Quintessence International, 01/2021

Objectives: The aim of this study was to carry out a morphometric analysis of small oval root canals filled with GuttaFlow 2 sealer (Coltène/Whaledent) using different methods of sealer placement and different root canal filling techniques. Method and materials: Eighty extracted mandibular incisors with small oval root canals were instrumented with the Self-Adjusting File (Redent Nova). GuttaFlow 2 was placed using a lentulo spiral, paper point, master point, or sonically activated CanalBrush (Coltène/Whaledent), followed by the placement of a master point and accessory points (M?P+) (part 1). GuttaFlow 2 was placed using a lentulo spiral without a gutta-percha point, together with a single point, with a chloroform-dipped master point, or the latter with accessory points (ChMP+) (part 2). Serial cuts were made at 1-mm intervals up to 10 mm. The percentages of gutta-percha filled area (PGFA), sealer, voids, and debris were evaluated using interactive image analysis software. Results: For part 1 of the study (sealer placement), significant differences regarding PGFA at 2 and 5 mm from the apex were found, whereas for part 2 (filling technique), significant differences were found at all levels besides 2 and 4 mm (Kruskal-Wallis test, P = .05). ChMP+ reached 85% PGFA at 3 mm from the apex, but only 30% near the apex. The MP+ groups showed a relatively equal distribution of PGFA by 60% to 80% at different levels. GuttaFlow 2 without a gutta-percha point exhibited significantly more voids and debris than the other groups (Kruskal-Wallis test, P = .05). Conclusion: Within the limits of this study, MP+ could be recommended for clinical use. The presence of voids and debris for the group without a gutta-percha point needs further investigation. Keywords: CanalBrush, chloroform-softened master point, GuttaFlow, oval root canal, percentage of gutta-percha filled area, Self-Adjusting File

Objective: Considering the etiopathogenesis of periodontitis, it is relevant to evaluate the efficacy of the adjunctive use of systemic antimicrobials based on microbial occurrence. This report explores whether patients harboring Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), or Tannerella forsythia (Tf) at baseline could receive greater clinical benefits from adjunctive moxifloxacin (MXF) and amoxicillin plus metronidazole (AM+MT) in comparison to patients without the presence of these microorganisms before therapy for generalized periodontitis. A control group was established that received subgingival debridement (SD) alone. Method and materials: Thirty-six patients younger than 30 years of age were randomly allocated to one of three treatment groups: SD plus placebo, systemic MXF with SD, or AM+MT combined with SD. Subgingival samples were studied. The effects of the therapies on probing depth and clinical attachment level, including interactions with Aa, Pg, or Tf at baseline, were explored using regression models. Results: At 6 months, all treatment groups showed improved clinical outcomes in patients harboring Aa, Pg, or Tf at baseline compared to the patients who did not harbor these microorganisms at baseline. Indeed, in the presence of Aa, Pg, or Tf at baseline, the patients receiving antimicrobial protocols showed the most significant gains compared to the control group. Furthermore, the percentage of sites ≥ 6 mm was reduced in the test groups, compared to the control group; these periodontopathogens were not present in sites with probing depth ≥ 6 mm in the MXF group. The interactions of Aa, Pg, and Tf with the test groups significantly improved clinical parameters at 6 months (P < .001). Interestingly, the R2 value in the models that explored clinical attachment gain produced a high degree of correlation (> 0.75), indicating that a high percentage (> 75%) of the total variation in clinical attachment level gain can be explained by the independent variables. Conclusions: Although all patients benefited from the treatments, patients harboring Aa, Pg, or Tf at baseline showed improved clinical benefits at 6 months, suggesting that Aa, Pg, or Tf at baseline may change the effects of systemic MXF and AM+MT in generalized periodontitis. After 6 months, Aa, Pg, and Tf were not present in sites with probing depth ≥ 6 mm in the MXF group. Keywords: Aggregatibacter actinomycetemcomitans, amoxicillin, moxifloxacin, periodontitis, Porphyromonas gingivalis, Tannerella forsythia

Objective: To evaluate the long-term clinical results after treatment of multiple adjacent recession type (RT) I and II gingival recessions treated with the modified coronally advanced tunnel (MCAT) in conjunction with a porcine acellular dermal matrix (PADM). Method and materials: Nine periodontally healthy nonsmoking patients (seven women, 37.5 ± 7.36 years old) with a total of 41 adjacent RT I (n = 23) and RT II (n = 18) gingival recessions exhibiting a minimum depth of 2 mm were treated by means of MCAT+PADM. Recession depth and width, width of attached and keratinized tissue, probing depths, and clinical attachment level were measured at baseline and at 1 and 4 years postsurgically. The primary outcome variable was complete root coverage (ie 100% root coverage), while secondary outcomes were mean root coverage and increase in keratinized tissue and attached gingiva widths. Results: At 1 and 4 years, statistically highly significant (P < .001) root coverage was obtained in all nine patients compared to baseline. Mean root coverage decreased in these nine patients from 72.05 ± 30.18% at 1 year to 56.79 ± 27.53% at 4 years. Complete root coverage was obtained in 18 gingival recessions at 1 year (baseline RT: 12 RT I, 6 RT II) and in seven gingival recessions (5 RT I, 2 RT II) at 4 years. Most root coverage occurred in the first year postsurgically, showing a statistically significant decrease between the first and fourth year (P = .003). Mean width of attached gingiva increased statistically significantly (P < .05) from 2.85 ± 1.08 mm to 3.14 ± 1.08 mm at 1 year with a statistically significant decrease at 4 years. At 1 year, 78.05% of gingival recessions showed a root coverage > 50%, and 68.29% still exhibited a root coverage > 50% at 4 years. Conclusion: The use of MCAT+PADM represents a valuable treatment option for multiple adjacent maxillary and mandibular RT I and II gingival recessions on a long-term basis. Keywords: clinical study, coronally advanced tunnel, gingival recession, porcine acellular dermal matrix, root coverage

Objectives: Patients with xerostomia manifest various clinical signs of oral dryness, which has an impact on oral functions and wearing of dental prosthese?s, but the evidence of xerostomia-related changes in denture performance is unsatisfactorily documented. The purpose of this systematic review was to evaluate whether the available literature can answer the focused question “Is there an association between xerostomia and decreased denture performance among patients wearing removable dentures?” Data sources: Indexed databases were explored without time or language restrictions up to and including March 2019. All levels of available evidence including experimental studies, case reports, and case series were searched using different combinations of the following keywords: saliva, xerostomia, dentures, personal satisfaction, quality of life, oral dryness, and oral complaints. Nine studies were included for qualitative synthesis. Overall, five studies had a cross-sectional design and four studies were case-control studies. In these studies, the number of participants ranged between 35 patients and 493 patients with mean ages ?from 56 to 82 years; 66% of the patients were completely and 34% were partially edentulous. Conclusion: All studies included patient satisfaction with dentures and recorded the presence of oral dryness. Six out of nine studies demonstrated that xerostomia is significantly associated with the decreased performance of removable dentures. Although the available evidence lacks feedback from randomized, controlled clinical studies, it implies a negative impact of oral dryness on specific denture functions such as speaking, chewing, and retention, which affects both complete and partial denture wearers. Keywords: performance, removable dentures, saliva, satisfaction, xerostomia

Augmentation of alveolar ridge defects is a technique-sensitive procedure in dental implantology. Depending on the size of the defect, it may be necessary to use autogenous bone blocks. However, patients may be against these blocks as these procedures are surgically invasive. Case report: This report describes the restoration of a partially edentulous mandible, which suffered a major bone defect from the right canine to the third molar site after multiple implant losses. The use of a CAD/CAM allogeneic cancellous bone block from a living donor bone was planned for the reconstruction of the alveolar ridge at the defected site. A CBCT scan was taken and the virtual planning of the bone augmentation and placement of four implants was performed. The milled bone block was fixed for augmentation and the implants were placed using a CBCT-generated surgical guide. After osseointegration, a CAD/CAM-fabricated screw-retained metal-ceramic implant fixed partial denture with angulated screw channels was delivered. Results: The use of CAD/CAM-milled, allogeneic bone block resulted in a time-efficient and simplified reconstruction of the defect because no donor site was used, and the fit of the block on the native bone was uneventful and fast. At the 1-year follow-up, an average peri-implant vertical soft tissue decrease of 1 mm on buccal and 0.3 mm on lingual sites was observed and the peri-implant tissues were healthy. Conclusions: The long-term success of this CAD/CAM cancellous bone block needs to be evaluated in well-designed clinical studies. Keywords: allogeneic bone substitutes, alveolar bone loss, block graft, dental implants, guided implant surgery, prosthodontics

Implant dentistry is considered to be a safe and routine surgical procedure. However, cases of life-threatening hematoma of the floor of the mouth resulting in airway obstruction were previously reported as a complication of implant placement in the anterior mandible. Massive bleeding in this anatomical site may be caused by perforating the lingual cortex and/or damaging the lingual perimandibular vessels. In the long term, dental implants can fail, mainly due to peri-implantitis, and must be removed. Explantation procedure may occasionally become a complex challenge, with a risk for various complications. Case report: This report presents the first case of life-threatening hematoma of the floor of the mouth, as a complication secondary to a failed attempt of dental implant removal at the anterior mandible. The proximity of the implant to the lingual vascular canal might have served as a cause for vascular damage during explantation. Conclusions: Implant removal complications are scarcely described in the literature. Nonetheless, damaging blood vessels during explantation should not be underestimated. Computed tomography (CT) may be of value not only in preoperative implant planning but also before implant removal in jeopardized anatomical zones such as the anterior mandible. Lingual vascular canals should be looked for on computed tomography scans. Keywords: airway, anterior mandible, bleeding, explantation, hematoma, implant removal

Objective: An esthetic facial soft tissue profile is an important objective of contemporary orthodontics. The extent to which clinicians and the public agree on profiles that are esthetically acceptable versus profiles recommended for treatment is unclear. Thus, this work examined the profile considered esthetic by laypeople and general dental practitioners compared to orthodontists. Method and materials: An Israeli balanced male–female group comprising 284 participants (orthodontists [n = 86], general dental practitioners [n = 64], laypeople [n = 134]) rated the attractiveness of five standardized masculine and feminine profiles presented in standardized silhouettes ranging from concave to convex. Results: Laypeople see no esthetic difference between masculine and feminine profiles, and prefer moderately concave over moderately convex and severely concave over severely convex profiles. While all raters preferred the straight silhouettes, orthodontists rated them significantly higher than general dental practitioners (P < .0001) or laypeople (P < .020). Similar to the general population, orthodontists gave higher ratings to concave profiles for masculine profiles, but significantly lower ratings for feminine profiles. The severely convex male profile was the least attractive to clinicians and laypeople. There was a significant difference in the attractiveness of the female profile between practitioners (P < .001 and P < .02 for general dental practitioners and orthodontists, respectively) and laypeople. Conclusions: The findings suggest that orthodontic training and clinical adherence to strict beauty norms results in more critical judgment of female attractiveness, which may affect orthodontic treatment. They indicate trends that reflect changes in recent decades in the public perception of facial beauty, which may affect patient expectations of treatment outcomes. Keywords: esthetics, facial profile, gender differences, perception, soft tissue

Objectives: Although several studies have investigated the effectiveness of various interdental cleaning devices, there is a need for an evidence-based synopsis for clinicians to customize interdental hygiene instructions and provide specific devices for each patient. This literature review aims to establish an evidence-based decision-making tree recommending individualized approaches to interdental cleaning based on embrasure size and patient-specific conditions. Data sources: Specific keywords related to interdental cleaning were used to search and identify the existing literature in PubMed and the Cochrane Library. Through a series of review processes, qualifying studies were identified and assessed with respect to the inclusion criteria to establish the decision tree. Results: A total of 27 studies were included to support a decision tree. Traditional dental floss continues to remain the first choice for individuals of high motivation and good ?manual dexterity with type I closed embrasures. For individuals with closed embrasures, but lack of motivation and/or dexterity, the use of easy flossers, soft picks, oral irrigation, and small (0.6 to 0.7 mm) interdental brushes are alternatives. For individuals with type II and type III open embrasure spaces, an interdental brush has the highest evidence for its effectiveness to remove interdental plaque. However, two studies showed that residual plaque could be found over lingual embrasur?es and thus lingual approach of the interdental brush is sometimes needed. The use of gum stimulators and/or woodsticks continues to be supported when significant gingival inflammation is present. Conclusion: Each patient should be individually assessed and given tailored oral hygiene home care instructions for the most effective outcomes. The proposed decision tree provides clinicians with an evidence-based guideline to help customize the use of interdental cleaning devices for each patient. Keywords: biofilm, decision tree, dental hygiene, evidence, interdental, tooth brushing