Quintessence International, 03/2021

Objectives: This systematic review aimed to evaluate the clinical and radiographic outcomes of coronal and partial pulpotomies in mature permanent molars with cariously exposed vital pulp. Method and materials: The protocol of the current review was registered in the PROSPERO database (CRD 42020190785). Articles published between January 1980 and June 2020 were searched in eight different online databases and six textbooks according to PRISMA guidelines. Eleven studies were included in the analysis of 1-year success rates, whereas five studies were included in the analyses of 2-year and > 2-year success rates for coronal pulpotomy. Two studies were included in the analyses of the 1-year and 2-year success rates for partial pulpotomy. The clinical and radiographic success rates were estimated using the DerSimonian-Laird random effect method. The risks of bias were evaluated using Cochrane RoB 2, ROBINS-I, and Newcastle-Ottawa scale assessment tools. Evidence levels were determined using the Oxford Centre for Evidence-Based Medicine (OCEBM) recommendation tool. The success rates using different pulp capping medicaments and restorative materials were analyzed using meta-regression analysis. Results: The clinical and radiographic success rates of coronal pulpotomy ranged between 92.2% and 99.4%, whilst for partial pulpotomy, the success rates ranged between 78.2% and 80.6%. Different pulp capping medicaments and restorative materials showed no significant effect on the success rates of coronal pulpotomy, but the former significantly (P < .05) affected the success rates of partial pulpotomy. Conclusion: Coronal and partial pulpotomies demonstrated a high success rate in treating cariously exposed vital pulp of mature permanent molars. Further well-designed studies with longer follow-up periods are required to validate these findings. (Quintessence Int 2021;52:196–208; doi: 10.3290/j.qi.b912685) Schlagwörter: meta-analysis, permanent molar, pulp capping medicament, pulpotomy, systematic review

Objective: To analyze the loss of nonvital abutment teeth compared to vital abutment teeth supporting removable partial dentures (RPDs). Method and materials: An electronic search was conducted in the Ovid MEDLINE, Embase, and Web of Science databases, and supplemented by a manual search. The search was done to identify clinical studies reporting the loss of nonvital abutment teeth compared to vital abutment teeth for RPDs. The data were extracted from each selected article and meta-analysis was performed using a random effects model to estimate adjusted proportion of abutment loss with RPDs along with 95% confidence interval (CI). Risk of bias assessment was conducted using Cochrane Risk of Bias tools and Newcastle-Ottawa Scale. The statistical significance was set as P value < .05. Results: A total of 3,898 records were identified from electronic databases and 8 studies were included for quantitative synthesis of 834 subjects with 1,036 RPDs. No additional records were identified through manual search. Among 1,152 nonvital abutment teeth, 123 teeth were lost. The estimate of nonvital abutment loss was 13% (95% CI 9–18%]. The data were statistically significant (P < .0001), and were heterogenous between the studies (χ2 [df = 7] = 35.9, P < .0001; τ2 = 0.25, I2 = 76.46%). A total of 2,186 vital abutment teeth were compounded where 114 teeth were lost. The estimate of vital abutment loss was 4% (95% CI 2–7%). The data were statistically significant (P < .0001), and were heterogenous between the studies (χ2 [df = 7] = 23.7, P = .01; τ2 = 0.56, I2 = 86.31%). The risk of abutment loss was approximately three times greater with the loss of vitality (odds ratio = 3.04, 95% CI 1.53–6.05; P = .001). In addition, abutment loss was significantly greater with increasing follow-up time (P = .01). None of the included studies were considered to be at high risk of bias. Conclusion: Within the limitations of this systematic review and meta-analysis, the loss of nonvital abutment teeth was significantly greater than that of vital abutment teeth for RPDs. Further research is needed to identify critical factors associated with the loss of nonvital abutment teeth. (Quintessence Int 2021;52:210–219; doi: 10.3290/j.qi.a45425) Schlagwörter: abutment loss, fracture, nonvital abutment teeth, removable partial denture, vital abutment teeth

Objectives: Adequate gingival thickness provides a stable base for appropriate oral hygiene maintenance and mucogingival lesion prevention. The study aim was to assess attached gingiva thickness in relation to its width, probing depth, crowding, and tooth position in the arch during the early transitional dentition phase. Method and materials: A cross-sectional study in 193 children aged 7 years with healthy mucogingival complex was conducted, and PIROP ultrasonic biometer measurement of gingival thickness of mandibular incisors was applied. To compare qualitative variables across different dentition groups, chi-square test or Fisher exact test were used, and for quantitative variables Kruskal-Wallis test plus post-hoc analysis (Dunn test). Spearman correlation coefficient was used to correlate gingival thickness with width of attached gingiva, as well as Kruskal-Wallis test and post-hoc analysis to assess the relationship between gingival thickness and tooth position in the arch, type of incisor, and eruption phase. Results: The mean gingival thickness value was less than 1 mm in all incisor type groups. The thinnest gingiva was noticed at permanent newly erupted incisors (0.72 ± 0.36; P < .001). Thickness of attached gingiva positively correlated with its width and with probing depth (r = 0.164, P < .001). Gingival thickness was significantly thinner at incisors positioned labially. No correlation of attached gingiva thickness with transitional crowding in mandibular incisor segment was observed. Conclusions: The results revealed thin gingiva at mandibular incisors in white children during the early transitional dentition phase. Objective, ultrasound measurements were used for the first time in a pediatric population, and the device was simple and well tolerated. (Quintessence Int 2021;52:220–227; doi: 10.3290/j.qi.a45606) Schlagwörter: attached gingiva, gingival thickness, permanent dentition, primary dentition, ultrasonic measurements

Objective: Achieving high levels of primary implant stability is considered to be desirable, despite some studies warning of the risk of bone damage. It was the goal of this observational clinical study to compare two current bone level implant systems with respect to primary and secondary stability. Method and materials: Data on bone quality, insertion torque, implant stability at insertion and after healing, as well as number of implants lost during healing were obtained from two centers either placing BLT (Bone Level Tapered, Straumann) or Nobel Parallel CC (Nobel Biocare) implants. Statistical analysis was based on Spearman rank correlation tests, analysis of variance, and t tests with the level of significance set at α = .05. Results: A total of 312 BLT and 92 Nobel Parallel CC implants were placed. Ten BLT and two Nobel Parallel CC implants failed resulting in survival rates of 96.79% and 97.83%, respectively. Mean insertion torque recorded in the different bone classes showed large standard deviations, and only torque values for BLT implants recorded in type 3 bone differed significantly from type 2 bone and type 1 bone (P = .024). For BLT implants, bone quality and insertion torque correlated (Spearman rho = −.3326; P = .0023) as did ISQ at insertion (Spearman rho = −.2241; P = .0429). Implant diameter significantly affected primary (P = .0013) and secondary (P = .0050) stability of Nobel Parallel CC implants while for BLT implants a significant effect was only seen for secondary stability (P = .0000). Bone quality had a significant effect on implant insertion torque for BLT implants (P = .0059). Bone quality had no general effect on ISQ changes during healing but 3.3-mm BLT implants showed significantly (P = .0005) lower stability after healing. Conclusion: Huge variation with respect to primary and secondary stability seems to exist among similar looking implant systems clinically used for identical indications. (Quintessence Int 2021;52:230–235; doi: 10.3290/j.qi.a45605) Schlagwörter: bone quality, implant design, insertion torque, primary stability, resonance frequency analysis

Objectives: To monitor and compare the nonsubmerged (single-stage, SS) and submerged (two-stage, TS) implant placement techniques up to the final prosthesis delivery. Marginal bone level and marginal bone loss rate of both surgical techniques were compared. Method and materials: Marginal bone level was measured, using an image processing program (ImageJ), from periapical radiographs at the times of placement (T0), exposure (Te), initial loading (T1), and at the final prosthetic delivery (T2), with a total time span of a mean of 13.2 ± 3.3 months. By timing normalization, marginal bone level and marginal bone loss rate (mm/month), following SS and TS implant placement techniques and other local and systemic parameters were analyzed. Asymmetric analyses using Mann-Whitney test followed by the correlation Pearson analyses were applied. A P value < .05 defined statistical significance. Results: In total, 268 implants (42 patients) were monitored. Marginal bone loss rate was 0.15 ± 0.13 mm and 0.13 ± 0.11 mm, between T0 and T2, for the SS and TS techniques, respectively. Marginal bone level and marginal bone loss rate were higher among smokers for both techniques at various time points. Bruxers had higher marginal bone loss rate than nonbruxers between T0 and T1, and T0 and T2. Marginal bone loss rate around implants that were placed at the posterior maxilla was higher than those at the posterior mandible between T1 and T2. Interproximal implant distance correlated negatively with marginal bone loss rate between T0 and T2 (P < .05). Conclusions: The results suggest that both techniques achieved similar clinical outcome. Smoking, bruxism, anatomical location, and interproximal implant distance apparently affect the marginal bone level and marginal bone loss rate of both implant placement approaches. The implant placement surgical mode, combined with various systemic and/or anatomical factors could play a significant role in maintaining marginal osseous level around the implant neck. (Quintessence Int 2021;52:236–246; doi: 10.3290/j.qi.a45423) Schlagwörter: crestal bone resorption, implant placement, marginal bone level, single-stage, two-stage

Objective: This study analyzed two xenogenous biomaterials based on deproteinized bovine bone mineral applied for maxillary sinus elevation. Method and materials: Fourteen patients were submitted to maxillary sinus augmentation with one of the following biomaterials: Criteria Lumina Bone Porous (test group) or Geistlich Bio-Oss (control group), both of large granules (1 to 2 mm). After 6 months, trephine biopsies were collected at the time of implant placement: 27 samples (11 patients) in the test group; 7 samples (3 patients) in the control group. Biopsies were analyzed by descriptive histology and histomorphometry, in which the percentages of newly formed bone, residual biomaterial particles, and connective tissue were evaluated. Results: Histomorphometry showed means for test and control groups, respectively, of 32.41% ± 9.42% and 26.59% ± 4.88% for newly formed bone, 22.89% ± 4.58% and 25.00% ± 4.81% for residual biomaterial, and 44.70% ± 9.54% and 48.41% ± 3.36% for connective tissue. There were no differences between groups (P > .05). Conclusion: This study concluded that Criteria Lumina Bone Porous presented similar histologic and histomorphometric characteristics to Geistlich Bio-Oss 6 months after sinus elevation surgery, identifying the tested biomaterial as an interesting alternative for bone augmentation in the maxillary sinus. (Quintessence Int 2021;52:248–256; doi: 10.3290/j.qi.a45601) Schlagwörter: biomaterials, bone grafting, bone substitutes, clinical study, histomorphometry, maxillary sinus elevation

Raloxifene is a selective estrogen receptor modulator (SERM) that is used to manage osteoporosis in women. Because of its tissue selectivity, raloxifene has fewer side effects than estrogen therapy; however, raloxifene-associated osteonecrosis of the jaw (ONJ) has recently been reported. While most of the reported cases were treated with antiresorptive therapy in addition to raloxifene, ONJ can also occur with the isolated use of raloxifene. This report presents a case where there was no prior exposure to bisphosphonates, in which the patient incidentally had florid cemento-osseous dysplasia (FCOD). Raloxifene-associated ONJ has never been reported before in a patient with FCOD. It is unclear whether the presence of FCOD increases the risk of ONJ. Case report: Clinical and radiographic findings regarding an African-American patient with FCOD and raloxifene-induced ONJ are described. The patient underwent a battery of investigations and surgical debridement of the area in question. She has remained disease free in the 2 years following the treatment. Conclusions: The aim of this report is to shed some light on a serious complication of raloxifene, a medication that is increasingly encountered in dental practices. Dental practitioners should use this knowledge to increase their awareness of possible ONJ development after the use of raloxifene. Brief recommendations and guidance in general dental practice for management of patients on raloxifene are also presented. (Quintessence Int 2021;52:258–263; doi: 10.3290/j.qi.b912675) Schlagwörter: CBCT, inflammation, medication-related osteonecrosis of the jaw (MRONJ), multidetector computed tomography (MDCT), panoramic radiography, raloxifene

Objective: This study aimed to compare the clinical outcomes in dental prophylaxis between rubber cup polishing and an air polishing system using erythritol powder, with or without prior dental plaque disclosure. Method and materials: In this single-blind, randomized, controlled, split-mouth clinical trial, healthy participants with full-mouth plaque score ≥ 60% were recruited. Quadrants in each participant were randomly assigned to four treatment groups: air polishing with prior plaque disclosure; air polishing without plaque disclosure; rubber cup polishing with prior plaque disclosure; or rubber cup polishing without plaque disclosure. Plaque scores and treatment time for each quadrant were recorded. Posttreatment satisfaction questionnaires for both the participants and operators were also completed. Results: In total, 88 participants consisting of 42 men and 46 women (mean age 23.1 ± 2.0 years) were recruited. Air polishing with prior plaque disclosure had significantly lower posttreatment marginal mean plaque score (21.7 ± 17.5%) compared to air polishing (33.5 ± 23.4%) or rubber cup polishing (34.5 ± 19.7%) without prior plaque disclosure (P < .001). Marginal mean treatment time for air polishing (325 seconds; SE = 10 seconds) was significantly shorter compared to rubber cup polishing (407 seconds; SE = 15 seconds) (P < .001). Both the participants and operators preferred air polishing over rubber cup polishing (P < .001). Conclusion: Prior plaque disclosure enhanced the effectiveness of plaque removal. Air polishing exhibited better treatment efficiency than rubber cup polishing and was the patients’ and clinicians’ preferred treatment modality. (Quintessence Int 2021;52:264–274; doi: 10.3290/j.qi.a45602) Schlagwörter: air polishing, biofilm, dental prophylaxis, periodontal disease, rubber cup