Quintessence International, Pre-Print

Objective: To evaluate the long-term dimensional stability of dental ridges two years after soft tissue augmentation using a porcine-derived volume-stable collagen matrix (VCMX) at healing abutment connections. Methods: 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), one-month post-grafting, and 24 months after implant loading. Pre-implant cone-beam computed tomography (CBCT) scans were also obtained. Volumetric and profilometric changes were measured at 1mm, 2mm, and 3mm 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 two-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 two 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, one-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. Keywords: dimensional stability, soft tissue augmentation, volume-stable collagen matrix, volumetric analysis

Background: The relationship between periodontitis and rheumatoid arthritis (RA) has attracted considerable interest. However, the effect of non-surgical periodontal treatment (NSPT) on RA remains uncertain. This umbrella review aims to consolidate current research to establish a stronger evidence base. Methods: 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 (MD)with 95% confidence intervals (CI). Results: A total of 2,982 records were screened, with 41 full-text articles assessed for eligibility, and9 selected for evidence synthesis. Qualitative analysis suggests that NSPT may reduce clinical activityin patients with periodontitis and RA. Quantitative analysis provided suggestive evidence on theeffects of NSPT on DAS28, with the MD 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 RAsymptoms in patients with periodontitis; however, the potential bias of current evidence calls forfurther rigorous studies. Clinicians should account for the complex interplay between periodontitis andRA when devising treatment strategies. Keywords: Non-surgical periodontal treatment, Rheumatoid arthritis, Periodontitis, Umbrella review

Purpose: This study aimed to evaluate the clinical efficacy of an innovative preparation; honey inorabase (50% in 1:1) for treating atrophic/ erosive oral lichen planus (OLP) compared with triamcinolone acetonide 0.1% ointment. Subjects and methods: The study involved a total of 60 patients who were randomly dividedinto three groups: Group I (honey in orabase 50%, 1:1 paste), Group II (triamcinolone acetonide 0.1% ointment), and the control group, III, (orabase paste). The primary outcome measure utilized the Visual Analogue Scale (VAS), while the secondary outcome included evaluating the clinical manifestation through an OLP reduction score assessment. Results: Compared to Group III, Groups I and II experienced significant reductions in their VASand OLP 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 OLP. Therefore, as an alternative to utilizing the traditional triamcinolone acetonide 0.1% ointment to treat atrophic/erosive OLP, honey in orabase 50% paste may be an effective treatment option. Keywords: oral lichens planus, honey, triamcinolone acetonide, orabase

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. Additionally, 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, helium ions sputtering was used to produce nanospiked titanium surfaces with a height of 1000 nm (Ti1000). Smooth machined (Ti machined) and SLA 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 less 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 re-modification approach. Keywords: abutment design, adhesion, dental implants, implants, microbiology, peri-implantitis

Background: The wire syndrome (WS) 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. Aim of this study was to assess the effectiveness of fixed orthodontic treatment with completely customized lingual appliances (CCLA) and continuous archwires for a clinically significant reduction in the dimensions of labial gingival recessions in the anterior mandible, caused by the wire syndrome (WS), in a group of consecutive patients treated with the same approach. Moreover, the reduction in root prominence (ROP) of the affected teeth relative to the two neighboring teeth was evaluated. Subjects and methods: This retrospective cohort study from three centers included 20 consecutively recruited patients with labial gingival recession at lower incisors and canines due to WS. A total of 25 teeth were assessed. CCLA treatment with a standardized archwire sequence (0.012”/0.014” NiTi, 0.016”x0.022” NiTi, 0.018”x0.018” Beta-TMA with optional extra-torque) was identical in all three centers. Primary endpoints of recession depth (RD), recession width (RW), and recession surface (RS) 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<0.05. As a secondary endpoint, the reduction of ROP 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 RD was 1.86 mm (44.9%) and in RW 0.70 mm (35.6%). The mean RS was reduced from 10.77 mm2 to 3.93 mm2, indicating a mean RS reduction of 61.4%. All changes were statistically significant (p<0.001). The range of RS reduction was from 25.4% to 100%, while 18 out of the 25 recessions showed a reduction of more than 50%. The maximum reduction in ROP amounted to more than three millimeters. Conclusion: The use of completely customized lingual appliances to torque roots of the lower anterior teeth, exposed by the 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 as a critical step in optimizing the predictability of the surgical recession coverage. Keywords: wire syndrome, retainer X-effect, retainer twist-effect, gingival recessions, recession depth, recession width, completely customized lingual appliances, torque, root coverage, root prominence, alveolar yoke

Objective: To evaluate the effectiveness of mandibular exercises (ME) in patients with temporomandibular disorders (TMD) diagnosed by Research Diagnostic Criteria for TMD (RDC/TMD). Material and methods: Thirty-two patients seeking clinical treatment for TMD were randomly assigned to groups based on the treatment modality: conservative therapy (CT), including occlusal splint therapy and counseling; and ME. Muscle and joint pain were assessed using a 4-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 and pain-free. Outcomes were evaluated at baseline (T0) and after a 3-months intervention period (T1). Results: Both treatments significantly reduced muscle and joint pain intensity at most assessed sites. The reduction in pain with ME compared to CT was statistically significant at the right lateral pole of the temporomandibular joint (TMJ) (p = 0.048; rrb = 0.348). After three months, ME resulted in greater pain-free MUMO (T0 vs. T1; p = 0.004; rrb = 0.594), and the increase in MUMO was greater than that observed with CT (p < 0.001; rrb = 0.742). Conclusion: ME and CT similarly reduced palpatory pain, with ME showing greater clinical impact at the right lateral pole. Both treatments led to significant improvements in the masseter and TMJ pole. ME 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: temporomandibular joint disorders, mandibular exercises, occlusal splints, counseling

Objectives: To assess blood flow alterations after horizontal Guided Bone Regeneration (GBR) and to evaluate correlations between blood flow and hard tissue changes. Method and Materials: Twelve mandibular surgical sites were involved in the current case series. GBR was carried out using a split-thickness flap design. Blood circulation was assessed with Laser Speckle Contrast Imaging at baseline as well as 1, 4, 6, 11, 13, 20, 27, and 34 days after the surgery, subsequently on a monthly basis until 6 months. Hard tissue alterations were measured horizontally and vertically using linear measurements. The first measurement point was 2 mm distal to the distal surface of the last tooth; additional measurement points were placed every 3 mm up to the 15th mm. Volumetric hard tissue loss and gain were also assessed. Results: Baseline blood circulation was statistically significantly higher on the buccal side. On the first postoperative day, all regions presented a statistically significant decrease in blood flow circulation. The buccal-inner region presented significant ischemia on day 6. Mean volumetric hard tissue gain and loss were 712.62 ± 317.08 mm3 and 222.431 ± 103.19 mm3, respectively. Mean baseline alveolar ridge width was 4.82 ± 1.02 mm, 6 months ridge width averaged 7.21 ± 0.99 mm. Vertical resorption measured 1.24 ± 0.5 mm. Correlations between blood flow changes and hard tissue alterations were only found on Day 34 and Day 60. Conclusion: Laser Speckle Contrast Imaging is an efficient method to measure flap microcirculation. No correlation was found between flap microcirculation changes hard tissue and alterations. Keywords: Bone graft, Case-report/series, Guided Bone Regeneration, Membranes, Ridge augmentation

Radiation treatment plays a mainstream role in the management of head and neck cancers (HNSCC). Adverse effects from radiation therapy include osteoradionecrosis of the jaw, and rarely, pathological fracture. Immune checkpoint inhibitors (ICI) such as pembrolizumab are of growing relevance to the management of metastatic and recurrent HNSCC. Adverse impact on bone secondary to medications such as pembrolizumab and nivolumab have been sporadically documented in the literature. The objective of this manuscript is to raise awareness of possible increase in risk for adverse jaw outcomes in patients with HNSCC exposed to both radiation treatment to the jaws and ICI therapy. This manuscript documents adverse jaw outcomes including osteonecrosis and pathological fracture of the mandible in two patients receiving pembrolizumab for management of HNSCC and had received prior radiation treatment. A potential link between immunotherapy and adverse jaw outcomes is consistent with our growing understanding of osteoimmunology, investigating the closely interrelated processes in bone remodeling and immune system function, in health and disease. It is important to ascertain if pembrolizumab poses an incremental risk for such outcomes, beyond the risk from prior radiation, for patients managed with radiation treatment and ICI therapy for HNSCC. The general dentist may encounter such patients either in the context of facilitating dental clearance prior to initiation of chemotherapy, or rarely, with poorly explained jaw symptoms and must be alert to the possibility of occurrence of such adverse jaw events to facilitate timely diagnosis and optimal patient management. Keywords: Cancer, Case-report/series, immunotherapy, Oral surgery , Osteonecrosis, Pathology, Radiation Therapy

Objective: Currently, there is no established treatment protocol to treat Interdental papillary loss. This research aimed to evaluate the outcomes of interdental papillary reconstruction using minimally invasive surgery, with injectable hyaluronic acid (HA) gel. Materials and Methods: Seventeen patients were included, each with five sites of class 1 papillary recession; (forty sites in the upper jaw and forty-five sites in the lower jaw). Subperiosteal tunneling was performed through a horizontal incision made apical to the base of the papilla without penetrating it. The free gingival sulcus was sealed by 000 retraction cord. After that a total of 0.2-0.6 mL HA was injected gradually. The incision was sutured with polyglycolic sutures. Treated sites underwent clinical and digital evaluation at three follow up time points (1 month, 3 months and 6 months). Results: The interdental papillary defect height in the upper jaw sites significantly reduced by 60%, 66%, and 42% at 1 month, 3 and 6 months, respectively. Also, in lower jaw sites, the reduction was of about 54%, 55%, and 40% at the same follow up time points. Regarding interdental papillary defect surface area in the upper jaw the reduction was about 65%, 71%, and 45% at 1 month, 3 and 6 months. In the lower jaw, a reduction of about 60%, 64%, and 48% was noticed at the same time points. Regarding patients’ pain level score, during the day of surgery, sixteen patients reported pain, the average pain score out of 10 was 3.94, and eleven patients (64.7%) needed to take analgesics. The pain generally subsided in the following days. Also, at the day of the treatment twelve out of the seventeen patients (70.6%) reported mild difficulty in speaking and eating. No complication, hypersensitivity or allergy was noted in any patient. Conclusion: Subperiosteal tunneling with HA injection demonstrates clinical improvements in papilla height and papillary recession surface area reduction after 3 months of follow-up with reduction in improvement after 6 months. Keywords: black triangle, dental papilla augmentation , hyaluronic acid, minimal invasive surgery, periodontal surgery, Periodontology

Objectives: To assess the effect of Community Water Fluoridation (CWF) in the prevalence of dental caries and dental fluorosis in 12-year-old children living in Israel. Considering that CWF is important in the prevention of dental caries. Between 2002 and 2014, the water in communities of at least 5000 individuals was fluoridated. In 2014 CWF in Israel stopped. Methods: Data on 12-year-old children from all areas in Israel from the national crosssectional epidemiological survey conducted in 2011-2012 were stratified by city water fluoridation and by city and school socio-economic status (SES). Two dependent variables were defined: (1) DMFT index -caries experience in the permanent dentition; (2) dental fluorosis in central incisors using the Thylstrup-Fejerskov (TF) classification of fluorosis. Results: Data from 2181, 12-year-olds was analyzed. the average DMFT was 1.17+1.72 and 49% were caries free. Based on DMFT, the caries experience was significantly higher in nonfluoridated cities (1.38 vs. 0.98 in fluoridated cities) and there were more caries free children 56.4% in fluoridated cities vs. 40.6% in non-fluoridated. DMFT was higher in cities with lower SES than high SES (1.29 vs. 1.05 respectively, p<0.001) and there were less caries free children in low SES (44.5% vs. 53% in high SES cities, p<0.0001). Almost all the 10.3% of children with signs of fluorosis (scoring at least 1 in TF index), had questionable to mild fluorosis (9.3%). Conclusions: CWF is a cheap, simple method of dental health protection that reaches all socio-economic levels and cessation of water fluoridation reduced the health of Israel's children. Clinical Significance: Water fluoridation provides substantial caries prevention, by reaching a substantial number of people. The relevance of this work is for policymakers to consider CWF as clinically proven method for reducing health inequalities. Keywords: Caries detection, DMFT, Epidemiology, Fluoride, Public health