Publications by authors named "Camila Pachêco-Pereira"

40 Publications

Trends in oral and maxillofacial radiology career: A survey.

J Dent Educ 2021 May 17. Epub 2021 May 17.

Department of Comprehensive Dentistry, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA.

Purpose/objectives: To understand the professional aspirations of oral and maxillofacial radiologists (OMRs) by exploring their career choices and their association with educational background, engagement in professional activities, professional values, and overall level of career satisfaction.

Methods: This prospective cross-sectional study surveyed board-certified OMRs in the United States and Canada from September to December 2019. A web-based questionnaire was created comprising 37 multiple-choice questions and an open-ended question focusing on their opinions regarding the profession's future. A thematic approach qualitatively explored open questions.

Results: Of the 86 OMRs, 68, 10, and eight were board certified in the United States, Canada, and both countries, respectively. Activities considered "rewarding" included teaching and mentoring (65%) and radiologic reporting (55%). The majority spent approximately 20-30 h/week writing radiographic reports and less than 10 h in research. On an average, OMRs produced 21.9 (SD 12.8) reports per day. Activities considered less rewarding included administrative work (11%) and productivity pressure in institutions. OMRs working in academia reported higher incomes (p < 0.05). Finally, the majority of the OMRs were pleased with their career choices (79%).

Conclusions: There is an association between the contemporary OMRs' satisfaction feeling, teaching/mentoring, and the future challenges of participating in multidisciplinary teams. Overall, diverse career choices lead OMRs to be proud of their profession and significantly satisfied.
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http://dx.doi.org/10.1002/jdd.12641DOI Listing
May 2021

Trabecular and cortical mandibular bone investigation in familial adenomatous polyposis patients.

Sci Rep 2021 Apr 28;11(1):9143. Epub 2021 Apr 28.

Health Sciences Faculty, University of Brasília, Brasília, Brazil.

Mandibular cortical and trabecular bone abnormalities in patients with familial adenomatous polyposis (FAP) were evaluated using dental panoramic radiographs (DPR) radiomorphometric indices and fractal dimension (FD). Sixty DPRs from 15 FAP patients and 45 healthy controls were evaluated. FAP group was composed of 33.3% females and 66.6% males, age = 37.2 years (SD 15.79). The non-FAP group was paired by gender and sex. The parameters analyzed were: FD of the trabecular bone in four regions of interest (ROI), mandibular cortical index (MCI) and width (MCW). FD values were lower for the FAP group. Statistically significance differences were shown by ROI 2 and 3 anteriorly to the mental foramen bilaterally, p = 0.001, and p = 0.006. The ROI 1 and 4, at the mandibular angle trabeculae, indicated statistical significances on the right side (p = 0.036) and no differences on the left side (p = 0.091). There was no significant difference in MCI and MCW when the groups were compared, MCW (L) p = 0.247, and MCW (R) p = 0.070. Fractal values of FAP patients' mandibular trabecular bone were lower than healthy controls. The radiomorphometric indices MCI and MCW were not useful for analyzing the cortical bone pattern. Therefore, FD is a promising tool for detection of abnormal bone structure in DPRs and for supporting the appropriate referral of FAP patients.
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http://dx.doi.org/10.1038/s41598-021-88513-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8080795PMC
April 2021

Oropharyngeal 3-dimensional changes after maxillary expansion with 2 different orthodontic approaches.

Am J Orthod Dentofacial Orthop 2021 Mar;159(3):352-359

Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Alberta, Canada, University of Texas Health Science at San Antonio, San Antonio, Tex.

Introduction: The objective of this research was to compare the oropharyngeal volume and minimal cross-sectional area (MCA) changes after maxillary expansion using either the Damon system or Hyrax appliances as assessed through cone-beam computed tomography (CBCT) imaging.

Methods: Patients aged between 11 and 17 years with skeletal maxillary transverse discrepancy in need of maxillary expansion were included and allocated randomly into 1 of the 2 treatment groups, Damon or Hyrax. Patients underwent CBCT imaging at 2 time points: T1, after initial clinical evaluation before treatment, and T2, after completion of full orthodontic treatment. The CBCT data were assessed using Dolphin software (Dolphin Imaging & Management Solutions, Chatsworth, Calif). In addition, a qualitative assessment of breathing function was done using the modified Nasal Obstruction and Septoplasty Effectiveness Scale questionnaire.

Results: A statistically significant increase in the oropharyngeal volume (2.23 mL; P = 0.005) and MCA (29.72 mm; P = 0.007) after the completion of treatment (T2 - T1) for the Hyrax group was suggested. No statistically significant difference was found in the Damon group for volume (1 mL; P = 0.311) and for MCA (7.32 mm; P = 0.643). In addition, no statistically significant difference was found in the breathing function in both treatment groups (P >0.05).

Conclusions: Hyrax expansion followed by fixed appliances produced more dimensional upper airway changes at the oropharyngeal level than the Damon system approach. No breathing functional changes were noted in either samples.
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http://dx.doi.org/10.1016/j.ajodo.2020.05.013DOI Listing
March 2021

Intraoral Imaging in Dental Private Practice - A Rectangular Collimator Study.

J Can Dent Assoc 2020 Oct;86:k16

Objective: To gain a better understanding of the extent to which rectangular collimation is being used in private practice and the barriers to adoption by practitioners.

Methods: Licensed dentists in private practice were asked to answer a survey composed of 17 multiple-choice questions and 1 open-ended question regarding demographics, radiation safety, image receptor type, intraoral imaging techniques and use of rectangular collimation.

Results: Among all participants (n = 82), 86.6% used digital systems (n = 71) and 13.4% conventional film (n = 11). Most (74.0%, n = 60) were aware of the benefits of using rectangular collimation, with 5.5% reporting not knowing of the existence of this device (n = 3). Only 12.9% of the dentists reported using rectangular collimation routinely (n = 10). The youngest and oldest age groups had the lowest compliance rates, 5.6% and 0%, respectively.

Conclusion: Although 74.0%, (n = 60) of private practitioners were aware of the benefits of using rectangular collimation to reduce radiation dose, only 12.2% (n = 10) used it routinely for intraoral imaging. Barriers to implementing rectangular collimation in private practice settings included challenges in training support staff and fear of an increase in the occurrence of technical errors that would result in re-exposure of patients.
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October 2020

Development, validation and application of a 3D printed model depicting adenoid hypertrophy in comparison to a Nasoendoscopy.

Head Face Med 2020 Mar 9;16(1). Epub 2020 Mar 9.

School of Dentistry, University of Alberta, 11405 87Ave NW, 5528 Edmonton Clinic Health Academy,, Edmonton, AB, T6G1C9, Canada.

Background: The exploration of tridimensional (3D) technology of computational tomography and the development of valid 3D printed models may improve the assessment of adenoid obstruction. The identification of an enlarged adenoid in childhood would streamline the referral of appropriately selected cases to an otolaryngologist, leading to early treatment of affected children when indicated. The objective of this study is to validate the use of a 3D printed model depicting adenoid hypertrophy based on the pediatric otolaryngologist, head and neck surgeon (OHNS) participants assessment.

Methods: A cross-sectional study was performed to develop and validate 3D depictions, including print-outs, of the nasopharynx including different degrees of Adenoidal Hypertrophy (AH). The print-outs were obtained from 14 Cone-beam computed tomography (CBCT) scans of 14 children (12 boys, 2 girls; mean age of 10.61 years) representing grades 1, 2, 3, and 4 nasopharyngeal adenoidal obstructions, according to a previously Nasoendoscopy-graded (NE) classification by a licensed OHNS. The prevalence of AH in this study was 36%. Two OHNS were recruited to assess the print-outs representing two different representations of the nasopharyngeal airway, the lumen (LU) and adenoid mass (AD). LU and AD were visualized in 2D - pictures- and in 3D - printed prototypes. Intraclass correlation was used to assess intra- and inter-reliability. The validity of our depictions was analyzed through comparison (accuracy and correlation) to the reference standard (NE). The data were clustered to calculate the sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV). Cross-tab and Pearson's T-test were performed.

Results: Overall, the 3D depiction tools showed different diagnostic capabilities. AD representations showed strong (AD 2D, 75%) to almost perfect (AD 3D, 88%) accuracy compared to NE. Excellent sensitivity and specificity were observed for the AD 3D (100, 70%), as well as adequate PPV and NPV (66 and 97% respectively), with only 5% of false-negative cases.

Conclusion: The use of Dolphin software for the acquisition of a 3D printed prototype of the nasopharyngeal adenoidal region seems promising. These prototypes may be a practical and readily available alternative for the assessment of the nasopharyngeal obstructed area. CBCT in children must be taken under strong solid indications. Early referral to an OHNS for a full assessment remains the main objective in children with unclear symptoms.
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http://dx.doi.org/10.1186/s13005-020-00216-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7061480PMC
March 2020

Effectiveness and Perceptions of Flipped Learning Model in Dental Education: A Systematic Review.

J Dent Educ 2019 Aug 27;83(8):935-945. Epub 2019 May 27.

Silvia Gianoni-Capenakas, DDS, is an MSc student, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta; Manuel Lagravere, PhD, is Associate Professor, Orthodontics Department, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta; Camila Pacheco-Pereira, MSc, is Clinical Assistant Professor, Radiology Department, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta; and James Yacyshyn, PhD, is in Continuing Dental Education, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta.

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 abstract 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.
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http://dx.doi.org/10.21815/JDE.019.109DOI Listing
August 2019

Assessing students' confidence in interpreting dental radiographs following a blended learning module.

Int J Dent Hyg 2019 Aug 4;17(3):280-287. Epub 2019 Apr 4.

Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Objective: This study assessed senior dental hygiene (DH) students' self-reported confidence in interpreting dental radiographs following the introduction of a blended learning (BL) module for radiology interpretation. The assessment of students was conducted five months prior to graduation.

Methods: A BL oral radiology module was designed. In order to capture the context, descriptions and differences of students' experience and confidence, a qualitative research approach was selected. Data were captured using a semi-structured interview process and analysed using phenomenographic methods.

Results: Sixteen students were interviewed. Blinded transcripts were analysed, and the main themes relating to confidence were extracted and arranged into categories. The categories were coded as to how confident (low, medium or high) each of the students felt specific to varying contexts and complexities of radiographic interpretation.

Conclusion: Predominately, the BL model had a positive impact on DH students' confidence in the interpretation of radiographic findings. However, when asked about their level of overall confidence in interpreting dental radiographs, students still did not describe themselves as confident for all potential findings on radiographs at this point in their education. The students highlighted the importance of having patient history details and clinical assessment findings included in the interpretation exercises and expressed a desire to collaborate with other professionals when interpreting radiographs.
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http://dx.doi.org/10.1111/idh.12394DOI Listing
August 2019

Patient satisfaction and quality of life status after 2 treatment modalities: Invisalign and conventional fixed appliances.

Am J Orthod Dentofacial Orthop 2018 Nov;154(5):639-644

School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada. Electronic address:

Introduction: Our objectives were to assess patient satisfaction and quality of life among adults via 2 validated comprehensive questionnaires and to compare patient satisfaction and status in oral health-related quality of life immediately after orthodontic treatment in patients treated with Invisalign (Align Technology, San Jose, Calif) and those who received standard bracket-based treatment.

Methods: Adult patients (n = 145) treated with bracket-based or Invisalign therapy were recruited from several private practices and a university clinic. The survey comprised a combination of the Dental Impacts on Daily Living index and the Patient Satisfaction Questionnaire. This 94-question assessment focused on various dimensions of satisfaction and quality of life. Multivariate analysis of variance and the bootstrap test were applied. A reliability analysis was used to assess responses at a 6-month follow-up for a small sample of patients.

Results: Finally, 122 patients were assessed. The multivariate analysis of variance analysis showed that the eating and chewing dimension was significantly different between the 2 groups (Invisalign, 49%; bracket based, 24%; P = 0.047). No significant difference in any other satisfaction factors (all, P > 0.05) was identified. The follow-up assessment was only possible in a small sample of the bracket group; it showed adequate reliability values on the categories of oral comfort (intraclass correlation coefficient [ICC], 0.71), general performance (ICC, 0.755), situational (ICC, 0.80), and doctor-patient relationship (ICC, 0.75).

Conclusions: Of the patients surveyed to assess their satisfaction and oral health-related quality of life immediately after completion of their orthodontic treatment, both the bracket-based and Invisalign treated patients had statistically similar satisfaction outcomes across all dimensions analyzed, except for eating and chewing: the Invisalign group reported more satisfaction. Patient satisfaction remained relatively similar 6 months later for the bracket-type treatment.
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http://dx.doi.org/10.1016/j.ajodo.2018.01.013DOI Listing
November 2018

Diagnostic ultrasound assessment of temporomandibular joints: a systematic review and meta-analysis.

Dentomaxillofac Radiol 2019 Feb 1;48(2):20180144. Epub 2018 Nov 1.

1 School of Dentistry, University of Alberta , Edmonton, AB , Canada.

Objectives:: The purpose of this systematic review was to determine the diagnostic capability of ultrasound to assess TMJ alterations as disc displacement (DD), joint effusion (JE) and condylar changes (CC) using 3D imaging modalities as reference standard.

Methods:: Studies were gathered by searching several electronic databases and partial grey literature up to January eighth, 2018 without restrictions of language and time. The risk of bias was evaluated using the second version of Quality Assessment Tool for Diagnostic of Accuracy Studies-2 (QUADAS-2). The grading of Recommendation, Assessment, Development and Evaluation (GRADEpro system) instrument was applied to assess the level of evidence across the studies.

Results:: After applying the eligibility criteria, 28 studies were identified and synthesized. All studies were methodologically acceptable presenting low applicability concerns, although none of them fulfilled all QUADAS-2 criteria. The quantitative analysis included 22 studies, 2829 joints in total. The quality of the evidence evaluated by GRADE system suggested moderate confidence in estimating the outcomes.

Conclusion:: This systematic review demonstrated the ultrasound has acceptable capability to screen for DD and JE in TMD patients. For screening of condylar changes, ultrasound needs further studies using CT or CBCT as reference standard to support its use. More advanced imaging such as MRI can thereafter be used to confirm the diagnosis if deemed necessary.
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http://dx.doi.org/10.1259/dmfr.20180144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476374PMC
February 2019

Comparison of ultrasound imaging and cone-beam computed tomography for examination of the alveolar bone level: A systematic review.

PLoS One 2018 3;13(10):e0200596. Epub 2018 Oct 3.

Department of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada.

Background And Objective: 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.

Study Design: 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.

Results: 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%.

Conclusions: 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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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0200596PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6169851PMC
March 2019

Dental imaging of trabecular bone structure for systemic disorder screening: A systematic review.

Oral Dis 2019 May 17;25(4):1009-1026. Epub 2018 Sep 17.

Health Sciences Faculty, University of Brasília, Brasília, Brazil.

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.
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http://dx.doi.org/10.1111/odi.12950DOI Listing
May 2019

Evidence on radiation dose reduction using rectangular collimation: a systematic review.

Int Dent J 2019 Apr 29;69(2):84-97. Epub 2018 Jun 29.

School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonoton, AB, Canada.

Background: The goal of an intraoral radiograph is to be a valuable diagnostic tool while keeping the radiation exposure dose as low as reasonably achievable. The International Commission on Radiological Protection (ICRP) has strong recommendations for patient dose-reduction strategies.

Objective: To answer the following research question: 'In either patient or in phantoms, does rectangular collimation compared with other forms of collimation reduce the radiation absorbed dose during intraoral imaging?'

Methods: The search strategy was developed specifically for each electronic database. Information was collected from MEDLINE, all EBM Reviews including the Cochrane Library, EMBASE, LILACS, PubMed and Web of Science, and from a search of the grey literature via Google Scholar. Studies were included if they reported the radiation dose in intraoral imaging using rectangular collimation compared with any other type of collimation or the absence of it. Studies that did not involve comparison/control groups were excluded. A qualitative appraisal of the included studies was performed. The Methodological Index for NOn-Randomised Studies (MINORS) tool assessed the potential risk of bias among the studies, while the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach determined the level of available evidence.

Results: Thirteen studies using different types of receptors, including D-speed film, E-speed film, phosphor storage plates (PSP) and direct digital sensors, were included. Different methods to access absorbed and effective dose by exploring distinct technical parameters, such as distance object-receptor, long- and short-cone, kVp and mA, exposure time and beam filtering, were used. High heterogeneity between the studies was found. The level of evidence was classified as moderate. The radiation dose reduction ranged from 40% to 92% compared with circular collimation. The limitations of the cross-sectional design and in vivo studies were discussed. As this systematic review applied validated tools and guidelines designed for population-based studies, the application for studies based on computer simulations and dosimetry measurements was challenging.

Conclusion: There is moderate evidence suggesting that rectangular collimation significantly reduces radiation dose when compared with round collimation, justifying its implementation in clinical settings/private practices while taking intraoral radiographs.
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http://dx.doi.org/10.1111/idj.12411DOI Listing
April 2019

Radiographic methods to estimate surgical outcomes based on spinal flexibility assessment in patients who have adolescent idiopathic scoliosis: A systematic review.

Spine J 2018 11 26;18(11):2128-2139. Epub 2018 Jun 26.

Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada; Department of Biomedical Engineering, University of Alberta, Edmonton, Canada; Department of Electrical and Computer Engineering, University of Alberta, Edmonton, Canada. Electronic address:

Background Context: Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity recognized with lateral curvature of the spine as well as axial vertebral rotation. Surgical interventions are recommended when patients with AIS have severe curvature (Cobb angle >45). Spinal flexibility is one of important parameters for surgeons to plan surgical treatment. Few radiographic methods have been developed to assess spinal flexibility.

Purpose: A systematic review was performed to evaluate which preoperative radiographic methods should be used to estimate spinal flexibility based on the postoperative outcomes.

Study Design: Studies which included any of the five radiographic methods: (1) supine side-bending (SBR), (2) fulcrum-bending (FBR), (3) traction, (4) push-prone, and (5) suspension were reviewed and compared to determine which method provided the most accurate estimation of the postoperative outcomes.

Patient Sample: Seven case series, one case control, and multiple cohort studies reported the flexibility assessment methods with the estimations of postoperative outcomes on patients with AIS.

Outcome Measures: The flexibility index defined as a correction rate relative to flexibility rate was used to estimate the immediate and final follow-up postoperative outcomes.

Methods: Seven databases searched included MEDLINE, CENTRAL, EMBASE, CINAHL, Web of Science, LILACS, and Google Scholar. Three independent reviewers were involved for abstracts and full-texts screening as well as data extraction. The Quality in Prognostic Studies quality appraisal tool was used to assess the risk of bias within the studies. Also, the GRADE system rate was used to assess the evidence level across the studies.

Results: Forty-six articles were included. The distribution of the five flexibility methods in these 46 studies were SBR 38/46 (83%), fulcrum bending radiograph (FBR) 16/46 (35%), traction radiograph 5/46 (11%), push-prone 1/46 (2%), and suspension 1/46 (2%). Based on the overall assessment of flexibility indices, FBR had the best estimation of postoperative correction among the five methods. FBR method provided the best estimations of immediate and final follow-up postoperative outcomes for moderate (25°-45°) and severe (>45°) curves, respectively. For main thoracic and thoracolumbar/lumbar curves, the best estimations were traction, and FBR. However, in the reviewed articles, the risk of bias was rated moderate and the quality of evidence was rated very low to low so that a strong conclusive statement cannot be made.

Conclusions: SBR method was the most commonly used method to assess the spinal flexibility. The FBR method was the most accurate method to estimate the postoperative outcomes based on the limited evidence of the 46 articles.
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http://dx.doi.org/10.1016/j.spinee.2018.06.344DOI Listing
November 2018

Patient satisfaction and quality of life changes after Invisalign treatment.

Am J Orthod Dentofacial Orthop 2018 Jun;153(6):834-841

School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Introduction: Our objective was to assess patient satisfaction and changes in oral health-related quality of life immediately after orthodontic treatment using the Invisalign system (Align Technology, Santa Clara, Calif).

Methods: Adult patients were recruited from private practices in Canada and surveyed using a combination of 2 validated questionnaires: Dental Impact of Daily Living and Patient Satisfaction Questionnaire. This 94-question assessment focused on various dimensions of satisfaction and changes in quality of life. Multivariate analysis of variance, regression analysis, and canonical correlation analysis were applied in the data analysis.

Results: A total of 81 patients, 29.6% men and 70.4% women, exclusively treated with the Invisalign system participated. The most significant improvements were seen in the appearance and eating and chewing categories, with patients responding positively to more than 70% of the questions in those categories. Food packing between teeth, affecting 24% of the participants, and pain affecting 16% were the most common sources of dissatisfaction. However, these negative experiences were not strong enough to reduce the overall positive experience that patients reported. Appearance and dentofacial improvement were strongly correlated. Canonical correlation of the Patient Satisfaction Questionnaire factors showed that doctor-patient relationship had a significant correlation with situational aspects, dentofacial improvement, and the residual category. Phrases from the doctor-patient relationship category such as "the orthodontist treated me with respect" and "carefully explained what treatment would be like" were associated with higher patient satisfaction.

Conclusions: Although positive changes in appearance and eating categories were linked with patient satisfaction, doctor-patient relationship was the factor that correlated better with multiple aspects of patient satisfaction.
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http://dx.doi.org/10.1016/j.ajodo.2017.10.023DOI Listing
June 2018

Diagnostic validity of CT to assess degenerative temporomandibular joint disease: a systematic review.

Dentomaxillofac Radiol 2018 Jul 2;47(5):20170389. Epub 2018 Mar 2.

5 Department of Dentistry, Brazilian Centre for Evidence Based Research, Federal University of Santa Catarina , Florianópolis , Brazil.

Objectives: The aim of this systematic review was to answer the focus question: "In subjects with degenerative joint disease (DJD) of the temporomandibular joint (TMJ), what is the diagnostic validity of CT or cone-beam CT (CBCT) compared with clinical protocols"?

Methods: DJD should be assessed through clinical diagnosis according to RDC/TMD or DC/TMD. Search strategies were specifically developed to the following electronic databases: Cochrane, Latin American And Caribbean Health Sciences (LILACS), PubMed (including Medline), Scopus and Web of Science. Furthermore, partial grey literature search through Google Scholar, OpenGrey and ProQuest was performed. The risk of bias was evaluated using the second version of Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2).

Results: The databases search revealed 454 records. After applying the eligibility criteria, four studies were included in this review. All studies were methodologically acceptable, although none of the them fulfilled all criteria of risk of bias according to QUADAS-2. Despite there were some high values for sensitivity and specificity, they were not homogeneous between studies. Regarding specificity outcomes, there were three studies with poor values and only one considered as excellent.

Conclusions: CBCT could be a good image to evaluate DJD progression over time, but should not be used as a screening tool in healthy individuals.
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http://dx.doi.org/10.1259/dmfr.20170389DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6196046PMC
July 2018

Digital Intraoral Imaging Re-Exposure Rates of Dental Students.

J Dent Educ 2018 Jan;82(1):61-68

Dr. Senior is Associate Chair, DDS Clinical Education, and Clinical Associate Professor, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta; Dr. Winand was a DDS student, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta; Dr. Ganatra is Clinical Professor, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta; Dr. Lai is Associate Professor and Director of Assessment and Evaluation, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta; Dr. Alsulfyani, a Diplomate ABOMR, is Assistant Professor, Oral Medicine and Diagnostic Sciences, College of Dentistry, King Saud University and Adjunct Professor, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta; and Dr. Pachêco-Pereira is Clinical Assistant Professor, School of Dentistry, Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta.

A guiding principle of radiation safety is ensuring that radiation dosage is as low as possible while yielding the necessary diagnostic information. Intraoral images taken with conventional dental film have a higher re-exposure rate when taken by dental students compared to experienced staff. The aim of this study was to examine the prevalence of and reasons for re-exposure of digital intraoral images taken by third- and fourth-year dental students in a dental school clinic. At one dental school in Canada, the total number of intraoral images taken by third- and fourth-year dental students, re-exposures, and error descriptions were extracted from patient clinical records for an eight-month period (September 2015 to April 2016). The data were categorized to distinguish between digital images taken with solid-state sensors or photostimulable phosphor plates (PSP). The results showed that 9,397 intraoral images were made, and 1,064 required re-exposure. The most common error requiring re-exposure for bitewing images was an error in placement of the receptor too far mesially or distally (29% for sensors and 18% for PSP). The most common error requiring re-exposure for periapical images was inadequate capture of the periapical area (37% for sensors and 6% for PSP). A retake rate of 11% was calculated, and the common technique errors causing image deficiencies were identified. Educational intervention can now be specifically designed to reduce the retake rate and radiation dose for future patients.
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http://dx.doi.org/10.21815/JDE.018.011DOI Listing
January 2018

Prevalence of adenoid hypertrophy: A systematic review and meta-analysis.

Sleep Med Rev 2018 04 14;38:101-112. Epub 2017 Jun 14.

Health Sciences Faculty, University of Brasilia, Brasilia, Brazil; School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada. Electronic address:

The purpose of our review was to synthesize the existing literature about the prevalence of adenoid hypertrophy (AH) in children and adolescents confirmed by the reference standard - the nasoendoscopy (NE). Six electronic databases and partial grey literature were searched. Studies were included if they reported the prevalence of AH confirmed via NE. Studies involving participants with associated comorbidities and/or 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 5248 patients were included. Seventeen studies were included in the meta-analysis showing an AH prevalence of 49.70% (confidence interval (CI): 39.92 to 59.50). The studies were then divided into 3 groups based on the RoB assessment and patient selection method. The AH prevalence for group 1 (studies having low RoB) was 42.18% (CI: 34.93 to 49.60; n = 2794), for group 2 (studies having moderate RoB) was 70.02% (CI: 40.102 to 92.690; n = 538), and finally for group 3 (studies with randomly collected samples) was 34.46% (CI: 10.507 to 63.742; n = 1446). High heterogeneity between the studies was found. The GRADE approach classified the quality of evidence as moderate. In summary, in a randomized representative sample the prevalence of AH was 34.46%; however, in convenience samples the prevalence ranged from 42 to 70%.
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http://dx.doi.org/10.1016/j.smrv.2017.06.001DOI Listing
April 2018

Comparative analysis of imaging techniques for diagnostic accuracy of peri-implant bone defects: a meta-analysis.

Oral Surg Oral Med Oral Pathol Oral Radiol 2017 Oct 23;124(4):432-440.e5. Epub 2017 Jun 23.

Associate Professor, Brazilian Centre for Evidence-Based Research, Department of Dentistry, Federal University of Santa Catarina, Florianopolis, SC, Brazil; Adjunct Assistant Professor, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Canada.

Objective: The aim of this study was to systematically review the literature regarding diagnostic accuracy of imaging techniques in detecting peri-implant bone defects.

Study Design: The search was performed in 8 electronic databases from April to May 2016 and updated in September 2016. Studies that assessed imaging techniques to detect peri-implant bone defects were analyzed.

Results: The search yielded 680 articles published from 1991 to 2016. Of these, 12 studies were considered eligible for this review. The selected studies evaluated the use of cone beam computed tomography (CBCT), intraoral radiography (IR), computed tomography, and panoramic radiography. The sensitivity for CBCT was 59%, whereas the specificity was 67%. For IR, the sensitivity was 60%, and the specificity was 59%. Area under the curve values in receiver operating characteristic (ROC) analysis were 69% for CBCT and 63% for IR. For CBCT, the highest value for positive predictive value was 0.94, negative predictive value was 0.98, positive likelihood ratio was 21.3, and negative likelihood ratio was 1.28. For IR, the highest positive predictive value was 1.0, negative predictive value 1.0, positive likelihood ratio 50.0, and negative likelihood ratio 0.70. The highest diagnostic odds ratio was 80 for CBCT and 4.45 for IR. No conclusion could be drawn for additional techniques.

Conclusions: Both CBCT and IR showed a clinically acceptable performance for assessing peri-implant bone defects.
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http://dx.doi.org/10.1016/j.oooo.2017.06.119DOI Listing
October 2017

Correlation and reliability of cone-beam computed tomography nasopharyngeal volumetric and area measurements as determined by commercial software against nasopharyngoscopy-supported diagnosis of adenoid hypertrophy.

Am J Orthod Dentofacial Orthop 2017 Jul;152(1):92-103

School of Dentistry, Faculty of Medicine and Dentistry, School of Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Introduction: The aim of this study was to evaluate the diagnostic correlation and reliability of Dolphin Imaging fully automated segmentation (Dolphin Imaging and Management Solutions, Chatsworth, Calif) for assessing adenoid hypertrophy. This was investigated through 3 modes: (1) intraobserver and interobserver agreement of repeated airway auto-segmentation procedures, (2) correlation between auto-segmentation measures of volume and minimal cross-sectional airway against nasopharyngoscopy, and (3) optimum diagnostic cutoff thresholds for volume and minimal cross-sectional airway identified and tested with sensitivity and specificity analyses.

Methods: Cone-beam computed tomography scans of 38 patients with suspected upper airway obstruction were analyzed. Two calibrated evaluators applied a previously validated method to quantify nasopharyngeal minimal cross-sectional airway and volume using Dolphin Imaging. Assessments were compared against grades of obstruction provided by otolaryngologists' diagnoses.

Results: The reliability between the 2 assessments by the same evaluator on the Dolphin automatic segmentation function for volume (ICC, 0.97; 95% CI, 0.95, 0.98) and minimal cross-sectional airway (ICC, 0.84; 95% CI, 0.69, 0.91) was excellent. The interoperator reliability for volume was also excellent (ICC, 0.97; 95% CI, 0.95, 0.98), but only good (ICC, 0.701; 95% CI, 0.44, 0.85) for minimal cross-sectional airway. In contrast, the Spearman rank correlation test demonstrated weak associations between the values of the automatic measurements for both volume (4.9%; ρ = -0.22) and minimal cross-sectional airway (3.7%; ρ = 0.19). Assessments of accuracy via Receiver Operating characteristic analysis, sensitivity, specificity, negative predictive values, positive predictive values, and likelihood ratios demonstrated the poor clinical applicability of volume and minimal cross-sectional airway numbers provided by Dolphin Imaging.

Conclusions: The evaluators were reliable at manipulating the selected software, achieving consistent volume and minimal cross-sectional airway measurements, However, Dolphin Imaging volumetric and minimal cross-sectional airway measurements did not correlate well with the nasopharyngoscopy-supported reference standard for adenoid hypertrophy assessment. Under these study conditions, volume and minimal cross-sectional airway used to assess localized adenoid hypertrophy with cone-beam computed tomography imaging based on automated measurements may not yield high-quality clinically relevant information about upper airway constriction related to adenoid hypertrophy.
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http://dx.doi.org/10.1016/j.ajodo.2016.11.024DOI Listing
July 2017

Capability of CBCT to identify patients with low bone mineral density: a systematic review.

Dentomaxillofac Radiol 2017 Dec 3;46(8):20160475. Epub 2017 Jul 3.

1 Health Sciences Faculty, University of Brasília, Brasília, Brazil.

The aim of this study was to systematically review the literature about the capability of CBCT images to identify individuals with low bone mineral density (BMD). As the literature is scarce regarding this topic, the purpose of this systematic review is also to guide future research in this area. A detailed search was performed in five databases without restrictions of time or languages. Additionally, a grey literature search was conducted. The Quality Assessment Tool for Diagnostic Accuracy Studies-2 was applied to evaluate the methodological design of selected studies. With the inclusion of only six studies, the evidence is limited to endorse the use of CBCT assertively as a diagnostic tool for low BMD. All of the three studies that analyzed radiomorphometric indices found that the linear measurements of the mandibular inferior cortex were lower in osteoporotic individuals. CBCT-derived radiographic density vertebral and mandibular measurements were also capable for differentiating individuals with osteoporosis from individuals with normal BMD. The analysis of the cervical vertebrae showed high accuracy measurements. This systematic review indicates a scarcity of studies regarding the potential of CBCT for screening individuals with low BMD. However, the studies indicate that radiomorphometric indices and CBCT-derived radiographic density should be promising tools for differentiating individuals with osteoporosis from individuals with normal BMD.
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http://dx.doi.org/10.1259/dmfr.20160475DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5965944PMC
December 2017

Influence of Intracanal Materials in Vertical Root Fracture Pathway Detection with Cone-beam Computed Tomography.

J Endod 2017 Jul 17;43(7):1170-1175. Epub 2017 May 17.

Department of Radiology, Federal University of Santa Catarina, Florianópolis, Brazil.

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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http://dx.doi.org/10.1016/j.joen.2017.02.006DOI Listing
July 2017

Accuracy and reliability of orthodontists using cone-beam computerized tomography for assessment of adenoid hypertrophy.

Am J Orthod Dentofacial Orthop 2016 Nov;150(5):782-788

Professor and Orthodontic Graduate Program Director, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.

Introduction: Our objectives were to evaluate the reliability of agreement between orthodontists, with various degrees of cone-beam computed tomography (CBCT) imaging manipulation comfort, in classifying adenoid hypertrophy through CBCT generated images and also to determine how accurate orthodontists are compared with the gold standard diagnosis, nasopharyngoscopy.

Methods: This was a cross-sectional study in which a randomized list of board-certified orthodontists evaluated different degrees of adenoid hypertrophy of a stratified sampling of 10 scans. The available pool of CBCT images was from a multidisciplinary airway clinic in which children and adolescents had a CBCT scan and a nasopharyngoscopy (reference standard) by an otolaryngologist (head and neck surgeon) on the same day. The participating orthodontists used the same viewer software and computer, and had access to a previously published visual guideline for evaluating adenoid size.

Results: Fourteen orthodontists evaluated 10 CBCT reconstructions. Interoperator reliability was excellent (intraclass correlation coefficient [ICC], 0.941; 95% confidence interval, 0.882-0.984). However, the orthodontists' evaluations against the reference standard demonstrated poor accuracy, (ICC mean, 0.39; ICC range, 0.0-0.74). Dichotomous data representing healthy and unhealthy patients were analyzed individually, and the orthodontists' evaluations and the nasopharyngoscopy results (accuracy) showed, on average, poor kappa values (mean, 0.44; range, 0.20-0.80).

Conclusions: Different levels of CBCT expertise impacted the assessment accuracy. The participating orthodontists showed excellent consistency among themselves; however, poor agreement between their CBCT assessments compared with nasopharyngoscopy demonstrated that this sample of clinical orthodontists had poor diagnostic accuracy. Together, these findings suggest that orthodontists may make consistent and systematic errors in this type of evaluations.
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http://dx.doi.org/10.1016/j.ajodo.2016.03.030DOI Listing
November 2016

Predictors of postretention stability of mandibular dental arch dimensions in patients treated with a lip bumper during mixed dentition followed by fixed appliances.

Angle Orthod 2017 Mar 21;87(2):209-214. Epub 2016 Sep 21.

Objective: To identify which dental and/or cephalometric variables were predictors of postretention mandibular dental arch stability in patients who underwent treatment with transpalatal arch and lip bumper during mixed dentition followed by full fixed appliances in the permanent dentition.

Materials And Methods: Thirty-one patients were divided into stable and relapse groups based on the postretention presence or absence of relapse. Intercuspid, interpremolar, and intermolar widths; arch length and perimeter; crowding; and lower incisor proclination were evaluated before treatment (T0), after lip bumper treatment (T1), after fixed appliance treatment (T2), and a minimum of 3 years after removal of the full fixed appliance (T3). Logistic regression analyses were performed to evaluate the effect of changes between T0 and T1, as predictive variables, on the occurrence of relapse at T3.

Results: The model explained 53.5 % of the variance in treatment stability and correctly classified 80.6 % of the sample. Of the seven prediction variables, intermolar and interpremolar changes between T0 and T1 (P = .024 and P = .034, respectively) were statistically significant. For every millimeter of increase in intermolar and interpremolar widths there was a 1.52 and 2.70 times increase, respectively, in the odds of having stability. There was also weak evidence for the effect of sex (P = .047).

Conclusions: The best predictors of an average 4-year postretention mandibular dental arch stability after treatment with a lip bumper followed by full fixed appliances were intermolar and interpremolar width increases during lip bumper therapy. The amount of relapse in this crowding could be considered clinically irrelevant.
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http://dx.doi.org/10.2319/051216-379.1DOI Listing
March 2017

Gingival condition associated with two types of orthodontic fixed retainers: a meta-analysis.

Eur J Orthod 2017 Aug;39(4):446-452

School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.

Background: The maintenance of gingival health around orthodontic fixed retainers (FRs) is difficult and different designs have been proposed.

Objective: The goal of this systematic review was to analyse whether FR designs that allow unobstructed interproximal flossing, compared with the ones that do not, improve gingival parameters.

Search Methods: Detailed individual database search strategies for Cochrane Library, 'Latin' American and 'Caribbean' Health Sciences Literature, PubMed, Scopus, and Web of Science were developed. Grey literature was also considered.

Selection Criteria: Clinical trials and cross-sectional studies that compared two types of FRs (plain and waved) were included and evaluated.

Data Collection And Analysis: Study selection, data extraction, and risk of bias (RoB) assessment were performed individually and in duplicate. The methodology quality was assessed using the MAStARI RoB tool.

Results: Four studies met the inclusion criteria, and all presented moderate RoB. While two of those studies found a statistically significant difference in gingival parameters, the other two did not report differences. A meta-analysis was conducted based on two of the selected studies, which performed evaluations of plaque index (PI) and calculus index (CI). The results revealed no differences on PI between wave FR and plain FR of 0.46 (0.24 to 0.69) and no differences on CI of 0.12 (-0.10 to 0.33). Regarding comfort, no clear differences were identified.

Conclusions: There is not enough scientific evidence to support or not an association between FR design and gingival health, flossing frequency, or patient comfort.

Registration: PROSPERO - CRD42016030059.
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http://dx.doi.org/10.1093/ejo/cjw057DOI Listing
August 2017

Accuracy and reliability of oral maxillofacial radiologists when evaluating cone-beam computed tomography imaging for adenoid hypertrophy screening: a comparison with nasopharyngoscopy.

Oral Surg Oral Med Oral Pathol Oral Radiol 2016 Jun 18;121(6):e168-74. Epub 2016 Mar 18.

Professor & Orthodontic Graduate Program Director, School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada.

Objective: To determine how accurate and reliable oral maxillofacial radiologists (OMFRs) are in screening for adenoid hypertrophy when using cone-beam computed tomography (CBCT) imaging compared with nasopharyngoscopy (NP).

Study Design: CBCT scans of 10 patients with distinct levels of adenoid hypertrophy were randomly selected. Fourteen board-certified OMFRs classified the levels of hypertrophy. The intraclass correlation coefficient (ICC) was used to assess accuracy by comparing their diagnosis against an NP diagnosis, which is the reference standard. OMFRs' interreliability was assessed. Kappa statistics were used to analyze dichotomous data from healthy and unhealthy patients.

Results: Overall, the reliability among OMFRs was good (ICC = 0.79 with confidence interval [CI] 0.63-0.93). The "statistical mode" was very good (ICC = 0.81; CI 0.43-0.94). The accuracy of OMFRs against NP was good (ICCmean = 0.69; CI 0.43-0.94). On average, the Kappa statistics (Kmean = 0.77; CI 0.62-0.92) demonstrated a good agreement between OMFRs and NP diagnoses. The individualized results from each evaluator were presented and investigated according to their performance.

Conclusions: Compared with the reference standard, the accuracy of OMFRs to classify adenoid hypertrophy on a four-level scale was moderate to strong and improved when adenoid hypertrophy was classified as healthy or unhealthy. The reliability of the OMFRs was greater than 80%, assuring their consistency and reliability on screening adenoids hypertrophy via CBCT.
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http://dx.doi.org/10.1016/j.oooo.2016.03.010DOI Listing
June 2016

Informed consent comprehension and recollection in adult dental patients: A systematic review.

J Am Dent Assoc 2016 08 10;147(8):605-619.e7. Epub 2016 May 10.

Background: Patients' ability to recollect and comprehend treatment information plays a fundamental role in their decision making.

Types Of Studies Reviewed: The authors considered original studies assessing recollection or comprehension of dental informed consent in adults. The authors searched 6 electronic databases and partial gray literature and hand searched and cross-checked reference lists published through April 2015. The authors assessed the risk of bias in the included studies via different validated tools according to the study design.

Results: Nineteen studies were included: 5 randomized clinical trials, 8 cross-sectional studies, 3 qualitative studies, 2 mixed-methods studies, and 1 case series. Conventional informed consent processes yielded comprehension results of 27% to 85% and recollection of 20% to 86%, whereas informed consent processes enhanced by additional media ranged from 44% to 93% for comprehension and from 30% to 94% for recollection. Patient self-reported understanding ranged positively, with most patients feeling that they understood all or almost all the information presented. Results of qualitative data analyses indicated that patients did not always understand explanations, although dentists thought they did. Some patients firmly stated that they did not receive any related information. Only a few patients were able to remember complications related to their treatment options.

Conclusions And Practical Implications: Results of this systematic review should alert dentists that although patients in general report that they understand information given to them, they may have limited comprehension. Additional media may improve conventional informed consent processes in dentistry in a meaningful way.
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http://dx.doi.org/10.1016/j.adaj.2016.03.004DOI Listing
August 2016

Patient compliance and periodontal outcomes.

Evid Based Dent 2016 Mar;17(1):21-2

New York University College of Dentistry, New York, USA.

Data Sources: PubMed, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) were searched until 2014. Reference lists from the articles were examinedStudy selectionTwo authors independently searched for randomised and non-randomised controlled trials and prospective and retrospective cohorts with a mean follow up period of at least five years.

Data Extraction And Synthesis: Quality of the studies was assessed using the Newcastle-Ottawa scale (NOS) and the data were extracted on a specially designed form. The primary outcome was calculated as risk ratio of tooth loss (RRTL). Risk difference of tooth loss (RDTL) and weighted mean difference of tooth loss rate (WDTLR) were also calculated.

Results: One prospective and seven retrospective cohort studies including 1409 participants were included. The pooled RRTL was calculated as 0.56 (CI: 0.38,0.82) P<0.01, while the pooled RDTL was calculated as -0.05 (CI: -0.08, -0.01) p<0.01. Based on the risk difference, the NNT was calculated as 20.

Conclusions: Tooth loss rate was significantly lower in the regular compliance group over the five years. To prevent one extraction, 20 teeth have to be maintained with regular compliance for more than five years.
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http://dx.doi.org/10.1038/sj.ebd.6401153DOI Listing
March 2016

Short- and long-term evaluation of mandibular dental arch dimensional changes in patients treated with a lip bumper during mixed dentition followed by fixed appliances.

Angle Orthod 2016 Sep 15;86(5):753-60. Epub 2016 Jan 15.

f  Associate Professor, Head of Orthodontic Unit and Chair of Postgraduate Program, Multidisciplinary Department of Medical-Surgical and Dental Specialties, Second University of Naples, Naples, Italy.

Objective: 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.

Materials And Methods: 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.

Results: 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.

Conclusions: 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.
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http://dx.doi.org/10.2319/073015-519.1DOI Listing
September 2016

Prevalence of clinical signs of intra-articular temporomandibular disorders in children and adolescents: A systematic review and meta-analysis.

J Am Dent Assoc 2016 Jan 6;147(1):10-18.e8. Epub 2015 Nov 6.

Background: The aim of this systematic review and meta-analysis was to assess the prevalence of clinical signs of temporomandibular joint (TMJ) disorders in children and adolescents.

Type Of Studies Reviewed: The authors selected only studies in which the investigators' primary objective was to evaluate the prevalence of signs of TMJ disorders according to the international Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) in children and adolescents. The authors performed electronic searches without language restriction in 5 databases. The authors also assessed quality.

Results: In this review and meta-analysis, the authors included 11 articles that described studies in which 17,051 participants had been enrolled. The overall prevalence of clinical signs of intra-articular joint disorders was 16% (95% confidence interval [CI], 11.59-19.94; n = 17,051). The prevalence of TMJ sounds (click and crepitation) was 14% (95% CI, 9.67-19.79; n = 11,316). The most prevalent sign was clicking (10.0%; 95% CI, 7.97-12.28; n = 9,665) followed by jaw locking (2.3%; 95% CI, 0.56-5.22; n = 5,735).

Conclusions And Practical Implications: One in 6 children and adolescents have clinical signs of TMJ disorders. The results of this systematic research study can alert dentists about the importance of looking for signs of TMD in children and adolescents.
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http://dx.doi.org/10.1016/j.adaj.2015.07.017DOI Listing
January 2016