Quintessence International, 04/2023

Objective: This in vitro study aimed to compare the diagnostic outcomes of caries detection in premolar and molar teeth on digital periapical radiographs viewed as grayscale images and in the Java-based software (JBS) pseudocolor spectrum. Method and materials: The study comprised 92 premolar or molar human teeth (n = 46 with caries and n = 46 without clinical caries). For each tooth, digital periapical radiographic images (DPRIs), JBS pseudocolor images, and stereomicroscope images were collected, and caries presence and depth were recorded. In JBS pseudocolor images, regions of interest (ROIs) were detected, and ROI values for caries area (ROI1), non-caries area (ROI2), mesial area (ROI3), and distal area (ROI4) were obtained. The degree of inter-observer agreement was determined using the kappa coefficient, and the sensitivity and specificity of the methods were assessed using ROC analysis. Results: While neither method was consistent with stereomicroscopy in determining caries depth (P < .005), for both observers the kappa value of JBS pseudocolor images were slightly higher than those for DPRIs. ROI1 was found to be significantly lower than ROI2 (P < .001), whereas no difference was found between ROI3 and ROI4 (P = .877). For both observers, the sensitivity and specificity obtained from JBS pseudocolor were above 89%. Conclusion: JBS pseudocolor images can be used for caries detection and offer high sensitivity and specificity. Keywords: caries detection, computer software, digital dental radiography, intraoral radiography, radiography

Objective: The purpose of this randomized, controlled, split-mouth trial was to clarify the clinical efficacy of using low-level laser therapy (LLLT) as an adjunct to open flap debridement in the treatment of periodontitis. Method and materials: The study was conducted on 10 patients with stage III periodontitis. Clinical parameters were recorded for 70 sites of periodontal pockets at baseline and after 3 months and included Plaque Index (PI), Gingival Index (GI), bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), and relative attachment level (RAL), and evaluated postoperative pain and dental hypersensitivity. After open flap debridement, the sites were randomly divided into test sites receiving the low-level diode laser (wavelength 808 nm) and control sites treated with laser-off. The Wilcoxon test and Mann–Whitney U-test were used for intra- and inter-group comparisons, respectively, and the Friedman test to test between different periods. Results: Both treatments produced a reduction in GI, BOP, and PD, an increased RGR, and a gain in RAL between baseline and 3 months after surgery. There were significant improvements in GI, PD, and RAL after 3 months; postoperative pain after 24 hours and after 3 days; and dental hypersensitivity after 1 week and 1 month of the surgery, which significantly decreased in the test group. Conclusion: Both groups were clinically effective in treating stage III periodontitis, with a significant preference in reduction of GI and PD and gain of RAL, and decreased postoperative pain (after 24 hours and 3 days) and dentinal hypersensitivity (after 1 week and 1 month) for open flap debridement+LLLT. Clinical relevance: The use of LLLT as an adjunct to open flap debridement improved the clinical indices, postoperative pain, and dentinal hypersensitivity better than open flap debridement alone in the treatment of stage III periodontitis. Keywords: diode laser, low-level laser therapy, open flap debridement, periodontal pockets, periodontitis, stage III

Home care therapy is indispensable to manage periodontal disease successfully. Often, during and following initial periodontal treatment, it is unclear how much of the clinical improvement was due to patients’ home care or to professional intervention, as these two therapeutic components are often amalgamated in clinical practice as well as in studies. In this case series, four patients with periodontal disease received education on using oral hygiene devices and used them competently prior to initiation of professional periodontal treatment. The changes in their clinical presentations, solely attributed to their home care therapy, were documented. The rationale and suggested clinical guidelines are also presented. Conclusion: Home care therapy is an indispensable but often overlooked step in the successful management of periodontal diseases. Ideally, this step should be solidified prior to proceeding with any professional treatment. By motivating patients to participate in the treatment more actively, clinicians can significantly improve the outcome and longevity of their professional interventions. Keywords: bone loss, caries, dental plaque, gingivitis, oral hygiene, periodontitis

Interim rehabilitation of edentulous patients is essential in implant prosthodontics. However, surgical augmentation may be required for patients with reduced bone density, which complicates the use of an interim prosthesis. This report describes the rehabilitation of an edentulous patient with an interim maxillary overdenture retained by short implants with individual attachments during the healing period of vertical and horizontal ridge augmentation. This technique increased the stability of the interim prosthesis even with shortened flanges to eliminate any pressure on the surgical site. This technique could also be used when immediate loading is not possible due to lack of primary stability of the implants placed for definitive fixed prostheses. Keywords: horizontal augmentation, interim rehabilitation, overdenture, short implant, vertical augmentation

Implant-based rehabilitation is a clinical challenge, especially in the esthetic area. Numerous factors influence the outcome of the rehabilitation; however, the two main factors are the bone and soft-tissue deficiencies at the intended implant site. Peri-implant soft tissue complications can arise from a combination of factors that can be summarized as two categories: diagnostic errors and surgical planning management errors. Most of the complications can be corrected after each step of the treatment and even after the delivery of the prosthetic restoration with adequate soft tissue management in order to give the patient an esthetically pleasing outcome. The aims of this article were: to present the current literature, to propose a clinical checklist to guide clinicians in evaluating the prognosis of the treatment utilizing soft tissue grafting, and to illustrate a case series partially employing the proposed clinical checklist. The proposed checklist could be helpful in evaluating the prognosis of the treatment utilizing only soft tissue grafting. In clinical cases in which the prognosis is classified as good, soft tissue management could be a viable treatment option before attempting more radical procedures like implant removal. Keywords: connective tissue graft, coronal advanced flap, dental implant, mucosal recession, peri-implant soft tissue deficiency, peri-implant soft tissue recession, plastic peri-implant surgery, tunnel technique

Objectives: This manuscript presents a systematic review of the impact of the COVID-19 pandemic on head and neck cancer (HNC) patients. A meta-analysis was made to compare the number of treated/operated HNC patients in the pre-COVID-19 era versus the COVID-19 era. This investigation was based on previous reports showing a delay in the diagnosis and treatment of new cases of cancer during the pandemic. Worsening in cancer prognosis would be expected as a result of the delayed treatments. Method and materials: An electronic search was conducted using the PubMed/MEDLINE, Embase, Web of Science, Scopus, and The Cochrane Library databases. Relevant articles were selected based on specific inclusion criteria. Results: A total of 8,942 HNC patients were included. A higher prevalence in male (1,873) in comparison to female (1,695) was observed considering 3,568 patients. Regarding staging, the majority of cases were stage III to IV. The treatment type more frequently described was surgery. Positive diagnosis for COVID-19 in the pre-oncologic treatment was reported for 242 patients, and for post-oncologic treatment in 119 patients. Mortality by COVID-19 was reported for 27 HNC patients. The meta-analysis revealed a significantly smaller number of surgeries/oncologic treatments of HNC patients performed (2,666) in the COVID-19 era when compared to the pre-COVID-19 era (3,163) (Mantel–Haenszel odds ratio = 0.81, 95% CI = 0.65 to 1.00, P = .05). Conclusion: The impact of the COVID-19 pandemic on HNC patients occurred mainly in the number of surgeries/oncologic treatments, showing a significantly smaller number of surgeries/oncologic treatments performed in the COVID-19 era rather than the pre-COVID-19 era. Keywords: COVID-19, head and neck cancer, meta-analysis, pandemic, SARS-CoV-2, systematic review

Temporomandibular disorders (TMDs) encompass a number of different musculoskeletal disorders often accompanied by pain and dysfunction. Most TMDs are acute, but can become chronic leading to disability and quality of life issues. There is wide variation in treatment of TMDs, including both conservative/reversible therapies as well as invasive/irreversible treatments, which present difficulties for clinicians, patients, and third-party payers as to what constitutes appropriate care. Data sources: A recent report by the National Academies of Sciences, Engineering, and Medicine highlighted a number of deficiencies, most notably in the education of TMDs within United States of America dental schools at both the predoctoral and postdoctoral (dental) levels as well as addressing the historic inconsistencies in both diagnosis and treatment. New areas for research and interprofessional collaboration should assist in the understanding of TMDs, and updated clinical practice guidelines should help reduce variation in the delivery of evidence-based care. Recently, the American Dental Association recognized orofacial pain as a specialty, which should increase the level and availability of expertise in treating these issues. Summary: Based on the current best evidence, this report is an attempt to alert the profession to discontinue irreversible and invasive therapies for the vast majority of TMDs and recognize that the majority of these disorders are amenable to conservative, reversible interventions. Keywords: American Dental Association, Commission on Dental Accreditation, dental education and research, National Academies of Sciences, Engineering, and Medicine, temporomandibular disorders

Dental dilacerations are abrupt deviations of the longitudinal axis of the crown or root portion of the tooth, caused by traumatic axial displacement of previously formed hard tissue in relation to the developing soft tissue. Case presentation: A 13-year-old boy in good general health was referred for root canal treatment of the maxillary left central incisor, for which abnormal crown morphology impeded orthodontic treatment. He presented bilateral crown dilaceration at both maxillary central incisors. Treatment involved a CAD/CAM milled veneer of the maxillary left central incisor and semidirect warm composite veneer of the maxillary right central incisor. Follow-up and monitoring of the restoration was performed through .stl file analysis. Discussion: Crown dilaceration severity assessment is crucial for deciding the best treatment plan for each case. In this patient, additive restorative protocols, CBCT, and 3D digital model analysis were the most useful aids by providing key multidisciplinary information. Conclusion: A multidisciplinary treatment workflow with a minimally invasive approach aided by digital tools such as CBCT and CAD/CAM technologies is useful to achieve successful and predictable outcomes in crown dilaceration cases. Keywords: crown dilaceration, digital dentistry, minimal invasive dentistry, multidisciplinary management, monolithic veneers

Objective: Oral and dental health significantly impacts the quality of life and nutrition of the older population. While government action has been taken in Israel to reduce barriers to using dental care services by welfare recipients among older adults, there are still disparities associated with socioeconomic status in the older adult population. In 2019, a dental care reform for the older adults was implemented in Israel assuring dental Universal Health Coverage (UCH) for them. This has improved accessibility to dental services and reduced cost barriers. The aim of the present article was to explore the oral health disparities among the 65+ age group by their socioeconomic situation, and their additional barriers to using dental services at the start of the reform. Method and materials: Telephone interviews were conducted with a representative sample of 512 older adults aged 65+ from February to April 2020. Results: The self-perceived oral health status was rated as better in the higher socioeconomic group (73.4% perceived their oral health status as good or very good), compared with the lower socioeconomic group (52.5%). In the lower socioeconomic group, 38.5% were edentulous, compared with 18.1% of the higher socioeconomic group. The latter group had four more natural teeth, on average, than the former. Regarding the prevalence of dental problems, double and triple gaps were also found, as well as loose, sore, and sensitive teeth, and difficulty chewing. Oral health behavior, as reflected in tooth brushing patterns and routine preventive check-ups, was found to be better in the higher socioeconomic group than in the lower socioeconomic group. Dental care costs were found to be a barrier to dental care, primarily in the lower socioeconomic group (18.2%, compared with 4.8% of the higher socioeconomic group, were faced with a financial barrier). At the same time, 66.7% of the higher socioeconomic group were aware of the inclusion of dental care services for the older adult population in the basket of health services provided by the health plans, compared with 27.8% of the lower socioeconomic group. Conclusions: Lack of awareness to proper oral health behavior and to their legal rights were the main barriers to dental care in the lower socioeconomic groups. Dental practitioners play a vital role and have an opportunity to lower these barriers. Existing disparities and barriers should be monitored as a vital part of including dental care in Universal Health Coverage. Keywords: dental health policy, dental service utilization, elderly, oral health, oral health disparities, Universal Health Coverage