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1.  Effects of platelet-rich fibrin and piezosurgery on impacted mandibular third molar surgery outcomes 
Head & Face Medicine  2015;11:25.
Introduction
The aim of this study was the comparision of postoperative outcomes in impacted mandibular third molars that were treated using either platelet-rich fibrin (PRF), a combination of PRF and piezosurgery, or conventional rotatory osteotomy.
Patient and methods
The study included 20 patients; 40 extractions of impacted mandibular third molars were performed. Patients were divided into two main groups. In group A (n = 20), traditional surgery was performed on one side (Group 1, n = 10); traditional surgery was performed, and PRF was administered to the extracted socket on the other side of same patient (Group 2, n = 10). In group B (n = 20), on one side, piezosurgery was used for osteotomy, and PRF was administered (Group 3, n = 10); on the other side of same patient, traditional surgery was performed (Group 4, n = 10). Parameters assessed at baseline for each patient included pain, the number of analgesics taken, trismus, and cheek swelling. These variables were also assessed on postoperative days 1, 2, 3, and 7.
Results
Statistical analysis revealed a significant reduction in postoperative pain (sum of 1st, 2nd, 3rd and 7th days) and trismus (on postoperative day 1) in group 2 (traditional surgery + PRF group), and in postoperative pain, the number of analgesics taken (sum of 1st, 2nd,3rd and 7th days) and trismus (on postoperative day 1) in group 3 (piezosurgery + PRF group) compared to groups 1 and 4 (traditional surgery groups), (p ≤ 0.05). However, swelling on postoperative days 1, 3, and 7 did not differ among the groups (p > 0.05). Only difference was on second day between groups 1–4 and 2–4 (p ≤ 0.05).
Conclusions
The results of our study have shown that the use of PRF with traditional surgery and PRF combined with piezosurgery significantly reduced pain during the postoperative period. In addition, PRF in combination with piezosurgery significantly decreased the number of analgesics taken. Both operations also significantly decreased trismus 24 h after the surgery. As a result of this study, PRF and combination use of PRF and piezosurgery have positive effects in reducing postoperative outcomes after impacted third molar surgery.
doi:10.1186/s13005-015-0081-x
PMCID: PMC4514981  PMID: 26209242
Platelet-rich fibrin; Piezosurgery; Impacted third molar surgery; Pain; Swelling; Trismus
2.  Accuracy evaluation of CAD/CAM generated splints in orthognathic surgery: a cadaveric study 
Head & Face Medicine  2015;11:24.
Introduction
To evaluate the accuracy of CAD/CAM generated splints in orthognathic surgery by comparing planned versus actual post-operative 3D images.
Methods
Specific planning software (SimPlant® OMS Standalone 14.0) was used to perform a 3D virtual Le Fort I osteotomy in 10 fresh human cadaver heads. Stereolithographic splints were then generated and used during the surgical procedure to reposition the maxilla according to the planned position. Pre-operative planned and postoperative 3D CT scan images were fused and imported to dedicated software (MATLAB®) 7.11.) for calculating the translational and rotational (pitch, roll and yaw) differences between the two 3D images. Geometrical accuracy was estimated using the Root Mean Square Deviations (RMSD) and lower and upper limits of accuracy were computed using the Bland & Altman method, with 95 % confidence intervals around the limits. The accuracy cutoff was set at +/− 2 mm for translational and ≤ 4° for rotational measurements.
Results
Overall accuracy between the two 3D images was within the accuracy cutoff for all values except for the antero-posterior positioning of the maxilla (2.17 mm). The translational and rotational differences due to the splint were all within the accuracy cutoff. However, the width of the limits of agreement (range between lower and upper limits) showed that rotational differences could be particularly large.
Conclusion
This study demonstrated that maxillary repositioning can be accurately approximated and thus predicted by specific computational planning and CAD/CAM generated splints in orthognathic surgery. Further study should focus on the risk factors for inaccurate prediction.
doi:10.1186/s13005-015-0082-9
PMCID: PMC4514936  PMID: 26209339
Orthognathic surgery; Computer-assisted surgery; CAD/CAM splints
3.  Influence of maxillary advancement surgery on skeletal and soft-tissue changes in the nose — a retrospective cone-beam computed tomography study 
Head & Face Medicine  2015;11:23.
Objectives
Surgical correction of skeletal maxillary retroposition is often associated with changes in the morphology of the nose. Unwanted alar flaring of the nose is observed in many cases. The aim of the present study was therefore to investigate the influence of surgical advancement of the maxilla on changes in the soft-tissue morphology of the nose. Having a coefficient that allows prediction of change in the nasal width in Caucasian patients after surgery would be helpful for treatment planning.
Materials and methods
All 33 patients included in this retrospective study were of Caucasian descent and had skeletal Class III with maxillary retrognathia. They were all treated with maxillary advancement using a combination of orthodontic and maxillofacial surgery methods. Two cone-beam computed tomography (CBCT) datasets were available for all of the study's participants (16 female, 17 male; age 24.3 ± 10.4 years): the first CBCT imaging was obtained before the planned procedure (T0) and the second 14.1 ± 6.4 months postoperatively (T1). Morphological changes were recorded three-dimensionally using computer-aided methods (Mimics (Materialise NV, Leuven/Belgium), Geomagic (Geomagics, Morrisville/USA)). Statistical analysis was carried out using SPSS 21 for Mac.
Results
The mean sagittal advancement of the maxilla was 5.58 mm. The width of the nose at the alar base (Alb) changed by a mean of + 2.59 mm (±1.26 mm) and at the ala (Al) by a mean of + 3.17 mm (±1.32 mm). Both of these changes were statistically highly significant (P = 0.000). The increase in the width of the nose corresponded to approximately half of the maxillary advancement distance in over 80 % of the patients. The nasolabial angle declined by an average of −6.65° (±7.71°).
Conclusions
Maxillary advancement correlates with a distinct morphological change in nasal width. This should be taken into account in the treatment approach and in the information provided to patients.
doi:10.1186/s13005-015-0080-y
PMCID: PMC4495703  PMID: 26152559
Nasal changes; Orthognathic surgery; Retrognathia; CBCT superimposition; Three-dimensional analysis
4.  Comparison of anchorage reinforcement with temporary anchorage devices or a Herbst appliance during lingual orthodontic protraction of mandibular molars without maxillary counterbalance extraction 
Head & Face Medicine  2015;11:22.
Background
Orthodontic protraction of mandibular molars without maxillary counterbalance extraction in cases of aplasia or extraction requires stable anchorage. Reinforcement may be achieved by using either temporary anchorage devices (TAD) or a fixed, functional appliance. The objective was to compare the clinical effectiveness of both methods by testing the null-hypothesis of no significant difference in velocity of space closure (in mm/month) between them. In addition, we set out to describe the quality of posterior space management and treatment-related factors, such as loss of anchorage (assessed in terms of proportions of gap closure by posterior protraction or anterior retraction), frequencies of incomplete space closure, and potential improvement in the sagittal canine relationship.
Methods
Twenty-seven subjects (15 male/12 female) with a total of 36 sites treated with a lingual multi-bracket appliance were available for retrospective evaluation of the effects of anchorage reinforcement achieved with either a Herbst appliance (nsubjects = 15; 7 both-sided/8 single-sided Herbst appliances; nsites = 22) or TADs (nsubjects = 12; 2 both-sided; 10 single-sided; nsites = 14). Descriptive analysis was based on measurements using intra-oral photographs which were individually scaled to corresponding plaster casts and taken on insertion of anchorage mechanics (T1), following removal of anchorage mechanics (T2), and at the end of multi-bracket treatment (T3).
Results
The null-hypothesis was rejected: The rate of mean molar protraction was significantly faster in the Herbst-reinforced group (0.51 mm/month) than in the TAD group (0.35). While complete space closure by sheer protraction of posterior teeth was achieved in all Herbst-treated cases, space closure in the TAD group was achieved in 76.9 % of subjects by sheer protraction of molars, and it was incomplete in 50 % of cases (mean gap residues: 1 mm). Whilst there was a deterioration in the canine relationship towards Angle-Class II malocclusion in 57.14 % of space closure sites in TAD-treated subjects (indicating a loss of anchorage), an improvement in canine occlusion was observed in 90.9 % of Herbst-treated cases.
Conclusion
Subjects requiring rapid space closure by molar protraction in combination with a correction of distal occlusion may benefit from using Herbst appliances for anterior segment anchorage reinforcement rather than TAD anchorage.
doi:10.1186/s13005-015-0079-4
PMCID: PMC4475330  PMID: 26092262
Orthodontic molar protraction; Anchorage reinforcement; TAD; Herbst appliance; Lingual orthodontics
5.  Does facial soft tissue protect against zygomatic fractures? Results of a finite element analysis 
Head & Face Medicine  2015;11:21.
Introduction
Zygomatic fractures form a major entity in craniomaxillofacial traumatology. Few studies have dealt with biomechanical basics and none with the role of the facial soft tissues. Therefore this study should investigate, whether facial soft tissue plays a protecting role in lateral midfacial trauma.
Methods
A head-to-head encounter was simulated by way of finite element analysis. In two scenarios this impact - with and without soft tissues - was investigated to demonstrate the potential protective effects. To achieve realism, a transient simulation was chosen, which considers temporal dynamics and realistic material parameters derived from CT grey values.
Results
The simulation results presented a typical zygomatic fracture with all relevant fracture lines. Including soft tissues did not change the maximum bony stress pattern, but increased the time period from impact to maximal stresses by 1.3 msec.
Conclusions
Although this could have clinical implications, facial soft tissues may be disregarded in biomechanical simulations of the lateral midface, if only the bony structures are to be investigated. Soft tissue seems to act as a temporal buffer only.
doi:10.1186/s13005-015-0078-5
PMCID: PMC4467092  PMID: 26077866
Biomechanics; Zygomatic fracture; Facial soft tissue; Finite element analysis
6.  Case report of an internal granuloma investigated by light and scanning electron microscopy 
Head & Face Medicine  2015;11:20.
There is no doubt that the main reason for an internal grauloma is a traumatic event. The trauma may be physical or chemical as in the case of caries or coronal pulpectomy. In most of the cases it is diagnosed by hazard or, when in case of fracture or mobility, extraction is the only therapy to be performed. If diagnosed in time root canal treatment may be adequate.
In the presented case no single specific event could be determined being the cause of this large internal granuloma extending from the coronal third of the root canal to the whole crown just leaving an eggshell of enamel that fractured and mimicked mobility of the whole tooth to the patient finally causing him to attend the clinic. As the patient presented severe aggressive periodontitis and mobility of all teeth it first was assumed that periodontitis was the ethiological reason in this case. Due to secondary trauma the front teeth were labially positioned thus probably being exposed to traumatic insults more frequently. Clinically the upper right medial incisor appeared discoloured darkly not showing the typical pink spot. Without any force the coronal part of the right medial incisor could be removed manually and the root was extracted using a periostal extractor. As it was not suitable to leave the patient with a missing tooth in the front the wound was sutured and as a temporary solution the tooth was reconstructed with composite intraorally and fixed to the neighbour teeth adhesively. The histopathology of the internal granuloma and the crown was investigated.
doi:10.1186/s13005-015-0077-6
PMCID: PMC4465001  PMID: 26065880
Internal granuloma; Root resorption; Pulp inflammation
7.  Analysis of angiogenic markers in oral squamous cell carcinoma-gene and protein expression 
Head & Face Medicine  2015;11:19.
Purpose
Therapeutic strategies attacking oral squamous cell carcinoma have not essentially succeeded to improve long-term prognosis and overall survival over the last decades. Therefore, in this study, we aimed to illuminate the molecular regulation of angiogenesis in this tumour entity in order to demask novel markers of prognosis or therapeutic approach.
Materials and methods
A panel of significant transcriptional alterations in angiogenic genes of 83 cancer samples was established by comparison to 30 samples of healthy oral mucosa with microarray technique. Immunohistochemistry (IHC) was performed to trace the signalling cascade from gene to protein level.
Results
A distinctive expression profile of VEGFA, EFNB2, PECAM1/CD31, ANGPT1 and ANGPT2 was revealed: VEGFA, EFNB2, and ANGPT2 were found overexpressed in 84 % to 95 % of tumour samples. In contrast, the expression of CD31 and ANGPT1 was downregulated in 80 % to 95 % of tumour samples. IHC confirmed results of the microarray analysis.
Tumours with lymphatic spread showed higher gene expression rates of VEGFA, EFNB2 and ANGPT2 in moderately differentiated tumours and of VEGFA and EFNB2 in small tumours, respectively. The ANGPT1/ ANGPT2 transcription ratio was found decreased in larger tumours and especially in tumours without lymphatic spread.
Conclusions
A characteristic expression profile of angiogenic markers was established. The specific overexpression of EFNB2 in small tumours with lymphatic spread and the typical decrease of the ANGPT1/ ANGPT2 ratio in larger tumours give weight to EFNB2 and angiopoietins as prognostic factors and potential therapeutic targets.
doi:10.1186/s13005-015-0076-7
PMCID: PMC4461981  PMID: 26044849
Oral squamous cell carcinoma; Microarray analysis; Angiopoietins; VEGF; EFNB2; Angiogenesis
8.  Prenatal ultrasound and postmortem histologic evaluation of tooth germs: an observational, transversal study 
Head & Face Medicine  2015;11:18.
Introduction
Hypodontia is the most frequent developmental anomaly of the orofacial complex, and its detection in prenatal ultrasound may indicate the presence of congenital malformations, genetic syndromes and chromosomal abnormalities.
To date, only a few studies have evaluated the histological relationship of human tooth germs identified by two-dimensional (2D) ultrasonography. In order to analyze whether two-dimensional ultrasonography of tooth germs may be successfully used for identifying genetic syndromes, prenatal ultrasound images of fetal tooth germs obtained from a Portuguese population sample were compared with histological images obtained from fetal autopsies.
Methods
Observational, descriptive, transversal study. The study protocol followed the ethical principles outlined by the Helsinki Declaration and was approved by the Ethics Committee of the School of Dental Medicine, University of Porto (FMDUP, Porto, Portugal) and of the Centro Hospitalar de Vila Nova de Gaia/Espinho (CHVNG/EPE, Porto, Portugal) as well as by the CGC Genetics Embryofetal Pathology Laboratory. Eighty-five fetuses examined by prenatal ultrasound screening from May 2011 to August 2012 had an indication for autopsy following spontaneous fetal death or medical termination of pregnancy. Of the 85 fetuses, 37 (43.5%) were randomly selected for tooth germ evaluation by routine histopathological analysis. Fetuses who were up to 30 weeks of gestation, and whose histological pieces were not representative of all maxillary tooth germs was excluded. Twenty four fetus between the 13th and 30th weeks of gestation fulfilled the parameters to autopsy.
Results
Twenty four fetuses were submitted to histological evaluation and were determined the exact number, morphology, and mineralization of their tooth germs. All tooth germs were identifiable with ultrasonography as early as the 13th week of gestation. Of the fetuses autopsied, 41.7% had hypodontia (29.1% maxillary hypodontia and 20.9% mandibular hypodontia).
Conclusions
This results indicate that prenatal ultrasound is a reliable method for detecting of hypodontia an early gestational ages. Further studies with larger samples are needed to confirm these results.
doi:10.1186/s13005-015-0075-8
PMCID: PMC4440249  PMID: 25962445
Tooth germ; Tooth buds; Ultrasound; Prenatal; Diagnosis; Histology
9.  Reviewer acknowledgement 2014 
Head & Face Medicine  2015;11:17.
Contributing reviewers
The Editors of Head & Face Medicine would like to thank all our reviewers who have contributed to the journal in Volume 10 (2014).
doi:10.1186/s13005-015-0059-8
PMCID: PMC4424505  PMID: 25956246
10.  An in vitro study of different material properties of Biodentine compared to ProRoot MTA 
Head & Face Medicine  2015;11:16.
Introduction
The aim of this study was to compare solubility, microhardness, radiopacity, and setting time of Biodentine with ProRoot MTA.
Methods
Solubility in distilled water, radioopacity, and setting time were evaluated in accordance with International Standard ISO 6876:2001. In addition, the solubility in Phosphate Buffered Saline (PBS) buffer was determined. For microhardness-testing, ten samples of each cement were produced. All samples were loaded with a diamond indenter point with a weight of 100 g for 30s.
All data were analysed using the Student-t-test.
Results
Both materials fulfilled the requirements of the International Standard ISO 6876:2001 and showed a solubility of <3% after 24 h. At all exposure times Biodentine was significantly more soluble than ProRoot MTA (p < 0.0001). After immersion in PBS-buffer a precipitation of hydroxyapatite was visible.
The Vickers microhardness for Biodentine was significantly higher (62.35 ± 11.55HV) compared with ProRoot MTA (26.93 ± 4.66HV) (p < 0.0001).
ProRoot MTA was significantly more radiopaque (6.40 ± 0.06 mm Al) than Biodentine (1.50 ± 0.10 mm Al) (p < 0.0001).
The setting time for Biodentine (85.66 ± 6.03 min) was significantly lower than for ProRoot MTA (228.33 ± 2.88 min) (p < 0.0001).
Conclusions
Biodentine and ProRoot MTA displayed different material properties. The solubility of both cements was in accordance with the International Standard ISO 6876:2001, whereas ProRoot MTA showed a significantly lower solubility. With regard to microhardness, Biodentine may be used to replace dentine. The radioopacity of Biodentine did not fulfil the requirements laid down in the International Standard ISO 6876:2001. The setting time for ProRoot MTA is significantly higher. Both materials can be used in different indications where specific material properties may be favourable. Hence, the here tested material properties are of clinical relevance.
doi:10.1186/s13005-015-0074-9
PMCID: PMC4424823  PMID: 25934270
Biodentine; Radiopacity; Setting time; Solubility; Vickers microhardness
11.  One palatal implant for skeletal anchorage – frequency and range of indications 
Head & Face Medicine  2015;11:15.
Objective
Aim of this investigation was to analyze the frequency and range of indications of orthodontic treatments using one palatal implant for skeletal anchorage, in a time frame of four years.
Material and methods
A sample was comprised by viewing retrospectively the patient collective of a specialized university clinic who started orthodontic treatment in the time frame 01/09-12/12. Inclusion criterion was the first application of a superstructure within the investigated period after successful insertion of a palatal implant (Ortho-System®, Straumann, Basel, Switzerland). Frequency and range of indications of the conducted skeletally anchored tooth movement were determined by analyzing the individual patient documentation such as medical records, radiographs and casts.
Results
From a total of 1350 patients who started orthodontic treatment in this period met 56 (=4.2%) the inclusion criterion. In 85.7% of this sample was sagittal orthodontic tooth movement conducted, most frequently mesialization of ≥1 tooth (44.6%). Vertical tooth movement was in 57.1% of the sample performed, mostly extrusion of ≥1 tooth (34%). In 33.9% of the sample was ≥1 displaced tooth orthodontically relocated. One or two upper incisors were in 16.1% of the sample permanently replaced by the superstructure, all but one even after orthodontic treatment. In 66.1% of all cases were multi-functional anchorage challenges performed.
Conclusion
4.2 % of all treated patients within the investigated period required orthodontic treatment with skeletal anchorage (palatal implant), mainly for performing sagittal tooth movement (mesialization). The palatal implant was primarily used for multi-functional anchorage purposes, including skeletally anchored treatment in the mandible.
doi:10.1186/s13005-015-0073-x
PMCID: PMC4407421  PMID: 25895493
Palatal implant; Ortho system; Orthodontic treatment; Indication; Frequency; Skeletal anchorage
12.  Shear bond strength of Biodentine, ProRoot MTA, glass ionomer cement and composite resin on human dentine ex vivo 
Head & Face Medicine  2015;11:14.
Introduction
The aim of this study was to compare the shear bond strength of Biodentine, ProRoot MTA (MTA), glass ionomer cement (GIC) and composite resin (CR) on dentine.
Methods
120 extracted human third molars were embedded in cold-cured-resin and grinned down to the dentine. For each material 30 specimens were produced in standardised height and width and the materials were applied according to manufacturers´ instructions on the dentine samples. Only in the CR group a self-etching dentine-adhesive was used. In all other groups the dentine was not pre-treated. All specimens were stored at 37.5 °C and 100% humidity for 2d, 7d and 14d. With a testing device the shear bond strength was determined (separation of the specimens from the dentine surface). The statistical evaluation was performed using ANOVA and Tukey-test (p < 0.05).
Results
At all observation periods the CR showed the significant highest shear bond strength (p < 0.05). After 2d significant differences in the shear bond strength were detectable between all tested materials, whereby CR had the highest and MTA the lowest values (p < 0.05). After 7d and 14d the shear bond strengths of MTA and Biodentine increased significantly compared to the 2d investigation period (p < 0.05). Biodentine showed a significantly higher shear bond strength than MTA (p < 0.05), while the difference between Biodentine and GIC was not significant (p > 0.05).
Conclusions
After 7d Biodentine showed comparable shear bond values than GIC, whereas the shear bond values for MTA were significantly lower even after 14d. The adhesion of Biodentine to dentine surface seams to be superior compared to that of MTA.
doi:10.1186/s13005-015-0071-z
PMCID: PMC4408566  PMID: 25908430
Biodentine; Composite resin; Glass ionomer cement; ProRoot MTA; Shear bond strength
13.  Odontogenic cutaneous sinus tract associated with a mandibular second molar having a rare distolingual root: a case report 
Head & Face Medicine  2015;11:13.
Introduction
Odontogenic cutaneous sinus tracts are often misdiagnosed as lesions of non-odontogenic origin, leading to the treatment of patients with unnecessary and ineffective therapies. Sinus tracts of endodontic origin usually respond well to endodontic therapy. However, root canal treatment of mandibular molars with aberrant canal anatomy can be diagnostically and technically challenging. Herein we present a patient with a cutaneous odontogenic sinus tract in the right submandibular area.
Case report
A 23-year-old Chinese female patient presented with a cutaneous odontogenic sinus tract that was initially misdiagnosed as a sebaceous cyst. The patient had undergone surgical excision and traditional Chinese medical therapy before endodontic consultation. With the aid of cone beam computed tomography (CBCT), it was confirmed that the causative factor of the cutaneous odontogenic sinus tract was chronic periapical periodontitis of the right mandibular second molar, which had a rare and curved distolingual root. The resolution of the sinus tract and apical healing was accomplished following nonsurgical root canal treatment.
Conclusion
A dental aetiology must be included in the differential diagnosis of cutaneous sinus tracts in the neck and face. Elimination of odontogenic cutaneous sinus tract infection by endodontic therapy results in resolution of the sinus tract without surgical excision or systemic antibiotic therapy. This case report also indicates that CBCT imaging is useful for identifying the tooth involved, ascertaining the extent of surrounding bone destruction and accurately managing the aberrant canal morphology.
doi:10.1186/s13005-015-0072-y
PMCID: PMC4414428  PMID: 25885921
Cone-beam computed tomography; Distolingual root; Mandibular second molar; Odontogenic cutaneous sinus tract; Sodium hypochlorite accident
14.  Eggshells as natural calcium carbonate source in combination with hyaluronan as beneficial additives for bone graft materials, an in vitro study 
Head & Face Medicine  2015;11:12.
Introduction
In bone metabolism and the formation especially in bone substitution, calcium as basic module is of high importance. Different studies have shown that the use of eggshells as a bone substitute material is a promising and inexpensive alternative. In this in vitro study, the effects of eggshell granulate and calcium carbonate towards primary bovine osteoblasts were investigated. Hyaluronan (HA) was used as artificial extracellular matrix (ECM) for the used cells to facilitate proliferation and differentiation and to mimic the physiological requirements given by the egg in vivo.
Methods
Hyaluronan, eggshells, a combination of hyaluronan and eggshells and CaCO3 were applied to the cells as additive to the used standard medium (modified High Growth Enhancement Medium) in a concentration of 0,1 g/l. The effect of the additives in the culture medium was examined by proliferation tests, immunohistochemical staining (anti-collagen type I, anti-osteopontin, anti-osteonectin and anti-osteocalcin) and kinetic oxygen measurements.
Results
Our investigations revealed that all investigated additives show beneficial effect on osteoblast activity. Cell proliferation, differentiation and the metabolic activity of the differentiated cells could be influenced positively. Especially in the case cell cultures treated with eggshells the strongest effects were detected, while for the hyaluronan compared with eggshells, a weaker increase in cell activity was observed.
Conclusion
In summary, it can be stated that the investigated components come into consideration as beneficial supplements for bone graft materials especially for maxillo facial surgery application.
doi:10.1186/s13005-015-0070-0
PMCID: PMC4436844  PMID: 25885793
Calcium carbonate; Eggshell; Hyaluronan; Osteoblast; Bone; Bone graft material
15.  In-vivo durability of a fluoride-releasing sealant (OpalSeal) for protection against white-spot lesion formation in orthodontic patients 
Head & Face Medicine  2015;11:11.
Background
Sealant application during fixed appliances orthodontic treatment for enamel protection is common, however, reliable data on its durability in vivo are rare.
Objective
This study aims at assessing the durability of a sealant (OpalSeal, Ultradent) for protection against white-spot lesion formation in orthodontic patients over 26 weeks in vivo, taking into account the provision or absence of an adequate oral hygiene. We tested the null hypothesis of (1) no significant abatement of the sealant after 26 weeks in fixed orthodontic treatment compared to baseline, and (2) no significant influence of the factor of brushing and oral hygiene (as screened by approximal plaque index, API) on the abatement of the sealant.
Methods
Integrity and abatement of OpalSeal applicated directly following bracketing was assessed in thirty-six consecutive patients (nteeth = 796) undergoing orthodontic treatment with fixed appliances (male/female12/24; mean age/SD 14.4/1.33 Y). Assessment of the fluorescing sealant preservation was by a black-light lamp, using a classification that was concepted in analogy to the ARI index: (3, sealant completely preserved; 2= > 50% preserved; 1 = <50%; 0 = no sealant observable) immediately following application (Baseline, T0), after 2 (T1), 8 (T2), 14 (T3), 20 (T4) and 26 weeks (T5). API was assessed at T0 and T1. Statistical analysis was by non-parametric repeated measures ANOVA (α = 5%, power >80%).
Results
At baseline, 43.4% of teeth had a positive API. Oral hygiene deteriorated after bracketing (T1, 53%) significantly. Null hypothesis (1) was rejected, while (2) was accepted: Mean values of both the well brushed and non-brushed anterior teeth undercut the score “1” at T3 (week 14). Despite a slightly better preservation of the sealer before and after T3 in not-sufficiently brushed (API-positive) teeth, this finding was statistically not significant.
Conclusion
One single application of OpalSeal is unlikely to last throughout the entire fixed appliance treatment stage. On average, re-application of the sealant can be expected to be necessary after 3.5 months (week 14) in treatment.
doi:10.1186/s13005-015-0069-6
PMCID: PMC4409759  PMID: 25890225
Orthodontic sealant; Durability; OpalSeal; White-spot lesions; In-vivo
16.  Coronectomy as a surgical approach to impacted mandibular third molars: a systematic review 
Head & Face Medicine  2015;11:9.
The aim of this systematic review was to evaluate the clinical effectiveness of the surgical technique of coronectomy for third molars extraction in close proximity with the inferior alveolar nerve.
A literature survey carried out through PubMed, SCOPUS and the Cochrane Library from inceptions to the last access in January 31, 2014, was performed to intercept randomised clinical trials, controlled clinical trials, prospective cohort studies or retrospective studies (with or without control group) that examined the clinical outcomes after coronectomy. The following variable were evaluated: inferior alveolar nerve injury, lingual nerve injury, postoperative adverse effects, pulp disease, root migration and rate of reoperation. Ten articles qualified for the final analysis. The successful coronectomies varied from a minimum of 61.7% to a maximum of 100%. Coronectomy was associated with a low incidence of complications in terms of inferior alveolar nerve injury (0%-9.5%), lingual nerve injury (0%-2%), postoperative pain (1.1%-41.9%) and swelling (4.6%), dry socket infection (2%-12%), infection rate (1%-9.5%) and pulp disease (0.9%). Migration of the retained roots seems to be a frequent occurrence (2%-85.3%).
Coronectomy appears to be a safe procedure at least in the short term, with a reduced incidence of postoperative complications. Therefore, a coronectomy can be indicated for teeth that are very close to the inferior alveolar nerve. If a second operation is needed for the remnant roots, they can be removed with a low risk of paresthesia, because the roots are generally receded from the mandubular nerve.
doi:10.1186/s13005-015-0068-7
PMCID: PMC4397866  PMID: 25890111
Coronectomy; Inferior alveolar nerve; Review
17.  Comparative three-dimensional analysis of initial biofilm formation on three orthodontic bracket materials 
Head & Face Medicine  2015;11:10.
Introduction
The purpose of the present study was to investigate and compare early biofilm formation on biomaterials, which are being used in contemporary fixed orthodontic treatment.
Methods
This study comprised 10 healthy volunteers (5 females and 5 males) with a mean age of 27.3 +–3.7 years. Three slabs of different orthodontic materials (stainless steel, gold and ceramic) were placed in randomized order on a splint in the mandibular molar region. Splints were inserted intraorally for 48 h. Then the slabs were removed from the splints and the biofilms were stained with a two color fluorescence assay for bacterial viability (LIVE/DEAD BacLight–Bacterial Viability Kit 7012, Invitrogen, Mount Waverley, Australia). The quantitative biofilm formation was analyzed by using confocal laser scanning microscopy (CLSM).
Results
The biofilm coverage was 32.7 ± 37.7% on stainless steel surfaces, 59.5 ± 40.0% on gold surfaces and 56.8 ± 43.6% on ceramic surfaces. Statistical analysis showed significant differences in biofilm coverage between the tested materials (p=0.033). The Wilcoxon test demonstrated significantly lower biofilm coverage on steel compared to gold (p=0.011).
Biofilm height on stainless steel surfaces was 4.0 ± 7.3 μm, on gold surfaces 6.0 ± 6.6 μm and on ceramic 6.5 ± 6.0 μm. The Friedman test revealed no significant differences between the tested materials (p=0.150). Pairwise comparison demonstrated significant differences between stainless steel and gold (p=0.047).
Conclusion
Our results indicate that initial biofilm formation seemed to be less on stainless steel surfaces compared with other traditional materials in a short-term observation. Future studies should examine whether there is a difference in long-term biofilm accumulation between stainless steel, gold and ceramic brackets.
doi:10.1186/s13005-015-0062-0
PMCID: PMC4403927  PMID: 25889778
Biofilm; CLSM; Gold; Stainless steel; Ceramic; Orthodontics; Brackets
18.  New regression equations for predicting human teeth sizes 
Head & Face Medicine  2015;11:8.
Introduction
The aims of the study were; to evaluate the applicability of the Moyers and Tanaka-Johnston Methods to individuals with a Spanish ancestry, to propose new regression equations using the lower four permanents incisors as predictors for the sum of the widths of the lower permanent canine and premolars, and to compare the new data to those from other populations.
Methods
A total of 359 Spanish ancestry adolescents were selected. Their dental casts were measured using a 2D computerized system. Real teeth measurements were compared with those predicted using Moyers probability tables and Tanaka and Johnston equations, and standard regression equations were then developed.
Results
Results showed that Upper and Lower Canine and Premolar (UCPM, LCPM) predictions are quite different depending on the used method. Moyers tables can only be validly applied to a 75% percentile for the mandible in both, males and females, 85% in males and 90-92% in females.
Conclusions
Moyers predictions tend to underestimate UCPM and LCPM whereas Tanaka-Johnston predictions tend to overestimate them. Equations for estimating the combined width of the unerupted canine and premolars were; Male: UCPM = 12.68 + 0.42 LI and LCPM = 11.71 + 0.44 LI. Female: UCPM = 12.06 + 0.43LI and LCPM = 10.71 + 0.46 LI.
doi:10.1186/s13005-015-0067-8
PMCID: PMC4389662  PMID: 25890022
Moyers; Prediction; Regression equations; Tanaka-Johnston
19.  Current concepts and future of noninvasive procedures for diagnosing oral squamous cell carcinoma - a systematic review 
Head & Face Medicine  2015;11:6.
Background
Oral squamous cell carcinoma (OSCC) has a remarkably high incidence worldwide, and a fairly serious prognosis, encouraging further research into advanced technologies for noninvasive methods of making early diagnoses, ideally in primary care settings.
Objectives
Our purpose was to examine the validity of using advanced noninvasive technologies in diagnosis of OSCC by identifying and evaluating relevant published reports.
Data source
MEDLINE, EMBASE, and CINAHL were searched to identify clinical trials and other information published between 1990 and 10 June 2014; the searches of MEDLINE and EMBASE were updated to November 2014. Study selection: Studies of noninvasive methods of diagnosing OSCC, including oral brush biopsy, optical biopsy, saliva-based oral cancer diagnosis, and others were included.
Data extraction
Data were abstracted and evaluated in duplicate for possible relevance on two occasions at an interval of 2 months before being included or excluded.
Data synthesis
This study identified 163 studies of noninvasive methods for diagnosing OSCC that met the inclusion criteria. These included six studies of oral brush biopsy, 42 of saliva-based oral diagnosis, and 115 of optical biopsy. Sixty nine of these studies were assessed by the modified version of the QUADAS instrument. Saliva-based oral cancer diagnosis and optical biopsy were found to be promising noninvasive methods for diagnosing OSCC.
Limitation
The strength of evidence was rated low for accuracy outcomes because the studies did not report important details required to assess the risk for bias.
Conclusions
It is clear that screening for and early detection of cancer and pre-cancerous lesions have the potential to reduce the morbidity and mortality of this disease. Advances in technologies for saliva-based oral diagnosis and optical biopsy are promising pathways for the future development of more effective noninvasive methods for diagnosing OSCC that are easy to perform clinically in primary care settings.
doi:10.1186/s13005-015-0063-z
PMCID: PMC4396078  PMID: 25889859
Oral cancer; Noninvasive methods; Optical biopsy; Saliva-based diagnosis
20.  Application of the 2-piece orthodontic C-implant for provisional restoration with laser welded customized coping: a case report 
Head & Face Medicine  2015;11:7.
This article presents the application of laser welding technique to fabricate an orthodontic mini-implant provisional restoration in missing area after limited orthodontic treatment. A 15-year-old boy case is presented. Two-piece orthodontic C-implant was placed after regaining space for missing right mandibular central incisor. Due to angular deviation of implant, customized abutment was required. Ready-made head part was milled and lingual part of customized abutment was made with non-precious metal. Two parts then were laser welded (Master 1000, Elettrolaser Italy, Verona, Italy) and indirect lab composite (3 M ESPE Sinfony, St. Paul, MN, USA) was built up. The patient had successful result, confirmed by clinical and radiographic examinations. Before the patient is ready to get a permanent restoration later on, this provisional restoration will be used. This case shows that a two-piece orthodontic C-implant system can be used to maintain small edentulous space after orthodontic treatment.
doi:10.1186/s13005-015-0066-9
PMCID: PMC4404066  PMID: 25885663
Dental implant; Congenital missing; C-implant; Osseointegration; Laser welding
21.  The Polish face in profile: a cephalometric baseline study 
Head & Face Medicine  2015;11:5.
Background
This study reports the cephalometric evaluation of a group of adolescent Polish individuals describing dento-facial structure as well as details of incisor position and soft tissue characteristics. The results should reveal morphological features specific to Polish persons and serve as a comparative material for future diagnostic procedures.
Methods
The study was based on an analysis of cephalgrams of 122 Polish adolescents average age 18years 6 months analysed in a computer system using the Kracovia composite system analysis describing dento-facial morphology ad modum Björk as well as soft tissue factors. The control material was based on published reports by Björk (Dento-facial characteristics) Riketts and Holdaway (soft tissue profile).
Results
The comparative study revealed a slight reduction in the sagittal jaw relationship with a significant reduction in the vertical jaw relationship and a distinctive mandibular morphology with a reduced jaw angle and an increase in the "Beta angle". These findings were reflected in the soft tissue pattern. The soft tissue profile reflected the skeletal cephalometrics observation.
Conclusion
The dento-facial profile of Polish adolescents demonstrates specific characteristics which should be taken into account when diagnosing facial form in connection with orthodontic treatment planning in particular Polish patients.
doi:10.1186/s13005-015-0065-x
PMCID: PMC4407376  PMID: 25879745
22.  The validity of three neo-classical facial canons in young adults originating from the Arabian Peninsula 
Head & Face Medicine  2015;11:4.
Introduction
Understanding facial harmony and proportions is essential for facial reconstructive procedures and orthognathic surgery planning. In the literature, the neoclassical facial canons have been revisited in populations including North American whites and African Americans. The purpose of this study was to establish a baseline for selected facial anthropometric measurements and test the validity of 3 neoclassical facial canons in a cohort of young Saudi adults originating from the Arabian Peninsula.
Methods
The study group consisted of 168 healthy, esthetically pleasing Saudi Arabian dental students originating from the Arabian Peninsula (93 males and 75 females, age 20–24 years). Using a caliper, three neoclassical facial canons were measured; the vertical thirds of the face, the orbital canon (intercanthal distance = eye fissure length), and the orbito-nasal canon (intercanthal distance = nasal width) and analyzed using Student’s t-test, general linear modeling, and pairwise comparison of means.
Results
The upper, middle, and lower thirds were not equal in measurement to each other (p < 0.0001). Sex dimorphism was observed in the lower facial third and nasal width measurements, with both larger in men (both p < 0.0001). The majority of subjects had longer upper and lower thirds than middle thirds, with 91.4% of males and 88% of females demonstrating a larger lower third than middle third. The most frequent variation in the orbital canon was a wider intercanthal distance than eye fissure length (55.9% of males and 74.7% of females). The most frequent variation in the orbito-nasal canon was a wider nasal width than intercanthal distance (92% of males and 56% of females).
Conclusions
Although these individuals are esthetically pleasing, they do not exhibit equal facial thirds or conform to orbital or orbito-nasal canons. The three neoclassical canons studied could not be validated in young adults originating from the Arabian Peninsula. Thus, the esthetic goals in reconstructive and orthognathic surgery should respect this ethnic variation.
doi:10.1186/s13005-015-0064-y
PMCID: PMC4369102  PMID: 25889948
Neo-classical canons; Facial anthropometry; Direct anthropometry; Facial proportions
23.  NCAM (CD56) Expression in keratin-producing odontogenic cysts: aberrant expression in KCOT 
Head & Face Medicine  2015;11:3.
Objective
To investigate immunohistochemically the expression of neural cell adhesion molecule (NCAM), which has been identified as a signaling receptor with frequent reactivity in ameloblastomas (AB), in a series of keratin-producing odontogenic cysts (KPOCs).
Material and methods
Immunohistochemical expression of NCAM, using a monoclonal antibody, was determined in a series of 58 KPOCs comprising 12 orthokeratinized odontogenic cysts (OOCs) and 46 keratocystic odontogenic tumors (KCOTs), corresponding to 40 non-syndromic KCOT (NS-KCOTs) and 6 syndromic KCOT (S-KCOTs), associated with nevic basocellular syndrome (NBCS).
Results
NCAM expression was negative in all OOCs, but 36.45% of KCOTs exhibited focal and heterogeneous expression at the basal cell level, as well as in basal budding areas and the basal cells of daughter cysts. The latter two locations were especially applicable to S-KCOTs, with focal NCAM reactivity occurring in 66.66% of cases.
Conclusions
Aberrant NCAM expression, in KCOTs but especially in S-KCOTs, together with its immunomorphological location, suggests that this adhesion molecule and signaling receptor plays a role in the pathogenesis of KCOTs, with a probable impact on lesional recurrence.
Electronic supplementary material
The online version of this article (doi:10.1186/s13005-015-0060-2) contains supplementary material, which is available to authorized users.
doi:10.1186/s13005-015-0060-2
PMCID: PMC4337090  PMID: 25889612
NCAM; Keratocysts; Keratocystic odontogenic tumor; Orthokeratinized odontogenic cyst; Immunohistochemistry
24.  Interradicular trabecular bone density of the lateral maxilla for temporary anchorage devices – a histomorphometric study 
Head & Face Medicine  2015;11(1):1.
Objective
To analyze the interradicular trabecular bone density of the lateral maxilla regarding the insertion of temporary anchorage devices (TADs).
Material and methods
The material consisted of tissue blocks of autopsy material from 20 subjects (17 male, 3 female, 16 - 63y). The specimens comprised the dentated alveolar bone of the lateral maxilla. The interradicular areas (IRA) from canine to distally of the second molar (IRA 3–4, 4–5, 5–6, 6–7, 7d) were histomorphometrically measured with respect to the hard tissue fraction of the trabecular bone (HTFTB, %) and statistically analyzed.
Results
Histomorphometric measurements showed the following results: Mean HTFTB of IRA 3–4 was 44.08%, of IRA 4–5 31.07%, of IRA 5–6 33.96%, of IRA 6–7 36.33% and of IRA 7d 25.40%. Only the difference between the HTFTB of IRA 3–4 and the other IRAs was statistically significant (p < 0.05). Regarding the minimum and maximum HTFTB value of each IRA, there was a great amount of difference, especially for IRA 3–4: minimum HTFTB was 17.20% and maximum 67.03%.
Conclusion
Apart from the IRA between canine and first premolar, the HTFTB in the IRAs of the lateral maxilla have to be classified as low or even moderate. IRA 3–4 should also be considered cautious regarding its minimum values. Thus, it seems that the interradicular trabecular bone density of the lateral maxilla is unfavorable to achieve a good primary stability of TADs.
doi:10.1186/s13005-015-0058-9
PMCID: PMC4326331  PMID: 25889510
Orthodontic; Anchorage; Implant; Insertion site; Failure rate; Bone density
25.  Evaluation of the anesthetic effect of epinephrine-free articaine and mepivacaine through quantitative sensory testing 
Head & Face Medicine  2015;11:2.
Introduction
Long lasting anesthesia of the soft tissue beyond the dental treatment affects patients in daily routine. Therefore a sophisticated local anesthesia is needed. The purpose of this study was an evaluation of the clinical use of epinephrine-free local anesthetic solutions in routine short-time dental treatments.
Materials and methods
In a prospective, single-blind, non-randomized and controlled clinical trial, 31 patients (16 male, 15 female patients) undergoing short-time dental treatment under local anesthesia (plain solutions of articaine 4% and mepivacaine 3%) in area of maxillary canine were tested with quantitative sensory testing QST. Paired-Wilcoxon-testing (signed-rank-test) and Mc Nemar tests have been used for statistical results.
Results
Significant differences in all tested parameters to the time of measurements were found. Mepivacaine showed a significantly stronger impact for the whole period of measurement (128 min) on thermal and mechanical test parameters and to the associated nerve fibers.
Conclusion
Plain articaine shows a faster onset of action associated with a shorter time of activity in comparison to plain mepivacaine. In addition to this articaine shows a significant low-graded effect on the tested nerve-fibers and therefore a least affected anesthesia to the patient. The clinical use of an epinephrine-free anesthetic solution can be stated as possible option in short dental routine treatments to the frequently used vasoconstrictor containing local anesthetics. Patients may benefit from shorter numbness.
doi:10.1186/s13005-015-0061-1
PMCID: PMC4340117  PMID: 25889698
Articaine; Mepivacaine; Local anesthesia; Maxillary infiltration; Trigeminal region; Epinephrine-free

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