Quintessence International, 02/2023

Objective: The aim of this prospective, double-blind, randomized controlled trial was to compare the effect of oral premedication of meloxicam, ketorolac, dexamethasone, ibuprofen, or placebo on the success of inferior alveolar nerve blocks (IANB) of mandibular posterior teeth in patients experiencing symptomatic irreversible pulpitis. Method and materials: Two hundred and fifty emergency patients in moderate to severe pain diagnosed with symptomatic irreversible pulpitis of a mandibular first or second molar randomly received, in a double-blind manner, identical capsules containing either meloxicam 7.5 mg, ketorolac 10 mg, dexamethasone 0.5 mg, ibuprofen 600 mg, or placebo 60 minutes before the administration of an IANB. Profound lip numbness was assessed after 15 minutes. Access cavities were then prepared and success of IANB was defined as no or mild pain (Heft-Parker visual analog scale recordings) during access preparation and root canal instrumentation. The data were analyzed using chi-square and Kruskal-Wallis tests. Results: The overall success rates for the meloxicam 7.5 mg, ketorolac 10 mg, dexamethasone 0.5 mg, and ibuprofen 600 mg groups were 52%, 64%, 54%, and 58%, respectively, with no significant differences in success rates among the premedications groups (P > .05). However, the tested premedications revealed significant differences compared with the placebo group (32% success rate) (P < .05). Conclusion: Premedication with meloxicam, ketorolac, dexamethasone, and ibuprofen increased the efficacy of IANB in mandibular molars with symptomatic irreversible pulpitis. (Quintessence Int 2023;54:92–99; doi: 10.3290/j.qi.b3605097) Keywords: anesthesia, dexamethasone, inferior alveolar nerve block, ketorolac, meloxicam, symptomatic irreversible pulpitis

Objective: To evaluate the effectiveness of the use of adjuvant ozone therapy in the healing process of wounds resulting from periodontal and peri-implant surgical procedures by answering the following focused question: “Can adjuvant ozone therapy improve wound healing outcomes related to periodontal and peri-implant surgical procedures?”. Method and materials: MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched, without language restriction, for peer-reviewed articles published until 23 March 2022, in addition to manual search. Only controlled clinical trials (randomized or not) were considered. The risk of bias was evaluated by the Cochrane risk-of-bias tool for RCTs – version 1 (RoB1). Data were pooled into evidence tables and a descriptive summary was presented. Results: Of the 107 potentially eligible records, only seven studies were included. Four addressed free/deepithelialized gingival grafts with a palatal donor area, two evaluated implant sites, and one comprised gingivectomy and gingivoplasty. A total of 225 patients were evaluated in the included studies, considering control and test groups (ozone and other adjuvant therapies for comparison). Ozone therapy had a positive effect on outcomes directly or indirectly related to periodontal/peri-implant surgical wound healing. Furthermore, it could also increase the stability of immediately loaded single implants installed in the posterior mandible. Conclusion: In general, ozone therapy seems to both accelerate the healing processes of periodontal/peri-implant wounds and increase the secondary stability of dental implants; however, considering the limited evidence available and the risk of bias in the included studies (none classified as low risk), a definitive conclusion cannot be drawn. (Quintessence Int 2023;54: 100–110; doi: 10.3290/j.qi.b3512007) Keywords: dental implants, ozone, ozone therapy, periodontal surgery, wound healing/surgery

Objectives: In preparation of a definitive randomized clinical trial (RCT), the current parallel-grouped triple-blind pilot RCT assessed the efficacy of recombinant human bone morphogenetic protein-2 (rhBMP-2) with polylactic acid/polyglycolic acid (PLA/PGA) membrane for improvement of periodontal tissue regeneration in Class II furcation type defects. Method and materials: With the present single-center investigation, 24 patients/24 mandibular molars revealing Class II furcation lesions with involved buccal surfaces were randomly allocated and treated surgically, using either a PLA/PGA membrane alone (control, n = 12) or in combination with rhBMP-2 (n = 12). Assessors, participants, and the statistician were blinded to the treatment groups. Clinical parameters including Plaque Index (PI), Papillary Bleeding Index (PBI), clinical attachment level, vertical probing depth, horizontal probing depth, and gingival recession were assessed at baseline and 6 months postsurgery. Results: Baseline values concerning the investigated parameters were comparable between both groups (P > .05). After 6 months, clinical attachment level gain was similar (P = .76), while greater reductions in vertical probing depth (P = .01) and horizontal probing depth (P = .05), along with less gingival recession (P = .03) were observed in the PLA/PGA + rhBMP-2 group (compared to the controls). An increased number of completely closed furcation type defects was observed in the PLA/PGA + rhBMP-2 group (with no adverse effects). Conclusions: When treating Class II furcation lesions, the use of rhBMP-2 (combined with PLA/PGA membranes) seems advantageous. The presented set-up seems feasible with regards to recruitment, randomization, acceptance, retention, and adherence to the study protocol. (Quintessence Int 2023;54:112–124; doi: 10.3290/j.qi.b3631815) Keywords: furcation defects, Class II furcation, periodontal therapy, pilot study, polylactic acid/polyglycolic acid (PLA/PGA) membrane, randomized clinical trial, recombinant bone morphogenetic proteins, regeneration

Full-arch implant reconstructions are being utilized in clinical practice today. Very often these prostheses are prosthetically driven, but not periodontally maintainable. Often the patient presents to the general practitioner with a failing implant reconstruction, where several fixtures need to be removed and others are maintainable. The article presents a case report where a removable prosthesis is used as a transitional appliance during the retreatment of the case. A removable complete overdenture prosthesis using attachments was used to establish proper occlusion and function, prevent loading on the guided bone regeneration sites, and to assist in fabrication of a stable guide for implant placement. The staged approach facilitated laser periodontal therapy on the remaining fixtures, and allowed proper oral hygiene instruction and assessment of the patient’s ability to clean the remaining fixtures properly. Although the potential to treat this case with transitional implants or immediate load fixtures was discussed, the risk versus benefit scenario favored a removable prosthesis with attachments. Success required proper communication between the surgeon, restorative dental practitioner, laboratory, and patient. (Quintessence Int 2023;54:126–132; doi: 10.3290/j.qi.b3648969) Keywords: bone graft, full-arch fixed prosthesis, peri-implantitis, removable prosthesis with attachments, replacing failed implants, staging approach

Objective: The current study was designed to clinically compare and evaluate subepithelial connective tissue graft (SCTG) and advanced platelet-rich fibrin (A-PRF) membrane-based root coverage in the treatment of gingival recession type 1 (RT1). Method and materials: The current study involved 17 patients with bilateral gingival recession (RT1). Thirty-four sites were randomly allocated to test (A-PRF) and control (SCTG) sites and all the procedures were performed by a single operator. A single blinded observer evaluated the test and control sites at baseline, 3 months, and 6 months. The clinical parameters such as recession depth, recession width, width of keratinized gingiva, clinical attachment level, and percentage of root coverage were recorded. P < .05 was considered statistically significant. Results: The mean recession depth at baseline for control and test groups was 3.06 ± 0.56 mm and 2.35 ± 0.49 mm, respectively (P < .001). At the end of the study period, the mean recession depth was 0.53 ± 0.62 mm in the control group and 1.12 ± 0.49 mm in the test group (P < .05). No complications were associated with both the groups. The mean percentage of root coverage was 84.31 ± 17.89% in the control group and 51.96 ± 15.45% in the test group (P < .001). Conclusion: In conclusion, the study results suggest that both SCTG and A-PRF can be used in treating gingival recessions. However, SCTG is a better material in achieving root coverage and increasing keratinized tissue width. (Quintessence Int 2023;54:134–141; doi: 10.3290/j.qi.b3512389) Keywords: autograft, esthetics, keratinization, platelet concentrates, root surface attachment

Objective: Tooth autotransplantation (AT) is a viable option for the replacement of unrestorable or missing teeth. Recently, the use of a 3D replica of a donor tooth constructed from CBCT scans was described. The model is made to assess the recipient site’s size and minimize the required extraoral time of the donor tooth after extraction. The aim of the paper was to describe a new technique for AT using the 3D replica as a socket preparation tool. Case report: A 13-year-old boy who presented with hypodontia was referred for consultation and treatment. The treatment plan included combined orthodontic treatment and AT of the mandibular left second premolar into the site of the congenitally missing maxillary right canine. A titanium 3D model of the donor tooth was printed by a direct metal laser 3D printer utilizing the model from the CBCT scan. An intrasulcular flap was elevated, and the edentulous maxillary ridge was prepared using implant trephine burs with increasing diameters. A surgical mallet was utilized to apply vertical forces to the 3D-printed model, which was inserted into the prepared socket to allow a perfect fit for the donor tooth. After atraumatic extraction of the mandibular left second premolar, the donor tooth was inserted into the ready socket and splinted. Follow-up examinations at 1, 3, and 6 months, and 1 year after surgery demonstrated a successful outcome. Conclusion: The titanium replica was successfully used for precise preparation of the recipient site, minimizing the extraoral time of the procedure to 4 minutes, and thereby improving the expected outcome. (Quintessence Int 2023;54:142–148; doi: 10.3290/j.qi.b3649031) Keywords: autotransplantation, CBCT, donor, hypodontia, socket preparation, titanium replica

Objectives: Xerostomia, or dry mouth, is a condition that results from the reduction or absence of saliva flow secondary to the use of certain medications. The objective of the present study was to analyze the relationship between xerostomia patients and the consumption of serotonin norepinephrine reuptake inhibitors (SNRIs). Method and materials: The University of Florida (UF) Integrated Data (IDR) i2b2, for the period of June 2015 to September 2022, was used based on aggregates of the International Classification of Diseases 10th edition (ICD-10) diagnoses of dry mouth and use of SNRI. MedCalc Software was used to calculate odds ratios. Results: The odds ratio for dry mouth in the SNRI group was 5.95 (95% CI 5.47 to 6.48, P < .0001). The odds ratio for dry mouth in females on SNRI was 5.48 (95% CI 4.97 to 6.02, P < .0001), for males 5.48 (95% CI 4.56 to 6.95), P < .0001), for children 2.87 (95% CI 1.19 to 6.96, P = .0192), and for adults 4.46 (95% CI 4.09 to 4.86, P < .0001). When the different SNRIs were analyzed separately, the odds ratio for dry mouth with the use of venlafaxine was 5.83 (95% CI 5.12 to 6.6, P < .0001), duloxetine 6.97 (95% CI 6.33 to 7.67, P <.0001), desvenlafaxine 5.24 (95% CI 3.65 to 7.52, P < .0001), and milnacipran 9.61 (95% CI 5.66 to 16.31, P < .0001). Conclusion: According to the present study, patients who are taking SNRIs are five-fold more likely to develop dry mouth compared to those not on medications. The results could be informative to medical professionals who prescribe SNRIs and who are not currently aware of the effect they have on salivary production and therefore quality of life, as well as the dental practitioners treating these patients with dry mouth sequalae. (Quintessence Int 2023;54:150–154; doi: 10.3290/j.qi.b3704403) Keywords: antidepressant, dry mouth, SNRI, xerostomia

Objectives: Morphologic study is a common approach in the field of anterior disc displacement (ADD) pathology; however, analysis based on 3D reconstructive imaging has not been investigated. This study investigated the association between ADD and the status of the mandibular condyle and articular fossa. Method and materials: Thirty-four patients were divided into a normal articular disc position (NADP) group, an ADD with reduction (ADDwR) group, and an ADD without reduction (ADDwoR) group. Images reconstructed were used to determine multiple grouped comparisons of these three different types of disc position, and the diagnostic efficacy for the morphologic parameters with significant grouped difference was analyzed to assess. Results: The condylar volume and condylar superficial area of the NADP, ADDwR, and ADDwoR groups exhibited obvious changes (P < .05). A multivariate logistic ordinal regression model showed that the condylar volume (odds ratio [OR], 1.011; regression coefficient [RC] = .011, P = .018), superior joint space (OR, 8.817; RC = 2.177; P < .001), and medial joint space (OR, 1.492; RC = 0.400; P = .047) had a significantly positive impact on the groups. Conclusion: The mandibular condyle and articular fossa in temporomandibular joint ADD exhibited altered dimensions. The condylar volume, condylar superficial area, superior joint space, and medial joint space could be considered as promising biometric markers for assessing ADD, and were investigated in this current pilot study. (Quintessence Int 2023;54:156–166; doi: 10.3290/j.qi.b3512027) Keywords: articular disc, cone beam computed tomography, magnetic resonance imaging, mandibular condyle, temporomandibular joint disorders, theoretical model

Objectives: The aim of this study was to estimate the prevalence of dental attrition in a young adult population and to explore associated factors. Method and materials: Dental students aged 18 to 40 years old with a minimum of 24 natural teeth were invited to take part in this cross-sectional study. Their demographic information, medical history, perceived stress, frequency of dietary acid intake, and frequency of oral habits were obtained through several questionnaires. Assessment of each type of tooth wear (erosion, attrition, and abrasion) was performed according to the tooth wear evaluation system (TWES 1.0). All participants underwent salivary tests. Statistical analysis was performed by chi-squared or Mann–Whitney tests and logistic regression models. Results: In total, 178 participants (88 women and 90 men) with a median age of 22 years were included and of those 74.7% (95% confidence interval [CI], 68% to 81%) had dental attrition. Univariate analysis revealed positive associations for male sex, age, body mass index, awake bruxism frequency, and erosive tooth wear with the presence of dental attrition. Multivariable logistic regression (Nagelkerke r2 = 0.31) indicated that dental attrition was associated with erosive tooth wear (adjusted odds ratio [aOR], 6.3; 95% CI, 2.8 to 14.2), body mass index (aOR, 1.3; 95% CI, 1.1–1.5), and age (aOR, 1.2; 95% CI 1.0 to 1.3). Conclusion: Dental attrition is present in most young adults of Catalonia. The associated factors were erosive tooth wear, body mass index, and age. Slight alterations of salivary parameters do not seem to predict dental attrition. (Quintessence Int 2023;54:168–175; doi: 10.3290/j.qi.b3622405) Keywords: prevalence, tooth attrition, tooth erosion, tooth wear, young adult