Quintessence International, 03/2025

There is a plethora of studies reporting successful long-term retention of periodontally compromised teeth. However, such teeth are more likely to be extracted during active therapy than during supportive periodontal therapy. With the vastly growing dental implant market, the inclination to extract periodontally compromised teeth has become more pronounced. In this narrative review, relevant literature along with suggested guidelines for dental partitioners are presented, as well as four cases, in which teeth with compromised periodontal prognosis were successfully managed, with follow-ups of up to 36 years. Conclusion: Preserving periodontally compromised teeth should be highly considered, especially because they tend to outlast dental practitioners’ expectations as well as the implant alternatives. The decision to replace periodontally compromised teeth with implants should be taken with caution as there is increased evidence that the success rates of implants in treated periodontal disease patients are lower than in patients without the history of periodontitis. Furthermore, there are significantly lower overall costs of treating and maintaining stage III and IV periodontitis–affected teeth with periodontal regeneration than placing and maintaining implants in the long term. Keywords: periodontal disease, periodontal maintenance, plaque control, prognosis, tooth loss

Objectives: To evaluate changes in gingival recessions in periodontitis patients over 10 years of supportive periodontal therapy and to assess the impact of gingival recession on oral health-related quality of life (OHRQoL). Method and materials: Fifty-one patients with over 10 years of supportive periodontal therapy were followed up (V1) with complete periodontal status including periodontal probing depth (PPD) and clinical attachment level (CAL) at six sites/tooth, oral hygiene indices, and recession status. Patient anamnesis, oral hygiene habits, and orthodontic history were assessed. Data were compared with records from 10 to 11.5 years prior (V0). Gingival recession changes were analyzed at patient level, and for all teeth with deep gingival recession ≥ 3 mm at tooth and site level (midbuccal site). OHRQoL was assessed at V1 (OHIP-G14 questionnaire). Possible risk factors for gingival recession progression and the associations between the number of deep gingival recession and OHRQoL were tested (linear mixed-effects models, linear regression). Results: The analysis included 45 patients (stage III/IV periodontitis). Patients retained most teeth (V0, 23.87 ± 4.38; V1, 22.53 ± 4.78), with stable mean overall PPD (V0, 2.34 ± 0.35 mm; V1, 2.39 ± 0.26 mm), and CAL (V0, 3.56 ± 0.94 mm; V1, 3.56 ± 0.89 mm). Teeth with deep gingival recessions showed overall only minimal mean gingival recession progression (0.16 ± 0.97 mm). The mean increase at the midbuccal sites was 0.66 ± 1.58 mm. In total, 25% of teeth had > 1 mm gingival recession progression at the midbuccal site. Molars showed less gingival recession progression than anterior teeth. The number of deep gingival recessions did not significantly impact OHRQoL. Conclusions: Periodontitis patients on regular supportive periodontal therapy showed high periodontal stability with minimal gingival recession progression. The number of deep gingival recessions was not associated with OHRQoL. Keywords: gingival recessions, maintenance, oral-health related quality of life, periodontitis, supportive periodontal therapy

Objective: To evaluate the efficacy of sesame oil pulling in periodontitis with/without type 2 diabetes mellitus (T2DM), compared to chlorhexidine, for its oral and systemic health benefits. Method and materials: A total of 120 periodontitis patients, without (Group A; 60)/with (Group B; 60) T2DM, underwent control (chlorhexidine 0.12%; Group A1 and B1) and test (sesame oil pulling; Group A2 and B2) interventions. Plaque index, pocket depth, salivary total antioxidant capacity (T-AOC) enzyme-linked-immunosorbent-assay (ELISA), subgingival plaque BANA test, and serum C-reactive protein (CRP) were evaluated at baseline and 30 days post-intervention using analysis of variance (ANOVA) with a significant P value set at .05. Group B serum samples were also analyzed for fructosamine and lipid profile. Results: Both treatment regimens were equivalent in reduction of plaque, pocket depth, and red complex periodontopathogens in Group A and B. Significant increase in salivary T-AOC post-intervention was observed in Group B with both interventions (P .01). Sesame oil pulling significantly decreased systemic CRP and triglyceride levels, with no difference observed with chlorhexidine in Group B. Conclusion: Sesame oil pulling is equivalent to chlorhexidine for anti-plaque, antibacterial, and antioxidant effects in periodontitis patients with/without T2DM. Systemic anti-inflammatory, cardio-protective benefits (reduction of CRP and triglycerides) make it a better adjunct to scaling and root planing than chlorhexidine in periodontitis with T2DM. Keywords: antibacterial, antioxidant, diabetes mellitus type 2, periodontitis, sesame oil

Objectives: The goal of this systematic review was to critically appraise the existing evidence evaluating osteoporosis’ effects on dental implant osseointegration and survival rate. Data source: A search was conducted in two databases, PubMed/MEDLINE and Scopus, until October 2024, using the keywords “osteoporosis,” “osteopenia,” “osseointegration,” and “dental implants”. The inclusion criteria were clinical studies that evaluated the implant placement, complications, and osseointegration results in patients with osteoporosis; literature reviews and clinical studies addressing the outcome were considered; and articles written in English and published since 2000. Descriptive data analysis included author, year of publication, study design, number of patients, osteoporosis assessment, follow-up, and main findings. JBI quality assessment was performed. Overall, 24 articles were included with a total of 2,102 patients; 5,954 dental implants were considered and evaluated. Most studies evaluated bone density for osteoporosis by dual-energy x-ray technology. The follow-up ranged from 1 month to 25 years. Four studies evaluated implants with over 10 years of follow-up. All studies’ survival rate was higher than 90%, even for osteoporotic patients. Most studies indicated no differences between osteoporotic and healthy patients regarding marginal bone loss, bone-to-implant contact, cytokine levels, and mineral bone density. A prospective cohort study found a small marginal bone loss (−0.34 mm) in osteoporotic women, but there was insufficient evidence to prove any causal relationship between marginal bone loss and osteoporosis. Another study showed no clinical differences between implants placed in osteoporotic and healthy individuals. In contrast, other studies showed lower stability scores for implants placed in osteoporotic sites and a higher risk of failure for implant placement. Osteoporosis status was not a risk factor for dental implant failure, which was also confirmed by histologic studies. Three studies had a medium risk of bias, and 21 a low risk. Conclusion: Osteoporosis is not a contraindication for dental implant placement. Osseointegration in patients with osteoporosis is feasible; however, planning must be cautious and personalized for the placement of dental implants. Keywords: dental implants, osseointegration, osteoporosis, review, survival rate

Proper alignment of the teeth not only aids in functional occlusion but also promotes harmonious gingival contours, potentially reducing the risk of inflammation and gingival recession. This case series aimed to evaluate the effectiveness of optimizing axial inclination through clear aligner orthodontic treatment in addressing gingival recession defects. This case series included nine patients, aged 20 to 36 years, who presented with varying degrees of gingival recession on 12 mandibular incisors. All patients had undergone orthodontic treatment during childhood and were maintained with a fixed stainless-steel canine-to-canine retainer. The exhibited gingival recessions were potentially caused by inadvertent torque discrepancies in the teeth induced by the retention wire. Prior to treatment, a comprehensive radiographic and periodontal evaluation was performed, and clear aligner orthodontic treatment was used to correct the axial inclination of the affected teeth. Following the completion of the orthodontic treatment, patients were reevaluated to assess changes in recession depth and width; those with remaining recession were considered for soft tissue grafting. The average treatment duration was 21.6 ± 3.7 months, ranging from 18 to 29 months. Root torque adjustments averaged 12 ± 9 degrees, ranging from a correction of 14 degrees lingually to 33 degrees labially, while buccolingual crown movement averaged 1.7 ± 1.2 mm, with a range from 3.4 mm lingually to 0.6 mm labially. All cases showed improvement in gingival recession, with complete recovery in one tooth and an average of 58% ± 21% reduction in recession depth and width for the remaining 11 teeth. Surgical intervention, consisting of soft tissue grafting, was required in four cases, while the remaining eight teeth showed sufficient improvement and were monitored with follow-up care. Correcting axial inclination with clear aligner orthodontic treatment positively impacts both tooth alignment and gingival recession. These findings propose a new approach: initiating orthodontic treatment before periodontal surgery to streamline treatment and reduce the need for invasive procedures. Orthodontists, general dental practitioners, and patients should be aware of the potential complications of fixed retainers and their possible orthodontic adjustments correction. Keywords: attachment loss, periodontitis, root coverage, root malposition, soft-tissue deformities

Objective: This clinical trial aimed to evaluate and compare the effectiveness of diode laser gingivectomy, conventional gingivectomy, and nonsurgical periodontal treatment in the management of gingival enlargement during orthodontic treatment. Method and materials: Forty-five healthy, orthodontic patients with labial gingival enlargement on the six anterior teeth were selected and randomly assigned to one of the groups (conventional, laser, and nonsurgical periodontal treatment). Clinical parameters including clinical crown length, periodontal pocket depth, and Vertical Gingival Overgrowth Index were recorded at baseline, 1 month, 3 months, and 6 months. Postoperative pain was evaluated at 1, 3, and 7 days. Esthetic satisfaction and acceptance of the procedure were recorded on day 10 and repeated after 6 months. Results: Statistically significant results were obtained for mean reduction in periodontal pocket depth for conventional, laser, and nonsurgical periodontal treatment groups (−1.43, −1.75, and −0.9 mm, respectively; P .001), clinical crown length gain (1.45, 1.70, and 0.35 mm, respectively; P .001) and mean Vertical Gingival Overgrowth Index score (−1.14, −1.29, and −0.76, respectively; P .001) over 6 months. Both test groups showed greater statistically significant changes in clinical parameters over 6 months compared to nonsurgical periodontal treatment (P .001). There was a gradual decrease in postoperative pain for all three groups over 7 days, with the conventional group showing a statistically significant difference in mean pain score on days 1 and 3 compared to other groups. Conclusion: Both conventional and laser gingivectomies were more effective in controlling enlargement over nonsurgical periodontal treatment alone at 1, 3, and 6 months. Clinical significance: Laser and conventional gingivectomies as adjunctive treatments achieved superior results when compared to nonsurgical periodontal treatment alone in the treatment of gingival enlargement and gingival inflammation during orthodontic treatment, with no significant clinical differences between the two treatments. Keywords: gingival enlargement, gingivectomy, laser, orthodontic treatment, scalpel

Objective: This study aimed to evaluate the prevalence of different temporomandibular disorder (TMD) diagnoses according to the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) and to compare the diagnoses according to both guidelines. Method and materials: Clinical examinations of 218 patients with TMD complaints were conducted according to both guidelines. Descriptive statistics were performed to analyze the frequency of diagnoses and differences between the guidelines. Results: Most patients diagnosed with TMD were women and middle-aged. The number of patients in the myofascial pain class was significantly lower for the RDC/TMD classification than for the DC/TMD classification (P = .045). The number of patients in the disc displacement with reduction category was significantly higher for the RDC/TMD classification than for the DC/TMD classification (P .001). Other categories did not exhibit differences between the classifications. Conclusion: Women and middle-aged individuals are more affected by TMDs. Pain-related TMDs were the most common diagnosis, followed by disc displacement with reduction according to DC/TMD. According to the RDC/TMD classification, myofascial pain, arthralgia, and disc displacement with reduction were the most commonly observed diagnoses, respectively. Significant differences were observed between the pain-related TMD and disc displacement with reduction groups. Keywords: Axis I, DC/TMD, RDC/TMD, temporomandibular disorders, temporomandibular joint

Diffuse idiopathic skeletal hyperostosis (DISH) is a somewhat uncommon osteopathic disorder associated with interconnected ossifications along the anterior vertebrae and may be accompanied by systemic comorbidities. To date, there is limited information concerning DISH in the dental literature. The objective of this report was to provide an overview of DISH for the general dental practitioner, illustrated with a case report involving an asymptomatic patient. An 87-year-old man underwent a preprosthodontic assessment, including a CBCT scan. Incidental CBCT findings included bridging ossification involving the anterior aspects of C3 and C4, resulting in mild airway displacement and mild reduction in airway volume, left calcified carotid atheroma, and bilateral intracranial carotid artery calcifications. At a 5-month follow-up telephone call, the patient admitted that he had remained asymptomatic and has not experienced dyspnea, dysphagia, throat pain, or episodic choking. Dental health care clinicians should remain vigilant for the radiologic evidence of DISH, especially involving older patients. Patients with suspected cases of DISH warrant timely referral for a comprehensive medical evaluation. Keywords: case report, cone-beam computed tomography scan, diffuse idiopathic skeletal hyperostosis, etiology, geriatric