International Poster Journal of Dentistry and Oral Medicine, 03/2022

Objective: To improve the aesthetics of the patient. Introduction: Gingival pigmentation is a discoloration of oral mucosa or gingiva associated with several exogenous and endogenous factors. Endogenous factors include haemoglobin, bile pigments, melanin, hemosiderin while exogenous factors can be silver amalgam, graphite, lead, mercury, bismuth etc. Measurement of this can be done by various indices like Melanin Pigmentation Index, Oral Pigmentation Index and Smile Line classification. Methodology: A 19-year-old female patient reported to outpatient department of Periodontics and Oral Implantology with a chief complaint of black colour of gums on upper front teeth region for the previous 3 years. After evaluating the patient’s condition (pigmentation index, skin colour), the de-epithelisation technique chosen was a combination of scalpel technique and gingival abrasion technique using a diamond bur. Results: After a period of follow-up, satisfactory results were obtained with reduced pigmentation scores. Conclusion: After a 1-year follow up, we found a decrease in pigmentation scores, and the patient was satisfied with clinical results. In this case presentation, we explore the benefits of the scalpel technique over other treatment options. Keywords: Melanins, esthetics, gingiva

Background: Assessment of procedural distress is essential while treating children. Anxiety can be measured by subjective and objective methods. It has been shown that galvanic skin response is an extremely accurate objective method and has been used to measure dental anxiety. The subjective nature of anxiety has often made its measurement difficult. Audio and white noise can be used to distract children during dental procedures. Aim: To compare two non-aversive techniques: audio distraction and white noise and was evaluated by galvanic skin response, heart rate, and oxygen saturation during a dental procedure. Material and method: 60 children aged between 4 to 8 with no previous local anaesthesia (LA) (infiltration) exposure were selected. They were divided into three groups of 20 children each:. group 1 (n=20) control group- no distraction method used; group 2 (n=20) made to listen audio using headphones; group-3 (n=20) made to listen white noise by headphones. Simultaneously, local anaesthesia was delivered in all groups via infiltration technique. Anxiety was measured by using galvanic skin response, heart rate, and oxygen saturation in all the groups. Result: A statistically significant difference (p < 0.05) was observed between the control group and both distraction groups. No significant difference was reported between the audio distraction and white noise groups. Discussion: Local anaesthesia is the most fearful and anxiety-provoking procedure in paediatric dentistry. Some author suggest that 4-6 and 6-8 years revealed equal anxiety levels. Audio distraction is the most used relaxation method to distract children during procedures. Heart rate, according to McCarthy, 1957, acts as a reliable indicator of stress and anxiety. Galvanic skin response can be used as a valid and reliable objective indicator of children’s anxiety (Ebrahim Najafpour et al., 2017). Pulse-oximeter, measuring the pulse rate and oxygen saturation, is the most acceptable method to measure physiological changes. Conclusion: Distraction techniques of choice could be an effective method in reducing a child’s dental anxiety. Audio and white noise are equally effective in reducing anxiety in children. Keywords: Dental anxiety, audio presentation, white noise, objective methods, galvanic skin response

Pleomorphic adenoma, also known as benign mixed tumour, is the most common salivary tumour, constituting up to two-thirds of all salivary gland neoplasms. It shows a female predilection of 2:1. Mostly, pleomorphic adenoma is located in the parotid glands (85%), the submandibular glands (8%), and minor salivary glands (6.5%). Among minor salivary gland tumours intraorally, they are frequently encountered on the posterior palate (42.6%), followed by the lip (10%), cheek (5.5%), tongue, and floor of the mouth. Pleomorphic adenoma usually manifests as a slow progressing asymptomatic swelling. They are mostly benign; however, they can undergo malignant transformation with perineural invasion if not surgically removed. Clinically, pleomorphic adenomas are solitary, firm, round tumours. Radiographs play a major role in differentiating pleomorphic adenoma from other cysts and swellings of inflammatory origin. Ultrasound and FNAC can be useful for diagnosis. Histologically it is composed of epithelial and myoepithelial cells arranged in various morphological patterns. Pleomorphic adenoma of the major salivary glands has a capsule, although it varies in thickness and completeness, whereas pleomorphic adenoma of the minor salivary glands is usually unencapsulated. They are best treated by a wide local excision with good safety margins and follow-up for at least 3–4 years. A case of a 40-year-old female presented with swelling in the posterior palate, diagnosed as pleomorphic adenoma with the help of incisional biopsy, followed by complete enucleation under general anaesthesia, and is under regular follow up. Keywords: Pleomorphic adenoma, palatal swelling, minor salivary gland

Introduction: Complex, three-dimensional bony defects still represent challenging situations in routine implant dentistry. The aim of this study was to evaluate implant survival in customized bone regeneration using a patient-specific titanium mesh (Yxoss CBR^®) after >five years. Furthermore, bone loss and potential symptoms of periimplantitis were be evaluated. Methods: Patients (n=21, implants 36) who had obtained an augmentation procedure with Yxoss CBR^® as described elsewhere1 were examined after 5.7 ± 0.38 years. Survival rate, clinical parameters for periimplantitis (bleeding on probing (BOP), percussion, suppuration) and radiographic examination were evaluated. Bone loss was calculated using Image J^®1.53k. Additionally, the influence of various factors on treatment outcome like periodontitis, smoking, professional maintenance, or diabetes was assessed as well as the impact on quality of life applying the Oral Health Impact Profile (OHIP). Results: The implant survival rate was 97%, with one implant loss in the lower jaw. The lower jaw showed statistically significantly more bone loss mesial compared to the upper jaw (p=0.01). Periodontitis was significantly associated with bone loss mesial and distal (p<0.05). Smoking and gender were not significantly associated with bone loss. Pain was not associated with bone loss distally and mesially. Positive BOP (four implants) was significantly associated with bone loss mesially (p=0.0031) and distally (p=0.0018). Bone loss was significantly associated with suppuration (three implants) mesially (p<0.0001) and distally (p<0.0001). Suppuration was not related to smoking and diabetes. Evaluating bone loss and positive percussion, results were significant (mesial: p<0.0001, distal p<0.0001). Percussion was also significantly associated with positive BOP (p=0.0053) and suppuration (p=0.0014). Evaluation of quality of life showed an OHIP score of 2.97 ± 4.19. Discussion & Conclusion: CBR^® results in high implant survival rate and stabilized augmented marginal bone after follow-up of minimum 5 years. Quality of life was unaffected by the surgical procedure and remained stable after 5 years. Periodontitis seems to play the major role for long-term stability indicated by BOP, suppuration, and percussion sound. The importance of professional maintenance must be emphasized. References: 1 Chiapasco, M., et al. (2021). Customized CAD/CAM titanium meshes for the guided bone regeneration of severe alveolar ridge defects: Preliminary results of a retrospective clinical study in humans. Clin Oral Implants Res, 32(4), 498-510. Keywords: Customized titanium mesh, long-term evaluation, patient-specific grafting, bone augmentation, implant survival

Objectives: Double crowns with spark-eroded friction pins (DCP) perform comparable clinical long-term success compared to other double crown systems. Clinical data for this type of double crown are available for a period of 5 years. The aim of this follow-up study is the investigation of severely reduced dentures (SRD) compared to non-severely reduced dentures (NSRD) after a wearing period of 10 years. Materials and Methods: A total of 158 participants (71 female, 87 male) aged 24.5-87.0 years (mean age 62.5±12.7 years) with 182 prostheses on 520 abutment teeth were followed up in the period from 2006 to 2021. The SRD group included 144 dentures (RPD) supported on 314 abutment teeth. The 10-year survival rates of dentures and abutment teeth were determined according to the Kaplan-Meier method, the log-rank test was performed, and a Cox regression was calculated. Participant age, gender, jaw, localization (according to the Steffel classification), and vitality were considered as relevant factors. Results: The 10-year cumulative survival rate of all abutment teeth was 65.6% (CI: 59.0-72.2), with significantly lower values in the SRR (53.5%; CI: 43.9-63.1; log rank: p < 0.001). The survival rate for all DCP-dentures was (64.6 %, CI: 52.2-77.0 %). The SRD group showed significantly lower survival rates of (56.7%, CI: 41.7-71.7%; p = 0.006). The number, location and vitality of the abutment teeth had a significant influence on survival rates. Discussion and Conclusion: DCP showed an acceptable clinical survival rate after 10 years. These results are comparable to other double crown systems described in the literature. The age of the patient, sex, and the distribution and vitality of the abutment teeth showed a significant influence on the survival rates of the abutment teeth. Consideration of these factors could prove helpful in the prognostic evaluation of abutment teeth in the context of clinical treatment planning. Keywords: Partial denture, double crowns, friction pins, survival rate, severely reduced dentition

Introduction: Gingival recession presents differently, such as with inadequate width of attached gingiva and vestibular depth. Free gingival graft is the favourite choice of clinicians for the management of such cases. Fibrin, fibro-nectin and other growth factors (from platelet concentrate) are also crucial for tissue repair and regeneration. Objective: To increase the width of keratinized tissue. Methodology: 35-year-old female patient reported with the chief complaint of root exposure in the mandibular front region. Gingival recession was present with inadequate width of attached gingiva and vestibular depth as well as aberrant frenal pull with respect to the left mandibular central incisor. With the consent of patient, the site was treated using free gingival autograft along with a platelet-rich fibrin membrane to achieve better results. Results:- After 1 month, a thick band (2mm) of attached gingiva was obtained; 1 mm recession coverage was also observed. A thick fibrous reunion was observed in the frenum area, which was corrected by vestibular deepening at the 1 month visit only. Patient was recalled every three months. Conclusion: Free gingival graft with a platelet-rich fibrin membrane may be the best treatment option for gingival recession when an increase in the apico-coronal dimension of the keratinized gingival tissue is desirable. A free gingival graft procedure apical to the recession area is effective in halting progression of recession, increases the keratinized gingiva, and enhances plaque removal. Keywords: Gingival recession, platelet-rich fibrin

Introduction: Palato-gingival groove is a developmental anomaly which usually begins in the central fossa of the incisor, extends over the cingulum and then continues apically down the root surface. It acts as a plaque retentive site which can lead to endodontic or periodontal disease or combined periodontal-endodontic disease. Treatment is based on complete eradication of microbes from the groove. Objective: To diagnose and manage palato-gingival groove. Methodology: A 32-year-old, systemically healthy female reported to the Department of Periodontology, PGIDS, Rohtak, with a chief complaint of dirty teeth. On clinical examination, probing depths at all sites were in range of 2-3mm except the maxillary right lateral incisor, where the disto-palatal aspect revealed 7mm probing depth. Intraoral peri-apical radiograph revealed an isolated bone defect associated with the distal aspect of the lateral incisor. A palato-gingival groove extending to the junction of the coronal and middle third of the mid root was evident after raising the periodontal flap. Debridement of the defect, followed by preparation of the groove with a round bur and restoration with glass ionomer cement was done. Result: At 6 months follow-up, the probing depth reduced from 7 mm to 2mm; the gain in CAL was 5mm, and BOP was absent. Conclusion: Eradication of microbes and sealing the groove are successful in the management of a palato-gingival groove. Keywords: Dental plaque, glass ionomer cement

Case report: A 15- and a 16-year-old patient presented to Münster University Hospital with persistent oral mucositis, aphthae and mucosal swelling. One of the patients had chronic diarrhoea of unknown origin. An oral mucosal biopsy, an oesophagogastroduodenoscopy and a colonoscopy were performed. The tissue samples taken confirmed the diagnosis of MC of the upper and lower gastrointestinal tract. Systemic therapy was given with the TNF-alpha inhibitor infliximab every 6-8 weeks. The oral mucosa was treated topically with a clobetasol mouth rinse. Both patients experienced a significant decrease in oral symptoms. Discussion: MC is a dysregulation of the mucosal immune response and can basically occur in any section of the gastrointestinal tract. A discontinuous, granulomatous infestation of the entire intestinal wall with the formation of fistulas, ulcerations, thickenings and stenoses is characteristic. MC is most common in industrialised countries and begins between the ages of 15-30. Lesions of the oral mucosa precede signs in the digestive tract in 10 % of cases. Besides occasional leukoplakic and lichenoid changes, aphthoid ulcerative lesions of the oral mucosa have been associated with MC. However, mucosal and gingival hyperplasia, mucosal pseudopolyps ("mucosal tags"), lip swelling, and vestibular folds of the so-called "cobblestone pattern" with hyperplasia interrupted by fissures have also been described. Typically, MC progresses in relapses. In addition to non-specific symptoms, pain and cramps in the lower abdomen as well as diarrhoea may occur. In addition to the clinical course, laboratory and radiological findings, the diagnosis is ultimately made endoscopically and confirmed histologically. The oral biopsy alone is insufficient to establish the diagnosis. Differential diagnoses include granuloma due to reaction to foreign bodies, infectious diseases, lichen ruber, systemic inflammatory diseases, or leukaemias, which are often distinguished by clinical, microbiological, and/or histopathological symptoms, as well as stomatitis due to malnutrition, sarcoidosis, or Melkersson-Rosenthal syndrome. In the majority of cases, oral symptoms resolve with treatment of the intestinal disease. Locally applied glucocorticoid therapy is sufficient in 50% of patients, but recurrences are common. In patients with severe impairment, systemic treatment with corticosteroids, TNF-alpha inhibitors (infliximab, adalimumab) or immunosuppressants (azathioprine) are given. Summary: Unclear mucosal lesions, especially hyperplasia, may be due to Crohn's disease (MC). Sensitisation with regard to the detection of these lesions - sometimes preceding the actual disease - can enable early detection and improve the diagnostic and therapeutic management of the patient. Keywords: Crohn's disease, mucosal lesions, mucosal hyperplasia

Case report: In the present case, a 19-year-old female patient with no general medical history presented with multiple, small, pale yellow pustules in the area of the entire oral cavity. The changes had been present for 2 months. The greatest density of changes was found in the folds of the upper and lower jaw. Further symptoms were erythematous thickening of the gingiva and mucosa as well as hyperplastic cheek mucosa in places, especially in the buccal planum. There were no complaints. The microbiological examination of the mucosal swab was unremarkable. A biopsy of the left inframammary fold confirmed the clinical diagnosis. A local combination therapy with a glucocorticoid-containing mouth rinse and an accompanying antimycotic and antibacterial treatment was administered. The therapy resulted in a significant reduction of the pustules in the area of the gingiva and mucosa. Pyostomatis vegetans is often associated with inflammatory bowel diseases (Crohn's disease, ulcerative colitis). However, a colonoscopy with biopsies was negative. The patient is followed up regularly. Discussion: The clinical presentation of pyostomatitis vegetans allows a reliable diagnosis. Typical clinical signs are: multiple pale yellowish spots and pustules, an erythematous thickened orange-red gingiva, and mucosa, erosions and ulcers, hyperplastic folds of the buccal mucosa and vestibule, a nodular mucosa and fissures on the mucosal surface. Pus discharges from the pinhead-sized pustules on pressure. The erosions may fuse. The lesions usually occur bilaterally symmetrically throughout the oral cavity. The aetiology is largely unexplained. There are no pathogenic bacteria, viruses or fungi, so the most likely cause is thought to be an immune reaction. A frequent association with chronic inflammatory bowel diseases such as Crohn's disease or ulcerative colitis is known, but as in the present case, is not always present. Liver and biliary tract diseases are also associated with pyostomatitis vegetans. Other differential diagnoses are: Lichen ruber, oral pseudomembranous candidiasis, gingivostomtitis herpetica, bullous autoimmune dermatoses, or Fordyce spots. Therapy can be local or systemic. The most effective therapy is the topical application of glucocorticoids. The use of tetracycline or tacrolimus is also described in the literature. Glucocorticoid therapy should be supported by preventive antifungal treatment. Summary: Pyostomatitis vegetans is a rare oral mucosal disease with a very characteristic morphology. Typical are bass yellow mottled pustules on a reddened mucosa with erosions and thickening. Treatment is topical with glucocorticoids and antifungals. The general dentist should be familiar with the clinical picture, especially as it may be the first manifestation of a chronic inflammatory bowel disease. Keywords: Pyostomatits vegetans, oral mucosa diseases

Case report: A 58-year-old and 56-year-old female patient with unremarkable medical history presented to Münster University Hospital with a painful ulcer on the hard palate. One patient described complaints that had been present for about 2 weeks after a root canal treatment under local anaesthesia by her dentist. Clinically, the ulcer was about 2 cm in size. A CT scan was performed and a biopsy taken. Histology revealed sialometaplasia and chronic granulating and fibrosing inflammation. There were no signs of malignancy. Close follow-up showed complete healing of the oral mucosa under local therapy in both cases.   Discussion: The most common location of necrotising sialometaplasia is the lateral posterior hard palate in projection to the foramen palatinus majus, rarely the parotid gland, lips, or tongue are affected. Bone destruction has also been described in isolated cases. According to the literature, it mainly affects men between 40 and 50 years of age. In the early stages, a pressure-suppressed swelling develops, which leads to an ulcer within a few days. In contrast to malignant neoplasms, there is no crossing of the midline. The ulcer heals spontaneously, but a superinfection may occur. The pathogenesis of sialometaplasia is unclear. It leads to a so-called "salivary gland infarction" of the minor salivary glands, which results in the destruction of the salivary gland parenchyma. Histologically, squamous metaplasia of the acini of the local minor salivary glands is seen. The differential diagnosis must exclude malignant neoplasms such as squamous cell carcinoma or mucoepidermoid carcinoma. Treatment is purely symptomatic to avoid superinfection and pain. Antibiotic therapy may be applied. The lesions heal completely within 6-12 weeks. Summary: Necrotising sialometaplasia is a rare differential diagnosis of mucosal ulcer. It is a benign, self-limiting oral mucosal disease. The aetiology has not yet been conclusively clarified, but the ulcer appears to be caused by a local circulatory disorder. Early confirmation of the diagnosis with a biopsy can exclude a malignant tumour. Due to the good spontaneous healing rate, no specific therapy is required. Keywords: Sialometaplasia, mucosal ulcer