Quintessence International, 09/2020

Objectives: To evaluate masking effects of resin infiltration on labial white spot lesions (WSL), by comparing the latter with a remineralization approach (using hydroxyapatite and fluorides) and conventional oral care (using fluoride-free toothpaste). Method and materials: Fifteen patients with at least three WSL were enrolled for a within-person randomized controlled trial, thus allowing for intrapersonal comparisons. Each WSL per tooth in every patient was randomly assigned to one of the following groups. Group 1: lesions were resin-infiltrated with Icon (RI; DMG); Group 2: Remin Pro (RP; VOCO) was used as remineralizing agent; and Group 3 (control): affected teeth were brushed with Complete Care toothpaste (CC; Himalaya). RP and CC were applied by means of a polishing brush, using a low-speed handpiece (5 min), and these procedures were repeated chairside thrice daily for 7 consecutive days. Digital photographs were captured before and after lesion treatment under standardized conditions. The CIE L*a*b* color system was used to analyze the optical outcome, and intrapersonal color differences were statistically evaluated. Results: Compared to RP and CC, RI showed prompt and subjectively satisfactory color improvements, and this was primarily driven by L* and b* shifts. Statistical analysis of the objective color differences (ΔE*) between the three groups revealed significant differences for RI vs RP (P = .029), RI vs CC (P .001), and RP vs CC (P = .001). Conclusion: Resin infiltration is considered a time-effective treatment option for esthetically camouflaging WSL, while RP and CC failed to improve lesion appearance and oral health in the current short-term trial. Keywords: dental health, enamel caries, health care quality, improvement of oral health, remineralization, resin infiltration, white spot lesion

Objectives: To evaluate the healing of multiple adjacent type 1 and 2 gingival recessions (RT1 and RT2) treated with the modified coronally advanced tunnel (MCAT) or the laterally closed tunnel (LCT) in conjunction with a cross-linked hyaluronic acid and subepithelial palatal connective tissue grafts. Method and materials: Fifteen healthy patients exhibiting multiple adjacent mandibular or maxillary RT1 and RT2 of a depth of ≥ 2 mm, were treated with the MCAT or LCT in conjunction with cross-linked hyaluronic acid and subepithelial palatal connective tissue grafts. Results were assessed at baseline and after a minimum of 6 months. The primary outcome variable was root coverage. Esthetic outcomes were evaluated on photographs using the root coverage esthetic score. Results: Postoperative pain and discomfort were low and no complications occurred. Data analyses were performed at patient level. After a mean follow-up of 17 ± 5.4 months, statistically significant root coverage was obtained in all 15 cases (P .0001). Complete root coverage was obtained in 3 out of 15 cases (20%). Root coverage amounted to > 95% in three patients, was between 90% and 95% in four patients, and reached 87.5% in another patient. In three further patients root coverage measured 75%, 77%, and 64.6%, respectively. Mean root coverage measured 85.1 ± 23.2%. Mean keratinized tissue width increased from 2.5 ± 1.0 mm to 3.7 ± 0.7 mm (P .0001) from baseline to follow-up, while mean probing depth showed no statistically significant changes (1.3 ± 0.5 mm vs 1.5 ± 0.5 mm). The mean root coverage esthetic score was 7.9 ± 1.9, while in the three cases exhibiting complete root coverage, a maximum root coverage esthetic score (10) was given for all treated teeth. Conclusion: Within their limits, the present results indicate that the described treatment approach may lead to predictable root coverage of multiple mandibular and maxillary RT1 and RT2. Keywords: connective tissue graft, hyaluronic acid, laterally closed tunnel, modified coronally advanced tunnel, multiple gingival recession

Objective: To investigate bone loss in the anterior edentulous maxilla restored with maxillary complete dentures and opposed by mandibular two-implant-supported overdentures (2-IODs) or complete dentures. Method and materials: A systematic search was conducted using the Ovid MEDLINE, Embase, Web of Science, CINAHL, and Cochrane databases for studies investigating bone loss in the anterior edentulous maxilla with mandibular 2-IODs or complete dentures. Two reviewers assessed the eligibility of studies and risk of bias assessment was conducted according to the Newcastle-Ottawa Scale. A meta-analysis was performed using statistical software to estimate weighted mean difference in bone loss with 95% confidence interval (CI). The level of significance was defined as P value ( .05). Results: A total of 2,510 studies were identified through electronic and manual searching. Six studies were selected and compounded for quantitative synthesis of 163 patients. Bone loss in the anterior edentulous maxilla was greater with 2-IODs than with complete dentures. The total estimate of weighted mean difference between 2-IODs and complete dentures was −1.40 (95% CI −3.12 to 0.31). However, the difference was not statistically significant (P = .11). The data were heterogenous across the studies based on chi-square statistics (χ2 [df = 7] = 52.75, P .0001; τ2 = 5.53, I2 = 95.21%). In addition, the impact of implant splinting on bone loss was not significant (P > .29). None of the included studies were considered to be at high risk of bias. Conclusion: Within the limitations of the current systematic review and meta-analysis, the estimate of bone loss in the anterior edentulous maxilla was greater with 2-IODs than with complete dentures. However, the difference was not statistically significant. A well-designed randomized clinical study needs to be conducted to validate the results of this systematic review. Keywords: anterior edentulous maxilla, bone loss, combination syndrome, complete denture, implant supported overdenture, pressure

Objective: The present study compared the efficacy of preoperative administration of paracetamol and placebo in reducing postoperative pain after routine dental treatment in children. The primary objective was to compare postoperative pain level between the groups. The secondary objective was to identify other factors that can influence postoperative pain. Method and materials: A prospective, placebo-controlled parallel-group trial was conducted on two groups of children aged 5 to 12 years. One hundred and two children participated in the study, 51 in each group, 58 boys (56.9%) and 44 girls (43.1%). The average age was 7 ± 1.72 years, with no difference in age and sex between the groups. The study group received paracetamol (15 mg/kg) and the control group received placebo 15 minutes before dental treatment. Pretreatment baseline anxiety was recorded. Postoperative data were collected immediately at the end of the treatment, and by phone 2.5 hours after taking the remedy. Results: The groups showed no difference in postoperative pain immediately after the treatment and 1.5 hours after treatment. The pain score was higher among children who received stainless steel crowns and combinations of crowns, pulpectomy, and extractions. Conclusion: Preoperative use of paracetamol has the same preemptive analgesic effect as placebo in pediatric patients who receive routine dental treatment. Clinical relevance: Postoperative pain can influence the willingness of children to receive consecutive treatments. Dental practitioners should prevent postoperative pain and recommend analgesia when necessary. Pain is expected after performing stainless steel crowns, pulpectomies, and extractions. The current study confirms that preoperative paracetamol has no beneficial effect. Keywords: dental care for children, pediatric dentistry, preoperative analgesia, preoperative paracetamol, postoperative pain

Objective: The aim of this review was to systematically appraise the current evidence of utilizing vibration to reduce orthodontic pain. Method and materials: A comprehensive search was performed in ten databases. Only randomized controlled trials (RCTs) with patients receiving orthodontic treatment accompanied by vibrational force application were included. Risk of bias was assessed using the Cochrane tool. The lack of reasonable homogeneity across studies prevented the quantitative synthesis of the data. Results: Fifteen RCTs were included. Three out of four RCTs revealed lower pain levels in at least one time-point when aligners were enhanced by vibration. Three out of 11 RCTs found that vibration accompanying fixed appliances was effective in reducing orthodontic pain. All studies had different methodologic shortcomings including: performance bias due to lack of participants' blinding; inappropriate sample size calculation; nonuniform demographic characteristics of participants; high potential of retrospective documentation of pain perception; and attrition bias. Conclusion: It is difficult to answer the question of whether vibration alleviates orthodontic pain or not, especially with the multiple existing shortcomings. More precise research is needed. It is recommended to focus on comparing different vibrational variables in an attempt to find the optimal values that might contribute to pain reduction, including: vibrational frequency; magnitude; and number and duration of sessions per day. Based on the concept of stimulation-induced analgesia, it is suggested that future research highlights the number of vibration sessions/day. Keywords: orthodontics, pain, pain perception, systematic review, vibration

Objective: Conservative treatment modalities are recommended for managing masticatory myalgia in individuals with temporomandibular disorders. The aim of this study was to retrospectively review and compare the effectiveness of four conservative treatments: counseling and occlusal splint therapy, counseling and manipulation integrated with electrophysiotherapy, the combination of the two treatments, and counseling only. Method and materials: One hundred and sixty-eight patients who had myalgia with limited jaw movement were retrospectively observed in this study. Between January 2015 and December 2017, 63 patients received counseling and stabilization occlusal splint therapy (Group 1), 35 patients received counseling and manipulation integrated with electrophysiotherapy (Group 2), 33 patients received the combination of counseling, splint therapy, and manipulation integrated with electrophysiotherapy (Group 3), and 37 patients received counseling only (Group 4). All subjects were followed up for 12 weeks. The intensity of spontaneous pain, palpation pain, chewing pain in the masticatory muscles, and range of pain-free maximal mouth opening were recorded in the clinical assessments. Intragroup and intergroup differences were examined by using analysis of variance (ANOVA) and the Kruskal-Wallis test. Results: Spontaneous pain in the masticatory muscles was relieved significantly in all groups at the 6-week visit (P .05), and no significant difference was found among the groups (P > .05). Palpation pain was relieved significantly at the 9-week visit in the counseling + occlusal splint therapy group, counseling + manipulation + electrophysiotherapy group, and counseling + occlusal splint + manipulation + electrophysiotherapy group (P .05). In the treatment group with counseling alone, significant palpation pain relief occurred at 12 weeks. Chewing pain was relieved significantly at the 6-week visit in the counseling + occlusal splint therapy group, counseling + manipulation + electrophysiotherapy group, and counseling + occlusal splint + manipulation + electrophysiotherapy group (P .05), yet no significant difference compared to the baseline was observed in the counseling-only group (P > .05). A significant increase in the maximal range of pain-free mouth opening was observed at the 9-week visit in the counseling + occlusal splint therapy group, and at the 3-week visit in the counseling + manipulation + electrophysiotherapy group and counseling + occlusal splint + manipulation + electrophysiotherapy group (P .05). Nevertheless, no significant change in the range of mouth opening was found throughout the follow-up period in the counseling-only group (P > .05). Conclusion: Each of the included treatment modalities relieved spontaneous pain and tenderness to palpation of the masticatory muscles during the follow-up intervals. Counseling alone did not help patients with chewing pain and limited mouth opening in the short term. Treatment protocols including counseling, occlusal splint therapy, and manipulation, integrated with electrophysiotherapy showed the best short-term outcomes for symptomatic improvement. Keywords: electrophysiotherapy, manipulation, myalgia, occlusal splint, temporomandibular joint

When dental trauma occurs, initial management on the day of injury has a determining influence on healing and thus on the prognosis of the affected teeth. Improper, delayed, and/or inconsistent treatment often has far-reaching consequences that cannot be reversed later, even with great effort, especially in children and adolescents. In most cases, it is unrealistic or impossible for the patient to get to a specialized dental trauma facility in time. Therefore, it is every dental practitioner's duty to provide adequate initial diagnosis and treatment of dental trauma at their dental practice, even if they do not have routine experience in this area. This article serves as a guide to the initial management of dental trauma. It utilizes a three-tiered approach to illustrate which initial management measures are absolutely essential (MUSTS), which should ideally be performed (SHOULDS), and which are not top priorities but can be performed (CANS) if the necessary time, training and experience, and equipment and facilities are available. For further treatment, dental practitioners should realistically assess the limits of their ability to treat complex dental trauma cases and, if necessary, they should refer the patient to a specialist or specialized treatment center. (Quintessence Int 2020;51:763–774; doi: 10.3290/j.qi.a45103; modified from a previously published article (in German) Quintessenz 2019;70(9):990–1002) Keywords: dental trauma, emergency treatment, initial management

Virtual planning in digital dentistry enables easier communication between technicians, clinicians, and patients, and faster performance. Dental computer-aided design (CAD) software programs have been used for this purpose. One of the most crucial steps in virtual planning is mounting and articulating the maxillary and mandibular arch 3D models to simulate and evaluate the occlusion as a part of the virtual mock-up. The aim of this article was to describe a more cost-effective digital technique utilizing a scanned interocclusal record for articulating the cast models virtually. For this purpose, the open source Autodesk Meshmixer software program was used. Keywords: digital articulation, digital dentistry, Meshmixer, virtual planning