Objective: To investigate the effects of food hardness on chewing behavior in children compared with adults. Materials and methods: Healthy children (3–17 years) were equally divided into five groups based on their dental eruption stages. Each participant ate soft and hard viscoelastic test food models (3 each), while the three-dimensional jaw movements and electromyographic (EMG) activity of the bilateral masseter muscles were recorded. The data from the children were compared with a control group of healthy adults (18–35 years). The data were analyzed with nonparametric tests. Results: There was no significant difference in the number of chewing cycles and the duration of the chewing sequence between children groups and adults. Children with primary dentition (3–5 years) showed shorter lateral jaw movement and higher muscle activity at the end of the chewing sequence, compared with adults. Further, children’s age-groups (3–14 years) failed to adapt their jaw muscle activity to food hardness. However, at the late-permanent dentition stage (15–17 years), children were capable of performing adult-like chewing behavior. Conclusions: Overall, it seems that children as young as 3-year-old are quite competent in performing basic chewing function similar to adults. Yet, there are differences in the anticipation or adaption of jaw muscle activity and jaw kinematics to food hardness. Clinical relevance: The study may have clinical implication in the diagnosis and management of children with chewing impairment associated with dental malocclusions and other orofacial dysfunctions.

A clinical assessment of the masticatory performance of edentulous people treated with bimaxillary implant-supported fixed prostheses is lacking. The purpose of this case-control study was to compare the masticatory performance of edentulous people treated with bimaxillary implant-supported fixed prostheses to that of those with a natural dentition by using a simplified comminution test with hard viscoelastic test food and a mixing ability test. Thirty-six participants were recruited and divided into 2 equal groups (n=18) based on their dental status. The experimental group (7 women, mean ±standard deviation age=69.8 ±7.5 years) had bimaxillary implant-supported fixed prostheses, and the control group (9 women, mean ±standard deviation age=68.3 ±5.6 years) had a natural dentition. A hard viscoelastic food comminution test and a mixing ability test with 2-colored chewing gum were performed in both groups. The number and total area of the particles during the comminution test and the variance of hue during the mixing ability test were measured. The data were analyzed with the parametric (paired t test) and nonparametric (Mann-Whitney U) tests to assess differences between the groups (α=.05). The experimental group exhibited significantly fewer pieces in the food comminution test than the control group (P=.001). The experimental group also showed significantly higher variance of hue values than the control group (P<.001). Patients treated with bimaxillary implant-supported prostheses had reduced masticatory performance in comparison to those with a natural dentition, despite having been provided with satisfactory and well-functioning prostheses.

Background: Restoring vital teeth with indirect restorations may threaten dental pulp integrity. However, the incidence of and influential factors on pulp necrosis and periapical pathosis in such teeth are still unknown. Therefore, this systematic review and meta-analysis aimed to investigate the incidence of and influential factors on pulp necrosis and periapical pathosis of vital teeth following indirect restorations. Methods: The search was conducted in five databases, using MEDLINE via PubMed, Web of Science, EMBASE, CINAHL, and Cochrane Library. Eligible clinical trials and cohort studies were included. The risk of bias was assessed using Joanna Briggs Institute’s critical appraisal tool and Newcastle–Ottawa Scale. The overall incidences of pulp necrosis and periapical pathosis following indirect restorations were calculated using a random effects model. Subgroup meta-analyses were also performed to determine the potential influencing factors for pulp necrosis and periapical pathosis. The certainty of the evidence was assessed using the GRADE tool. Results: A total of 5,814 studies were identified, of which 37 were included in the meta-analysis. The overall incidences of pulp necrosis and periapical pathosis following indirect restorations were determined to be 5.02% and 3.63%, respectively. All studies were assessed as having a moderate-low risk of bias. The incidence of pulp necrosis following indirect restorations increased when the pulp status was objectively assessed (thermal/electrical testing). The presence of pre-operative caries or restorations, treatment of anterior teeth, temporization for more than two weeks, and cementation with eugenol-free temporary cement, all increased this incidence. Final impression with polyether and permanent cementation with glass ionomer cement both increased the incidence of pulp necrosis. Longer follow-up periods (> 10 years) and treatment provided by undergraduate students or general practitioners were also factors that increased this incidence. On the other hand, the incidence of periapical pathosis increased when teeth were restored with fixed partial dentures, the bone level was < 35%, and the follow-up was > 10 years. The certainty of the evidence overall was assessed as low. Conclusions: Although the incidences of pulp necrosis and periapical pathosis following indirect restorations remain low, many factors affect these incidences that should thus be considered when planning indirect restorations on vital teeth. Database registration: PROSPERO (CRD42020218378).

Objectives: The demand for clear aligner treatment has increased in recent years. Thus, this study investigated public knowledge regarding Invisalign clear aligner treatment. Material and Methods: A web-based survey was administered through different social media platforms covering different aspects of Invisalign treatment, namely: Treatment efficiency, patient discomfort, appliance esthetic attractiveness, oral hygiene maintenance, and treatment aesthetic results. Participants were also asked to outline their perception of Invisalign treatment cost. A Likert-type scale was used to rank the participant responses. Data were analyzed with the Chi-square test and Bonferroni correction for multiple comparisons. Results: Out of 934 eligible adult participants, 19.6% were aware of Invisalign. Most of the Invisalign-familiar respondents were unaware of its cost (27.9%) but agree it is generally better (49.7%), requires fewer visits (38.2%), results in shorter treatment duration (39.4%) and reduced teeth discomfort (35%), more esthetically attractive (64%), yields easier oral hygiene maintenance (55.2%), and produces superior esthetic results (43.7%) than traditional braces. In addition, males and average-income participants were more likely to believe that Invisalign treatment produces superior esthetic results than traditional braces (P = 0.0002 and P = 0.002, respectively). Average-income participants also believed that Invisalign treatment was generally better (P < 0.0001). While participants in the age-range 55–64 years strongly believe, it is cheaper (P < 0.0001) than traditional braces. Conclusion: This study highlighted the lack of public knowledge about Invisalign treatment. The results also indicated the importance of ensuring public access to reliable information backed up by high-quality evidence.