Quintessence International, 05/2020

Objectives: The purpose of the present prospective and randomized clinical trial was to evaluate the clinical performance of noncarious cervical lesions (NCCLs) restored with different adhesion strategies on the dental substrate. Method and materials: An adhesive restorative system (Single Bond Universal/ Z350XT) with and without selective enamel conditioning was evaluated, as well as a resin-modified glass-ionomer cement (Vitremer), with and without pretreatment with ethylenediaminetetraacetic acid (EDTA). Two operators placed a total of 200 restorations in 50 patients (four restorations per patient). Data from decayed, missing, and filled teeth (DMFT), visible plaque, and gingival bleeding were collected prior to the restorations and at each evaluation time. All restorations were evaluated using the modified United States Public Health Service (USPHS) evaluation system at baseline, and at 6 and 12 months. Data were analyzed by the Friedman, chi-square, Cochran, Wilcoxon, and multiple logistic regression analysis tests (P ≤ .05). Results: There was a gradual and significant increase in DMFT with a difference among the three evaluations (P ≤ .001). There was no difference for the Visible Plaque Index over time (P = .28); however, there was a significant reduction in the Gingival Bleeding Index between the baseline and the other evaluations (P ≤ .001). There was no statistically significant difference among groups and periods of evaluations (P > .05). Regarding logistic regression, the model as a whole was statistically significant (P = .034). Conclusion: The four different adhesion strategies in the NCCL restorations presented similar clinical performance after 1 year of follow-up. Keywords: acid etching, adhesive system, dentin, randomized controlled clinical trial, resin-modified glass-ionomer cement

The most commonly used bleaching agents contain different concentrations of hydrogen peroxide and carbamide peroxide. In the present case, the bleaching procedure was performed using an induced field of cold atmospheric plasma, obtained from dielectric barrier discharge. The therapeutic effect of the device used in the clinical procedure is based on floating electrode dielectric barrier discharge, in which the glass electrode functions as the primary electrode, while the therapeutic area, which in this case is the tooth, represents the secondary electrode. A periodontal (PA) probe is a glass tube filled with a noble gas, which generates an electrical discharge in the gap between the tip of the electrode surface and the therapeutic area, thus producing reactive oxygen species. Bleaching with only the cold atmospheric plasma bleaching technique, without any conventional bleaching agents, was performed successfully for an endodontically treated tooth. The cold atmospheric plasma bleaching technique, which could be a novel approach for the bleaching of non-vital teeth, provides good clinical results and is safe for clinical use. Keywords: bleaching agents, cold atmospheric plasma, nonvital tooth, tooth bleaching procedure

Objectives: The aim of the present randomized controlled clinical trial was to evaluate the outcomes of the use of free gingival graft (FGG), of a collagen matrix and of vestibuloplasty to increase the amount of keratinized attached mucosa (KM) before healing abutment placement. Method and materials: The study was a randomized, parallel-group controlled investigation. All patients were treated to increase the KM width before placement of implant-supported prostheses. The implants were placed 3 to 6 months before the interventions. Three techniques were tested: an apically positioned flap (control group), FGG (test group 1), and use of a collagen matrix (test group 2). Biopsy was performed during healing abutment placement by means of a mucotome. Results: A total of 63 patients were recruited and treated, and 58 were available for follow-up visits. After 4 weeks, the KM width gain was 1.93 ± 0.85 mm, 4.85 ± 1.11 mm, and 3.03 ± 0.58 mm, respectively, for control group, test group 1, and test group 2. Postoperative pain was significantly higher in the FGG group than in the others. Edema and hyperemia decreased gradually during the first week without significant differences among groups. Conclusion: Despite the limitations of the study, it was found that FGG was the most effective technique to augment the amount of KM in sites of implant placement. The use of a collagen matrix could be a viable alternative to diminish the intervention's impact on patients' postoperative quality of life. Keywords: dental implants, mouth mucosa, randomized controlled trial, vestibuloplasty

Objective: The purpose of the present study was to compare and assess maxillary edentulous patients treated with four-implant-retained overdentures and with implant-supported fixed prostheses using the All-on-4 concept in terms of patient satisfaction, oral health-related quality of life, and marginal bone loss. Method and materials: Thirty-three patients treated with either maxillary four-implant-retained overdentures (n = 15) or with maxillary implant-supported fixed prosthesis using the All-on-4 concept (n = 18) were compared in terms of patient satisfaction, quality of life, and marginal bone loss. Independent sample t test was used to compare the two groups in terms of satisfaction, OHIP-14 scores, and marginal bone loss. The paired sample t test was used to compare bone loss at different time intervals. The comparison of marginal bone loss with regard to implant location was accomplished with the one-way ANOVA test. P values of .05 were considered as statistically significant. Results: No statistically significant differences were found between the two groups' OHIP-14 scores (P > .05). When patient satisfaction scores were evaluated, hygiene maintenance (P = .001) and pain scores (P = .001) were significantly higher in the implant-retained overdenture group than in the implant-supported fixed prosthesis group (P .05). No statistically significant difference was observed between axial and tilted implants at both the 12-month (P = .59) and 24-month (P = .77) follow-up periods in the implant-supported fixed prosthesis group. Conclusion: Four-implant-supported fixed prostheses with the All-on-4 concept and four-implant-retained overdentures present similar marginal bone loss and quality of life scores after 2 years of function. However, patients found overdentures easier to clean but more painful in comparison with the fixed prosthesis. Keywords: edentulous maxilla, implant, marginal bone loss, patient satisfaction, quality of life

Objective: To describe and illustrate the histologic characteristics of luting cement-induced peri-implantitis in the posterior maxilla of a 56-year-old man. Case presentation: A dental implant inserted 6 years previously in the maxillary left first premolar region revealed pus and swelling. A periapical radiograph showed severe bone loss around the dental implant, and the presence of surrounding residual particles of luting cement. The implant was removed with its adjacent tissues. The harvested implant was fixed in formaldehyde solution (formalin). A 4-mm fragment of soft tissue and a 6-mm fragment of bone were cut from the implant specimen and submitted for routine processing of hematoxylin-eosin (h&e) slides for histologic analysis. The implant specimen was processed and embedded in glycol methacrylate resin and ground to a thickness of 50 µm for histologic examination. Results: The microscopic examination of the h&e slides showed connective tissue with an inflammatory infiltrate composed of histiocytes, lymphocytes, and plasma cells. There was a fragment of viable bone integrated with the bone graft material. The bone showed evidence of active resorption by osteoclasts in Howship lacunae. The implant sections showed trabecular bone with lamellar structure in the apical portion. Foreign body, compatible with luting cement, was present in the coronal portion, adjacent to the threads of the implant, as well as osteoclasts in Howship lacunae. Conclusion: This report, documenting a case of peri-implantitis associated with excess cement extrusion, revealed that that the bone loss was associated with an inflammatory infiltrate. Additional studies focusing on the histopathologic characteristics of peri-implantitis could help to increase the knowledge of peri-implant disease to shed light on prevention and treatment. Keywords: excess cement extrusion, histology, peri-implantitis

Objective: The aim of this randomized controlled clinical study was to evaluate the efficacy of a new technique fully based on the use of a piezoelectric device for third molar root extraction versus the conventional technique based on the use of manual and rotary instruments. Method and materials: Patients referred to the hospital of Bolzano for third molar extraction were randomly divided into two groups and treated by two experienced oral surgeons. In the test group all the procedures were performed using piezoelectric instruments and a specially designed piezoelectric lever, whereas in the control group conventional manual and rotary instruments were used. The main outcome measure was patient's pain perception, and the secondary outcome measures were complications, duration of the surgical treatment, and soft tissue healing. The study had a 1-week follow-up. Results: Fifty patients (23 females and 27 males) out of 90 were included in the study, and 100 third molars (50 maxillary and 50 mandibular) were extracted. All patients completed the expected follow-up. No differences were found between the two groups regarding patient's pain perception, complications, and soft tissue healing. However, the new piezoelectric extraction technique took less than half the time when compared to the conventional technique (4.6 ± 4.5 minutes versus 10.2 ± 13.1 minutes; P = .049). Conclusions: The new piezoelectric third molar root extraction technique allowed third molar extraction in less than one half the surgical time required by the traditional technique. The advantages seem to be more pronounced in difficult cases. However, both surgeons who performed the procedures were very experienced and all the patients were young. Therefore, caution should be given to the generalization of the results. Multicenter studies with a larger variety of patients are needed to confirm the promising results of this study. Keywords: extraction, oral surgery, piezoelectric, randomized clinical trial, third molar

Objectives: This paper is aimed at addressing the urgent need to develop a protocol that will address the operatory and clinical aspects of dental care during the Coronavirus disease 2019 (COVID-19) outbreak. Data sources: The epidemiology, clinical signs and symptoms, and modes of transmission of COVID-19 are presented. This protocol was established as an international collaboration of three dental universities: Hadassah School of Dental Medicine, Israel; University of Rochester Medical Center, USA; and the University of Pennsylvania, USA. This protocol is based on a detailed review of the existing English language literature as well on the logistic and clinical experience of each facility and the opinion of the authors. The protocol is designed for a hospital setting and includes considerations related to dental treatment in both healthy subjects and those suspected or diagnosed with COVID-19. The first part of this review discusses operatory considerations; the second part discusses general dental clinical aspects; the third part discusses endodontic considerations; and the fourth part discusses surgical aspects. This protocol may be applicable to other future similar pandemics. Conclusion: Logistic and clinical steps are required to provide dental care during the COVID-19 outbreak while preventing cross-contamination and protecting the dental team during the provision of care. Keywords: coronavirus, COVID-19, dental, endodontics, infection control, pulpitis