Quintessence International, 05/2023

Objectives: The aim of this report was to present the effectiveness of a novel augmented corticotomy performed before orthodontic treatments in the prevention of buccal alveolar dehiscence and gingival recession. Method and materials: Four periodontally healthy individuals presenting crowding and thin bone morphotype in the mandibular anterior area were treated with a double-layer tunnel flap, piezotomy, and hard and soft-tissue augmentation. Patients were divided into two groups according to the utilized graft material. The exclusive use of demineralized bovine bone minerals (group 2) was compared to the use of autologous concentrated growth factor-enriched bone graft matrix, “sticky bone” (group 1). CBCT measurements were performed before and 6 months after surgery. Orthodontic treatment was initialized 1 week after surgery. Results: Postoperative wound healing was uneventful, and tooth alignments were successful in all cases. Postoperative buccal hard tissue dimensions were favorable in both groups, with no occurring bone dehiscence or gingival recession. The seemingly better results of group 2, in terms of quantitative hard tissue changes, did not have any clinical significance according to the objective to be achieved. In contrast, qualitative radiographic analysis showed a more homogenous tissue formation around teeth in group 1. Conclusion: It can be concluded that the presented preorthodontic treatment approach seems to be successful in preventing alveolar dehiscence and gingival recession around buccally inclined mandibular anterior teeth. Keywords: alveolar bone regeneration, alveolar dehiscence, growth factors, minimally invasive flap, periodontally accelerated osteogenic orthodontics, sticky bone

Objectives: Gingivitis refers to inflammation of the gingiva and its connective tissues. Research has revealed a higher prevalence of gingivitis in individuals with intellectual disability than in healthy individuals. Milk fermented with Lacticaseibacillus rhamnosus L8020 (L8020 yogurt) inhibits the accumulation of periodontal disease-related pathogens in vitro and alleviates the symptoms of periodontal disease. The aim of this study was to investigate the influence of L8020 yogurt on oral microbiota and the abundance of four periodontal pathogens (Tannerella forsythia, Porphyromonas gingivalis, Prevotella intermedia, and Treponema denticola) and on the microbiota in individuals with intellectual disability and gingivitis. Method and materials: Forty-one outpatients with intellectual disability participated in this study. To examine the effects of daily consumption of L8020 yogurt, the patients were randomly divided into L8020 (test group, n = 21) and placebo (n = 20) yogurt groups. All patients consumed 80 g of yogurt for 12 weeks. Oral examination was performed before the first intake of yogurt and dental plaque was collected before and after the intake of yogurt. DNA was extracted from dental plaque and subjected to next-generation sequencing. Results: The relative abundance of T forsythia was significantly lower in the test group than in the placebo group. Additionally, the relative abundance of the four pathogens reduced after 84 days of consuming L8020 yogurt compared with that after consuming placebo yogurt. Conclusion: Mixing L rhamnosus L8020 with probiotic products that are consumed daily would be effective in suppressing the increase in periodontal disease-causing bacteria and beneficial for individuals with intellectual disability. Keywords: gingivitis, intellectual disability, oral microbiota, periodontitis, probiotics, yogurt

Objectives: To assess the association between the baseline radiographic defect angle and the long-term clinical outcomes following periodontal regenerative therapy with enamel matrix derivative (EMD). Method and materials: Baseline periapical radiographs obtained from a cohort of patients treated with periodontal regenerative therapy were digitized and the radiographic angle width between the root surface and the bony wall of the adjacent intraosseous defect was calculated and reported (in degrees). Changes in pocket probing depth (PD) and clinical attachment level (CAL) were assessed and reported (in mm). Clinical outcomes were evaluated at baseline (T0), 6 months following therapy (T1), and at the latest follow-up (T2). Results: Thirty-eight defects in 26 patients enrolled in supportive periodontal care for a mean period of 10.4 years (range 8.0 to 15.5 years) were available for analysis. The mean PD change between T0 and T2 was 2.33 ± 1.66 mm at teeth with a defect angle width < 20 degrees and 0.86 ± 1.66 mm at teeth with a defect angle width > 30 degrees (P = .021). When the baseline radiographic angle width was < 20 degrees the probability of obtaining a CAL gain > 3 mm was 1.5-times higher (95% CI 0.19 to 13.8) at T1 and 2.5-times higher (95% CI 0.40 to 15.6) at T2 compared with defects with a radiographic angle width > 30 degrees. Conclusion: Within their limitations, these results indicate that pretherapeutic measurement of the radiographic defect angle width might provide relevant information on the short-/long-term clinical outcomes following regenerative periodontal therapy with EMD. Keywords: enamel matrix derivative, intrabony defects, long-term results, periodontal regeneration, radiographic evaluation

A peg-shaped maxillary lateral incisor is an underdeveloped, small, malformed permanent tooth that erupts following the loss of a primary tooth. The maxillary lateral irregularly shaped incisor may be unilateral, on both sides of the central incisors, or accompanied by a missing lateral tooth on the contralateral side of the arch. Peg-shaped maxillary lateral incisors receive a great deal of attention, play a significant role in the displayed smile, and present a treatment challenge during all stages of a patient’s life. Clinicians are called to plan the treatment and the timing from as early as the beginning of growth and development. Careful diagnosis may dictate postponing a treatment to later stages of life, especially if the tooth is malpositioned in the arch. The goal of this clinical report was to present a combined treatment for a case with a palatal malpositioned peg-shaped maxillary lateral incisor and a missing contralateral permanent maxillary lateral incisor, creating an esthetic challenge. Moving the malpositioned peg-shaped lateral tooth to the arch simplified and eased the final prosthetic treatment procedure, increasing the treatment predictability. The presented sequence of therapy further stresses the importance of incorporating minor tooth movement, without referring to a specialist, in the daily practice of a prosthodontic-oriented general clinic, by simple accessible means. Keywords: anterior esthetics, congenitally missing teeth, peg-shaped lateral maxillary teeth, sectional orthodontic appliance

Ectopic eruption of the permanent first molar can lead to malocclusion if left untreated. Despite several reported etiologic factors and treatment options, ectopic eruption caused by an improper restoration on an adjacent tooth and a simple solution have never been documented. Case report: An 8-year-old boy presented with an entrapped ectopic permanent mandibular first molar under the poorly adapted margin of a preformed metal crown (PMC) on the adjacent primary second molar. Replacement with a PMC that had well-contoured margins followed by inserting a separating module between the proximal contact of the two teeth resulted in successful management of this situation in 1 month. Conclusion: This simple approach with good interdisciplinary communication is practical for correcting eruption problems due to a poorly adapted PMC, with long-term satisfactory results. To avoid subsequent malocclusion and unnecessary treatments, dental practitioners must be vigilant when manipulating PMCs and assessing the marginal adaptation prior to their cementation. Keywords: ectopic eruption, first molar, interceptive orthodontics, preformed metal crown, separating module

Objective: The aim of this study was to evaluate the patient’s morbidity and postsurgical complications after treatment of palatal donor sites after free gingival graft harvesting using leucocyte- and platelet-rich fibrin (L-PRF) membranes or a hemostatic agent with oxidized and regenerated cellulose. Method and materials: Forty-two palatal donor sites after free gingival graft harvesting in 42 patients were randomly assigned to experimental (L-PRF membrane) or control procedure (hemostatic agent). The primary outcome was postoperative pain related to the wound located at the palatal area, and the secondary outcomes were postoperative discomfort, inability to chew, postoperative stress, surgical chair time, thickness of the palatal fibromucosa, and thickness of the free gingival graft. The patient-reported outcome measures were recorded after 1 week. Results: After 1 week, a statistically significant difference was found between groups in terms of postoperative stress (P = .008). No statistically significant differences in terms of postoperative pain (P = .326), patient discomfort (P = .509), inability to chew (P = .936), or surgical chair time (P = .932) were recorded between the test and the control group. No statistically significant differences were recorded in terms of thickness of the palatal fibromucosa (P = .647) and thickness of the free gingival graft (P = .756) between groups. Postsurgical wound healing complications (ie, necrosis or infections) were not observed in both groups. Conclusion: Within their limitations, the present outcomes indicated that the application of L-PRF membrane at palatal donor sites after FGG harvesting did not produce significant advantages for the patients. Keywords: analog pain scale, free gingival graft, morbidity, platelet-rich plasma, wound healing

Peripheral facial nerve palsy (PFP) is a rare occurrence after dental extraction. Early onset PFP after the procedure can be caused by trauma and/or local anesthesia, whereas delayed onset PFP has more speculative etiologies. The latter has a certain affiliation to Bell’s palsy and is therefore primarily treated with corticosteroids, and long-term follow-up is often warranted. This article reports a unique case of a 30-year-old woman developing a delayed onset right-sided PFP after local intraoral anesthetic injection for molar extraction. Facial nerve injury was identified with signs of denervation and neuritis and the patient was treated with nonsteroidal anti-inflammatory drug, corticosteroids, vitamin B supplements, and mime therapy. After 9 months, the patient showed an improvement of the facial muscle activity and went from a grade IV to a grade III on the House–Brackmann grading scale. Keywords: cranial nerves, facial paralysis, local anesthesia, tooth extraction

Objective: The objective was to evaluate oral health-related knowledge, and to compare the effectiveness of three different oral health education interventions (OHEI) on plaque removal in a cohort with Parkinson disease. Method and materials: The three-arm, parallel-group, randomized controlled trial included 63 Parkinson disease stage 1 and 2 patients aged ≥ 40 years and scores ≥ 26 in both Montreal Cognitive Assessment test and Mini-Mental State Exam. These patients were allocated to three OHEI groups: lectures, presentation, and demonstration. The validated questionnaire assessed knowledge level at baseline (0), 1, 2, and 3 months. Oral hygiene at 0 and 3 months was assessed by the Plaque Index and the Patient Hygiene Performance Index (PHPI). Unstimulated whole saliva was collected to assess the salivary flow rate. Results: Pairwise comparison using ANOVA showed a significant decrease in mean percentage knowledge 0, 1, 2, and 3 months in all three groups (P < .001). After Tukey post-hoc analysis the presentation group had significantly higher knowledge (P = .030). ANOVA showed that the percentage of knowledge decreased as time passed (P = .001). Comparison of means of Plaque Index and PHPI scores by MANOVA followed by Tukey post-hoc analysis showed significant decrease in Plaque Index scores from 0 to 3 months (P = .001). No significant change in the salivary flow rate was noted. Conclusion: Pictorial representation of OHEI is a better mode of intervention compared to lectures and demonstrations in Parkinson disease stage 1 and 2 patients. Despite the decline in knowledge with time, Plaque Index scores reduced significantly, implying that this form OHEI offers positive benefits. Keywords: cohort, intervention, knowledge, oral hygiene, Parkinson disease, salivary rate