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Psychometric analysis of a KAP questionnaire on green dentistry using PLS-SEM and EFA: a pilot study
No full textBackground: Green dentistry promotes sustainable practices in oral healthcare. As environmental challenges intensify, integrating eco-friendly principles into dental education and practice becomes increasingly important. To advance sustainability in oral health settings, it is crucial to comprehend the knowledge, attitudes, and practices (KAP) of dental professionals and students. Despite growing interest, there is scarcity of research on green dentistry and a lack of standardized, validated tools to measure KAP makes it more difficult to compare studies. The rationale for this study was to conduct a psychometric analysis of a KAP questionnaire designed to assess eco-friendly clinical dental practices among dental school personnel and students in a dental school of Karachi. Method: A 43-item questionnaire on green dentistry, adapted from existing green models and literature, and further validated through expert consultation and psychometric analysis, covers knowledge, attitudes, and practices. This cross-sectional pilot study involved 150 dental school personnel and students from the clinical side of an institution, using a self-administered, web-based questionnaire based on the Green Dental Model (GDM). The construct validity of ‘knowledge’ and ‘practice’ sections of the questionnaire was assessed using Partial Least Squares- Structural Equation Modeling (PLS-SEM) whereas Exploratory Factor Analysis (EFA) to uncover the latent factor structure of the ‘attitude’ section. Results: Findings indicate that the model was identified as formative, with VIF values (\u3c 5) indicating no multicollinearity. Through careful decision-making, almost all formative indicators were retained based on outer loads \u3e 0.5. In EFA, factor loadings for the three extracted factors exceeded the reliability threshold. Factor 1 dealt with digital radiography and energy and water conservation; factor 2 involved waste management, recycling, and sterilization; and factor 3 represented green practices as a financial burden. Conclusion: The instrument’s construct validity and feasibility makes it a valuable resource for sustainability focused researchers and dental professionals. This study uses advanced statistical techniques intended to address the questionnaire’s formative and reflective elements, improving the validity of assessment, a factor that was frequently overlooked in other studies on green dentistry. The distinctive contribution of this novel approach to the existing body of literature could facilitate potential research on the tool’s responsiveness to interventions on KAP change
Replacing brackets with simple tubes for the finishing stage of orthodontic treatment
No full textThe term simple tube generically refers to a tube-shaped orthodontic appliance that lacks a bracket base and is bonded to the tooth surface by partially covering it with a flowable composite resin. This report introduces the application of simple tubes in combination with the deflection-based bonding (DbB) technique as an alternative to conventional orthodontic brackets during the finishing stage of orthodontic treatment. The DbB technique involves pre-threading simple tubes onto a nickel-titanium archwire and bonding them to the teeth under deflected conditions, thereby allowing precise adjustments of tooth position through controlled wire deflections. This approach enables individualized in-out compensation and passive bonding for teeth that require no further movement, facilitating efficient detailing and occlusal settling. By leveraging the low-profile design of simple tubes and the mechanical advantages of the DbB technique, this method enhances patient comfort, improves oral hygiene, and provides a more aesthetic appearance. Despite inherent limitations, such as the difficulty of archwire replacement, the integration of simple tubes with the DbB technique offers notable biomechanical benefits, including the application of lighter, more controlled forces tailored to the incisors. This report highlights the potential of using simple tubes in conjunction with the DbB technique to enhance clinical outcomes and improve patient experience during the orthodontic finishing phase
Periodontal changes in supraerupted maxillary molars after orthodontic intrusion using miniscrews: A retrospective study
No full textIntroduction: This study aimed to analyze periodontal changes in supraerupted maxillary molars that underwent orthodontic intrusion with miniscrews during the treatment and the postretention period. Methods: Forty supraerupted maxillary molars were treated with buccal and palatal miniscrews and power chain loading of 100 g for orthodontic intrusion. Clinical examinations and periapical radiography were performed pretreatment, posttreatment, 6 months posttreatment, and 2 years posttreatment to measure the following parameters: clinical crown length, sulcus probing depth, bone probing depth (BPD), attached gingiva width, root length, alveolar crest level, and bone support. The extent of intrusion and relapse was measured by superimposing the dental casts. Periodontal care was performed regularly during and after treatment for all patients, and the gingival indexes were maintained \u3c1. Results: Immediately after treatment, clinical crown length decreased, and sulcus probing depth and BPD increased compared with the baseline; however, 6 months posttreatment, they returned to the baseline levels, except for palatal BPD. The attached gingiva width remained unchanged at all time points. Root length significantly decreased between pretreatment and posttreatment, but as the amount was \u3c1 mm, it was considered clinically insignificant. Six months after the treatment, the alveolar crest level and bone support showed significant improvements compared with the baseline. All periodontal parameters showed no statistically significant differences between 6 months and 2 years posttreatment, indicating stability after 6 months posttreatment. Conclusions: Orthodontic intrusion of supraerupted maxillary molars can enhance the periodontium in the long term
Influence of Sport Specialization on Quality of Life, Physical Literacy, and Injury History in Hockey Players
No full textSport specialization and its effect on health-related quality of life, physical literacy, and injury among ice hockey players is poorly understood. We examined specialization patterns, quality of life, physical literacy, and injury history in a sample of 63 high school-aged hockey players. Thirty-eight percent of participants reported moderate specialization; over half of the sample reported high specialization. Highly specialized players spent a greater amount of weekly time per week in hockey activities (21.14 hr, 95% confidence interval [17.4, 24.88]) and reported a greater number of injuries when compared with moderate and low specializers (χ2 = 0.026). Acute injuries were more prevalent than chronic or overuse injuries across all groups. No differences were observed on physical literacy or quality of life scores. Despite their increased participation and greater frequency of injuries, specialization did not significantly impact health-related quality of life
Considerations of Throwing Athletes With Upper Extremity Injury When Completing the Single Assessment Numeric Evaluation (SANE): A Report From the Athletic Training Practice-Based Research Network
No full textContext: The Single Assessment Numeric Evaluation (SANE) is a widely used patient-reported outcome (PRO) measure that provides an efficient but limited view of patient perceptions of health. Knowledge of what throwing athletes with upper extremity injury consider when answering the SANE would inform score interpretation and increase its value for clinical decision-making in this patient population. Objective: To investigate the global rating of the SANE and its ability to capture constructs of health reflected in PRO measures that are commonly used in throwing athletes with upper extremity sport-related injury. Design: Cross-sectional study. Setting: Retrospective database review. Patients or Other Participants: De-identified patient records of baseball and softball athletes diagnosed with upper extremity sport-related injury between October 2009 and June 2021 were reviewed. Main Outcome Measure(s): Primary outcomes were scores on the SANE; Functional Arm Scale for Throwers total; Disabilities of the Arm, Shoulder, and Hand total; and Global Rating of Daily Activities. The first administration of all PROs that patients completed postinjury was analyzed as a potential predictor of SANE scores. The proportion of variance uniquely accounted for in the SANE by each predictor (R2) variable was estimated. Results: Fifty-five patients completed PRO measures. The Functional Arm Scale for Throwers total uniquely accounted for 32.9% (P \u3c .001), the Global Rating of Daily Activities uniquely accounted for 11.6% (P \u3c .001), and the Disabilities of the Arm, Shoulder, and Hand total uniquely accounted for 4.6% (P = .036) of the variance in the SANE score. Overall, the predictors accounted for 49.2% of the variance in the SANE score (P \u3c .001). Conclusions: Given that the SANE captures multiple constructs of health, it may be useful in gathering a quick, broad view of throwing athletes’ perception of their health. When SANE scores suggest diminished health, then multi-item PROs should be considered to further explore constructs of health most affected
Long-term evaluation of a patient with skeletal Class III malocclusion treated with a temporary skeletal anchorage device-anchored maxillary protraction
No full textThis case report describes the long-term treatment of a patient with severe skeletal Class III malocclusion. An 11-year-old boy with maxillary hypoplasia underwent growth modification therapy using a skeletal anchorage facemask. After maxillary protraction and fixed appliance therapy, his pubertal growth was monitored, and he was instructed to wear a facemask continuously. Although there was mandibular growth, it was primarily vertical, resulting in an anterior open bite. Consequently, adjunctive orthodontic treatment, including molar intrusion, was performed. Throughout this treatment, no significant skeletal changes were observed as growth had ceased. The treatment took 8.3 years and achieved successful outcomes. Maxillary protraction with skeletal anchorage played a crucial role in improving the skeletal relationship. However, it is essential to recognize that mandibular growth also significantly influences the success of correcting Class III malocclusion
Osteoporosis’ effects on dental implants osseointegration and survival rate: a systematic review of clinical studies
No full textObjectives: The goal of this systematic review was to critically appraise the existing evidence evaluating osteoporosis’ effects on dental implant osseointegration and survival rate. Data source: A search was conducted in two databases, PubMed/ MEDLINE and Scopus, until October 2024, using the keywords “osteoporosis,” “osteopenia,” “osseointegration,” and “dental implants”. The inclusion criteria were clinical studies that evaluated the implant placement, complications, and osseointegration results in patients with osteoporosis; literature reviews and clinical studies addressing the outcome were considered; and articles written in English and published since 2000. Descriptive data analysis included author, year of publication, study design, number of patients, osteoporosis assessment, follow-up, and main findings. JBI quality assessment was performed. Overall, 24 articles were included with a total of 2,102 patients; 5,954 dental implants were considered and evaluated. Most studies evaluated bone density for osteoporosis by dual-energy x-ray technology. The follow-up ranged from 1 month to 25 years. Four studies evaluated implants with over 10 years of follow-up. All studies’ survival rate was higher than 90%, even for osteoporotic patients. Most studies indicated no differences between osteoporotic and healthy patients regarding marginal bone loss, bone-to-implant contact, cytokine levels, and mineral bone density. A prospective cohort study found a small marginal bone loss (−0.34 mm) in osteoporotic women, but there was insufficient evidence to prove any causal relationship between marginal bone loss and osteoporosis. Another study showed no clinical differences between implants placed in osteoporotic and healthy individuals. In contrast, other studies showed lower stability scores for implants placed in osteoporotic sites and a higher risk of failure for implant placement. Osteoporosis status was not a risk factor for dental implant failure, which was also confirmed by histologic studies. Three studies had a medium risk of bias, and 21 a low risk. Conclusion: Osteoporosis is not a contraindication for dental implant placement. Osseointegration in patients with osteoporosis is feasible; however, planning must be cautious and personalized for the placement of dental implants
Myofascial Pain Syndromes: Controversies and Suggestions for Improving Diagnosis and Treatment
No full textMyofascial pain syndromes (MPSs) affect a significant portion of the population. However, they remain controversial because their etiology, diagnostics, and effect mechanisms rely on theoretical frameworks with limited scientific rigor. This Viewpoint highlights 3 main challenges and proposes solutions: First, diagnosis lacks consistent criteria and is at risk of verification and incorporation biases. Tightened diagnostic criteria and differentiating myofascial pain syndrome from competing conditions will improve accuracy in research and clinical practice. Second, the etiology/pain mechanisms are poorly understood, with symptoms overlapping other conditions. We recommend recording of standardized assessments in national registries including psychological stress and systemic factors to identify distinct phenotypes. Third, the mechanisms behind treatments such as myofascial release and acupuncture are unclear. We advocate for mechanistic clinical trials to uncover how these treatments exert effects. Addressing these challenges will enhance understanding, diagnosis, and treatment of MPS and guide policymakers to fund appropriate research
Accuracy of Artificial Intelligence in Predicting the Treatment Effects of Headgear and/or Functional Appliance on the Maxillo-Mandibular Growth in Preadolescent Patients With Skeletal Class II Malocclusion
No full textObjective: To evaluate the accuracy of artificial intelligence (AI) in predicting the effects of headgear (HG) and/or functional appliance (FA) on the maxillo-mandibular growth in preadolescent patients with skeletal Class II (C-II) malocclusion. Materials and Methods: The study included 206 Japanese preadolescent C-II patients treated with HG and/or FA, with serial lateral cephalograms taken at ages of 8 (T0) and 10 (T1). A single orthodontist with 7 years of experience identified 28 hard-tissue cephalometric landmarks. A Treatment Prediction Graph Convolutional Neural Network (TP-GCNN), integrating a high-resolution network and a graph neural network, was trained and validated using the landmarks\u27 x- and y-coordinates. Data was split into training, validation and testing sets (ratio of 8:1:1; n = 164, n = 21 and n = 21). Model performance was assessed using the values of prediction error (PE, excellent, ≤ 0.5 mm; very good, 0.5–1.0 mm; good, 1.0–1.5 mm; acceptable, 1.5–2.0 mm; unsatisfactory, \u3e 2.0 mm) and the degree of accurate prediction percentage (APP; very high, ≥ 90%; high, 70%–90%; medium, 50%–70%; low, \u3c 50%). Results: The mean PE value was 1.45 mm. In terms of PE, all landmarks showed the accuracy above the ‘acceptable’ category. In terms of APP, ‘High’ APP was observed at Hinge axis, Pterygoid point, A-point, PNS, ANS, R1, R3 and Articulare. However, ‘Low’ APP was noted for Pm, Pogonion, B-point and Menton. The remaining landmarks demonstrated ‘Medium’ APP. Conclusion: This study demonstrates the potential of AI to reliably predict the effects of HG and/or FA treatment in preadolescent patients with Class II malocclusion
Network Analysis of Anxiety and Depression Symptoms in Individuals With Oral Lichen Planus and Evaluation of Salivary Biomarkers: A New Approach
No full textObjective: To estimate the network structure of 21 symptoms of anxiety and depression in individuals diagnosed with oral lichen planus (OLP) and compare it with salivary biomarkers, cortisol and alpha-amylase. Materials and Methods: A case–control study was conducted with 21 OLP cases and 21 controls matched by sex and age. Beck Anxiety and Depression Inventories were administered, and salivary cortisol and alpha-amylase levels were determined. Descriptive analysis used the Mann–Whitney U test to compare participants\u27 responses and the Benjamini-Hochberg Method to control the False Discovery Rate (FDR). Network analysis was performed using regularized partial correlation network models. Results: A significant association was found between anxiety (p = 0.001) and depression (p = 0.004) scores and OLP. The “shaky/unsteady” symptom was most central in the anxiety network for OLP patients, while “feelings of punishment” and “self-criticism” were central in the depression network. Weak correlations were observed between cortisol and alpha-amylase in anxiety and depressive symptoms. Cortisol awekening response (CAR) had a negative correlation with alpha-amylase awakening response (AAR) (−0.54), as like AAR and Faint/lightheaded (−0.57) in anxiety network. Anxiety network structures did not differ between groups (p = 0.18), but the depression network was more connected in controls than in OLP cases (overall strength 69.29 vs. 27.35, p \u3c 0.000). Conclusion: This study reveals the distinct network structures of anxiety and depression symptoms in OLP patients, highlighting a new methodological approach to exploring symptom configurations. When exploring the relationship with cortisol and alpha-amylase, weak relationships were found between them. The findings may prompt further network studies involving biomarkers and their interaction with anxiety and depression