Quintessence International, 03/2023

To date, no consensus exists regarding the management of enamel infractions (cracks and craze lines), which may be associated with sensitivity. Two clinical cases are presented on the management of enamel infractions using a modified erosion-infiltration protocol for resin infiltration. Initially indicated for the treatment of early caries lesions, Icon (DMG) low-viscosity resin infiltrant has also been used to mask unesthetic developmental defects of enamel in anterior teeth. Treatment using this modified infiltration protocol immediately eliminated tooth sensitivity associated with the enamel infractions. Resin infiltration has the potential as a minimally invasive and effective treatment for the management of sensitivity associated with enamel infractions. (Quintessence Int 2023;54:180–185; doi: 10.3290/j.qi.b3631849) Keywords: adhesive, enamel craze lines, low viscosity resin, restorative, sensitivity

Objectives: To evaluate the clinical performance of two methacrylate-based flowable composites and an ormocer-based flowable composite in noncarious cervical lesions (NCCLs) in adult participants. Method and materials: In total, 183 restorations were performed on NCCLs. All cavities were restored using a universal adhesive system (Futurabond U, Voco) with selective enamel etching and with one of the three evaluated flowable composites (n = 61): low-viscosity methacrylate-based composite (GrandioSO Flow, LV), high-viscosity methacrylate-based composite (GrandioSO Heavy Flow, HV), and an ormocer-based flowable composite (Admira Fusion Flow, ORM). All restorations were evaluated using FDI and USPHS criteria after 24 months. Kruskall-Wallis analysis of variance rank (α = .05) was used for statistical analysis. Results: After 24 months of clinical evaluation, 16 restorations were lost (LV = 3, HV = 10, ORM = 3) and the retention rates (95% confidence interval) were 95.0% for LV, 82.2% for HV, and 95.0% for ORM, with statistical differences observed between HV and LV as well as HV and ORM (P < .05). When secondary parameters were evaluated, no significant differences between groups were observed (P > .05). Thirty-three restorations (LV = 8, HV = 13, ORM = 12) showed minor marginal staining, 71 restorations (LV = 26, HV = 20, ORM = 25) presented small marginal adaptation defects, and one restoration for HV presented recurrence of caries. Conclusion: The universal adhesive associated with the ormocer-based and methacrylate-based flowable composite showed promising clinical performance after 24 months. However, the heavy-flow restorations showed significantly more failures. (Quintessence Int 2023;54:186–199; doi: 10.3290/j.qi.b3631841) Keywords: clinical performance, dental restoration, noncarious cervical lesions, randomized clinical trial, retention rate

Objectives: Recognizing the construct of the Big Five personality factors with health beliefs could help in better evaluation of distinctive factors that may impact a patient’s behavioral responses with reference to compliance to primary and secondary preventive measures in periodontitis. The aim of the present study was to explore association among the personality traits, oral health beliefs, and periodontal parameters in patients with periodontitis. Method and materials: The present single-centered, cross-sectional study consisted of 118 systemically healthy participants with generalized periodontitis stage II and III with grade B. The neuroticism-extraversion-openness five-factor inventory 3 (NEO-FFI-3) instrument was applied to assess personality traits (neuroticism, extraversion, openness to experience, agreeableness, and conscientiousness). The oral health belief questionnaire was administered to determine five oral health beliefs, namely perceived seriousness (PS), benefit of preventative practices (BPP), benefit of plaque control (BPC), efficacy of clinicians (EC), and perceived importance (I). Results: Spearman correlation analysis revealed that BPP and BPC were inversely correlated with neuroticism. Extraversion was positively correlated with the personality traits openness to experience, agreeableness, and conscientiousness, whereas it was inversely correlated with neuroticism. Binomial logistic regression showed that the predictor “very low” and “low” levels of conscientiousness were positive and significant for clinical attachment loss ≥ 4.89 mm (b = 1.90 and 1.55; standard error = 0.70 and 0.72, P = .007 and .033), with odds ratios of 6.73 (95% CI 1.68 to 26.95) and 4.75 (95% CI 1.13 to 19.83). Conclusion: The intensity of an individual’s perception of the benefits of clinicians achieving dental health is directly correlated with levels of conscientiousness. Trends of higher odds ratios for clinical attachment loss were observed with decreasing levels of conscientiousness. (Quintessence Int 2023;54:200–208; doi: 10.3290/j.qi.b3648947) Keywords: compliance, health behavior, health belief model, periodontal attachment loss, periodontitis, personality inventory

Objective: The aim of this systematic review and meta-analysis was to evaluate the clinical efficacy of the use of systemic antibiotics in regenerative periodontal surgery for treating teeth affected by periodontitis. Data sources: Electronic (MEDLINE, EMBASE, LILACS, Scopus, and Cochrane) and manual literature searches for human randomized controlled trial studies published up to November 2022 were conducted by two reviewers. Meta-analysis was performed to assess probing pocket depth (PPD) reduction and clinical attachment level (CAL) gain in groups receiving systemic antibiotics compared to those not receiving systemic antibiotics. A total of eight studies were included. While treated sites were intrabony defects in six papers, two studies focused on furcation defects. For intrabony defects, the weighted mean difference (WMD) of 0.30 mm (95% CI −0.18 to 0.78) and 0.27 mm (95% CI −0.13 to 0.66) was calculated for PPD reduction and CAL gain, respectively. The differences between antibiotics and non-antibiotics groups for PPD and CAL were not statistically significant. Quantitative analysis could not be performed for furcation defects due to the limited number of studies. However, regardless of the membrane type selection, the existing evidence indicated that antibiotics did not lead to superior clinical outcomes for furcation defects at 9 to 12 months after the regenerative procedures. Conclusion: Based on this meta-analysis study’s findings, the use of adjunct systemic antibiotics in regenerative periodontal surgery did not appear to achieve more favorable clinical outcomes. Thus, the use of adjunct systemic antibiotics as part of the regenerative periodontal therapy might not be justifiable and should be reconsidered. (Quintessence Int 2023;54:210–219; doi: 10.3290/j.qi.b3648957) Keywords: periodontal regeneration, periodontitis, periodontology, surgical procedure, systematic review, systemic antibiotics

Objective: The aim of this case report was to present a minimally invasive and esthetic treatment approach for the replacement of missing teeth removable partial dentures retained by zirconia ceramic resin-bonded attachments. Method and materials: The resin-bonded attachments were digitally designed and milled using CAD/CAM technology from monolithic 3Y-TZP zirconia ceramic. The resin-bonded attachments had an optimized attachment design approved for zirconia ceramic. The preparation was based on general preparation guidelines for resin-bonded attachments and resin-bonded fixed dental prostheses (RBFDPs). After placement of rubber dam, the resin-bonded attachments were bonded with a phosphate monomer-containing luting resin. Results: The presented resin-bonded attachment-retained removable partial denture was successful over 30 months of clinical observation without any complications. The patient was satisfied with the minimally invasive treatment procedure. Conclusion: Zirconia ceramic resin-bonded attachments fabricated with a special attachment design are an esthetic and minimally invasive treatment approach. However, clinical data on the long-term outcome of zirconia resin-bonded attachments are still needed. (Quintessence Int 2023;54:220–226; doi: 10.3290/j.qi.b3819523) Keywords: all-ceramic, precision-retained removable dental prostheses, resin-bonded attachments, zirconia

Tooth autotransplantation is becoming a predictable method to replace a missing tooth, especially in young patients, with many benefits. This case report presents a 14-year-old male with an unrestorable, decayed mandibular first molar with bifurcation and periapical lesions. After the extraction, the socket was debrided and prepared for an immediate autotransplantation of the immature mandibular third molar. Radiologic and clinical follow‑up for 1 year showed periodontal healing with the absence of any complications despite the autotransplantation into an infected site. Thus, third-molar autotransplantation was a good solution to replace an unrestorable first molar with a satisfactory result. Despite the existence of periradicular lesion, the curettage, debridement, and irrigation were enough to perform successful immediate tooth autotransplantation in this case. (Quintessence Int 2023;54:228–233; doi: 10.3290/j.qi.b3631831) Keywords: first mandibular permanent molar, immature mandibular third molar, periradicular lesion, tooth autotransplantation

Objective: Primary Sjögren syndrome (pSS) is a chronic systemic autoimmune disorder that harms exocrine glands located mainly in the oral and ocular regions. pSS patients often complain about pain and mouth dryness. The aim of this retrospective study was to evaluate the influence of parotid glands’ sialendoscopy on salivary flow in pSS patients and to assess the tissue characteristics of the parotid glands during the sialendoscopy procedure. Method and materials: Twenty-six pSS patients (52 glands) treated with sialendoscopy for their parotid glands between the years 2017 and 2019 were included. The unstimulated whole saliva (UWS) flow rate was obtained 2 weeks before intervention (T1) and 3 months post intervention (T2). For 20 patients, UWS was measured 6 months post intervention (T3); and for 11 patients, UWS was measured 12 months post intervention (T4). Patients were asked about their oral quality of life before and after sialendoscopy. Results: UWS was significantly higher at T2, T3, and T4 compared to T1 (P = .002, P = .01, and P = .04 respectively). In total, 22 patients (84.6%) reported substantial improvement of their oral quality of life at T2. Of the 52 glands, 33 (63.5%) exhibited avascularity in the walls of the Stensen duct, 33 (63.5%) had strictures, and in 8 (15.4%) mucus plugs were present. No major complications were observed in this study except for one patient who suffered from duct perforation, which during follow-up was spontaneously healed. Conclusion: This study indicates a positive effect of sialendoscopy on salivary flow rate and oral quality of life in pSS patients. Sialendoscopy should be considered as a vital tool in treating pSS patients. (Quintessence Int 2023;54:234–240; doi: 10.3290/j.qi.b3609681) Keywords: sialendoscopy, sialometry, sicca symptoms, Sjögren syndrome

Objective: Maintaining appropriate salivary levels of an active ingredient is challenging. Intraoral trays can be used to deliver medications for localized treatment. Based on previous successful daytime studies with a slow-release sirolimus varnish, the aim was to optimize intraoral appliances/trays for overnight use to deliver slow-release medications in a manner that maintains therapeutic salivary levels of the active ingredient to treat oral conditions. Method and materials: An acrylic tray appliance containing 0.5 mg of sirolimus in a sustained-release varnish was placed on six anterior teeth for 12 hours, in ten healthy volunteers. Whole unstimulated saliva was collected at 1, 2, 10, and 12 hours after application. Blood was collected at the time of recruitment to confirm eligibility, and 12 hours after device removal to measure sirolimus levels. Drug levels in the blood and saliva were analyzed. Slow- and fast-release formulations, varnish position (buccal, palatal, or lingual), and tray placement (mandibular or maxillary) were qualitatively compared. Participants evaluated the varnish and tray. Results: Moderate concentrations of sirolimus were detected in the saliva when the fast-release formulation was used. The highest levels were from the mandibular tray with lingual varnish application. Sialometry of all participants was within normal range, and the highest drug levels were detected when low flow was measured. No traces of the medication were found in the blood. Conclusions: Salivary concentrations of medications applied to an intraoral appliance are affected by the placement in the maxilla or mandible, varnish formulation, location of varnish, and salivation rate. These results may help optimize medication release following application to various oral devices. (Quintessence Int 2023;54:242–249; doi: 10.3290/j.qi.b3604821) Keywords: acrylic tray, overnight, salivary flow, sirolimus, sustained-release, varnish

Objectives: Necrotic lesions affecting the head and neck region are of significance to dental professionals as they pose challenges in diagnosis and management. Necrotic oral lesions manifest with symptoms like pain, burning, altered sensation, oral malodor, fistula, exposed bone, and pathologic fracture of the bone in extensive cases. The manifestation of necrosis is a definitive clinical sign which helps to narrow down the exhaustive list of causative conditions. This article provides a comprehensive review of the pathogenesis, causative conditions, and management aspects of various necrotic lesions affecting the maxillofacial region. The prompt identification of the cause helps in streamlining the management aspects of necrotic lesions thus reducing the morbidity caused by these conditions. (Quintessence Int 2023;54:250–260; doi: 10.3290/j.qi.b3652393) Keywords: cell cycle, cell death, necroptosis, necrosis, osteonecrosis