DOI: 10.3290/j.qi.b5517931, PubMed ID (PMID): 38934774June 27, 2024,Pages 1-27, Language: EnglishBarth de Andrade Luz, Sabrina / Melo da Cunha Oliveira, Rayrane Iris / Alvares Leite Guanabara, Letícia / Barros Viana, Beatriz / Tibau Aguiar Dias, Rebeca / Dantas Batista, André Ulisses / Regalado Galvão Rabelo Caldas, Marília / Ferreira Gadelha de Araújo, Diana
Objectives: This study aimed to evaluate the influence of different whitening toothpastes on color change and alteration in enamel surface roughness and microhardness compared to a conventional toothpaste.
Method and materials: Fifty bovine incisors were selected, cleaned, and stored before being divided into five groups: a conventional toothpaste group (C) and three whitening toothpaste groups containing different abrasive agents: silica (S), hydrogen peroxide (PH), and activated charcoal (CA). Specimens underwent simulated brushing, staining with black tea solution, and subsequent analyses of color, surface roughness, and microhardness. Statistical analysis was performed using three-way ANOVA and Tukey post-hoc tests (P < .05).
Results: The results showed that the color analysis revealed similar whitening potential among all toothpastes. Otherwise, showed significant differences in surface roughness (P < .001) and microhardness (P < .001) after simulated brushing. While all toothpastes caused a decrease in microhardness, the charcoal-based toothpaste showed a significant increase in surface roughness compared to the initial condition.
Conclusion: All toothpastes demonstrated whitening capability. Surface roughness changed after brushing with activated charcoal-based whitening toothpaste, but final roughness was similar across all groups. Whitening toothpastes led to a decrease in enamel microhardness, with similar final performance across all toothpastes analyzed.
Keywords: animal studies, bleaching agents, dental enamel, tooth brushing, tooth wear, toothpastes
DOI: 10.3290/j.qi.b5517911, PubMed ID (PMID): 38934773June 27, 2024,Pages 1-16, Language: EnglishAhlers, M. Oliver / Roehl, Jakob C. / Jakstat, Holger A. / Kielbassa, Andrej M.
Objectives: To evaluate the survival rate of minimally invasive semipermanent occlusal polymethylmethacrylate (PMMA) onlays/veneers in previous temporomandibular disorder (TMD) patients with severe tooth wear and with a loss of vertical dimension after up to 7 years.
Method and materials: This case series was designed as a follow-up evaluation with consecutive patient recruitment. All patients bearing the indication for this kind of rehabilitation were treated by the same clinician using the same adhesive methodology. The study included 22 patients (3 males/19 females), with a mean [SD] age of 50.7 [11.6] years. Controls followed within the first 4 weeks (and subsequently as required). Failure criteria included damage by fracture, chipping, and retention loss. Survival rates were determined based on the Kaplan-Meier analysis.
Results: 328 semipermanent occlusal/incisal veneers were included (142 maxillary/186 mandibular teeth). Almost 80% of the restorations were in place and in function when starting the follow-up treatment after 180 days; failures predominantly occurred within the first 3 to 6 months but proved reparable. Depending on the patients’ priorities, scheduled replacements followed successively, and more than 65% did not show repair or any renewal needs for more than 360 days.
Conclusion: Within the limitations of this study the survival rates of occlusal veneers made of PMMA were sufficiently high to allow for consecutive treatment of the respective teeth by means of permanent restorations while preserving the restored vertical dimension. In patients with severe tooth wear and a TMD history, semipermanent restorative therapy with occlusal PMMA onlays/veneers would seem a noteworthy option.
Keywords: attrition, case series, occlusal onlays, occlusal veneers, open bite, oral rehabilitation, polymethylmethacrylate, temporomandibular disorders (TMD), tooth wear, vertical dimension, wax-up
DOI: 10.3290/j.qi.b5503749, PubMed ID (PMID): 38912671June 24, 2024,Pages 1-32, Language: EnglishManor, Yifat / Safadi, Hanan / Shpack, Nir / Blumer, Sigalit / Gal, Gabriel
Objective: The study aims to provide a comprehensive case analysis from a single center, with the objective of clarifying the optimal timing and recommending a preferred treatment strategy customized to the specific presentation of each type of supernumerary tooth (SNT) identified in our research.
Methods and Material: A retrospective study was conducted on patients who presented with SNT and were treated through an interdisciplinary at the clinic.
Results: 55 patients with 81 SNT of the permanent dentition were analyzed. They included 30 males and 25 females. The dentition status of the patients was as follows: 31 patients with mixed dentition, 0 patients with deciduous dentition, and 24 patients with permanent dentition. The diagnosis of SNT diagnosis was primarily made by general or pediatric dentists and/or orthodontists. Patients were then referred to maxillofacial surgeons for treatment decision. The timing of treatment was mainly determined by the oral surgeon, based on the recommendations of the other specialists involved. Cases involving mal-eruption or malalignment of permanent teeth required both surgical and orthodontic treatment. Patients over 9 years old were treated either under local anesthesia or sedation, while those under 9 years old were treated under deep sedation or general anesthesia A comprehensive investigation of cases involved the utilization of cone beam computerized tomography (CBCT) at the SNT site to facilitate treatment planning. There was a significant correlation between younger age and the preference for treatment under sedation or general anesthesia (p=0.01, t-test). Similarly, a strong association was found between younger age and the need for additional orthodontic treatment (p=0.016, t-test). Cases of surgical removal of SNT at a young age typically did not require orthodontic traction of the permanent tooth, in contrast to cases of late surgical intervention (patients over 11 years old), which often did necessitate such traction. There was a strong tendency for treating supernumerary teeth (SNT) in the maxilla. The proximity of SNTs to vital anatomical landmarks significantly influenced treatment decisions. Patients with SNTs near the mental foramen or the inferior dental canal in the premolar area were exclusively placed under follow-up care (p=0.002, Pearson’s chi-square test). However, in the maxilla, the proximity of SNTs to vital structures such as the floor of the nose and the incisive nerve did not affect the treatment approach, and those supernumerary teeth were mostly removed.
Conclusions: A team approach for managing supernumerary teeth (SNT) is recommended. The timing of treatment should carefully consider the advantages and disadvantages of early versus late intervention. Early surgical treatment in cases where eruption is disturbed might result in spontaneous eruption, eliminating the need for orthodontic traction of the permanent teeth.
Keywords: hyperdontia, supernumerary teeth, surgical extraction
DOI: 10.3290/j.qi.b5465309, PubMed ID (PMID): 38874210June 14, 2024,Pages 1-32, Language: EnglishKrikeli, Eleni / Lambrianidis, Theodoros / Molyvdas, Ioannis / Mikrogeorgis, Georgios
Objectives: The purpose of the present study was the radiographic evaluation of endodontically treated teeth presenting periapical radiolucency and unintentional overfilling with gutta-percha or sealer on treatment outcome and persistence of the extruded materials.
Method and Materials: After assessment using periapical index (PAI), 202 roots filled with gutta-percha and zinc oxide eugenol sealer (Roth 811, Roth International), exhibiting unintentional overfilling and periapical radiolucency were selected. All cases had at least 1 year follow-up. Type of extruded material, periapical status, and removal/persistence of the extruded material were evaluated by two independent observers. Data were statistically analyzed using logistic and linear regression analysis.
Results: Tooth location (P <.001), follow-up period (P <.001), and type of extruded material (P =.004) significantly influenced treatment outcomes. Specifically, posterior roots exhibited better outcomes compared to anterior, and cases with overfilling of sealer showed superior healing potential compared to those with gutta-percha overfilling. Additionally, longer recall periods were associated with improved treatment success. It is also seen that the type of extruded material (P <.001) and follow-up period (P <.001) have significantly affected the presence of extruded material in the follow-up radiograph. The persistence of extruded material was greater when gutta-percha was extruded as well as extruded materials were less detected when the follow-up period was longer.
Conclusion: Teeth with periapical radiolucency and unintentional overfilling require longer follow-up intervals for effective monitoring of healing. Treatment outcome was associated with the type of extruded materials used in the present study. The persistence of those materials in the periapex did not affect healing.
Keywords: endodontically treated teeth, overfilling, periapical radiolucency, radiographic evaluation, treatment outcome
DOI: 10.3290/j.qi.b5437505, PubMed ID (PMID): 38847139June 7, 2024,Pages 1-17, Language: EnglishVerma, Richa / Tewari, Shikha / Anand, Deepti
Objective: Varying levels of sex hormones across the menstrual cycle in young systemically healthy females may alter tissue responses to plaque, resulting in increased gingival inflammation. Also, higher severity and prevalence of gingivitis has been demonstrated in adult females than males, attributed to hormonal changes. Further, literature reported that Gingivitis raises the levels of systemic inflammatory markers such as C Reactive Protein. This interventional trial aimed to evaluate the effect of supragingival scaling on serum highsensitivity C-reactive protein (hsCRP) levels along with periodontal parameters in systemically healthy women of reproductive age group with natural gingivitis.
Material and Methods: 57 women of reproductive age were enrolled into two groups. Test Group (n=30) comprised of systemically healthy women with gingivitis who received supragingival scaling. Control Group (n=27) included systemically and periodontally healthy females. Periodontal parameters [gingival index (GI), plaque index (PI), pocket probing depth (PPD), bleeding on probing (BOP)], and serum hsCRP levels were recorded at baseline for both the groups. Follow up of Test Group participants was done at 3 and 6 months.
Results: Serum hsCRP and periodontal parameters were significantly higher in Test Group than control group at baseline which decreased significantly after treatment in Test Group at 6 months follow up (p≤0.05). GI, BOP and hsCRP in Test Group at 6 months were reduced up to the baseline levels of systemically and periodontally healthy females.
Conclusion: Treatment of gingival inflammation can help in lowering the systemic and local inflammation up to the levels of systemically and periodontally healthy females.
Keywords: C-Reactive Protein, dental scaling, gingivitis, gingival bleeding on probing, inflammation
DOI: 10.3290/j.qi.b5414733, PubMed ID (PMID): 38818638May 31, 2024,Pages 1-32, Language: EnglishHalabi, Dima / Slutzkey, Gil / Meir, Haya / Sebaoun, Alon / Beitlitum, Ilan
Objective: To evaluate the survival of fully guided implants placed with a hollow tooth-supported computerized surgical guide (TSSG).
Materials and Methods: This retrospective study included 94 patients who underwent implant placement using freehand (FH) or tooth-supported computerized surgical guide (TSSG) by the same operator between 2015 and 2020. Early implant failures occurring within one-year post-rehabilitation were assessed.
Results: In the study, two types of implants were placed using two different techniques: TSSG and FH. The TSSG group consisted of 84 S implants and 100 LP implants, while the FH group included 90 S implants and 94 LP implants. The results showed that more implants survived when placed FH compared to TSSG (181 (98.4%) vs 172 (93.5%) respectively, p < 0.05). The only significant factor affecting the success rate was the type of implant, with LP implants having a higher survival rate in the TSSG group (p < 0.05).
Conclusion: Surgeons should consider the impact of implant type on survival rates when utilizing the TSSG system.
Keywords: computer-guided implant placement, dental implant, free-hand placement, smoking, survival rate
DOI: 10.3290/j.qi.b5342511, PubMed ID (PMID): 38757949May 17, 2024,Pages 1-33, Language: EnglishZhang, Qinglai / Zhang, Yue / Lin, Lili / Meng, Fei / Jia, Meng
Objective: To determine the oral health status of patients on maintenance hemodialysis (MHD) and to identify the factors influencing their oral health.
Methods: This observational study included 1,186 patients with chronic kidney disease who received MHD across 33 hospitals in China. The patients were recruited for a questionnaire survey between April and August 2023 at Beijing Chaoyang Hospital using stratified sampling. Data collection tools included the General Information Questionnaire for Maintenance Hemodialysis Patients, the Oral Health Assessment Tool, the Pittsburgh Sleep Quality Index, and the Hospital Anxiety and Depression Scale. Spearman’s rank correlation coefficients were used to assess the relationships between the oral health of patients on MHD and continuous variables such as sleep quality and emotional status. Multiple linear regression analysis was employed to explore the relationship between oral health and various variables.
Results: The oral health scores of the patients ranged from 8 to 22, with a mean score of 12.54 ± 2.63. The final model of the multiple linear regression analysis indicated a goodness of fit of 22.19%. Independent factors affecting the oral health of patients included smoking, the proportion of medical expenses, water consumption, sleep quality, and anxiety scores (all P < 0.05). High levels of smoking, substantial medical expenses, poor sleep quality, and elevated anxiety scores were risk factors for poor oral health (all P < 0.05). Adequate daily water intake served as a protective factor for oral health (P < 0.05).
Conclusion: This study proposes targeted interventions to enhance the management and improvement of oral health in patients on hemodialysis, aiming to provide highly personalised and effective oral health care. These interventions are expected to improve oral health outcomes in future clinical practice.
Keywords: maintenance hemodialysis, oral health, influencing factors, nursing care
DOI: 10.3290/j.qi.b5316977, PubMed ID (PMID): 38726763May 10, 2024,Pages 1-21, Language: EnglishKablan, Fares / Fahoum, Abdallah / Moreinos, Daniel / Srouji, Samer / Slutzky-Goldberg, Iris
Objective: An altered sensation during endodontic treatment can occur due to the extrusion of endodontic materials. This study aims to discuss intentional replantation to address paresthesia resulting from an endodontic file penetrating the inferior alveolar nerve canal (IANC) and provide a protocol for managing nerve injuries in such incidents.
Case presentation: A 12-year-old girl developed paresthesia when an endodontic file separated and was inadvertently pushed through the apical foramen into IANC during root canal treatment of the mandibular left first molar. A CBCT scan revealed the file penetrating the canal towards the inferior border of the mandible. After considering the treatment options, intentional replantation was deemed suitable. The tooth was a-traumatically extracted and preserved in sterile saline. The surgeon then carefully cleaned and irrigated the socket. The radiographic assessment confirmed successful file removal from the socket. The Root ends were resected, and retrograde preparation and obturation were conducted using ultrasonic tips and MTA. The tooth was then replanted into the socket. Successful replantation was confirmed by tooth stability and an audible click. The patient was prescribed antibiotics and steroids. Subsequently, after completing the endodontic treatment. a stainless-steel crown was cemented. The successful intentional replantation procedure resulted in rapid improvement in the patient's condition. The normal sensation had been restored, indicating nerve recovery. At the 15-month follow-up, Periapical bone healing and the eruption of the adjacent second molar were observed, affirming the treatment protocol's overall success.
Conclusion: Prompt intervention and immediate intentional replantation facilitated direct inspection of the separated file within the socket. Collaboration between an oral maxillofacial surgeon and an endodontist ensures expedited and targeted treatment, leading to favorable outcomes.
Keywords: altered sensation, endodontic file extrusion, intentional replantation, multidisciplinary approach, inferior alveolar nerve canal
DOI: 10.3290/j.qi.b5223635, PubMed ID (PMID): 38634627April 18, 2024,Pages 1-16, Language: EnglishAhmed, Eilaf E. A. / Vielhauer, Annina / Splieth, Christian H. / Schmoeckel, Julian / Mourad, Mhd Said
Background: Pre-eruptive intra-coronal radiolucency (PEIR) is a rare dental anomaly often incidentally detected during routine radiographic examinations. This condition manifests as a radiolucent lesion beneath the enamel-dentinal junction of unerupted teeth, particularly in lower molars, posing diagnostic and management challenges due to its asymptomatic nature. The treatment of PEIR depends on the extent of the lesion and the degree of pulp involvement.
Case series: This case series reports on four patients with progressive pre-eruptive intra-coronal radiolucency. In case 1 and 2, lesions were incidentally discovered in an OPG during orthodontic planning (lower permanent 2nd molars), and additional surgical exposure to access the lesion was required as teeth were only partially erupted. Interestingly in case 3, the PEIR was not visible in earlier x-rays though the crown of the tooth was already mineralized (lower permanent 2nd molar). For case 4, the tooth presented with symptoms of reversible pulpitis (lower permanent 1st molar). All lesions were treated with indirect pulp capping using biocompatible material. The patients were followed-up for a period of up to 8 years to evaluate treatment success. Indirect pulp capping and restorations were found to be successful in all four cases in the last follow-up: 1 year (case 2), 1.4 years (case 1), 1.5 years (case 4), and 8 years (case 3).
Conclusion: This case series demonstrates the effectiveness of early intervention via surgical exposure and indirect pulp capping and restoration for managing severe cases of PEIR. However, further research with larger samples and long follow-up is necessary.
Keywords: pre-eruptive intracoronal radiolucency/resorption, hidden caries, occult caries, pulp capping
DOI: 10.3290/j.qi.b5223619, PubMed ID (PMID): 38634626April 18, 2024,Pages 1-21, Language: EnglishSayed Taha, Aisha M. / Almahdi, Wael H. / Alhamad, Nada A.
Objectives: The frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. Frenectomy is the surgical removal of the whole frenum, including the area connected to the bones. This study's purpose was to compare the healing period and postsurgical pain experienced by patients operated with diode and erbium:yttrium-aluminium-garnet (Er:YAG) lasers.
Methods: Twenty referred patients need to excision of the abnormal upper labial frenum were included in this study. Patients were randomly assigned into two groups; Diode group (810 nm, 2W, continuous emission, initiated tip) and Er:YAG group (2940 nm, 2W, 200 mJ, 10 Hz). Both lasers were applied in contact mode. Post-operative pain was assessed with Numerical Rating Scale (NRS) at post-operative 3rd hour and every day during the first week. Epithelialization process of the wound surface was evaluated by hydrogen peroxide solution applied to the wound on days 7, 14, 30, 60 and 90 following operations.
Results: The result shows mean values in Pain index after 3 hours (Diode Group 2.1±2.0, Er:YAG Group 2.6±1.4), 1st day (Diode Group 1.1±1.1, Er:YAG Group 1.9±1.4), and 2nd day (Diode Group 0, Er:YAG Group 0.9±1.1) and shows no significant difference after (3-7 days); p =1.00). In Healing index the results shows a significant difference between the Diode Group and the Er:YAG Group (after 7 days; p = 0.029 and 14 days; p = 0.001) and show no significant difference after (30-60-90 days; p = 1.00).
Conclusions: The Er:YAG laser has better clinical results in healing wounds, whereas the diode laser is better in decreasing pain after frenectomy during follow-up periods.
Keywords: diode laser, erbium:yttrium-aluminium-garnet laser, frenectomy, papillary, papilla penetrating
DOI: 10.3290/j.qi.b4925761, PubMed ID (PMID): 38299599February 1, 2024,Pages 1-19, Language: EnglishSubramanian, Gayathri / Yeung, Vincent / Baredes, Soly / Kim, Sung / Bergsbaken, Tessa / Quek, Samuel Y. P.
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
DOI: 10.3290/j.qi.b4920305, PubMed ID (PMID): 38289001January 30, 2024,Pages 1-25, Language: EnglishHamadeh, Wiam / Alhabashneh, Rola / Abdelhafez, Reem / Khader, Yousef
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
DOI: 10.3290/j.qi.b4790573, PubMed ID (PMID): 38126717December 21, 2023,Pages 1-21, Language: EnglishTobias, Guy / Khaimov, Alexander / Zini, Avi / Sgan-Cohen, Harod D / Mann, Jonathan / Chotiner Bar-Yehuda, Yael / Aflalo, Efrat / Vered, Yuval
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