Quintessence International, Pre-Print

Objectives: To review the dynamic analytical elements used in the functional assessment of the stomatognathic system, summarize the available scientific evidence, and consider interrelations with body posture and cognition. Method and materials: A thorough literature search was conducted using PubMed, the Cochrane Library database, and Google Scholar. Peer-reviewed articles and literature reviews provided up-to-date information addressing three topics: (a) the available knowledge and recent evidence on the relationship between the morphologic aspects of dental/craniofacial anatomy and oral function/dysfunction, (b) mandibular dynamics, considering mobility, functional activity, and existing methodologies of analysis, and (c) a possible correlation between the stomatognathic system, body posture, and cognition. Results: Modern dentistry may be regarded as a human adaptation strategy, helping to conserve healthy teeth for much longer without risking overall health. It is futile to treat patients using a mechanistic, sectorial approach that misrepresents patient behavior and requests, just as it is to affirm the absence of any structure-function relationships. However, it is also evident that there is a lack of general consensus on the precise functional assessment of the stomatognathic system, mostly due to the methodologic heterogeneity employed and the high risk of bias. Despite the abundant evidence produced with the aim of providing solid arguments to define dynamic models of functional assessment of the stomatognathic system, it is yet to become highly empirical, based as it is on operator experience in daily clinical practice. Conclusions: Further efforts from the scientific and clinical community, with the help of progress in technology, remain should this gap be filled and should substantial data on differences between pathologic and physiologic dynamic models of function be provided. Dentistry needs to employ – on a larger scale – objective, dynamic methods of analysis for the functional evaluation of the stomatognathic system, embracing concepts of “personalized medicine” and “interprofessional collaborations.” Schlagwörter: cognition, kinesiography, mastication, neuroplasticity, oral function, posture

Objective: The purpose of this study was to evaluate the root canal shaping abilities of different heat-treated NiTi engine-driven single files. Method and materials: A total of 45 mandibular first molar teeth with a root canal curvature of between 25 and 35 degrees were selected for this in vitro study. The mesial roots were separated and scanned with micro-CT. The specimens were randomly divided into three groups. Root canal preparations were performed using HyFlex EDM OneFile in Group 1; OneCurve (25/06) in Group 2, and WaveOne Gold Primary in Group 3. Root canals were scanned again with micro- CT after root canal preparation. Apical transportation value and centering ability ratio of files were evaluated using the preinstrumentation and postinstrumentation micro-CT images at 1, 2, 3, 4, and 7 mm. The data were statistically analyzed using the Kruskal-Wallis test. The Bonferroni-Dunn test was used for multiple comparisons. The level of statistical significance was set at P < .05. Results: There was no significant difference between the apical transportation values of experimental groups in mesiodistal direction (P > .05) and buccolingual direction (P > .05). The OneCurve file group showed better centering ability in the buccolingual direction than the WaveOne Gold file group at 4 mm (P = .048). The difference between the centering ability values of experimental groups was not significant at other levels (P > .05). Conclusion: According to the results of this study, all tested single files caused apical transportation and showed similar centering ratio at most of the root sections. Schlagwörter: apical transportation, centering ability, endodontics, micro-computed tomography, NiTi single files

Objective: Occlusal stabilization splints (OSSs) are first-line therapy for temporomandibular disorder (TMD) and sleep-related-bruxism (SRB). The main goal of this study was to quantify adherence rates to OSS therapy in TMD patients and among non-painful conditions such as clenching and bruxism. It was hypothesized that adherence rates would be similar to those for other chronic conditions. Method and materials: Medical records of 99 patients seen in the Orofacial Pain Clinic between 2006 and 2014 were reviewed. Patients meeting the inclusion criteria were interviewed over the telephone regarding OSS adherence. Results: Of the 99 patients interviewed, 80 had chronic orofacial pain related to TMD and 19 received OSS due to (non-painful) SRB. Patients were divided according to usage; the USER group (58 patients, 58.6%) used their OSS for more than 1 year; the NUSE group was the remaining 41 (41.4%) patients who used their device for less than 1 year. Of the patients with pain as the reason for OSS use, 50 (62.5%) were in the USER group and 30 (37.5%) were in the NUSE group. The most common diagnosis was masticatory muscle disorders (MMD) with a 71.4% adherence rate, representing 60.3% of the USER group, which was significantly higher than those with SRB and other facial pain (P = .039). The most common reasons for non-adherence were sleep difficulties with OSS (31.6%) and resolution of the problem (25%). Conclusions: Patients reporting mild to major pain reduction had higher adherence rates than those with complete pain relief or none at all. Patients with MMD exhibited higher adherence rates than those with other facial pain types and SRB. Schlagwörter: adherence, masticatory muscle disorders, occlusal stabilization splint, temporomandibular disorders

Objectives: The objective of this retrospective study was to compare the 7-year outcomes of coronally advanced flap with vertical incisions (CAF) and the envelope type of flap (e-CAF), using a subepithelial connective tissue graft (SCTG) in the treatment of multiple recession defects. Method and materials: Twenty-two patients (13 CAF and 9 e-CAF) with at least two adjacent recession defects in the esthetic zone contributed to a total of 50 sites (29 CAF and 21 e-CAF). Complete root coverage (CRC), mean root coverage (MRC), and keratinized tissue (KT) width were recorded over the course of the study. Results: In the short term (8 months), CRC, MRC, and KT outcomes were similar between the groups (P > .05). However, at the 3-year follow-up, the e-CAF group displayed significantly higher KT, MRC (100%), and CRC (100% at both tooth- and patient-levels) than the CAF group (MRC 91.43%; CRC 79.31% at tooth-level and 69.23% at patient-level). Similarly, at the 7-year follow-up, statistically significantly superior KT, MRC (94.24%), and CRC (87.71% at tooth-level and 77.78% at patient-level) values were recorded for the e-CAF group compared to the CAF group (MRC 68.98%; CRC 31.03% at tooth-level and 15.38% at patient-level). Conclusions: Despite similar treatment outcomes recorded by both surgical procedures in the short term, sites treated with e-CAF showed better stability of the gingival margin and superior KT width in the medium (3 years) and long term (7 years). Schlagwörter: connective tissue, gingival recession, surgical flaps, tooth root

Objectives: Teeth with combined endodontic-periodontal lesions (EPLs) have favorable to hopeless prognoses. The new classification system was developed by the World Workshop on the Classification of Periodontal and Peri‐Implant Disease in 2017 and suitable epidemiologic data related to this new system are currently lacking. This study aims to contribute data about the prevalence of EPLs according to the new system. Method and materials: A total of 1,008 panoramic views taken in 2019 were analyzed, recording the presence of an EPL and other periodontic parameters. Radiographs of bad quality and of the same person were excluded. Additionally, the EPLs’ radiographic patterns were rated by two raters according to their shape (j-shaped vs cone-shaped). Descriptive statistical methods as well as t tests for continuous and chi-squared tests for categorical variables were used. Results: Overall, 866 patients (with 18,963 teeth) were included. Prevalence of EPLs was 4.9% (n = 43) (patient-related)/0.4% (n = 71) (tooth-related). Mean age (62.3 years vs 51.5 years), mean maximal percentage of bone loss (60% vs 30%), and mean age-adjusted bone-loss index (1.0 vs 0.6) were considerably higher compared to patients without EPL. A total of 67 EPLs were found in patients with stage III/IV periodontitis and 4 in patients with stage II periodontitis. Conclusions: This is the first study showing prevalence of EPLs (4.9%/0.4%) according to the 2017 World Workshop on the Classification of Periodontal and Peri‐Implant Disease. Patients with EPLs have a substantially higher maximal percentage of bone loss and a higher age-adjusted bone-loss index at residual teeth, excluding teeth with EPLs. All patients have at least stage II periodontitis. Schlagwörter: dental radiology, endo-perio lesions, periodontal disease, periodontitis

Objectives: This study aimed to assess the degree of dental practitioner adherence to recommendations made during the COVID-19 pandemic. Method and materials: An online questionnaire was distributed via social media among dental practitioners in Israel who worked during the COVID-19 outbreak. Results: In total, 144 dental practitioners completed the survey; it was found that dental practitioner adherence to all the official PPE use recommendations was 69.8%, whereas 36.8% of dental practitioners reported the use of N95 when needed. Knowledge of self-protection against COVID-19 was rated as “very good” by 37.5% of responders. However, only 25.7% felt “highly protected” by personal protective equipment. Interestingly, many dental practitioners (46.8%) reported adherence to extra protection in addition to the required PPE communicated by the Ministry of Health guidelines. Conclusion: Stricter regimens should be applied for dealing with the current challenging pandemic, especially in clinical work with a higher risk for viral transmission. Specific strategies should be followed to ensure good practice to improve dental practitioners’ and patients’ safety. Schlagwörter: adherence, aerosol, coronavirus disease 2019, N95, personal protective equipment

Resolution of a periapical periodontal lesion as determined by radiographic examination may take a year or longer. Orthodontic movement is known to have a positive effect on the bone topography and morphology. The literature presents no information about the effect of orthodontic movement on the rate of periapical endodontic healing following a root canal treatment. The aim of this report was to present the use of orthodontic root extrusion in cases with a periapical lesion, where other options are ruled out. Three case reports involving endodontically treated teeth with a periapical lesion are presented. In each case, the performed orthodontic extrusion resulted with healing of the periapical environment towards a predictable crown fabrication or replacing a hopeless tooth more safely with an implant-supported crown. In all cases presented, signs of radiographic healing were demonstrated in a relatively shorter time than is considered acceptable, following the extrusive orthodontic movement, with no clinical sensitivity to percussion or periodontal pockets. In conclusion, orthodontic extrusion of endodontically treated teeth with periapical lesions presented positive radiographic healing signs along with no clinical symptoms of pain and mobility and a positive effect on marginal bone level and soft tissues, at a faster rate than was expected. This report may assist in supporting a clinical decision to apply vertical extrusive forces on compromised endodontically treated teeth presenting with a periapical lesion. Healing signs may be observed within a shorter time period, which may allow better prediction for the prosthetic phase. Schlagwörter: dental implant, endodontically treated teeth, forced eruption, implant replacement, implant site, orthodontic extrusion, periapical lesion, radiographic healing, root resorption

Objective: The primary objective of this meta-analysis (PROSPERO No: CRD42019124695) was to assess the association between psychologic stress, anxiety, and periodontitis. Data sources: The electronic search was conducted using PubMed, Embase, and Scopus, by three independent reviewers till December 2019. The search was limited to human studies published only in English language. The fixed-effect model and random-effects model were used to obtain the overall mean difference, odds ratio (OR), and its 95% CI for all studies. The heterogeneity was calculated by I2 statistics. The Newcastle-Ottawa scale was used to assess the risk of bias in the included studies. Out of 775 potentially relevant articles, 25 studies were selected for systematic review and only 14 studies could be used for meta-analysis in three subsets. The pooled OR for stress and periodontitis was 1.78, which was statistically highly significant (I2 = 98.6%, P = .00). Mean salivary cortisol levels as a measure of stress in patients with periodontitis was 4.81 nmol/L (I2 = 98.0%, P = .08). State-Trait Anxiety Inventory value was seen as −1.28 (I2 = 0.0%, P = .06) for state anxiety and −0.11 (I2 = 0.0%, P = .85) for trait anxiety in patients with periodontitis. Conclusion: The findings indicate a role of psychologic stress and anxiety in the progression of periodontitis. Schlagwörter: adult periodontitis, anxiety, chronic periodontitis, meta-analysis, psychologic stress, stressful events

Objective: The opacity of the zirconia ceramic restoration may influence the degree of conversion (%DC) of dual-cured resin cements. The aim of this study was to evaluate the degree of conversion of resin luting agents photocured under different high translucency zirconia shades. The opacity of each ceramic shade was evaluated. Method and materials: The opacity percentage of Lava Frame and three Lava Plus High Translucency Zirconia ceramic shades (W1, A2, and B4) was determined. A spectrophotometer MiniScan was used to measure the opacity percentage of each specimen (0.7 mm thick) and then the opacity was calculated. Specimens from three different resin cements (Panavia F2.0, RelyX Unicem 2 Automix Self-Adhesive, and PermaFlo DC) were prepared with 100-µm thickness. The specimens were photocured according to the manufacturers’ instructions under a ceramic block (0.7 mm thick). Specimens photocured without the ceramic block were used as control. Fifteen groups (n = 3) were evaluated. Micro-ATR/FTIR (micro-attenuated total reflectance/Fourier-transformed infrared spectroscopy) spectrometry was used to evaluate the extent of polymerization of all specimens after 24 hours. The %DC was determined using experimentally polymerized versus maximally polymerized composite. Results: The opacity percentages (mean ± SD) of W1, Lava Frame, A2, and B4 ceramics were 72.41% ± 0.04%, 74.24% ± 0.09%, 77.63% ± 0.11%, and 78.17% ± 0.12%, respectively. There was a statistically significant difference in %DC among the different cements investigated (P = .003) and a statistical difference in %DC was also found among the different ceramic shades studied (P = .030). For the Lava Frame and A2 ceramic blocks, the resin cements tested presented the lowest %DC except for the RelyX Unicem resin cement. Conclusions: The %DC of RelyX Unicem 2 cement under low zirconia opacities (W1 and Lava Frame) was greater compared to high zirconia opacities (A2 and B4). For the Panavia F2.0 cement, no effect on the %DC under different high translucency shades was observed. The highest %DC of PermaFlo cement was exhibited when the ceramic shade W1 was used. Clinical implications: Dual-cured resin cements exhibited different degrees of conversion depending on the opacity of the zirconia restoration. However, different brands demonstrated higher or lower dependency of the light transmittance on their degree of conversion. Schlagwörter: ceramic shade, degree of conversion, dual-cure resin cement, FTIR

Objective: This systematic review aimed to evaluate the acceptance level of atraumatic restorative treatment (ART) and Hall Technique (HT) among children, parents, and general dental practitioners. Method and materials: The study was registered in the PROSPERO database. Articles published between January 1960 and January 2021 were searched in 11 online databases and six textbooks according to PRISMA guidelines. Fifteen studies were chosen for qualitative and quantitative analyses. Among them, five studies focused on ART, seven studies on HT, and the remaining three studies compared both ART and HT. The children, parents, and general dental practitioners’ acceptance were estimated using the DerSimonian-Laird random-effects method based on both single-arm and two-arm approaches. The risks of bias were evaluated using Cochrane RoB 2, ROBINS-1, NOS, and JBI assessment tools, while evidence levels were determined using OCEBM. Subgroup analysis and meta-regression were conducted to assess the effect of different evaluation methods on the acceptance rates of ART and HT among children and parents. Results: The acceptance rates of ART among children, parents and general dental practitioners were 90.1%, 95.7%, and 67.7%, respectively, whilst the acceptance rates of HT were 88.3%, 85.7%, and 81.8%, respectively. Two-arm meta-analysis revealed no significant difference (P > .05) between the acceptance of HT and ART among children and parents, respectively. Subgroup analysis showed that using questionnaire-based evaluation had a higher (P < .05) acceptance value than using face scale-based evaluation. Conclusion: Both ART and HT are considered well-accepted among children, parents, and general dental practitioners, although general dental practitioners showed a slightly lower level of acceptance. A standardized evaluation tool for assessing acceptance level should be established for better comparison among published articles. Future well-designed studies are warranted to verify the validity of the present review. Schlagwörter: acceptance level, atraumatic restorative treatment, Hall Technique, meta-analysis, systematic review

Objectives: This clinical trial evaluated the effects of red wine exposure on the effectiveness of at-home bleaching with 10% carbamide peroxide, degree of tooth sensitivity, and levels of periodontal inflammatory markers. Method and materials: Eighty participants were assigned to two groups, namely, those who drank red wine (experimental group), and those who did not drink red wine (control group). The experimental group participants rinsed their mouths with 25 mL of red wine four times a day during the bleaching period. Shade evaluation was assessed visually by using the Vita Classical and Vita Easyshade techniques. Tooth sensitivity was evaluated by the numeric and visual analog scales, and the salivary and gingival crevicular fluids were collected for assessment of nitric oxide (NO) levels, a marker of inflammation. Differences in color change were analyzed by one-way analysis of variance (ANOVA). The absolute risks of tooth sensitivity were compared by the Fisher exact test. Tooth sensitivity intensity data sets for both the visual analog scale and the numeric rating scale were compared using the Wilcoxon signed rank test (α = .05). Repeated measures and two-way ANOVA followed by the Bonferroni test were used to assess time-course and differences between groups in NO production. Results: The bleaching technique was effective regardless of wine consumption (P > .05). Tooth sensitivity was classified as mild, with no differences between groups (P > .05). Red wine reduced both the gingival crevicular fluid and salivary levels of NO (P < .05). Conclusion: Red wine does not interfere with the effectiveness and sensitivity of at-home teeth bleaching with 10% carbamide peroxide and protects against bleaching-induced inflammation. Schlagwörter: at-home bleaching, carbamide peroxide, crevicular gingival fluid, nitric oxide, tooth sensitivity

Periodontal disease is highly prevalent and contributes to the global burden of chronic diseases. Inherent and institutional inequities contribute to the prevalence of periodontal disease by facilitating barriers to accessing dental care and maintaining good oral health. The aim of this paper is to review the inequities experienced in the dental field in relation to periodontal disease. Barriers to dental care are experienced in many countries globally. They include cost, insurance coverage, geography, physician availability, and oral health literacy. These barriers influence the frequency of dental visits, oral hygiene, and risk behaviors of individuals which impact an individual’s oral health status. Most often, postponed or improper dental care leads to worsened dental conditions that are more costly and detrimental to one’s wellbeing. These dental conditions, like periodontitis, fall back on the health care system for treatment through emergency department resource use and comorbidities that can develop or be worsened as a result. To reduce the global burden of chronic disease and the costs of treatments for preventable conditions, and increase oral health, corrective actions are required. Such actions may include the use of teledentistry, greater oral health education, emergency departments staffing dental practitioners, subsidies for rural or remote dental practitioners, and policy changes for universal coverage of basic dental needs. Schlagwörter: accessibility, barriers to care, health care systems, oral disease, treatment, wellbeing

Objectives: The aim of this retrospective case series was to report the performance up to 5 years of an innovative surgical design (the apically incised coronally advanced surgical technique [AICAST]) for the regenerative treatment of one- or two-walled intrabony periodontal lesions. Method and materials: After completion of standard step I to II periodontal therapy, nine isolated periodontal defects were treated through AICAST. The following clinical outcome measurements were collected before the surgical intervention and at the last available follow-up: probing pocket depth (PPD), recession depth (REC), and clinical attachment level (CAL). Periapical radiographs of the treated teeth were also taken at baseline and at the last available follow-up (18 months or 5 years postoperatively). Results: A mean (± standard deviation) PPD reduction of 6.05 ± 1.76 mm (P < .01), REC reduction of 1.15 ± 1.97 mm (P = .119), and CAL gain of 7.20 ± 2.13 mm (P < .01) were attained when comparing preoperative results with the last follow-up visit. CAL gain of 6 mm or more was reached in eight out of nine treated cases (88.9%), with a residual PPD of 2 to 3 mm in all the cases. Complete radiographic fill of the intrabony component was present in all the defects, while detectable suprabony radiographic filling was identified in two cases. Conclusion: AICAST represents an innovative surgical design for the treatment of deep intrabony defects and the eventual reduction of the associated gingival recessions. Preliminary results show good performance in terms of clinical attachment gains and maintenance of the marginal tissues. Schlagwörter: coronally advanced flap, enamel matrix derivatives (EMD), papilla preservation flap, periodontal regeneration, periodontitis

Objectives: The literature review aimed to compile and summarize the results of research relating to the recordings of condylar displacements obtained with extraoral devices, to guide clinicians to set dental (virtual) articulator parameters. The meta-analysis was undertaken to assess the sagittal condylar inclination (SCI) and transversal condylar inclination (TCI, also known as Bennett angle) values according to horizontal reference planes, movement studied, and patient characteristics: dental status, interocclusal relationship, skeletal pattern, and signs and symptoms of temporomandibular disorders (TMD). Data sources: A bibliographic search was conducted in the three following electronic databases: MEDLINE, EMBASE, and Cochrane Library and Best Evidence. The review was restricted to trials involving participants meeting the following criteria: (1) adult, (2) no previous surgery in the temporomandibular region, and (3) no serious comorbidity conditions. Descriptive statistics were calculated for all study groups and were compared by applying a one-way ANOVA. Conclusion: All 20 articles selected corresponded to a total of 933 subjects evaluated. The recording devices and horizontal reference planes had a significant impact on the SCI values. Age, dental status, and the presence of symptoms and signs of TMD in subjects had no influence on SCI values, unlike Angle class II, division 2, the class II sagittal pattern, or the increased vertical skeletal pattern SCI parameters (P < .05). The mean TCI value was 8 degrees and was independent of individual patient characteristics and the extraoral recording device used. For accurate kinematic simulation, the patient’s personal plane of reference must be transferred to the system. Schlagwörter: Bennett angle, condylar inclination, condylar kinematic, dental articulator, literature review, temporomandibular joint

Objectives: Candida adherence to the denture base is an important cause of denture stomatitis in elderly and handicapped patients where effective patient- and physician-based disinfection methods are required. The purpose of this study was to investigate the in vivo effectiveness of chemical and physicochemical methods and their combinations against common oral Candida species on denture base acrylic resin. Method and materials: Patients were divided into six groups according to disinfection methods. For chemical disinfection, chlorhexidine, sodium hypochlorite, and glutaraldehyde were used by the patients. Microwave and ozone therapy were applied by physicians for physicochemical disinfection. Fungal load count was performed. This procedure was repeated before applying any disinfection procedures, at 1 week and 1 month after the patient started to use the relevant chemical disinfectant and apply physicochemical methods. A multivariate analysis test was used to determine the change in fungal load over time and whether this change led to a difference among the groups (P < .05). Results: The most frequently isolated Candida strain was Candida albicans. The change in fungal load over time was significantly different (P < .001). However, the difference between the groups did not show any significant difference in the paired comparison analyses of the chemical disinfection groups (P >.05). No Candida strains were detected in either physicochemical method at any of the control time points. Conclusions: The study concluded that chemical disinfectants used by patients were effective for but total eradication of Candida adhesion requires the use of additional ozone or microwave therapy. Schlagwörter: Candida albicans, chemical disinfection, complete dentures, microwave, ozone therapy

Objectives: Healing of postextraction alveolus is a complex process that involves soft and hard tissue regeneration. Pain, swelling, difficulty in opening the mouth, delayed bone tissue healing, alveolitis, and horizontal or vertical resorption of bone tissue are the main problems that impact on consequent treatment. Blood concentrates PRGF (plasma rich in growth factors) and PRF (platelet-rich fibrin), which are rich in growth factors, create better conditions for postextraction alveolus healing, enhance quality of soft tissues and bone regeneration, and decrease pain. The study objective was to compare physiologic healing of the postextraction zone with PRF- and PRGF-induced changes. Method and materials: In total, 43 patients were randomly divided into three groups: control group (mandibular molar extraction and filling of postextraction alveolus with hemostatic sponge containing gentamicin), group 2 (postextraction alveolus filled with PRGF), and group 3 (postextraction alveolus filled with PRF). Bone regeneration was evaluated in CBCT scans after 1 month. Pain was evaluated using the visual analog scale (VAS). Results: After evaluating VAS results 1 day after surgery the lowest pain score was in the PRGF group. Tooth alveolus vertical and diagonal dimensions in the control group were significantly (P = .017) smaller than in the PRGF group. The vertical dimension of the alveolar ridge did not change significantly (P = .859) in the PRGF group; however, it was significantly reduced (P = .04) in the PRF group. One month after surgery the age of the control group was inversely proportionally correlated with the height and diagonal dimension of callus. Conclusion: Both blood concentrates had great anti-inflammatory properties, but PRGF had better osteoblastic properties and resulted in lower postoperative pain. Schlagwörter: alveolar process, bone regeneration, plasma-rich in growth factors, platelet-rich fibrin, postoperative pain, tooth socket