Quintessence International, 04/2025

Objective: The relationship between periodontitis and rheumatoid arthritis has attracted considerable interest. However, the effect of nonsurgical periodontal treatment (NSPT) on rheumatoid arthritis remains uncertain. This umbrella review aims to consolidate current research to establish a stronger evidence base. Method and materials: Medline, Embase, and the Cochrane library were searched from inception to August 2024. Two independent reviewers handled study selection, data extraction, and quality assessment (AMSTAR 2). The qualitative analysis covered clinical activity, joint symptoms, inflammatory markers, cytokines, and autoantibodies. Quantitative results for disease activity score 28 (DAS28), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) were reported as mean differences with 95% confidence intervals (CIs). Results: A total of 2,982 records were screened, with 41 full-text articles assessed for eligibility, and 9 selected for evidence synthesis. Qualitative analysis suggests that NSPT may reduce clinical activity in patients with periodontitis and rheumatoid arthritis. Quantitative analysis provided suggestive evidence on the effects of NSPT on DAS28, with the mean difference ranging from −0.38 (95% CI −0.46 to −0.31) to −1.18 (95% CI −1.43 to −0.93). One-third of the included studies were rated as “high” quality, while another one-third were “critically low.” Conclusions: The present evidence suggests that NSPT may provide benefits in managing rheumatoid arthritis symptoms in patients with periodontitis; however, the potential bias of current evidence calls for further rigorous studies. Clinicians should account for the complex interplay between periodontitis and rheumatoid arthritis when devising treatment strategies. Keywords: nonsurgical periodontal treatment, periodontitis, rheumatoid arthritis, umbrella review

Objective: To evaluate the long-term dimensional stability of dental ridges 2 years after soft tissue augmentation using a porcine-derived volume-stable collagen matrix (VCMX) at healing abutment connections. Method and materials: A retrospective study was conducted at a private clinic from 2021 to 2023, involving 13 patients who underwent delayed single implant placement in both maxillae and mandible. Three months after implant placement, the buccal soft tissue adjacent to the abutment was augmented with VCMX. Intraoral scans were taken at three points: at implant placement (baseline), 1-month post-grafting, and 24 months after implant loading. Pre-implant CBCT scans were also obtained. Volumetric and profilometric changes were measured at 1, 2, and 3 mm below the mucosal margin by superimposing intraoral and CBCT scans. The Wilcoxon signed-rank test was used for statistical analysis. Results: All 13 patients completed the 2-year follow-up. Mean volumetric changes at the graft site were + 18.15 ± 15.34 mm3 initially, decreasing by 11.73 ± 21.91 mm3 over 2 years. Profilometric analysis showed increases of 0.72 ± 0.88 mm, 0.54 ± 0.65 mm, and 0.32 ± 0.65 mm at 1, 2, and 3 mm, respectively, 1-month post-grafting. At 24 months, reductions of −0.17 ± 0.77 mm, −0.45 ± 0.58 mm, and −0.48 ± 0.60 mm were recorded. Conclusions: VCMX use for soft tissue augmentation shows minimal remodeling after 24 months, supporting its efficacy for soft tissue stability in dental implantology. Further long-term studies are recommended. (Quintessence Int 2025;56:274–283; doi: 10.3290/j.qi.b6094895) Keywords: dimensional stability, soft tissue augmentation, volume-stable collagen matrix, volumetric analysis

Objectives: The aim of this study was to assess the antibacterial efficacy of nanostructured dental implant surfaces against Porphyromonas gingivalis, a crucial bacterium in the progression of peri-implantitis. An additional aim was to evaluate the possible effect of the modified implant surface on the viability of human gingival fibroblasts (HGnFs). Method and materials: As detailed in prior research, sputtering by helium ions was used to produce nanospiked titanium surfaces with a height of 1,000 nm (Ti1000). Smooth machined (Ti machined) and sand-blasted, large-grit, acid-etched titanium disks (TiSLA) served as controls. The antibacterial characteristics of the samples against P gingivalis were evaluated by conventional culturing and SEM. The vitality of HGnFs was assessed using the MTT assay. Results: Generally, nanostructured Ti1000 surfaces exhibited lower bacterial counts than the two controls (Ti1000 vs TiSLA −36% and Ti1000 vs Ti machined −37%) without being statistically significant. Moreover, the nanosurface did not affect the vitality of HGnFs. Conclusion: The nanospikes of the modified titanium implant surface did not hinder gingival fibroblasts’ vitality or proliferation characteristics. Optimizing the spacing and height parameters of the nanospikes could further improve the antibacterial effects of this unique remodification approach. Keywords: abutment design, adhesion, dental implants, implants, microbiology, peri-implantitis

Objectives: This single-arm prospective interventional study evaluated the effectiveness of silver-fluoride combined with potassium-iodide (AgF+KI; Riva Star Aqua, SDI) in decreasing hypersensitivity after its application on permanent molars affected by molar incisor hypomineralization (MIH Treatment Need Index [TNI] 3 and 4) immediately (15 minutes) and after 3 months. Method and materials: In total, 22 children with 53 hypersensitive MIH-affected permanent molars (MIH TNI 3 or 4) underwent AgF+KI application after isolation with cotton rolls. Teeth included had no prior in-office desensitizing agents or sealants within 1 month before recruitment. Hypersensitivity was assessed using a 1-second air blast stimulus at three intervals: baseline, 15 minutes, and 3 months posttreatment (blinded). The response to the air-stimulus was quantified using the Schiff Cold Air Sensitivity Scale (SCASS), and teeth with grades 2 and 3 only were included. Statistical analysis involved the Wilcoxon signed-rank test, Mann–Whitney U test, and Friedman test. Results: The reported mean SCASS scores declined significantly from 2.5 (± 0.5) at baseline to 1.2 (± 0.9) after 15 minutes and 1.0 (± 1.0) after 3 months (n = 20 patients, n = 49 molars). Molars with SCASS 2 had a statistically significantly lower mean hypersensitivity score (from n = 26 to n = 24) compared to SCASS 3 teeth (from n = 27 to n = 19) at the subsequent posttreatment evaluation. However, the percentage reduction from baseline was not significant. Additionally, the reduction in hypersensitivity after AgF+KI application was almost identical for treated (desensitizing agent >1 month prior enrolment) and untreated molars. Conclusion: AgF+KI is an effective and simple desensitizer providing instant and mid-term relief in schoolchildren with hypersensitive MIH-molars. Keywords: clinical trial, desensitization, hypersensitivity, molar incisor hypomineralization, potassium iodide, silver fluoride

Objective: Wire syndrome or X-effect/twist-effect describes undesired long-term tooth movements following fixed retainer placement. Since it includes root torque changes that might cause gingival recession, those situations often require periodontal, orthodontic, and conservative treatment. The aim of this study was to assess the effectiveness of fixed orthodontic treatment with completely customized lingual appliances (CCLAs) and continuous archwires for a clinically significant reduction in the dimensions of labial gingival recessions in the anterior mandible, caused by wire syndrome, in a group of consecutive patients treated with the same approach. Moreover, the reduction in root prominence of the affected teeth relative to the two neighboring teeth was evaluated. Method and materials: This retrospective cohort study from three centers included 20 consecutively recruited patients with labial gingival recession at mandibular incisors and canines due to wire syndrome. A total of 25 teeth were assessed. CCLA treatment with a standardized archwire sequence (0.012″/0.014″ NiTi, 0.016″ × 0.022″ NiTi, 0.018″ × 0.018″ beta-titanium with optional extra-torque) was identical in all three centers. Primary endpoints of recession depth, recession width, and recession surface were assessed on digital models at debonding (T1) and compared to baseline (T0) both as absolute differences (T0 − T1), and as ratios ([T0 − T1]/T0) by one-sample t tests with P .05. As a secondary endpoint, the reduction of root prominence relative to the gingival surface of the alveolar yoke of the two neighboring teeth was measured in millimeters. Results: Treatment resulted in a significant reduction in all dimensions of gingival recession. The mean reduction in recession depth was 1.86 mm (44.9%) and in recession width 0.70 mm (35.6%). The mean recession surface was reduced from 10.77 mm2 to 3.93 mm2, indicating a mean recession surface reduction of 61.4%. All changes were statistically significant (P .001). The range of recession surface reduction was from 25.4% to 100%, and 18 out of the 25 recessions showed a reduction of more than 50%. The maximum reduction in root prominence amounted to more than 3 mm. Conclusion: The use of CCLAs to torque roots of the anterior mandibular teeth, exposed by wire syndrome, towards the middle of the alveolar process reduces the area of subsequent labial gingival recession and reduces the root prominence of the affected teeth substantially. This is considered a critical step in optimizing the predictability of surgical recession coverage. Keywords: alveolar yoke, completely customized lingual appliances, gingival recessions, recession depth, recession width, retainer twist-effect, retainer X-effect, root coverage, root prominence, torque, wire syndrome

Objective: This study aimed to evaluate the clinical efficacy of an innovative preparation, honey in orabase (50% in 1:1), for treating atrophic/erosive oral lichen planus compared with triamcinolone acetonide 0.1% ointment. Method and materials: The study involved a total of 60 patients who were randomly divided into three groups: Group I (honey in orabase 50%, 1:1 paste), Group II (triamcinolone acetonide 0.1% ointment), and the control group, Group III (orabase paste). The primary outcome measure was pain, measured on a visual analog scale, and the secondary outcome was the evaluation of the clinical manifestation through an oral lichen planus reduction score assessment. Results: Compared to Group III, Groups I and II experienced significant reductions in their pain visual analog scale scores and oral lichen planus scores. Participants in Groups I and II reported minimal to no discomfort, with Group I demonstrating the most substantial pain relief. Conclusion: In comparison to triamcinolone acetonide 0.1% ointment and the control group, the study showed that honey in orabase 50% paste is effective in the reduction of pain and lesion size in patients with atrophic/erosive oral lichen planus. Therefore, as an alternative to utilizing the traditional triamcinolone acetonide 0.1% ointment to treat atrophic/erosive oral lichen planus, honey in orabase 50% paste may be an effective treatment option. Keywords: honey, orabase, oral lichens planus, triamcinolone acetonide

Objective: To evaluate the effectiveness of mandibular exercises in patients with temporomandibular disorders (TMD) diagnosed by Research Diagnostic Criteria for TMD (RDC/TMD). Method and materials: Thirty-two patients seeking clinical treatment for TMD were randomly assigned to groups based on the treatment modality: conservative therapy, including occlusal splint therapy and counseling; and mandibular exercises. Muscle and joint pain were assessed using a four-point scale (0 = no pain, 1 = mild pain, 2 = moderate pain, and 3 = severe pain). The maximum unassisted mouth opening (MUMO) was measured in millimeters, both with pain and pain-free. Outcomes were evaluated at baseline (T0) and after a 3-month intervention period (T1). Results: Both treatments significantly reduced muscle and joint pain intensity at most assessed sites. The reduction in pain with mandibular exercises compared to conservative therapy was statistically significant at the right lateral pole of the temporomandibular joint (P = .048; rank-biserial correlation coefficient [rrb] = 0.348). After 3 months, mandibular exercises resulted in greater pain-free MUMO (T0 vs T1; P = .004; rrb = 0.594), and the increase in MUMO was greater than that observed with conservative therapy (P .001; rrb = 0.742). Conclusion: Mandibular exercises and conservative therapy similarly reduced palpatory pain, with mandibular exercises showing greater clinical impact at the right lateral pole. Both treatments led to significant improvements in the masseter and temperomandibular joint pole. Mandibular exercises also provided superior, clinically meaningful gains in pain-free MUMO, positioning it as a preferred option when enhancing jaw mobility is a primary goal in TMD management. Keywords: counseling, mandibular exercises, occlusal splints, temporomandibular joint disorders