Quintessence International, 06/2022

Objective: To evaluate whether root canal obturation with resin-based sealers increases the incidence and intensity of postoperative pain compared to other sealer types. Data sources: Medline, Scopus, Web of Science, Google Scholar, Cochrane Library, and gray literature were searched through December 2020. Clinical studies evaluating postoperative pain after obturation with resin-based sealers and other sealer types were included. Risk of bias was assessed through the Cochrane RoB 2.0 tool for randomized clinical trials (RCTs) and ROBINS-I tool for non-randomized clinical trials (nRCTs). Pooled relative risks (RR), standardized mean differences (SMD), and 95% confidence intervals were calculated for quantitative analyses. Of 524 studies, 11 clinical studies (eight RCTs and three nRCTs) involving 1,123 teeth were included. Four studies were assigned low risk of overall bias while seven studies presented high risk of overall bias. Quantitative analyses were performed with six studies for pain incidence, five studies for pain intensity, and four studies for analgesic intake. There was no significant difference between resin- based sealers and other sealer types in postoperative pain incidence at 24 hours (RR 1.102, P = .53), 48 hours (RR 0.943, P = .93), 72 hours (RR 1.019, P = .93), and 1 week (RR 0.559, P = .31), in pain intensity at 12 hours (SMD 0.100, P = .35), 24 hours (SMD 0.090, P = .25), and 48 hours (SMD 0.217, P = .26), and in analgesic intake at 24 hours (RR 2.253, P = .15) and 72 hours (RR 0.650, P = .59). Conclusion: Based on the available evidence, resin-based sealers do not increase the postoperative pain incidence, intensity, and analgesic intake compared to other sealer types. Keywords: discomfort, flare up, meta-analysis, paste, posttreatment, sensitivity

Objectives: Common dental diseases may develop into severe odontogenic infections (OIs). This study aimed to characterize the occurrence and nature of dental diseases in OIs requiring hospitalization. Method and materials: Data of a total of 168 adult patients requiring hospital care for severe OI were retrospectively investigated. Study participants were grouped according to OI etiology: apical periodontitis, marginal periodontitis, combined infection (apical and marginal periodontitis) or vertical root fracture, pericoronitis, and root remnant. The categorization of the dental diseases was achieved by radiologic evaluation and supplemented with clinical findings from patient records. Differences in background variables and infection severity were statistically analyzed. Results: Apical periodontitis was the most common dental infection disease leading to OI (n = 113; 67%). In 83 cases, no root canal treatment (RCT) was administered prior to hospital admission; in 30 cases, RCT had been commenced or completed. Between study groups, significant differences were observed in age (P < .001), immunocompromised status (P = .024), and pulse (P = .012). Patients with marginal periodontitis were older and more often immunocompromised; patients with pericoronitis were younger. Pulse was higher in patients with a severe OI originating from apical periodontitis than in patients with OI originating from other dental diseases. Conclusion: Apical periodontitis, specifically with no prior endodontic treatment, was observed in the majority of severe OIs. Additionally, when compared with other types of dental diseases, apical periodontitis was associated with features of more severe infections. This highlights the importance of periapical health. Keywords: apical periodontitis, hospital care, intensive care, odontogenic infection, periapical abscess

Objective: The aim of the current article was to present a radiographic method to determine the surface area of newly formed periodontal attachment, as well as to analyze volumetric and morphologic changes after regenerative periodontal treatment. Method and materials: In this retrospective study, 11 singular intrabony periodontal defects were selected for minimally invasive surgical treatment and 3D evaluation. 3D virtual models were acquired by the segmentation of pre- and postoperative CBCT scans. This study determined the surface area of baseline periodontal attachment (RSA-A) and defect-involved root surface (RSA-D) on the preoperative 3D models, and the surface area of new periodontal attachment (RSA-NA) on the postoperative models. Finally, cumulative change of periodontal attachment (∆RSA-A) was calculated and Boolean subtraction was applied on pre- and postoperative 3D models to demonstrate postoperative 3D hard tissue alterations. Results: The average RSA-A was 84.39 ± 33.27 mm2, while the average RSA-D was 24.26 ± 11.94 mm2. The average surface area of RSA-NA after regenerative periodontal surgery was 17.68 ± 10.56 mm2. Additionally, ∆RSA-A was determined to assess the overall effects of ridge alterations on periodontal attachment, averaging 15.53 ± 12.47 mm2, which was found to be statistically significant (P = .00149). Lastly, the volumetric hard tissue gain was found to be 33.56 ± 19.35 mm3, whereas hard tissue resorption of 26.31 ± 38.39 mm3 occurred. Conclusion: The proposed 3D radiographic method provides a detailed understanding of new periodontal attachment formation and hard tissue alterations following regenerative surgical treatment of intrabony periodontal defects. Keywords: 3D evaluation, CBCT segmentation, minimally invasive periodontal surgery, new periodontal attachment, regenerative periodontal surgery, root surface area

Objective: The aim of this study was to evaluate functional and esthetic clinical outcomes and patient satisfaction with narrow-diameter implants in comparison to standard-diameter implants in the anterior zone of the maxilla in a follow-up examination after 1 to 6 years. Method and materials: The study was designed as a retrospective cohort study investigation including 27 patients receiving a 3.3-mm diameter single implant (NDI, n = 14) or a standard-diameter 4.1-mm single implant in the anterior zone of the maxilla (SDI, n = 16). Descriptive and analytical statistics were performed comparing both groups with regard to clinical examination including esthetic outcome, sulcus fluid flow-rate, crown esthetics, patients’ satisfaction on visual analog scales, occurrence of biologic or technical complication, probing pocket depths (Fisher exact test), pink esthetic score (PES) and Periotest (Mann-Whitney U test). The level of significance was set at α = .05. Results: The mean observation period was 4.8 years after crown insertion in the NDI group, and 4.9 years in the SDI group. Significant differences were observed for Periotest values in favor of the 4.1-mm implants (P = .014). No differences were found with regards to esthetics (PES; P = .27) or sulcus fluid flow-rate (P = 0.73) and probing pocket depths (P = .35). Overall patient satisfaction was high for both groups with visual analog scale scores of 9.3 ± 1.1 for NDI and 9.4 ± 1.0 for SDI (P = .39). Conclusion: Clinical outcome with narrow-diameter implants was comparable to standard-diameter implants in the anterior zone of the maxilla with similar esthetic assessments and patients’ satisfaction. Keywords: implants, narrow-diameter implants, oral surgery, pink esthetic score

Objectives: Temporomandibular disorders (TMDs) are a group of disorders with varied pathophysiology and clinical manifestations. Masticatory and cervical motor systems have a functional relationship. Superficial cervical muscles have greater hyperactivity in myogenous and mixed TMDs than in healthy individuals, demonstrating an abnormal pattern of contraction. This study aimed to demonstrate the effects of superficial cervical plexus block (SCPB) anesthesia during arthrocentesis in patients with temporomandibular joint (TMJ) internal derangement and headache. Method and materials: This retrospective cohort study included 2 men and 23 women with cervicogenic headache and TMJ internal derangement treated by arthrocentesis, and 40 TMJs with established cervicogenic headaches. The average follow-up period was 9.36 ± 2.679 months. TMJ and muscle pain during mastication, maximum and non-assisted mouth opening, and lateral excursion were recorded. Pain and dysfunction were determined using the visual analog scale. Patients were monitored before, during, and after arthrocentesis while inducing SCPB anesthesia, and vital findings were recorded. In addition, skin surface temperature was measured. Results: Patients experienced a significant increase in their clinical values. Changes in non-assisted mouth opening (mean from 29.65 ± 6.31 to 33.3 ± 5.21 mm) (P < .05), assisted mouth opening (mean from 38.98 ± 7.62 to 43.35 ± 6.17 mm), right excursions (mean from 7.28 ± 2.08 to 9.13 ± 1.86 mm), and left excursions (mean from 7.48 ± 1.71 to 8.90 ± 1.82 mm) were statistically significant (P < .05). Patients were relieved after SCPB, resulting in decreased pain and hemodynamic values. Increase in mean temperature after SCPB was statistically significant (P = .002, P < .05). Conclusion: This study presents a straightforward novel protocol, clinically efficient for arthrocentesis on pain control in patients with TMJ internal derangement and cervicogenic headache. Keywords: arthrocentesis, cervicogenic headache, pain, superficial cervical plexus blockage, temporomandibular internal derangement

Maintaining and restoring teeth exhibiting subgingival or even subcrestal defect extensions represent a common problem in daily practice. Such teeth are often deemed “unrestorable” due to a significant hard tissue loss and defect locations violating the biologic width. In order to achieve a sufficient 2-mm-ferrule design and reestablish the biologic width, both surgical crown lengthening and orthodontic extrusion have been suggested. However, surgical crown lengthening has a negative effect on the attachment level of adjacent teeth as well as esthetic disadvantages particularly in the esthetic zone. Therefore, orthodontic extrusion might be considered as a valid therapeutic alternative since gingival architecture is maintained. While most orthodontic appliances are too complex for daily application, forced orthodontic extrusion by means of the Tissue Master Concept might be a cost- and time-effective approach due to advances in adhesive and computer-assisted dentistry. This clinical case series illustrates the methodology of the rather straightforward Tissue Master Concept in specific clinical situations that may occur in clinical routine. Keywords:  forced eruption, orthodontic extrusion, tooth extrusion

The treatment management of patients with hemifacial microsomia (HM) includes both surgical and nonsurgical approaches and depends primarily on the degree of deformity of the facial and skeletal structures. In this context, the combined efforts of the maxillofacial surgeon, the orthodontist, and the prosthodontist are essential for a satisfactory functional and esthetic outcome. Case presentation: A 31-year-old man presented with a chief complaint of facial asymmetry. The patient had been diagnosed with HM on the right side, with severe external ear deformity, and hypoplasia of the facial muscles and the zygomatic bone. The intraoral examination showed a Class I molar and canine relationship with a reduced horizontal overlap and an occlusal plane canting. The maxillary anterior teeth were severely worn due to traumatic occlusion. Orthodontic treatment in conjunction with combined orthognathic surgery was planned to address the facial asymmetry. Ramus distraction osteogenesis was carried out, followed by conventional presurgical orthodontic treatment. The treatment was completed by prosthetic rehabilitation for the reconstruction of the maxillary teeth and fine occlusal adjustment. Conclusion: The cooperation between the orthodontist, surgeon, and prosthodontist becomes indispensable when treating complex cases of HM. An interdisciplinary approach should be adopted from the start of treatment, promoting integrated customized care. Keywords: functional rehabilitation, hemifacial microsomia, interdisciplinary treatment, orthodontics, prosthodontics

Objectives: To describe the planning stage and the first year of “Smiles,” an innovative, inclusive oral health promotion program among preschool children, ages 3 to 5, encompassing the enhancement of daily toothbrushing skills, engagement of teaching staff and parents, and integration of a supportive environment of supervised toothbrushing in kindergartens. Method and materials: The major components of the first year of the program included workshops with the teaching staff, working sessions with the preschool children, and workshops with the parents. Program participation, program cooperation, program satisfaction, and kindergarten teachers, kindergarten parents, and dental hygienists’ attitudes towards this component of the program were recorded and evaluated. Minor components of the first year of the program included assimilation and integration of daily supervised toothbrushing in some of the kindergartens. Program participation, kindergarten teachers, kindergarten teachers’ assistants, and kindergarten parents’ attitudes towards this component of the program were recorded and evaluated. Results: In total, 180 kindergartens, in nine locations across Israel, including 5,311 preschool children, their parents, and teaching staff, took part in the first year of the program. High levels of participation (80% and above), cooperation (9.55 to 9.78) and satisfaction (9.62 to 9.81) were recorded in the first year of the program. Kindergarten teachers, parents, and dental hygienists expressed high levels of support for continuing the program beyond its first year (9.86 to 10.00). Regarding the daily supervised toothbrushing model in the kindergartens, high levels of satisfaction (9.50 to 9.75) and willingness to continue the program (9.50–10.00) were recorded among kindergarten teachers, assistants, and parents. Conclusion: The “Smiles” program serves as an example of successful collaboration between many partners and stakeholders from different organizations, sectors, and government ministries, local authorities, kindergarten management and staff, parents, and the most important partners, the preschool children. Its adherence to the basic principles of health promotion, and its professional adjustment to early childhood with positive atmosphere of happiness, joy, and shared warmth, contributed to the success of the program. Keywords: community dentistry, early childhood caries, health promotion, kindergarten children, proportionate universalism