantification of changes in incipient carious lesions. Twelve subjects with 127 test teeth exhibiting white spot lesions on the buccal surfaces after completed orthodontic therapy were enrolled in the study. Visual examination was performed at baseline and after 12 months. The subjects were divided into two groups: one group received repeated professional tooth cleaning combined with oral hygiene instruction; and the control group received repeated oral hygiene instruction only. The white spot lesions were measured by DIAGNOdent at baseline, and at 3, 6, 9, and 12 months thereafter. There was a significant difference in the DIAGNOdent readings between the first and the final evaluations. However, there was no statistically significant difference between the two treatment groups regarding changes of DIAGNOdent values over time. In conclusion, it may be possible to use DIAGNOdent for longitudinal quantification of carious lesions on smooth surfaces over a period of 1 yr under in vivo conditions. The combination of professional tooth cleaning and oral hygiene instruction had a similar efficacy to professional tooth cleaning only for promoting the remineralization of white spot lesions.

The aim of this study was to evaluate the reliability of a laser-induced infrared fluorescence method, DIAGNOdent, for measuring orthodontically induced white spot lesions. The subjects comprised 13 orthodontic patients, aged 13-17 years, who had recently completed fixed appliance therapy: 137 test teeth were selected, with white spot lesions on the facial or buccal smooth surfaces. An initial visual inspection was performed to localise and record the measuring region. The predetermined measuring regions were scanned to locate the sites of the highest reading. The readings and their corresponding sites were registered on the print out photographs. Following the measurement by the first examiner, the second and the third examiners took DIAGNOdent readings independently at the same lesion sites indicated on the photographs, under identical conditions. One week later, DIAGNOdent readings of the same lesions were retaken by the three observers working independently. Intra- and inter- examiner agreements on DIAGNOdent quantification of lesion severity were analysed by Intra-class correlation coefficient (ICC). The ICC values for intra-examiner agreement for the three examiners were 0.91, 0.97, and 0.98, respectively, with a mean value of 0.95, indicating excellent agreement. The ICC values for inter-examiner agreement were comparatively lower: 0.69 and 0.82 for the first and second measurements, respectively. It was concluded that the reliability of the DIAGNOdent readings on white spot lesions associated with orthodontic banding was good.

The diagnostic value of DIAGNOdent in detecting primary occlusal caries has been investigated in many studies, although its use in in vivo detection of secondary caries remains unclear. The aim of this study was to investigate the ability of DIAGNOdent in in vivo detection of secondary caries on teeth with amalgam restorations. The material comprised 51 posterior teeth restored with amalgam material. Bitewing radiographs were taken of all teeth, in accordance with the standard clinical protocol, and analysed by five observers with respect to secondary caries. The restoration margins of each tooth were carefully scanned with DIAGNOdent and the site of the highest reading and its value were registered in a digital picture. The color (stained/unstained) of the restoration margins was also documented. The restoration material was removed and all cavities were examined carefully by two observers together, both visually and by probe. The results showed that the sensitivity and specificity of DIAGNOdent and conventional radiography in detecting secondary caries were 0.60/0.81 and 0.56/0.92, respectively. For DIAGNOdent, 100% of the teeth in the false-positive fraction had stains. Regarding receiver operating characteristic analyses, the Az values were 0.78 and 0.69 for DIAGNOdent and radiography, respectively. We conclude that DIAGNOdent may be used only as an adjunct to conventional methods in detecting secondary caries on teeth with amalgam restorations.

It is hypothesized that occlusal lesions are initiated on the fissure walls and can therefore be obscured by sound superficial tissue. Additionally, there is evidence that one effect of regular use of fluorides is greater opacity of enamel, which may obscure underlying lesions in dentin, the so-called 'hidden lesions'. Dental radiographs are inadequate for detecting decay in the occlusal surfaces until the lesion is well advanced through the enamel and into the dentin. The clinician relies on visual observation of texture and discoloration, clinical judgment based upon experience, and on tactile sense by probing with an explorer. An objective detection method to complement the traditional visual assessment is used by the clinician for arriving at clinical decisions on the management of the carious lesion: whether invasive therapy or a more conservative, noninvasive approach. Objective and reliable longitudinal monitoring of the lesion's response to preventive measures allow the selection of an appropriate therapy before the lesion progresses to the stage where invasive treatment is required. This paper discusses the problem of the lack of appropriate clinical methods for the detection and quantification of carious lesions. A few commercially available methods are described (the quantitative light-induced fluorescence method, the DIAGNOdent device, and electrical caries monitor) and some new techniques mentioned.