Clinical Oral Investigations

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Schematic illustration of the groups and assessment of OTM in 2D. a. Cranial growth: the change in distance between the most distocranial point of the clivus and the orbital line (defined by the most mesial point of the orbit, perpendicular to line A). b. Distal movement of the upper incisors: the change in distance between the most distocranial point of the Cclivus and the Incisor line (defined by the anterior margin of the maxillary left incisor, perpendicular to line B). c. Tipping of the first maxillary molar (M1): the change in angle between the horizontal line and the line connecting the anterior root apex and cusp of M1. d. Mesial movement of M1: the change in movement of the apex of the mesial root and the mesial cusp towards the Incisor line. Based on [4]
3D workflow and assessment of OTM in 3D. a, b Micro-CT images at T0 and T1 were superimposed by manual registration; c the superimposition was further optimized by automatic registration; d: The validity of the superimposition was confirmed by inspecting the structural compatibility of different anatomical reference points; e, f, g, h, i the VOIs of the maxilla, mini-screw, incisors, first and second molars were delineated, segmented and saved as 3D models; j the 3D models were loaded in 3-Matic and analyzed in the same coordinate system. The displacement of mini-screw, incisors, first, and second maxillary molars were measured by a global registration strategy, in which the reference points were only defined at T0 and then transferred into the T1 model. The transfer of reference points on T0 models was reiterated (≥ 50 times) until the outcome was constant. Finally, the linear or angular differences between reference points were measured
Article
Abstract Objective (1) To test the accuracy of split-mouth models in rats for the study of orthodontic tooth movement (OTM) and (2) to propose an improved 3D model for quantification of OTM in rats. Methods Eleven Wistar rats were split into group 1 (dental anchorage) and group 2 (skeletal anchorage). In both groups, no orthodontic force (OF) was applied on the contralateral hemi-maxilla. In vivo micro-CT images were taken before (T0) and 31 days (T1) after OF. OTM was compared between time-points and experimental sides using conventional 2D analysis and a novel 3D model. Results Using incisors as anchorage leads to their distal displacement in both OF and no OF sides. In the OF side, movement of M1 is underestimated by incisor displacement. Mesial displacement of M1 was found in the no OF side of all groups 31 days after the application of OF. Conclusions The new 3D model yielded higher sensitivity for tooth displacement in planes other than sagittal and incisor displacement was reduced by using skeletal anchorage. Clinical significance Studies following split-mouth designs in orthodontic research in rats might be systematically underestimating the effects of techniques and/or medication on OTM, since there is tooth displacement on the control side. 3D quantification of OTM with skeletal anchorage is more sensitive and avoids displacement of the dental units used as anchorage.
 
Article
  • Z. AssyZ. Assy
  • D. H. J. JagerD. H. J. Jager
  • H. S. BrandH. S. Brand
  • F. J. BikkerF. J. Bikker
Objectives In this study, we investigated the salivary film thickness and the MUC5B levels at various intra-oral locations in healthy volunteers, with a focus on the palate. Besides, measurements of the palatal surface area were included to explore the possible relationships between the palatal surface area and the palatal salivary film and MUC5B levels. Materials and methods The salivary film thickness was determined using filter strips, which were pressed to the mucosal surfaces of five different intra-oral locations; conductance was then analysed using a Periotron. After elution of the strips, the MUC5B levels at various intra-oral locations were determined using ELISA. The palatal surface area was measured using an intra-oral scanner. The surface area was subsequently calculated using the software. Results The anterior tongue had the thickest salivary film and also the highest levels of MUC5B, while the anterior palate had the thinnest salivary film and lowest MUC5B levels. There was no association between the palatal surface area and the salivary film thickness of the palate. Conclusion The salivary film and MUC5B levels are unequally distributed over the intra-oral regions of the soft tissues. The lack of association between the palatal surface area and the salivary film thickness indicates that a larger surface area is not associated with a relative thinner palatal salivary film. Clinical relevance The results of the current study increase our understanding of saliva distribution in the oral cavity and could be used as reference values for future studies.
 
Article
  • Anton StraubAnton Straub
  • Andreas VollmerAndreas Vollmer
  • Thiên-Trí LâmThiên-Trí Lâm
  • [...]
  • Stefan HartmannStefan Hartmann
Objectives Mechanisms of wound healing are often impaired in patients with osteonecrosis of the jaw (ONJ). According to the guidelines for the treatment of this disease, early surgical intervention is indicated. However, surgery often faces complications such as wound healing disorders. The application of platelet-rich fibrin (PRF) after necrosectomy between bone and mucosa may constitute a promising approach to improve surgical results. An aspect that was not investigated until now is that PRF acts as a “bio-carrier” for antibiotics previously applied intravenously. Materials and methods We investigated the antimicrobial properties of PRF in 24 patients presenting ONJ undergoing systemic antibiosis with ampicillin/sulbactam. We measured the concentration of ampicillin/sulbactam in plasma and PRF and performed agar diffusion tests. Ampicillin/sulbactam was applied intravenously to the patient 10 minutes for blood sampling for PRF. No further incorporation of patients’ blood or PRF product with antibiotic drugs was obtained. Four healthy patients served as controls. Results Our results revealed that PRF is highly enriched with ampicillin/sulbactam that is released to the environment. The antibiotic concentration in PRF was comparable to the plasma concentration of ampicillin/sulbactam. The inhibition zone (IZ) of PRF was comparable to the standard ampicillin/sulbactam discs used in sensitivity testing. Conclusions The results of our study demonstrated that PRF is a reliable bio-carrier for systemic applied antibiotics and exhibits a large antimicrobial effect. Clinical relevance We describe a clinically useful feature of PRF as a bio-carrier for antibiotics. Especially when applied to poorly perfused tissues and bone such as in ONJ, the local release of antibiotics can reduce wound healing disorders like infections.
 
The quality of bone union scores of FRC, FRC-C, and control group at the 4th and 12th weeks. FRC, fiber-reinforced composite; FRC-C, woven-coated fiber-reinforced composite. Asterisk means statistical difference according to chi-square test (p<0.05)
The scores of osteoblastic activity, osteoclastic activity, soft and hard tissue inflammation, periosteal reaction, and fibrosis of FRC, FRC-C, and control group at the 4th and 12th weeks. FRC, fiber-reinforced composite; FRC-C, woven-coated fiber-reinforced composite. Asterisk means statistical difference according to chi-square test (p<0.05)
Histopathological examinations: A severe odontoblastic activity and callus formation of FRC at 12th week, original magnification ×40; B odontoblastic activity and callus formation of FRC at 12th week, original magnification ×100; C callus formation and the periosteal reaction of FRC 12th week, original magnification ×40; D periosteal reaction, fibrosis, and callus formation of FRC-C 4th week, original magnification ×40. FRC, fiber-reinforced composite; FRC-C, woven-coated fiber-reinforced composite
SEM examinations. A Bone and FRC material at 12th week. B Control group at 12th week. C Organic matrix and fibers of FRC at12th week. D FRC-C material and bone at 12th week. FRC, fiber-reinforced composite; FRC-C, woven-coated fiber-reinforced composite
Article
  • Ahmet Mert NalbantoğluAhmet Mert Nalbantoğlu
  • Kaya ErenKaya Eren
  • Deniz YanikDeniz Yanik
  • [...]
  • Ersin TuncerErsin Tuncer
Objectives To investigate biocompatibility and bone contact area of FRC and woven-coated FRC (FRC-C) in rats. Materials and methods Sixty rats were allocated to three groups: FRC (n=20), FRC-C (n=20), and control group (n=20). Subgroups were determined as 4th (n=10) and 12th weeks (n=10). The specimens were placed in the femur of rats. In the control group, the bone defects were left empty and sutured. Four and 12 weeks after implantation, the rats were sacrificed. Histopathological examinations were performed in a semi-quantitative manner. Twenty rats (n=20) were used for scanning electron microscopy (SEM) examination. Bone contact surfaces were calculated in SEM analysis. A chi-square test was performed to analyze the data. Results No statistical difference was detected between the 4th and 12th weeks in the quality of bone union. Quality of bone union was lower in FRC compared to the control group in the 4th week (p=0.012) and the 12th week (p=0.017). The periosteal reaction at the 12th week was lower in FRC than in the control group (p=0.021). Bone contact of FRC and FRC-C was 85.5% and 86.3%, respectively. Conclusions FRC and FRC-C were biocompatible and showed no inflammation. The woven coating did not increase the quality of bone union and bone contact area, while not reducing biocompatibility. Clinical relevance The biocompatibility and good bone response of the woven glass fiber net were demonstrated to have the potential as a scaffold for the augmentation of alveolar bone deficiencies and the reconstruction of maxillofacial defects.
 
Article
Objectives To investigate the effect of inclusion of silver nano-particles (SNP) or bioactive glass (BG) on the surface characteristics and bacterial adhesion of prototype tricalcium silicate (TCS)–based cements alongside two commercial cements, under different aging periods and exposure conditions. Materials and methods A basic formulation of radio-opacified TCS without (TZ-base) and with additions of SNP (0.5, 1, or 2 mg/ml) or BG (10 or 20%) was used. Biodentine and intermediate restorative material (IRM) served as reference materials. Material disks were immersed in ultrapure water or fetal bovine serum (FBS) for 1, 7, or 28 days. Surface roughness ( n = 3), microhardness ( n = 9), and wettability ( n = 6) were analyzed by standard procedures. Adhesion of Enterococcus faecalis was assessed by fluorescence microscopy ( n = 5). Data from these assays were evaluated for normality and comparisons among groups were conducted with statistical procedures ( p < 0.05 for significance). Results The surface morphology of SNP- and BG-containing cements had higher roughness values than TZ-base after 28 days ( p < 0.05). No differences in microhardness were observed among prototype cements ( p > 0.05). Biodentine presented smooth surface characteristics and the highest hardness values ( p < 0.05). The FBS-immersion resulted in surface reactions in prototype materials and Biodentine, depicted with scanning electron microscopy. All 1- and 7-day prototype cements showed negligible bacterial adhesion, while in Biodentine and IRM, noticeable E. faecalis adherence was observed from day 1 ( p < 0.05). Conclusions Incorporation of SNP or BG did not improve the antibacterial effect of the experimental cement; all 28-day aged materials failed to inhibit bacterial adherence. The measured physical parameters did not appear to be related to the degree of bacterial adhesion. Exposure of TCS-based cements in FBS resulted in surface reactions, which did not affect bacterial adhesion. Clinical relevance Changes in the surface characteristics of prototype TCS-based cements by inclusion of SNP and BG or exposure to different environments did not affect bacterial adhesion. All experimental materials showed inferior physical properties and higher antibacterial effect than Biodentine.
 
Article
Aim This study aimed to identify medications taken by patients before dental appointments and to simulate and characterize their interactions with medications often prescribed by dental surgeons. Materials and methods A retrospective cross-sectional study evaluated 320 medical records, 118 from the Emergency Service (ES) archives, and 202 from elective appointments at the Dental Clinic (DC) of a university in southern Brazil. Drug interactions were identified and classified according to severity using the Medscape® application into four grades: (1) Minor, (2) Monitor closely, (3) Serious, or (4) Contraindicated. Descriptive and inferential statistical analyses were carried out (α = 5%). Results Preexisting systemic conditions were noted in 55.9% of the medical records from the ES and 64.35% from the DC. In the ES records, 47.45% contained information on continuous use medication for treatment of systemic conditions and 59.40% of DC records contained such information. A total of 359 potential interactions were found. Drug interactions with analgesics were most frequent, accounting for 50.41% of the sample. Conclusions The most prevalent drug interaction severity was grade 2: monitor or use with caution. Many patients take medications to treat systemic conditions and seek dental care, generating a significant possible source of drug interactions. Clinical relevance Prescribers must carefully analyze the patients’ medical histories and obtain accurate data regarding their use of medications to be able to assess the risk–benefit relationships of possible combinations.
 
Schematic diagram of the experimental design
Representative SEM images of the dentin specimens after erosive challenge at 5000 × magnification. a Control group. b MMP inhibitor group. c Cysteine cathepsin inhibitor group. d MMP + cysteine cathepsin inhibitor group. The demineralized organic matrix (DOM) is indicated by the dashed lines
Article
Objective This in situ study aimed to evaluate the effects of the inhibitors of matrix metalloproteinases (MMPs) and cysteine cathepsins on dentin erosion. Materials and methods Ten volunteers participated in this study. Each volunteer wore an intraoral appliance containing 4 dentin specimens subjected to different treatments: deionized water as a control, 1 mM 1,10-phenanthroline (an MMP inhibitor), 50 µM E-64 (a cysteine cathepsin inhibitor), and 1 mM 1,10-phenanthroline + 50 µM E-64. The specimens were dipped in 5 ml of the respective solutions for 30 min at room temperature and then exposed to in vivo erosive challenges by rinsing with 150 ml of a cola drink (4 × 5 min/day) for 7 days. The substance loss of the specimens was measured by profilometry. The transverse sections of the specimens were examined using scanning electron microscopy. Thereafter, the demineralized organic matrix (DOM) of the specimens was removed using type I collagen enzyme and assessed by performing profilometry. The differences in substance loss and DOM thickness among the groups were analyzed by one-way repeated-measures analysis of variance (ANOVA) and Bonferroni’s test at a level of P < 0.05. Results Protease inhibitors significantly reduced substance loss in comparison to that of the control group (all P < 0.05). A significantly thicker DOM was observed for the specimens treated with protease inhibitors than for the control specimens (all P < 0.05). No significant differences in substance loss or DOM thickness were found among the MMP inhibitor, cysteine cathepsin inhibitor, and MMP + cysteine cathepsin inhibitor groups. Conclusions The use of MMP and cysteine cathepsin inhibitors was shown to increase the acid resistance of human dentin, which may be due to the preservation of the DOM. Clinical relevance The application of protease inhibitors could be considered an appropriate preventive strategy for dentin erosion.
 
Overall survival rate of oral mucosal melanoma patients (n = 69). The 2-year and 5-year OS rates were 64.6% and 42.5%, respectively
Overall survival rate according to the clinical stage (n = 69). The 2-year and 5-year OS rates were 85.9% and 72.5%, respectively, for patients with stage III disease, and 56.3% and 26.0%, respectively, for those with stage IVA disease. Among the stage IVB/IVC patients, the 1-year OS rate was 26.7%
Overall survival rate according to the therapeutic approach (n = 69). The 2-year and 5-year OS rates of the radical therapy group were 74.1% and 50.5%, respectively, whereas the 2-year OS rate of the non-radical therapy group was 26.0%
Article
Objectives The purpose of this multicenter retrospective study was to investigate the demographic characteristics and treatment outcomes of patients with mucosal malignant melanoma (MM) of the oral cavity. Materials and methods This was a multicenter study involving 8 Japanese universities. The medical records of 69 patients who were diagnosed with primary oral MM between January 2000 and December 2020 were retrospectively analyzed. Overall survival (OS) and prognostic factors for OS were analyzed statistically. Results There were 40 (58.0%) males and 29 (42.0%) females, and their mean (range) age was 69.8 ± 14.6 (22–96) years old. The most common primary site was the palate (30 patients, 43.5%). Stage IVA was the most common disease stage (36 patients, 52.2%). Radical therapy was performed in 55 patients (79.7%). The 2-year and 5-year OS rates of the 69 patients were 64.6% and 42.5%, respectively. The 2-year and 5-year OS rates of the stage III patients were 85.9% and 72.5%, respectively, and those of the stage IVA patients were 56.3% and 26.0%, respectively. The 1-year OS rate of the stage IVB/IVC patients was 26.7%. The 2-year and 5-year OS rates of the radical therapy group were 74.1% and 50.5%, respectively, whereas the 2-year OS rate of the non-radical therapy group was 26.0%. An advanced T classification was the only identified prognostic factor for OS (hazard ratio: 6.312, 95% confidence interval: 1.133–38.522, p < 0.05). Conclusions Early detection and radical treatment are essential for improving the prognosis of oral MM patients. Clinical relevance Early detection and adequate radical therapy leads to the better prognosis of oral MM patients.
 
Viability of Vero cells after incubation with resin composites after 24, 48, 72, and 168 h
Article
Objectives To analyze and compare, in vitro, the microhardness, sorption, solubility, color stability, and cytotoxicity of three types of resin composites: self-adhesive (SARC) (Dyad Flow (DF)/Kerr), bulk-fill (Filtek Bulk Fill Flow (FBF)/3 M ESPE), and conventional (Filtek Z350XT Flow (Z350)/3 M ESPE). Materials and methods Thirty cylindrical specimens were prepared using a split metal mold (15 mm × 1 mm), divided into 3 groups (n = 10) according to the material used. Vickers hardness (VH) was calculated from three indentations (300gf/15 s) per specimen. The sorption and solubility were measured according to the ISO 4049:2009 specification after storing in distilled water for 7 days. The color of each resin composite was measured using a portable digital spectrophotometer according to the CIELAB system. After a 7-day immersion in coffee, the color variation (∆E) was calculated. Following the ISO 10993:2012, the cytotoxicity in Vero cells was evaluated through the MTT assay. The results were analyzed using the Kruskal–Wallis test to compare the studied groups. The Wilcoxon test was used to compare the assessments in each studied group. For cytotoxicity analysis, the data were compared by the ANOVA test (α = 0.05). Results DF showed the lowest VH (28.67), highest sorption (0.543 µg/mm³) and solubility (1.700 µg/mm³), and higher ∆E after 7 days of coffee immersion (p = 0.008). The resin composites studied were considered non-cytotoxic. Conclusions The SARC presented inferior mechanical and physical–chemical properties than bulk-fill and conventional resin composites, with comparable cytotoxicity against Vero cells. Clinical relevance The simplification of the clinical protocol of SARC can minimize the number of possible failures during the restorative technique. However, considering their inferior physical and mechanical properties, their coverage with materials of higher mechanical properties and physical–chemical stability should be considered.
 
Cephalometric angular and linear variables measured in the study: (1) SNA, (2) SNB, (3) ANB, (4) SN.GoGn, (5) LAFH, (6) 1.PP, (7) IMPA, (8) Overjet, and (9) Overbite
a Overbite changes in the PC group. b Overbite changes in the EPC group
Article
Objectives This study aimed to compare the stability of anterior open bite (AOB) in patients treated with and without rapid maxillary expansion (RME) before fixed palatal crib (PC) therapy in the mixed dentition. Material and methods Expansion/palatal crib group (EPC) was comprised of 25 patients (10 male, 15 female, mean initial age of 7.8 years) with AOB treated with RME before PC therapy. Palatal crib group (PC) included 25 patients with AOB (10 male, 15 female, mean initial age of 8.0 years) treated only with PC therapy. Lateral cephalograms were analyzed at pre-treatment (T0), after PC therapy (T1), and 3 years after PC removal (T2) in both groups. AOB relapse was considered when a negative overbite was observed at T2. Intergroup comparisons of interphase changes were performed using t and Mann–Whitney tests (p < 0.05). Results Treatment and post-treatment alterations showed similar changes in both groups for all cephalometric variables. Overall changes from T0 to T2 were similar between the groups except for the maxillary incisors that tipped lingually in PC group (1.PP = − 3.37°) and labially in EPC group (1.PP = 1.76°). The frequency of AOB relapse was 8% and 4% in the EPC and PC groups, respectively. Treatment time in the EPC group (9.7 months) was shorter (p = 0.024) when compared to the PC group (11.0 months). Conclusions In the mixed dentition, stability of AOB treated with RME before fixed PC therapy was similar to PC therapy alone. However, treatment time with fixed PC was slightly shorter in the group treated with RME. Clinical relevance This study aims to understand if RME performed previously to fixed palatal crib contributes to the index of stability of AOB treatment in the mixed dentition.
 
Article
Objectives Free fibula flap is the first choice for jaw reconstruction in head and neck oncology, but postoperative complications in donor site are ignored always. The main purpose of this study was to investigate the long-term complications and potential risk factors of donor site after vascularized fibular transplantation, and to explore the precautions of preparing vascularized fibular flap and the measures of preventing donor site complications. Materials and methods Data were retrospectively collected on 31 patients who had undergone immediate mandibular reconstruction with a fibular flap after segmental mandibulectomy from 2013 to 2018 in Shanghai Ninth People’s Hospital. Thirty-one patients (24 male, 7 female) were available for the long-term complications in donor site analysis from 25 to 96 months after surgery. The data were collected and analyzed, including age at time of operation, early postoperative complications, incidence of dorsiflexion weakness of hallux, donor site missing fibula length, proximal and distal stump fibula length, and subjective evaluation of foot function (AOFAS-hallux, AOFAS-ankle hindfoot, Enneking lower limb function score). In the single-factor analysis in this study, the correlation between related factors and long-term complications was statistically analyzed. For inter-group comparisons of quantitative data, if the normal distribution was satisfied, two independent sample t-tests were used; p < 0.05 was statistical significant. If the normal distribution was not satisfied, Wilcoxon rank-sum test was used, and p < 0.05 was considered statistically significant. For qualitative data, the Fisher exact probability method was compared between group differences, and p < 0.05 was statistically significant. Results The most commonly encountered complication in our series was dorsiflexion disorder, flexion deformity, numbness of the lateral side of the lower leg, and dorsum of the foot. Ten patients (32.26%) developed hallux flexion deformity after operation, 17 patients (54.84%) had hallux dorsiflexion dysfunction after operation, and 10 patients (32.26%) had numbness of the lateral side of the lower leg and dorsum of the foot. The incidence of hallux dorsiflexion dysfunction, thumb flexion deformity, and sensory disturbance was higher than that of other long-term complications in the donor area. The residual length of fibular distal was related to the dorsiflexion dysfunction and flexion deformity of hallux (p < 0.05). The early complications of donor site were correlated with the hallux dorsiflexion dysfunction (p < 0.05). Conclusions The incidence of dorsiflexion disorder and flexion deformity is higher in patients after fibula transplantation. The less the residual length of fibular distal, the more obvious the long-term complications in the donor site, and the higher the incidence of dorsiflexion dysfunction and flexion deformity of hallux. Clinical relevance The long-term complications of donor site after fibular transplantation seriously affect the quality of life of patients and provide clinical reference for further reducing the occurrence of donor site complications.
 
Article
Objectives The aim of this study is to analyze the esthetic perception of selected canine features, namely crown length, shade, inclination, and angle of incisal edge tip. Materials and methods The anterior maxillary teeth of a Central European woman were photographed and digitally modified in order to investigate esthetic perceptions of the above four categories. Three groups of examiners with different levels of experience in the field of dentistry (laypersons/inexperienced dental students, advanced dental students, dentists) evaluated the photographs twice with the help of visual analogue scales. Results The best-evaluated canines have approximately the same length as the central incisor, have the same shade as the other anterior teeth, are best embedded in a lighter overall tooth shade, are neutral to slightly palatal inclined, and have a right angled to rounded incisal edge (≥ 90°). The canines evaluated as least esthetic, however, are longer than the central incisors, darker, inclined labially, and have a tapered incisal edge. No significant differences could be found between the evaluations of the groups with regard to the four feature categories. Conclusions Laypersons, advanced dental students, and dentists generally evaluate according to the same esthetic standards. Gender does not have a significant influence on evaluation. Clear definitions of esthetically favored shades, incisal edge shapes, inclination, and lengths of the canines can be given. Clinical relevance Since the esthetics of the smile line play a critical role for patients, dentists, dental technicians, and their supplying industry, knowledge of the esthetically preferred morphology of canines is essential. Clinical significance The aim of this study is to give clear definitions of esthetically favored shades, incisal edge shapes, and lengths of the canines, as the esthetics of the smile line play a critical role for patients, dentists, dental technicians, and their supplying industry (e.g., denture tooth manufacturers). Precise knowledge of esthetic preferences is important in clinical practice for both dentists and dental technicians, for example, in order to adequately advise patients regarding esthetic corrections. Also, in the case of missing teeth, this knowledge is essential for optimal and satisfactory restorations. Thus, this study can contribute to the satisfaction of general practitioners and patients.
 
Mean value of number of teeth in the age cohorts 60 years and 81 years examined at exam 1 and exam 2
Illustration of percent teeth with different pocket depth 5 mm, 6 mm, 7 mm, and 8 mm or more in the age cohorts of 60 years
Illustration of percent teeth with different pocket depth 5 mm, 6 mm, 7 mm, and 8 mm or more in the age cohorts of 81 years
Article
Objective This study aimed to analyze the oral health status of four different birth cohorts: two cohorts of 60-year-olds born in 1941–1943 and 1954–1955 and 2 cohorts of 81-year-olds born in 1920–1922 and 1933–1934. Material and methods The study was based on data from an ongoing longitudinal population project, The Swedish National Study on Aging and Care (SNAC). Oral health status was repeatedly examined clinically and radiographically in 2001–2003 and 2014–2015, including 60- and 81-year-olds, in total 412 individuals. Statistical analyses were performed using independent-samples t test and Pearson’s χ² test. Results More individuals were dentate in 2014–2015 compared to 2001–2003 in the two age groups: 60 and 81 years (p < 0.001 for both). The mean number of teeth increased in the 60-year-olds from 24.2 to 27.0 and in the 81-year-olds from 14.3 to 20.2. The numbers of at least one intact tooth increased for both age groups (p < 0.001 and p < 0.004, respectively). In the age groups 81 years, there was an increase in having at least one PPD ≥ 6 mm (p < 0.016) and bone loss ≥ 5 mm (p < 0.029) between the two examinations. No such differences were found in the age groups of 60 years. Conclusion Over 13 years, oral health improved for both 60- and 81-year-old age groups. The most significant changes were in the 81-year-olds where oral health had improved except for periodontal status. Clinical relevance More natural teeth and impaired periodontal status potentially impact oral health and should increase focus on preventive and supportive dental care in older individuals.
 
Article
Introduction Throat packs (TP) are used in upper airway surgery to avoid accumulation and aspiration of blood, foreign bodies, and fluids. But side effects such as sore throat and TP retention have been reported and challenge the standardized use of TP. The aim of this study is to compare benefits and side effects of TP versus no TP for upper airway procedures in intubation anesthesia. Material and methods One hundred forty-eight patients with surgical interventions at the upper airway under intubation anesthesia were included. Of those, n = 74 each were treated without (A, control) and with (B) TP. Study group B was subdivided whether TP was placed by the surgeon (B1; n = 37) or by the anesthesiologist (B2; n = 37). TP-related side effects such as sore throat, foreign body sensation, hoarseness, dyspnea, difficulty of swallowing, nausea, retching, nausea, aspiration, and pneumonia as well as the influence of TP design and the applicant (surgeon or anesthetist) were analyzed. Results A significantly increased rate of difficulty of swallowing (p = 0.045), intensity of sore throat (p = 0.04), and foreign body sensation (p = 0.024) was found in group B when compared to group A. There was no correlation between hoarseness, dyspnea, nausea, retching, and TP. No case of aspiration or pneumonia was seen but one TP was accidentally forgotten in the patient. B2 showed an increased frequency of difficulty swallowing, followed by A and B1. B1 led to the highest incidence of nausea followed by the A and B2. Conclusion The use of TP led to a high rate of side effects without showing the propagated advantages. Clinical relevance The use of TP must be considered critically and cannot generally be recommended without specific reasons, such as high aspiration risk.
 
Box plots of the blood work of COVID-19 patients at admission (initial) comparing patients without periodontitis with those with periodontitis that have received treatment for periodontitis and those that did not receive periodontal treatment. (*) indicates significant differences between groups (p < 0.05). The letter n indicates the number of patients analysed for each parameter and condition
Box plots of the blood work of COVID-19 patients before being discharged, comparing patients without periodontitis with those with periodontitis that have received treatment for periodontitis and those that did not receive periodontal treatment. (*) indicates significant differences between groups (p < 0.05). The letter n indicates the number of patients analysed for each parameter and condition
Article
Background In previous studies, COVID-19 complications were reported to be associated with periodontitis. Accordingly, this study was designed to test the hypothesis that a history of periodontal therapy could be associated with lower risk of COVID-19 complications. Methods A case–control study was performed using the medical health records of COVID-19 patients in the State of Qatar between March 2020 and February 2021 and dental records between January 2017 and December 2021. Cases were defined as COVID-19 patients who suffered complications (death, ICU admissions and/or mechanical ventilation); controls were COVID-19 patients who recovered without major complications. Associations between a history of periodontal therapy and COVID-19 complications were analysed using logistic regression models adjusted for demographic and medical factors. Blood parameters were compared using Kruskal–Wallis test. Results In total, 1,325 patients were included. Adjusted odds ratio (AOR) analysis revealed that non-treated periodontitis was associated with significant risk of need for mechanical ventilation (AOR = 3.91, 95% CI 1.21–12.57, p = 0.022) compared to periodontally healthy patients, while treated periodontitis was not (AOR = 1.28, 95% CI 0.25–6.58, p = 0.768). Blood analyses revealed that periodontitis patients with a history of periodontal therapy had significantly lower levels of D-dimer and Ferritin than non-treated periodontitis patients. Conclusion Among COVID-19 patients with periodontal bone loss, only those that have not received periodontal therapy had higher risk of need for assisted ventilation. COVID-19 patients with a history of periodontal therapy were associated with significantly lower D-dimer levels than those without recent records of periodontal therapy. Clinical relevance The fact that patients with treated periodontitis were less likely to suffer COVID-19 complications than non-treated ones further strengthen the hypothesis linking periodontitis to COVID-19 complications and suggests that managing periodontitis could help reduce the risk for COVID-19 complications, although future research is needed to verify this.
 
Relation between duration of mucositis and periodontal health status. *Comparison to healthy group, healing duration of mucositis was significantly longer in the gingivitis group healthy group (p: 0.026). Healing duration of mucositis was significantly longer in the periodontitis group than healthy group (p: 0.012)
Article
Objectives Oral mucositis (OM) is a frequent complication of cancer treatments. Oral mucositis and periodontal disease have a common inflammatory pattern. The purpose of this study was to evaluate the OM and its association with periodontal status in patients with hematologic malignancies who undergo high-dose chemotherapy. Materials and methods Fifty-five patients who received high-dose chemotherapy were included in the study. Full-mouth periodontal clinical measurements including plaque index (PI), gingival index (GI), clinical attachment level (CAL), and probing depth (PD) values were recorded before the condition chemotherapy regime. OM monitoring was initiated 1 day after the chemotherapy and maintained for 20 days. Results Twenty-two of patients (40%) were observed oral mucositis after high-dose chemotherapy. Patients with mucositis had significantly higher GI scores than those who did not have mucositis (p < 0.05). There was a significantly moderate positive correlation between the grade of mucositis and GI scores (p < 0.05). In patients with periodontitis, the incidence of grade 1–2 mucositis was significantly higher than in the healthy group (p < 0.05). In individuals with periodontitis and gingivitis, the healing duration of mucositis was significantly longer than the healthy group (p < 0.05). Conclusions The results of this study showed that the severity grades of oral mucositis may increase in patients with gingival inflammation. The results also suggest that periodontal diseases may have a significant impact on the duration of oral mucositis. Clinical relevance The current study contributes to our understanding of the importance of oral health status in reducing the occurrence, severity, and duration of OM in hematological cancer patients treated with high-dose chemotherapy.
 
Consort flow diagram on subject enrollment, allocation, follow-up, and analysis
Article
Objectives To evaluate the efficacy of a gel-containing propolis extract, nanovitamin C, and nanovitamin E as adjuvants to professional plaque removal on desquamative gingivitis (DG). Materials and methods A randomized clinical trial was conducted on patients suffering DG due to mucocutaneous diseases. Patients received professional supragingival prophylaxis with oral hygiene instructions and were randomly assigned to use test or control gels as toothpaste and to apply it on DG lesions 3 times/day for 4 weeks. DG clinical score (DGCS), clinical periodontal variables, and visual analog scale (VAS) for pain and oral health impact profile (OHIP-14) were collected at baseline, 2 and 4 weeks. Results Twenty-two patients were randomly assigned to test ( n = 11) or control group ( n = 11). Eighteen had diagnosis of oral lichen planus and four of mucous membrane pemphigoid. DGCS statistically decreased in both groups after treatment with no significant differences between groups. Clinical periodontal outcomes decreased in both groups, but no significant differences were observed. Periodontal variables statistically improved only in test group after treatment. VAS and OHIP-14 scores decreased in test and control groups without significant differences. However, only one test group showed a statistically significant decrease in VAS and OHIP-14 scores after treatment. No adverse effects were reported. Conclusions Test gel may alleviate DG and improve quality of life without side effects. Clinical relevance A gel-containing propolis extract, nanovitamin C, and nanovitamin E as adjuvants to mechanical debridement may improve both clinical and patient related outcomes in DG patients without side effects. Clinical trial registration. The study protocol was registered at clinicaltrials.gov with the following number: NCT05124366 on October 16, 2021.
 
Article
Objectives Different parameters have been identified in patients with oral squamous cell carcinomas (OSCC) that have a serious impact on survival, including residual tumour and extracapsular spread. Moreover, other factors, including the lymph node ratio (LNR) and lymph node yield (LNY), have been suggested as prognostic markers. Material and methods This retrospective study included patients diagnosed with OSCC and cervical lymph node metastases during the years 2010–2020. Patients’ records were evaluated regarding lymph node status, final therapy regime, tumour recurrence, time to death, tumour association with death, disease-free survival (DSF), and overall survival (OS). Results In 242 patients with a mean age of 63.57 ± 11.24 years, treated either by selective neck dissection (SND; n = 70) or by modified radical neck dissection (MRND; n = 172), 5772 lymph nodes were detected. The LNR and LNY were identified as independent risk factors in OS and DFS. The optimal cut-off point for the LNY was ≥ 17 lymph nodes in the SND and ≥ 27 lymph nodes in the MRND group. The metastatic lymph node clearance (MLNC) was established as a score to relate the LNR and LNY to the extent of lymph node removal. Survival analysis showed statistically significant differences among score levels. Conclusions As information about the extent of nodal dissection is excluded from LNR and LNY, we propose the use of a new scoring system comprising individual cut-off values for LNY and LNR with regard to the extent of neck dissection. Clinical Relevance MLNC might help to identify high-risk OSCC patients with metastatic lymph nodes.
 
Pearson’s correlation between (a) ΔE00 and ΔEab and (b) ΔTP00 and ΔTPab values, coefficient of determination (R²) and regression equations for ΔEab and ΔTPab from the known ΔE00 and ΔTP00 values, respectively
CIEDE2000 color differences (ΔE00) compared with literature data for visual thresholds for gingiva and gingiva-colored materials [15]. Excellent match: ΔE00 ≤ 1.1 or ΔEab ≤ 1.7 (PT); acceptable match: ΔE00 > 1.1 and 2.8 or ΔEab > 1.7 and ≤ 3.7 (AT); mismatch type [a]: ΔE00 > 2.8 and ≤ 5.6 or ΔEab > 3.7 and ≤ 7.4 (> AT and ≤ AT × 2); mismatch type [b]: ΔE00 > 5.6 and ≤ 8.4 or ΔEab > 7.4 and ≤ 11.1 (> AT × 2 and ≤ AT × 3); and mismatch type [c]: ΔE00 > 8.4 or ΔEab > 11.1 (> AT × 3). C, coffee; W, wine; A, artificial aging; BG, Beautifil; IB, IvoBase; CL, crea.lign; PB, ProBase; NX, Nexco Paste
Article
Objectives To evaluate CIEDE2000/CIELAB differences in color (ΔE00/ΔEab), and translucency parameter (ΔTP00/ΔTPab), and gloss of gingiva-colored resin-based restorative materials upon staining/aging. Materials and methods Disc-shaped, 10 mm in diameter, and 2-mm-thick samples (n = 5/group) were made from giomer (Beautifil II gingiva), oligomer-based (crea.lign GUM gel), CAD/CAM polymethyl-methacrylate-based (IvoBase CAD), PMMA-based (ProBase Hot), and dimethacrylate-based (SR Nexco Paste Gingiva). Color and gloss were recording using a benchtop spectrophotometer and gloss meter, respectively, at baseline (T0), and upon staining in coffee or red wine for 60 (T1) and 120 h (T2), or artificial aging of 150 kJ/m² (T1) and 300 kJ/m² (T2). Three-way analysis of variance (materials x staining conditions x time intervals), Tukey’s test (α = 0.05), and Pearson’s correlation test were used in analytical statistics. Results CIEDE2000 color differences ranged from 1.0 to 4.4 (coffee), 1.5 to 5.3 (wine), and 0.9 to 2.0 after artificial aging, with ΔE00 values being significantly higher for Beautifil than other materials (p < 0.05). ΔTP00 values ranged from 0.2 to 0.7 and were statistically higher upon staining in wine compared to artificial aging (p < 0.05). Gloss values at T0 were 76.7–87.0. Beautifil exhibited the lowest gloss retention (50.8–60.2%) after staining, compared to > 90% of other materials (p < 0.05). ΔE00/ΔEab and ΔTP00/ΔTPab were positively correlated (p < 0.0001). Conclusions Color, translucency, and gloss changes of gingiva-colored restorative materials were material- and staining/aging-dependent. Generally, wine caused greatest changes in color (with IvoBase CAD being the most color stable) and translucency parameter. All materials except Beautifil gingiva II exhibited staining- and aging-dependent gloss retention greater than 90% for all compared time intervals. Clinical relevance Optical properties of resin-based gingiva-colored restorative materials depend on material, staining/aging conditions, and exposure time. Certain materials should be avoided in individuals with high consumption of red wine and coffee.
 
Clinical pictures showing first implant surgery and study group creation. Placing 2.9-mm diameter smooth bone level tapered implant. Ligature placed at the implant-abutment connection at the test group
Four weeks after first implantation, explantation and new implant installation were performed. New 3.3-mm diameter bone level tapered SLActive implant. Note the amount of inflammation at the test in comparison to the control sites
Sequence of the bone healing process in defects created around lost implants. a Lost in the last 3 weeks, b 3–4 weeks, c, d 4–5 weeks, e 5–6 weeks, f 6–7 weeks, g 7–8 weeks
Control group (b). Implants were surrounded by lamellar bone in narrow contact with the bone, with abundant blood vessels. Crestal bone loss in buccal side was limited. Measurements of the bone implant contact (BIC) in the buccal (a) and lingual (c) side
Test group (b). Implants showed an increment in the remodeled bone (blue intense) with a higher bone loss around buccal crest. BIC in buccal (a) and lingual (c) side
Article
Objectives To develop a new preclinical model to study early implant loss, where local infection conditions would impair the implant osseointegration. Materials and methods Forty-eight smooth, 2.9-mm diameter experimental implants were placed in the mandible of 8 beagle dogs (3 in each side). In half of the animals (test group, n = 24 implants), the implants received ligatures around the implant-abutment connection. In the other half, no ligatures were placed (control group, n = 24 implants). Four weeks later, implants were extracted in a flapless approach and standard 3.3-mm diameter SLActive implants were placed into the same osteotomy site without any further drilling. Eight weeks after the second implantation, animals were sacrificed and analyzed in terms of implant survival. Results After 8 weeks of healing, 4 implants were lost in the control group and 14 in the test group. This corresponded to a 17.4% of early implant loss in the control group and 58.3% in the test. Most of the early failures occurred within the first 5 weeks of healing. Conclusions Implants placed in a pre-contaminated site present higher early loss than those placed in a non-contaminated site. This study represents a valid and robust preclinical model to study mechanisms and reduction of early implant loss as new technologies become available. Clinical relevance Scientific rationale for the study: There is lack of animal models to study early implant loss. Thus, a proposal of a new model is presented. With the validation of this model, new technologies can be implemented to prevent early implant loss.
 
Positive for tumor cells: There are huge differences in size, form and staining of the nuclei together (1) with an increased Nuclear/cytoplasmatic (N/C) ratio (2). There is proteinaceous necrotic debris, i.e. tumor diathesis (3). Dark irregular groups of highly atypical cells (4) and signs of abnormal keratinisation of some tumor cells (5). These abnormal findings are visible in all fields of view. Picture by H. Neumann
Suspicious for tumor cells: The high nuclear atypia can be appreciated in those nuclei that are in focus. (1) Uneven nuclear contour with several nuclei. (2) Opaque nucleoli, representing atypical pykosis. (3) Atypical mitotic figure. In this case, this was the only cell group with these characteristics. Picture by H. Neumann
Doubtful: (1) numerous cells with small perinuclear clearing (“halos”). (2) mild differences in size, form and staining of the nucleoli. (3) Polymorphis infiltrating groups of squamous epithelia. (4) branching and septated hyphae of Candida albicans. Picture by H. Neumann
Negative for tumor cells: Clear background, normal squamous cells, small nuclei, low N/C ratio. Minimal variation in nuclear form. Picture by H. Neumann
Homogeneous Leukoplakia on the left and right side of the anterior part of floor of the mouth. Additionally a current version of an Orcellex cell collector is presented. Picture by T.W. Remmerbach
Article
Objectives Oral brush biopsies are a well researched index for early detection of oral cancer in specialised centers. But the performance of the exfoliative biopsy is not yet researched in daily dental routine. Methods Private dentists and private oral surgeons in Germany took brush biopsies out of 814 suspicious lesions from 670 patients using the Orcellex brush while regular dental appointments. The analyses of the biopsies were performed by the Cytological Laboratory of Bonn (CLB) using liquid-based cytology. Results The final results were 74 oral squamous cell carcinomas and one verrucous carcinoma, histological proven, 232 cases of leukoplakia, 242 cases of lichen planus, 17 cases of erythroplakia, 259 cases of benign inflammatory, traumatic or hyperplastic oral lesions. The sensitivity for the detection of cancer cells using brush biopsy archived 100%, the specificity for the detection of non-neoplastic cells was 86.5%. The positive predictive value was 43.1%, the negative predicative value was at 100%. Conclusion The oral brush biopsy seems to be a sufficient tool for early cancer detection in private dental offices. Clinical Relevance Generally, practicing dentists do not see various oral squamous cell carcinomas in their careers, so the experience in identifying oral squamous cell carcinomas as such is very low. The brush biopsy might help them in cases of doubt to prevent tumors from expansive growth.
 
Article
Objective Successful application of deep machine learning could reduce time-consuming and labor-intensive clinical work of calculating the amount of radiographic bone loss (RBL) in diagnosing and treatment planning for periodontitis. This study aimed to test the accuracy of RBL classification by machine learning. Materials and methods A total of 236 patients with standardized full mouth radiographs were included. Each tooth from the periapical films was evaluated by three calibrated periodontists for categorization of RBL and radiographic defect morphology. Each image was pre-processed and augmented to ensure proper data balancing without data pollution, then a novel multitasking InceptionV3 model was applied. Results The model demonstrated an average accuracy of 0.87 ± 0.01 in the categorization of mild (< 15%) or severe (≥ 15%) bone loss with fivefold cross-validation. Sensitivity, specificity, positive predictive, and negative predictive values of the model were 0.86 ± 0.03, 0.88 ± 0.03, 0.88 ± 0.03, and 0.86 ± 0.02, respectively. Conclusions Application of deep machine learning for the detection of alveolar bone loss yielded promising results in this study. Additional data would be beneficial to enhance model construction and enable better machine learning performance for clinical implementation. Clinical relevance Higher accuracy of radiographic bone loss classification by machine learning can be achieved with more clinical data and proper model construction for valuable clinical application.
 
Selection of specimens (1) and root preparation (2)
Production of milled posts (3) and production of anatomized posts (4). Sealer 26 (Dentsply LTD, Pirassununga, SP, Brazil); Silane (Angelus, Londrina, PR, Brazil); Adper Scotchbond Multipurpose (3 M ESPE, St Paul, MN, USA); Filtek Z250XT (3 M ESPE, St Paul, MN, USA); KY Lubricant Gel (Johnson & Johnson, São José dos Campos, SP, Brazil)
Preparation of root canals (4) and preparation of posts (5). Ultra-Etch—phosphoric acid 35% (Ultradent, Indaiatuba, SP, Brazil); Adper Scotchbond Multiuse Plus (3 M ESPE, St Paul, MN, USA); Visio.link (Bredent, Senden, Germany); RelyX ARC (3 M ESPE, St Paul, MN, USA); RelyX U200 Clicker (3 M ESPE, St Paul, MN, USA); Single Bond Universal (3 M ESPE, St Paul, MN, USA)
Preparation of posts (5) and luting procedures (6)
Article
Objectives To evaluate the bond strength of four types of posts (pre-fabricated fiberglass post, fiberglass post anatomized with composite resin, milled fiberglass post, and milled polyetheretherketone (PEEK) post), and two types of resin cements (conventional and self-adhesive) by assessing immediate bond strength and post-mechanical aging at each root third. Materials and methods Bovine endodontically treated roots (16 groups, n = 8) were prepared and the posts were produced and luted; the specimens of aging groups were cycled (300,000 cycles under 50 N load at 1.2 Hz frequency); six slices of each root were obtained; push-out test was performed by using a universal testing machine (500 N load at 1 mm/min cross speed); fracture pattern was classified into five levels. The statistical analyses used were three-way ANOVA, Tukey’s test (for bond strength), and Fisher’s test (for fracture pattern) (α < 0.05). Results Differences were found between the cements for posts (conventional: p < 0.001; self-adhesive: p = 0.002), whereas no difference was found for root region (p = 0.941; p = 0.056, respectively); analysis of each root showed significant differences for cements (p < 0.001), posts (p < 0.001), and mechanical cycling (p = 0.001); in terms of double interaction, differences were found for posts and mechanical cycling (p = 0.005); no other interactions were observed (double or triple); the fracture pattern showed difference between the groups for both cements. Conclusions Milled PEEK posts seem to be a good clinical option, but they require improvement of CAD-CAM technology and advances towards their adhesion. Clinical relevance Milled posts are promising and can reduce clinical time for rehabilitation of extensively destroyed teeth.
 
2D images obtained from the 3D scans illustrating the main “degradation features” observed at the 1-month follow-up. Irregularities observed included overhang of the buccal veneer (A – teeth 11, 12), surface roughness (B – teeth 11, 13, 23), ditching at the interface (C – teeth 11, 21, 22), void (C – tooth 13), and chip fractures (D – tooth 11)
2D images obtained from the 3D scans illustrating the main “degradation features” observed at the 36-month follow-up. Irregularities observed included overhang of the buccal veneer (A – tooth 11), voids (B – teeth 11, 12, 13, 23), ditching at the interface (C – teeth 11, 21), interfacial irregularities (C – tooth 13), and fractures involving the buccal veneer (D – tooth 11)
Heatmap showing the percentage of deterioration observed in the restorations after 36 months. Differences in the shades of grey indicate the percentage of deterioration for each criterion, with darker shades of grey representing higher percentages and lighter shades of grey representing lower percentages. Each percentage of deterioration is visible in the respective cell. The FDI criteria (esthetic, functional, and biological properties) and the “degradation features” are presented according to the combination of restorative materials used (n = 47 patients, 270 restorations). The overall deterioration is shown in the first column (mean). In the comparison of esthetic properties, groups with similar veneering materials (APX + IPS and EST + IPS; SUP + SUP and LU + SUP) were analyzed together. The same veneering material are merged: APX + IPS and EST + IPS; SUP + SUP and LU + SUP. The combinations of restorative materials are APX + IPS (palatal veneer Clearfil AP-X, buccal veneer IPS Empress Direct), EST + IPS (palatal veneer Clearfil Estenia C&B, buccal veneer IPS Empress Direct), SUP + SUP (palatal and buccal veneers Filtek Supreme), LU + SUP (palatal veneer Lava Ultimate, buccal veneer Filtek Supreme XTE)
Results for the multiple logistic regression analysis, including odds ratios (OR) and 95% confidence intervals for different variables considering esthetic properties ( +), functional properties (●), and “degradation features” (▲). Asterisks indicate significant associations between the variables and chances of deterioration for a given criterion. In the comparison of esthetic properties, groups with similar veneering materials (APX + IPS and EST + IPS; SUP + SUP and LU + SUP) were analyzed together. The combinations of restorative materials are APX + IPS (palatal veneer Clearfil AP-X, buccal veneer IPS Empress Direct), EST + IPS (palatal veneer Clearfil Estenia C&B, buccal veneer IPS Empress Direct), SUP + SUP (palatal and buccal veneers Filtek Supreme), LU + SUP (palatal veneer Lava Ultimate, buccal veneer Filtek Supreme XTE)
Article
Objectives Deterioration in anterior resin composite restorations placed in tooth wear patients was investigated after 36 months. Materials and methods Data collected prospectively for 47 participants of the Radboud Tooth Wear Project were used (41 ± 8 years, 90% male, n = 270 restorations). Restorations were individually evaluated using intraoral photographs and 3D scans to rate modified FDI scores and to record the presence of degradation features. Four groups with distinct combinations of composites and techniques were assessed, and multivariable logistic regression models were used to analyze the data ( p < 0.05). Results For all groups together, early degradation signs were present at 1 month: irregularities (41.5%) and ditching (7.4%) were observed at the surface and adhesive interfaces. The frequency of irregularities decreased in the 36-month evaluation (37%), but ditching (12.2%) and fractures (10.7%) were more common. The most frequent deterioration (based on photographs) was observed for staining (44%) and loss of luster (31%). In 3D scans, the most frequent were for wear (25%), marginal adaptation (24%), and the presence of irregularities (19%). Canines had 5.5 times more chances of deterioration by ditching than incisors ( p < 0.001). The differences between composites and restorative techniques were minor. Conclusions A continuous degradation process of restorations placed in tooth wear patients was observed in anterior teeth restored with different composites, with a progression of the deterioration over 36 months. Clinical relevance When placing anterior resin composite restorations in tooth wear patients, it could be important to establish realistic expectations and the need for checkup appointments.
 
Article
Objectives As prevalence of molar-incisor hypomineralisation varies considerably in different countries and regions, the aim of this study was to obtain representative epidemiological data for schoolchildren living in the canton of Basel-Landschaft, Switzerland. Material and methods A representative population of schoolchildren of three different age groups, i.e. 1st grade (mean age: 7.4 years), 6th grade (mean age: 12.6 years), and 9th grade (mean age: 15.7 years) visiting compulsory schools in the canton of Basel-Landschaft, Switzerland, was examined. The presence or absence of molar-incisor hypomineralisation at time of examination was recorded as well as potential influencing factors such as age group, gender, nationality, or the children’s place of residence. Results A total of 1252 schoolchildren could be included. On average, the prevalence of MIH in the study population was 14.8%. No statistically significant differences were found for nationality, gender, or place of residence. Although not statistically significant, children from the youngest age group had the highest while children from the oldest age group had the lowest MIH prevalence. Conclusion With a mean value of 14.8%, MIH prevalence among schoolchildren living in the canton of Basel-Landschaft, Switzerland, is comparable to mean values recorded globally. Clinical relevance This study represents the first study on MIH prevalence in Switzerland and also provides further evidence on potential influencing factors.
 
Endodontic ultrasonic device VDW ULTRA with IRRI S 25/25 ultrasonic tip
Endodontic laser fiber tips (Fotona): A radial tip 400/9; B flat tip 400/9; C radial tip 600/9
Three-dimensional micro-CT models of teeth after root canal filling (A), basic retreatment (B), and final irrigation protocol (C) in four experimental groups: PUI, LAI/SSP, SWEEPS/radial tip, SWEEPS/flat tip. The filling material inside the root canals is colored according to volume size in mm.³ (pseudocolor display)
Article
Objectives To evaluate the efficacy of passive ultrasonic irrigation (PUI) and super short pulse (SSP) and shock wave–enhanced emission photoacoustic streaming (SWEEPS) modes of Er:YAG laser–activated irrigation (LAI) with two different laser tips, in removing filling remnants after conventional retreatment in severely curved root canals. Materials and methods The study sample consisted of 40 extracted molars with curved mesiobuccal root canals. The canals were instrumented with ProTaper Next and filled with an epoxy resin–based sealer and gutta-percha using continuous wave vertical compaction and warm injection back-filling. After retreatment with ProTaper Universal Retreatment system and sodium hypochlorite (NaOCl), all samples were randomly divided into four groups (n = 10) according to the final irrigation technique: PUI, LAI/SSP, SWEEPS/flat-tip, and SWEEPS/radial-tip, using 6 mL of 3% NaOCl for an activation time of 3 × 30 s. The samples were subjected to micro-CT scans after root canal filling, retreatment, and final irrigation. The filling material volume and percentage reduction were calculated. Results All tested irrigation techniques were successful in the elimination of the filling remnants after the retreatment (p < 0.001). The LAI/SSP group showed a higher reduction rate than the SWEEPS/flat-tip group (p = 0.032). No significant differences were found between the other groups (p > 0.05). Conclusion All tested techniques improved the removal of filling material during retreatment in curved canals. LAI/SSP showed slightly better results than other techniques. Clinical relevance The study highlights the need for additional activated irrigation after the retreatment of curved root canals. The choice between PUI and LAI is not decisive for success.
 
Clinical steps for test (A–F) and control (G–J) groups. Test group: baseline measurements taken using a prefabricated stent (A), intra-osseous defect at the mesial site of upper right first molar (B), low-speed platelet-rich fibrin (PRF) preparation (C), low-speed PRF placed into the intra-osseous defect (D), flap approximation and suturing (E), and final clinical measurements 9 months post-operatively (F). Control group: baseline measurements taken using a prefabricated stent (G), intra-osseous defect at the mesial site of lower first molar (H), flap approximation and suturing (I), and final clinical measurements 9 months post-operatively (J)
Article
Aim The current randomized controlled trial assessed for the first time the effect of a low-speed platelet-rich fibrin (PRF) with open flap debridement (OFD) versus OFD alone in the treatment of periodontal intra-osseous defects of stage-III periodontitis patients. Methods Twenty-two periodontitis patients with ≥ 6 mm probing depth (PD) and ≥ 3 mm intra-osseous defects were randomized into test (PRF + OFD; n = 11) and control (OFD; n = 11) groups. Clinical attachment level (CAL)–gain (primary outcome), PD-reduction, gingival recession depth (GRD), full-mouth bleeding scores (FMBS), full-mouth plaque scores (FMPS), radiographic linear defect depth (RLDD), and radiographic bone fill (secondary-outcomes) were examined over 9 months post-surgically. Results Low-speed PRF + OFD and OFD demonstrated significant intra-group CAL-gain and PD- and RLDD-reduction at 3, 6, and 9 months (p < 0.01). Low-speed PRF + OFD exhibited a significant CAL-gain of 3.36 ± 1.12 mm at 6 months (2.36 ± 0.81 mm for the control group; p < 0.05), and a significantly greater PD-reduction of 3.36 ± 1.12 mm at 3 months, of 3.64 ± 1.12 mm at 6 months and of 3.73 ± 1.19 mm at 9 months (2.00 ± 0.89 mm, 2.09 ± 1.04 mm, and 2.18 ± 1.17 mm in the control group respectively; p < 0.05). No significant differences were notable regarding GRD, FMPS, FMBS, RLDD, or bone fill between both groups (p > 0.05). Conclusions Within the current clinical trial’s limitations, the use of low-speed PRF in conjunction with OFD improved CAL and PD post-surgically, and could provide a cost-effective modality to augment surgical periodontal therapy of intra-osseous defects of stage-III periodontitis patients. Clinical relevance Low-speed PRF could provide a cost-effective modality to improve clinical attachment gain and periodontal probing depth reduction with open flap debridement approaches.
 
Article
Objective To evaluate the effect of a time delay before the light activation of resin composite on the microtensile bond strength (µTBS) of self-etch adhesives under dynamic simulated pulpal pressure. Materials and methods One hundred twenty crown segments were prepared from human third molars. Dentin surfaces were prepared with coarse diamond burs and connected to a dynamic pulpal pressure device. The self-etch adhesives used were Clearfil SE Bond (CSE), G2-Bond Universal (G2B), Clearfil Universal Bond Quick (CBQ), and G-Premio Bond (GPB). Each adhesive was divided into 3 subgroups: immediate light activation of resin composite (T0), delayed light activation for 150 s (T1), and 300 s (T2). The µTBS data were obtained after 24-h water storage. Scanning electron microscopy was used to evaluate the nanoleakage at the resin–dentin surface. The µTBS data were analyzed using two-way ANOVA and Duncan’s multiple comparisons. Results All adhesives demonstrated a significant reduction in µTBS at T2, except for CBQ where the bond strength was not affected by the delayed light activation times. The two-step self-etch adhesives (CSE and G2B) demonstrated higher bond strength than the one-step adhesives at all conditions. Nanoleakage was observed in all adhesives at T2; however, nanoleakage was detected only in CBQ and GPB at T1. Conclusions Delayed light activation of resin composite adversely affected the dentin bond strength of self-etch adhesives. Two-step self-etch adhesives had better bonding performance than one-step self-etch adhesives. Clinical relevance After adhesive application, resin composite should be adapted and cured as soon as possible.
 
CONSORT flow diagram of the clinical trial
Article
Objectives This randomized controlled trial aimed to evaluate different protocols for dentin hypersensitivity treatment with low-power lasers and desensitizing agents, and the association between low-power lasers and desensitizing agents. Materials and methods Fifty-four patients (303 teeth) were randomly allocated to three groups: G1, 3% nitrate potassium gel, UltraEZ (n = 17); G2, photobiomodulation therapy (PBM) with a low-level infrared laser (n = 17), 100 mW, spot size of 0.028 cm², and dose of 1 J per point; and G3, nitrate potassium + PBM (n = 20). Treatments were applied to the buccal cervical region at intervals of 72 h, and all protocols were performed in three sessions. The patients’ response to evaporative stimuli was rated using the visual analog scale (VAS). Re-evaluations were performed immediately after each application and 1 week, 1 month, and 3 months after treatment. A two-way repeated measures test and Tukey’s post hoc test were used for multiple comparisons (α = 5%). Results There was a reduction in pain levels at the end of treatment in all groups. There were no significant differences in VAS score changes between the groups immediately after treatment and after the third month, compared to the baseline (p > 0.05). Conclusion Under the limitations of this in vivo study, the proposed three-session protocol was effective in reducing dentin hypersensitivity after 3 months, regardless of the desensitization mechanism used. Conservative and long-term protocols are interesting for the control of pain caused by dentin hypersensitivity. Clinical relevance The increase in cervical dentin hypersensitivity prevalence warrants easy-to-apply and long-lasting desensitizing protocols for pain control.
 
Flowchart of study selection for inclusion
Quality assessment of included studies. (1) Was randomization carried out appropriately? (2) Were the samples free of caries? (3) Did the study have a control group? (4) Was examiner blinding carried out in the study? (5) Was statistical analysis carried out appropriately? (6) Were the outcomes explained clearly? (7) Was the sample preparation explained clearly? (8) Methodological quality
Article
Objective Bioactive glass and hydroxyapatite are biocompatible materials used as an adjunct to various dental materials. The present study aimed to evaluate the occlusion effects of bioactive glasses and hydroxyapatite on dental tubules. Materials and methods We searched the PubMed/Medline, Embase, and Web of Science databases for the relevant records. The methodological quality of the studies was assessed by an accepted quality assessment tool. Results From the electronic databases, 372 articles were retrieved. After evaluating the records, 35 in vitro studies were included. The studies revealed a low risk of bias. The primary outcomes from bioactive glass studies demonstrated the potential efficacy of both bioactive glass and hydroxyapatite in dentin tubule occlusion compared to the control. Conclusion The current systematic review showed that bioactive glass and hydroxyapatite could effectively occlude the dentinal tubules. Thus, desensitizing agents containing bioactive glass and hydroxyapatite can be used to manage dentin hypersensitivity (DH). However, long-term follow-up clinical trials are required in the future before definitive recommendations can be made. Clinical relevance This work achieved a satisfactorily systematic review for assessing desensitizing agents containing bioactive glass and hydroxyapatite in dentine hypersensitivity treatments recommended for clinical practice and research.
 
PRISMA flow diagram used for record retrieval and inclusion
Elution per sample surface (µmol/mm²) of the most detected monomers in organic and water-based solvents
Elution per sample volume (µmol/mm³) of the most detected monomers in organic and water-based solvents
Article
Objectives Resin-based materials are applied in every branch of dentistry. Due to their tendency to release substances in the oral environment, doubts have been raised about their actual safety. This review aims to provide a comprehensive analysis of the last decade literature regarding the concentrations of elutable substances released from dental resin-based materials in different type of solvents. Materials and methods All the literature published on dental journals between January 2010 and April 2022 was searched using international databases (PubMed, Scopus, Web of Science). Due to strict inclusion criteria, only 23 papers out of 877 were considered eligible. The concentration of eluted substances related to surface and volume of the sample was analyzed, considering data at 24 h as a reference. The total cumulative release was examined as well. Results The most eluted substances were HEMA, TEGDMA, and BPA, while the less eluted were Bis-GMA and UDMA. Organic solvents caused significantly higher release of substances than water-based ones. A statistically significant inverse correlation between the release of molecules and their molecular mass was observed. A statistically significant positive correlation between the amount of released molecule and the specimen surface area was detected, as well as a weak positive correlation between the release and the specimen volume. Conclusions Type of solvent, molecular mass of eluates, and specimen surface and volume affect substances release from materials. Clinical relevance It could be advisable to rely on materials based on monomers with a reduced elution tendency for clinical procedures.
 
Article
Objectives The aim of this study was to evaluate the mechanical analysis of diferent three-unit metal-free fxed dental prostheses (FDPs) produced by computer-aided design (CAD)/computer-aided manufacturing (CAM). Materials and methods A hundred stainless steel die models of a mandibular left frst premolar and a mandibular left frst molar were prepared. The specimens were divided into fve CAD/CAM material groups (n=20): Group ZIR, a cubic zirconia (DD cube ONE®); Group FRC, FRC resin material (Trinia); Group PEEK, a PEEK material (KERA® starPEEK); Group PEKK, a PEKK material (Pekkton® ivory); and Group COMP, a polymer composite material (BreCAM.HIPC). Compression test was applied to the specimens, and then the results were analyzed statistically using one-way ANOVA and Tukey’s tests. In addition, deformation analyses in FDPs were compared with fnite element method (FEM). After the compression test, the damage to FDPs was evaluated with a scanning electron microscopy. Results Although ZIR (2461±93.70 N) showed high fracture load values, FRC (1571±35.96 N) material was found to be advantageous in terms of toughness. These were followed by PEEK (1398±38.26 N), PEKK (1227±44.25 N), and COMP (829±32.33 N), respectively. A ductile fracture was observed in PEEK, PEKK, and FRC due to their elastic structures. The deformation properties examined by the FEM were found to be similar to the compression test. Conclusions CAD/CAM high-performance polymers and cubic zirconia material can be used in three-unit FDPs. In three�unit FDPs, the use of FRC material can be advantageous due to both biomechanics and lightness. Clinical relevance Metal-free CAD/CAM materials may ofer new possibilities in three-unit FDPs.
 
Article
Objectives To investigate the correlation between serum and gingival crevicular fluid (GCF) levels of inflammatory cytokines and the association with periodontal parameters in patients with maintenance hemodialysis (MHD) and healthy control. Materials and methods Patients who were undergoing MHD were enrolled as the MHD group. Healthy individuals who underwent oral examination were selected as the control group after matching for the MHD group. All participants underwent a full-mouth periodontal evaluation, and the levels of eight inflammatory cytokines, including IL-1β, IL-17, IL-6, IL-8, and tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1), matrix metalloproteinase-8 (MMP-8), and C-reactive protein (CRP), in the GCF and serum were measured. Results A total of 63 MHD patients and 75 healthy persons were included. The prevalence of moderate/severe periodontitis was significantly higher in the MHD group than in the control group (88.9 vs. 66.7%, P < 0.05). The GCF levels of CRP, TNF-α, MCP-1, and MMP-8 were higher in patients in the MHD group with moderate/severe periodontitis than in the control group (P < 0.05). Serum CRP, MCP-1, TNF-α, and MMP-8 levels were positively correlated with the GCF CRP levels (P < 0.05). The GCF and serum CRP levels were positively correlated with the periodontal clinical parameters (P < 0.05). Conclusions Serum CRP, MCP-1, TNF-α, and MMP-8 may relate with the GCF CRP levels. The GCF and serum CRP levels correlated positively with the periodontal clinical parameters, including the VPI, PPD, and CAL, indicating that CRP may play an important role between periodontitis and ESRD. Clinical relevance The present study indicated that GCF and serum CRP levels correlated positively with the periodontal clinical parameters, and the CRP levels may be selected as an indicator to evaluate the severity of inflammation and the effectiveness, prognosis of periodontal treatment in ESRD patients.
 
Working length measurements in CBCT and dMRI for premolars (left, A–D) and molars (right, E–H); a first left lower (A, B) and first right lower premolar (C, D); a second left upper molar (E, F) and second left lower molar (G, H)
Bland–Altman plots of the mean differences between CBCT and dMRI for working length measurements for premolars (A) and molars (B) illustrating an underestimation of dMRI-derived measurements for both premolars and molars. The solid line represents the mean of all differences (bias) and the dotted lines represent the upper and lower 95% limits of agreement (LOA)
Article
Objectives To prospectively assess the reliability and accuracy of high-resolution, dental MRI (dMRI) for endodontic working length (WL) measurements of premolars and molars under clinical conditions. Materials and methods Three-Tesla dMRI was performed in 9 subjects who also had undergone cone-beam computed tomography (CBCT) (mean age: 47 ± 13.5 years). A total of 34 root canals from 12 molars (4/8, upper/lower jaw; 22 root canals) and 11 premolars (2/9 upper/lower jaw; 12 root canals) were included. CBCT and dMRI datasets were reconstructed to visualize the root canal in one single slice. Subsequently, two radiologists measured the root canal lengths in both modalities twice in blinded fashion. Reliability and accuracy for both modalities were assessed using intraclass correlation coefficients (ICCs) and Bland–Altman analysis, respectively. Results Reliability (intra-rater I/II; inter-rater) of dental MRI measurements was excellent and comparable to CBCT for premolars (0.993/0.900; 0.958 vs. 0.993/0.956; 0.951) and for molars (0.978/0.995; 0.986 vs. 0.992/0.996; 0.989). Bland–Altman analysis revealed a mean underestimation/bias (95% confidence interval) of dMRI measurements of 0.8 (− 1.44/3.05) mm for premolars and 0.4 (− 1.55/2.39) mm for molars. In up to 59% of the cases, the accuracy of dMRI for WL measurements was within the underestimation margin of 0 to 2 mm short of the apical foramen AF. Conclusions In vivo demonstration and measurement of WL are feasible using dMRI. The reliability of measurements is high and equivalent to CBCT. Nonetheless, due to lower spatial resolution and longer acquisition time, the accuracy of dMRI is inferior to CBCT, impeding its current use for clinical treatment planning. Clinical relevance dMRI is a promising radiation-free imaging technique. Its reliability for endodontic working length measurements is high, but its accuracy is not satisfactory enough yet.
 
Article
Objectives The retrospective study reported herein was the first of three that investigated dental trauma in primary teeth. This article discusses the study that aimed to reveal the epidemiology of trauma with data such as prevalence, risk factors, and types of injuries, and to highlight prevention. Materials and methods The records of 320 patients aged 0–9 years who visited the Erciyes University Faculty of Dentistry Pedodontics Department due to dental trauma were evaluated according to the age, gender, medical condition, season, oral habits, trauma environment/type/cause, personal characteristics, and number of siblings. The chi-square test was used to compare the categorical variables by group. Results Of the patients, 25.9% were aged 24–35 months at the time of study, 62.8% were male, 38.1% had two siblings, 37.2% had a sucking habit, 93.4% had a healthy medical condition, 41.3% experienced the trauma in summer, and 26.3% were aged 30–34 months at the time they incurred the trauma. Of the traumas, 54.1% were caused by falling, 60% occurred at home, 23% pertained to lateral luxation, and 70% were incurred when the patients were with their mother. Conclusion Given the results of this study, mothers with low education levels should be informed about their children’s risk of incurring injuries from falling at home, especially in summer. Parents should also be warned that their children’s oral habits increase their risk of trauma. Clinical relevance This study can help increase the knowledge level of clinicians, can raise social awareness, and can guide plan formulation for preventing risks.
 
The PRISMA flow diagram. An overview of the search methodology used in this review
Properties of natural products used for endodontic therapy in primary teeth
Studies evaluating the performance of natural products as pulpotomy medicament
Studies evaluating the performance of natural products as irrigating solution
Studies evaluating the performance of natural products as root canal filling material
Article
Objectives: The use of natural products for pulp therapy has experienced a remarkable advancement in recent years. The aim was to provide a critical appraisal of the safety and efficacy of natural products for endodontic therapy in primary teeth and verify whether their uses in clinical practice have sufficient evidence. Materials and methods: Two reviewers searched ten databases (Cochrane, DOSS, Embase, Google Scholar, LILACS, Open-Grey, Proquest, PubMed, Scopus, and Web of Science) until January 2022, identifying references that evaluated the safety and efficacy of the use of natural products for endodontic therapy in primary teeth. Cohort, randomized, and non-randomized clinical trials were included. Results: A total of 3583 references were initially identified. From the 63 studies retrieved for full-text reading, 37 fulfilled the selection criteria and were included in the qualitative analysis. The studies investigated 19 natural products for pulpotomy medicament, irrigating solution, intracanal medication, and root canal filling material. Most studies showed similar efficacy of natural products and their control groups; however, many methodological biases and concerns about the safety and efficacy of natural products were identified, questioning their clinical applicability. Conclusions: The included studies provided insufficient evidence to support safe and effective clinical application of natural products for endodontic therapy in primary teeth. Future well-designed studies with representative samples are needed to support the use of natural products for endodontic therapy in primary teeth. Clinical relevance: The use of natural products for endodontic therapy in primary teeth requires caution by clinicians, due to the insufficient available evidence.
 
Article
Objectives The aim of this study is to investigate the influence of the material and corresponding sintering protocol, layer thickness, and aging on the two-body wear (2BW) and fracture load (FL) of 4Y-TZP crowns. Materials and methods Multi-layer 4Y-TZP crowns in three thicknesses (0.5 mm/1.0 mm/1.5 mm) were sintered by high-speed (Zolid RS) or conventional (Zolid Gen-X) sintering. 2BW of ceramic and enamel antagonist after aging (1,200,000 mechanical-, 6000 thermal-cycles) was determined by 3D-scanning before and after aging and subsequent matching to determine volume and height loss (6 subgroups, n = 16/subgroup). FL was examined initially and after aging (12 subgroups, n = 16/subgroup). Fractographic analyses were performed using light-microscope imaging. Global univariate analysis of variance, one-way ANOVA, linear regression, Spearman’s correlation, Kolgomorov–Smirnov, Mann–Whitney U , and t test were computed (alpha = 0.05). Weibull moduli were determined. Fracture types were analyzed using Ciba Geigy table. Results Material/sintering protocol did not influence 2BW (crowns: p = 0.908, antagonists: p = 0.059). High-speed sintered Zolid RS presented similar ( p = 0.325–0.633) or reduced ( p < 0.001–0.047) FL as Zolid Gen-X. Both 4Y-TZPs showed an increased FL with an increasing thickness (0.5(797.3–1429 N) < 1.0(2087–2634 N) < 1.5(2683–3715 N)mm; p < 0.001). For most groups, aging negatively impacted FL ( p < 0.001–0.002). Five 0.5 mm specimens fractured, four showed cracks during and after aging. Conclusions High-speed sintered crowns with a minimum thickness of 1.0 mm showed sufficient mechanical properties to withstand masticatory forces, even after a simulated aging period of 5 years. Clinical relevance Despite the manufacturer indicating a thickness of 0.5 mm to be suitable for single crowns, a minimum thickness of 1.0 mm should be used to ensure long-term satisfactory results.
 
Flow chart
Implant abutment estimated 5-year survival rate
Tooth abutment estimated 5-year survival rate
Prosthetic estimated 5-year survival rate
Article
Objective To assess the clinical performance of tooth implant–supported removable partial dentures in terms of abutment survival in relation to the attachment system used. Methods An electronic search in MEDLINE/PubMed Web of Science and Cochrane Central Register of Controlled Trials databases was performed. The methodological quality of the studies was assessed using the Newcastle–Ottawa Scale. Survival rates after 3 years and 5 years, loss, and complication rates per 100 years were estimated by Poisson regression. Results A total of twelve studies were included; eleven studies were used for the meta-analysis. Survival analysis for mixed attachments showed an estimated survival rate of 100% after 3 years and 5 years. For uniform attachments, the estimated survival rate was 99.3% after 3 years and 98.8% after 5 years. Tooth abutment survival analysis for mixed attachments estimated a survival rate of 95% after 3 years and 91.7% after 5 years: Uniform attachments reached a survival rate of 97.2% after 3 years and 95.4% after 5 years. The prosthetic survival rate was 100% for mixed and uniform abutments after 3 years and 5 years of function. Conclusions Tooth implant–supported removable partial dentures can be considered as a reliable option with excellent prosthetic and implant survival rates and favorable rates for the abutments after 3-year and 5-year follow-ups. Complications may be reduced when 5 or more abutments are used. Clinical relevance Tooth implant–supported removable partial dentures are a favorable and potential alternative to restore a partially edentulous arch by optimizing the number and distribution of abutments.
 
Comparison of mean plaque index scores among all groups at baseline and after 15 days
Comparison of mean gingival index scores among all groups at baseline and after 15 days
Article
Objectives :The aim of this study was to evaluate the effectiveness of Mozart’s music on the learning of toothbrushing behavior in children with high and low dental anxiety levels. Materials and methods :A randomized, controlled, single-blinded, and observational study was conducted with 60 children, aged 8–12, who were recruited to high dental anxiety level (HDAL) and low dental anxiety level (LDAL) groups. Both groups were divided into two equal subgroups (with or without Mozart’s music). In the Mozart’s music subgroups, children were exposed to Mozart’s Sonata for 7 min and toothbrushing training was given accompanied by music. The training was instructed to the second subgroup without listening to Mozart’s music. The periodontal measurements were repeated after 15 days. Three-factor variance analysis was used to analyze the data. Results :There was a statistically significant decrease in plaque index (PI) and gingival index (GI) scores in the follow-up visits for all groups (p < 0.05). A statistically significant decrease was found in PI values between groups with or without music in those with HDAL (p < 0.001). However, no statistically significant differences were found between groups with or without music in those with LDAL (p = 0.07). Conclusions : Listening to Mozart’s music before toothbrushing training had a significant effect on plaque removal in children with high dental anxiety, while Mozart’s music did not have a positive effect in the group with low dental anxiety. Clinical relevance :The use of Mozart’s music may be beneficial in oral hygiene education for children with high dental anxiety levels. Keywords : Dental anxiety · Mozart's music · Oral hygiene education · Periodontal health · Toothbrushing
 
Mean enamel loss of bovine enamel specimens by contact profilometry. Light gray columns represent the groups with the erosion procedure. Dark gray columns represent the groups with erosion and abrasion procedures. Upper case letters denote significant differences between the conditions. Lower case letters show significant differences among the treatments (2-way RM ANOVA and Sidak’s test, p < 0.05). n = 16. Bars denote SD
Relative surface reflection intensity (%SRI) of bovine enamel specimens. Light gray columns represent the groups with the erosion procedure. Dark gray columns represent the groups with erosion and abrasion procedures. Upper case letters denote significant differences between the conditions. Lower case letters show significant differences among the treatments (2-way RM ANOVA and Sidak’s test, p < 0.05). n = 16. Bars denote SD
Correlation between contact profilometry (μm) and reflectometer Optipen (%SRI) for erosion (solid line; y =  − 0.0149x + 2.1231) and erosion + abrasion (dashed line; y =  − 0.0163x + 2.2887)
Article
Objective: This study evaluated the preventive effect of a chitosan gel containing CaneCPI-5 against enamel erosion and erosion + abrasion in situ. Methods: Sixteen volunteers participated in a crossover, double-blind protocol, comprising 4 phases: (1) no treatment (Nt); (2) chitosan gel (Cg); (3) chitosan gel + 12,300 ppm NaF (Cg + NaF); and (4) chitosan gel + 0.1 mg/mL CaneCPI-5 (Cg + Cane). Volunteers wore an appliance containing 4 specimens. Once/day, they applied the gel (except for Nt) (4 min/specimen). Erosive challenges were performed extra-orally (0.1% citric acid, 90 s, 4 × /day; ERO). Specimens were also abraded (toothbrush, 15 s/specimen, 2 × /day; ERO + ABR). Enamel wear was assessed by profilometry and relative surface reflection intensity (%SRI). Two-way RM-ANOVA/Sidak's tests and Spearman's correlation were used (p < 0.05). Results: For profilometry, ERO + ABR promoted significantly greater wear when compared with ERO. There was a significant difference among all treatments. The lowest enamel loss occurred for Cg + Cane, followed by Cg + NaF, Cg, and Nt (p < 0.05). The %SRI was significantly lower for ERO + ABR when compared to ERO, only for the Nt group. The greatest %SRI was found for the Cg + NaF and Cg + Cane groups, which did not differ significantly, regardless of the conditions. The lowest %SRI was found for the Nt and Cg groups, which did not differ from each other, regardless of the conditions. The Nt group did not differ significantly from the Cg + NaF (ERO). There was a significant correlation between both analyses. Conclusion: The incorporation of CaneCPI-5 in the chitosan gel prevented erosive wear in situ. Clinical relevance: These results open a new perspective for the use of CaneCPI-5 in other application vehicles, such as chitosan gel.
 
Flowchart of the in situ evaluation
Comparison of means, and limits of perception (0.8) and acceptability (1.8). Different uppercase letters comparing times (p < .05), for the same group. There was no significant difference for treatments (p > .05), for the same tested time. S+TB: PHS (spray) + toothbrushing; TB+S: toothbrushing + PHS (spray); I+TB: PHS (immersion) + toothbrushing; TB+I: toothbrushing + PHS (immersion); TB: toothbrushing; S: PHS spray; I: immersion in solution of PHS and Saliva: immersion in saliva
Flowchart of participants (adapted from the CONSORT statement)
Article
Objective: This study evaluated the in vitro and in situ effects of phytosphingosine (PHS) associated with tooth brushing on color stability, surface roughness, and microhardness of dental enamel. Methods: Sixty-four specimens of bovine teeth (6 × 6 × 2 mm) were separated into 8 groups (n = 8): S + TB: PHS (spray) + tooth brushing; TB + S: tooth brushing + PHS (spray); I + TB: PHS (immersion) + tooth brushing; TB + I: tooth brushing + PHS (immersion); TB: tooth brushing; S: PHS spray; I: immersion in PHS solution, and Saliva: immersion in saliva. Tooth brushing simulation (Mavtec, Brazil) was performed (356 rpm on 3.8 cm area by the toothbrush - Soft Tek) for 1, 7, 15, and 30 days. PHS remained in contact with specimens for 15 min. The specimens were evaluated before and after tooth brushing for color alteration (Easy Shade, VITA), and surface roughness (Model SJ-201P Mitutoyo), and Knoop microhardness (HMV-2, Shimadzu Corporation). For the in situ analyses, 8 participants were recruited and received an intraoral device with 6 fragments of bovine enamel (6 × 6 × 2 mm). The properties evaluated were the same as those of the in vitro study. Participants were randomized following best results of in vitro tested protocols, for 15 days: TB, TB + S, I + TB. Data obtained by in vitro (two-way ANOVA, Tukey, p < .05) and in situ (one-way ANOVA, Tukey, p < .05) studies were analyzed. Results: The in vitro study showed that greater color change was found after 30 days. The greatest differences in surface roughness occurred between the initial value and after 1 day. Regarding microhardness, the highest values occurred after 15 and 30 days, which showed similar results. The in situ study showed greater color changes for the TB and I + TB, and greater surface roughness changes for TB as well as a similar increase in microhardness for the PHS protocols, which were higher than TB. Conclusions: Phytosphingosine leads to an increase in performance regarding color stability, surface roughness, and microhardness when applied. In general, the application of PHS after brushing showed a positive impact on its performance. Clinical relevance: Phytosphingosine proved to be interesting for compound prevention formulations in the dentistry field.
 
CONSORT flow chart of patient enrolment and follow-up examination
Timeline of the study
Article
Objectives: The aim of this study is to assess the clinical and microbiological effects of a single subgingival administration of sodium hypochlorite gel (NaOCl) and compare it with 1% chlorhexidine (CHX) gel and a placebo gel following mechanical re-instrumentation during supportive periodontal therapy (SPT). Materials and methods: Sixty-two patients who had been treated for stage III-IV periodontitis and enrolled in SPT were included in the study based on following criteria: (1) active periodontal therapy completed at least 6 months before enrollment in the study, (2) presence of at least 4 non-adjacent sites with probing pocket depths (PPDs) ≥ 4 mm with bleeding on probing (BOP), or presence of 5-8 mm PPDs with or without BOP. All sites presenting PPD ≥ 4 mm and BOP at baseline and 3-, 6-, and 9-month follow-up timepoints were subgingivally re-instrumented with ultrasounds. Selected patients were randomly assigned into three groups and treated additionally with a single subgingival administration of NaOCl gel (group A); 1% CHX gel (group B); and placebo gel (group C). Main outcome variable was pocket closure at 12 months. Secondary outcome variables were changes in mean PPD, BOP, and clinical attachment level (CAL) along with changes in the numbers of the following five keystone bacterial pathogens: Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), Prevotella intermedia (P.i.), Tannerella forsythia (T.f.), and Treponema denticola (T.d.). Results: At 12 months, pocket closure was obtained in 77.5% in the NaOCl treated sites. The reduction in PPD was higher with CHX than with NaOCl, although a statistically significant adjunctive effect for NaOCl (P = 0.028) was only observed in comparison with placebo only. Mean CAL improved in all groups and at all timepoints, compared to the baseline (P < 0.05). However, after 6 months, CAL gain was statistically significantly higher in the NaOCl treated group than following application of CHX (P = 0.0026). Conclusion: In SPT patients, a single adjunctive use of a NaOCl gel may provide benefits in controlling inflammation and residual pockets. Trial registration: ISRCTN Registry of Clinical Trials (ISRCTN11387188). Clinical relevance: A baseline single application of NaOCl gel in conjunction with mechanical debridement may achieve substantial pocket closure in patients enrolled in SPT; treatment time, cost, and applicability considerations should be taken into account when selecting this therapy.
 
Article
Objectives: This study aimed to compare post-treatment stability in patients with anterior open-bite (AOB) between those treated surgically (orthognathic 2-jaw surgery) and non-surgically (molar intrusion using orthodontic miniscrews). Materials and methods: All subjects had initial overbite (OB) < -1 mm and lateral cephalograms taken before treatment (T0), immediately after AOB correction (T1), after orthodontic treatment (T2), and at least 1 year after treatment (T3). The non-surgical group was enrolled retrospectively; then, the surgical group was matched by OB, sex, and age to the non-surgical group (n = 21 each). Changes in cephalometric measurements during treatment (T1-T0), finishing (T2-T1), and retention (T3-T2) periods were compared between two groups. Results: OB increased by 4.5-5.1 mm during the treatment period with 3.3 mm upward movement of the maxillary first molar (U6) in both groups. Changes in OB were not significantly different between the groups: 0.5-0.9 mm increase during the finishing period but 1.0 mm decrease during the retention period (P > 0.05). U6 moved 0.5 mm downward in non-surgical group and 0.1 mm upward in the surgical group during the finishing period, and 1.0 mm and 0.4 mm downward in the non-surgical and surgical groups, respectively, during the retention period. Conclusions: Post-treatment stability of AOB was similar for surgical and non-surgical methods (76.8 - 78.7%), although U6 moved more downward in the non-surgical group than in the surgical group. Clinical relevance: AOB without severe skeletal deformity can be treated by either molar intrusion or orthognathic surgery with similar treatment outcome and stability.
 
Flow diagram. np number of patients; nr, number of restorations
Kaplan–Meier survival rate at 5 years
Clinical mirror images of the cervical restorations after 5 years of clinical service. NCCL, initial cervical lesion; B, baseline; 5y, 5-year recall. a, b, c Cervical lesion on tooth 34 restored with the 3-ER strategy, exhibiting superficial marginal discoloration on the occlusal margin that was rated as bravo. d, e, f Cervical lesion on tooth 45 restored with the 2-ER strategy that was rated alfa for all parameters. g, h, i Cervical restoration on tooth 44 belonging to group 2-SE that was rated charlie in marginal discoloration. j, k, h Tooth 44 restored with the 1-SE strategy that was rated bravo for marginal discoloration
Article
Objectives: To evaluate the effect of the application of an additional hydrophobic bonding resin on the clinical performance of a universal adhesive applied in etch-and-rinse (ER) or self-etch adhesive (SE) strategy in non-carious cervical lesions (NCCLs) after 5 years. Materials and methods: Scotchbond Universal Adhesive (3M Oral Care) was applied in 134 NCCLs of 39 subjects using different adhesion approaches: 3-step ER (3-ER), 2-step ER (2-ER), 2-step SE (2-SE), and 1-step SE (1-SE). Enamel and dentin were acid etched prior to application of the universal adhesive for the 3-ER and 2-ER groups. An extra layer of a hydrophobic bonding resin was applied for groups 3-ER and 2-SE. All lesions were restored with Filtek Supreme XTE resin composite (3M Oral Care). Restorations were evaluated at baseline and at 5 years using the modified USPHS criteria. Mann-Whitney U and Wilcoxon tests were performed, and the survival rates (retention/fracture) were analyzed using Kaplan-Meier and log-rank tests (p < 0.05). Results: The recall rate was 66.7% at 5 years. The cumulative survival rate was 96.9% for 3-ER, 96.8% for 2-ER, 71.4% for 2-SE, and 81.3% for 1-SE strategies. The log-rank test was statistically significant (p = 0.006). Retention rates were 100% for both ER groups, 75% for 2-SE and 81.3% for 1-SE. At 5 years, 2- and 1-SE approaches showed similar retention rates, but lower than those for 3- and 2-ER. A significant decrease in retention rate was detected for 2-SE (p = 0.007) and 1-SE (p = 0.014) groups between baseline and 5 years. All groups, except 2-ER, showed an increase in marginal discoloration. For this parameter, significant differences were detected between 2-ER and 1-SE (p = 0.004). Conclusions: The addition of a hydrophobic bonding resin to the recommended application sequence of Scotchbond Universal Adhesive did not improve its clinical performance in NCCLs after 5 years. Higher retention rates were measured when this adhesive was applied in ER mode. Trial registration: This manuscript is a 5-year follow-up of a randomized clinical trial that started in 2012 when there was no strong recommendation for registration in clinicaltrials.gov. The results after 36 months of clinical service were previously published in this journal.
 
Article
Objectives To evaluate the wear resistance and abrasiveness of monolithic CAD/CAM ceramics. Materials and methods Rectangular-shaped specimens (12 mm × 6.5 mm × 1.5 mm) were sectioned from the following CAD/CAM blocks ( n = 10); partially crystallized lithium disilicate (PLD), experimental fully crystallized lithium disilicate (FLD), zirconia-reinforced lithium silicate (ZLS), super-translucent monolithic zirconia (SMZ), and ultra-translucent monolithic zirconia (UMZ). Silicon carbide papers were used to mechanically flatten and polish the surfaces. PLD specimens were subjected to a combined crystallization/glazing firing cycle. Ceramic specimens were mounted to the wear device and tested for 200,000 cycles against human premolars at 20 N force and 2 mm sliding distance. Artificial saliva was used as a lubricant. The teeth were scanned using micro-CT before and after the wear test and the generated models were overlapped to determine the volumetric tooth loss. Before and after the test, specimens’ weights and surface roughness ( R a ) values were measured, and the differences were calculated. Scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) were utilized for microstructural and chemical analysis. Statistical analysis was performed using one-way ANOVA or an equivalent test for non-parametric results. Significance level was set at P ≤ 0.05. Results The type of ceramic material affected the ceramic and antagonist wear rates ( P < 0.001). PLD and ZLS had the highest ceramic and antagonist wear, whereas UMZ and SMZ demonstrated the lowest wear values. The FLD group showed comparable antagonist wear and significantly less ceramic wear than PLD and ZLS. Conclusions Monolithic zirconia demonstrated the best wear resistance and least abrasiveness to the antagonist. The experimental lithium disilicate was more wear-resistant than other glass–ceramic groups. Clinical relevance Monolithic zirconia is wear-resistant and gentle on the antagonist. In contrast, glass–ceramics are more abrasive to enamel.
 
Article
Objective To identify and describe unusual soft tissue complications of periodontal plastic surgery procedures at the recipient site after periodontal grafts. Materials and methods Two independent reviewers performed a comprehensive search in MEDLINE, Cochrane, periodontics journals, reference lists, and grey literature for articles dated up to July 2021. Publications related to surgical interventions only around the teeth with an unusual complication at the recipient site were selected. No restrictions were made in the number of cases, follow-up period, or language. The Cochrane Collaboration’s tool for assessing risk of bias, the Newcastle–Ottawa Scale (NOS), and two validated case report/series checklists were used to critically appraise the studies. Results A total of 1434 articles were examined, of which 28 met the inclusion criteria: one RCT, two cohort studies, and twenty-five case reports/series. The periodontal plastic surgery procedures described in these articles were conducted to treat lack of attached gingiva and gingival recessions. The following unusual complications were found: bone exostosis, epithelial inclusion, root resorption, abscess, overgrowth, “liver clot” formation, and oroantral communication. Conclusion Bone exostosis and epithelial inclusions were the most prevalent unusual complications following treatment with subepithelial connective tissue graft, free gingival graft, and acellular dermal matrix allograft. Due to the nature of the reports, the clinical recommendations for diagnosis and treatment cannot be homogenized. Clinical studies reporting complications are required to develop management protocols (PROSPERO CRD42021230875). Clinical relevance Clinicians need to know the main complications that can occur in mucogingival surgeries as well as their clinical management to provide a successful and predictable treatment.
 
ISQ values of the three operators in alternative measures. Values are expressed as mean and standard deviation
Article
Objective Resonance frequency analysis (RFA) provides an evaluation of implant stability over time. This analysis is a non-invasive, precise, and objective method. Several studies compare the RFA system with other devices. However, few investigations analyze repeatability and reproducibility between different operators. The aim of this study was to evaluate the intra- and inter-operator concordance of the Osstell® ISQ. Material and methods RFA measurements were performed with Osstell® ISQ in a total of 37 implants placed in 21 patients. At the time of implant placement, 6 measurements per implant were taken by three different experienced operators. Three measurements were carried out consecutively and three by removing and placing the SmartPeg-Osstell® to assess intra-operator and inter-operator agreement. Results Intra-operator concordance according to the intraclass correlation coefficient (ICC) showed high concordance. The ICC values were higher than 0.9 (p < 0.0001) for consecutive measures and alternative measures, being almost perfect of Landis & Koch classification. For inter-operator concordance The ICC was 0.709 (p < 0.0001) and 0.670 (p < 0.0001) for consecutive and alternative measures, respectively, both estimates being in the substantial category. In torque and ISQ values, no statistically significant differences were observed when operators and measurements were compared. Conclusions Osstell® ISQ system was stable both in intra-operator and inter-operator measurements. This device has excellent repeatability and reproducibility, demonstrating reliability to measure the stability of dental implants. Clinical relevance Resonance frequency analysis (RFA) is a non-invasive, objective, and reliable diagnostic method to determine the ideal moment to load the implant, as well as to predict possible failures.
 
Top-cited authors
Anton Sculean
  • Universität Bern
Nicoleta Ilie
  • Ludwig-Maximilians-University of Munich
Reinhard Hickel
  • Ludwig-Maximilians-University of Munich
Adrian Lussi
  • Universität Bern
Richard J Miron
  • Nova Southeastern University