Quintessence International, Pre-Print

Objective: The aim of this study was to investigate whether psoriasis disease constitutes a comorbity of OLP and to elucidate the effect of depression and anxiety treatment. Methods and material: We analyzed a cohort of consecutive patients diagnosed clinical and histologically of OLP from years 2014–2022. The results were contrasted with those obtained in control series matched for age and sex. The correlation between OLP and gender, age, tobacco, alcohol, psoriasis, treatment of depression and anxiety was assessed using Chi-square of Pearson test. Multivariate regression analysis was performed to evaluate the association between psoriasis and OLP. For the assessment of the quality of the statistical models, the Akaike Information Criterion (AIC) was used. Results: The study involved 1016 patients, being 738 women (72.6%), and 278 men (27.4%). The average age was 59.38 (±12.55) years. From 508 patients with OLP 16 (3.15%) had comorbid psoriasis and in the control group 5 (0.98%). Age, gender, smoking and alcoholic habits are not predictive variables in the relationship between association of psoriasis and OLP patients. According to the multivariate analysis, the odd ratio (OR) of OLP were for psoriasis (OR 3.13, 1.20-9.68), and when compared to univariate analysis was higher for depression drugs (OR 1.88, 1.13-3.19] and for treatment of anxiety (OR 2.06, 1.18-2.70]. Conclusions: As far as we are aware, this is the first study showing the potential risk of psoriasis in OLP patients and our results should be taken into account to improve knowledge of comorbidity of OLP. Schlagwörter: Case-control study, Epidemiology, Oral Lesions, Oral lichen planus, Oral medicine, Psoriasis

Bariatric dentistry is the branch of dental medicine, focused on preventive and comprehensive oral health care of overweight or obese patients. Obesity is an increasing U.S. and international health problem and is a condition characterized by abnormal or excessive fat accumulation in the adipose tissue and is categorized by body mass index (BMI) according to the World Health Organization (WHO). With the increase of morbid obesity worldwide and the unfavorable effect on the overall health and life expectancy it is necessary proper accommodations to be made for accessible dental care of this vulnerable population of patients. The following case report details the emergency and the subsequent elective dental treatment of a patient with a morbid obesity and demonstrates the importance of necessary equipment, a multidisciplinary approach, and broad networking communication needed to treat bariatric patients. Our goal was through this case report to bring awareness and start professional discussions on the importance of all dentists in the community and dental academic programs working together to assure access for primary oral health for bariatric patients. Schlagwörter: bariatric bench, bariatric dentistry, BMI, class III obesity, Complex diseases, Diabetes, Diagnostic procedure, Diet, Education, Epidemiology, interdisciplinary practice , morbid obesity, multidisciplinary approach, special care dentistry

Objectives: This systematic review aimed to search the literature for the answer to the following questions: In human studies: Does the osseodensification technique (OD) increase the resonance frequency analysis (RFA) given in implant stability quotient values (ISQ) and the insertion torque value (ITV) compared to conventional technique (SD)? In animal studies: Does the OD increase ISQ, bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) over conventional technique? Data Sources: A search for studies was carried out in eight databases until August 2021. Out of the 447 publications found, 11 were included. In human studies, OD showed better results for ISQ with a summarized median difference (SMD) of 8.57. As for secondary stability, there was no significant difference, with SMD of 4.49 in favor of OD. In animal studies, all results were favorable to OD. Regarding insertion torque, BIC and BAFO between counterclockwise OD vs conventional, the SMD was 46.79 for IT, 2.17 for BIC and 2.11 for BAFO. High heterogeneity was observed between the studies. The Risk of Bias in humans was moderate in three studies and low in one; and in animal studies, four presented moderate risk, two low risk, and one high risk. The certainty of evidence ranged from low to moderate. Conclusion: The osseodensification technique showed improvement concerning the resonance frequency and the insertion torque value of implants in human studies. In addition, it increased the values of BIC, BAFO and ISQ in animal studies, when compared to conventional technique. Schlagwörter: conventional technique, dental implants, osseodensification, primarystability, secondary stability

Objectives: The role of antibiotics as an adjunct to non-surgical peri-implantitis treatment approaches has not reach a consensus. This meta-analysis aimed to review the adjunctive effect of systemic use of metronidazole and amoxicillin in patients with peri-implantitis. Method and Materials: PubMed, Embase, and the Cochrane library were searched for randomized controlled trials (RCTs) published from inception to January 2023. Results: A total of 5 clinical trials with a total of 211 patients were included in our analyses. No significant difference was found in the reduction of probing pocket depth (PD) at 3- and 6-month follow-up (3-month: WMD=-0.336, 95%CI: -0.966, 0.233, p=0.231; 6-month: WMD=-0.533, 95%CI: -1.654, 0.587, p=0.351). Statistically significance was found at 12-month follow-up: WMD=-1.327, 95%CI: -1.803, -0.852, p<0.001) between the treatment group and control. And the combined results indicated the difference in reduction of bleeding on probing (BOP), plaque score (PI), and bone level (BL) at 6-month follow-up were significant (p<0.05). Conclusion: Our study demonstrated that the adjunctive use of systemic metronidazole and amoxicillin did not significantly improve PD compared to non-surgical treatment alone, and should not be routinely recommended. However, the significant reduction in BOP, PI, and BL at 6-month may indicate potential effect for treating peri-implantitis. Schlagwörter: Meta-analysis, Metronidazole, Peri-implantitis, Statistical methods, Systemic

Background: The prevalence and the economic burden of periodontal disease are high. To save or replace diseased teeth, an objective prognosis assessment using the long-term predictability of the various treatment options should be performed. As dental implants have become a treatment of choice for replacing missing teeth, the number of implant failures and complications has also increased. Objectives: To compare the cost-effectiveness of saving and maintaining the teeth vs. replacing them with dental implants in patients with severe periodontal disease (with hopeless or questionable teeth). Methods: A database search was conducted using Medline (OVID), EMBASE, Web of Science, CINAHL electronic sources until July 2023. Two reviewers reviewed the papers in accordance with the specific selection criteria after choosing the abstracts that met the initial selection criterion for full article retrieval. Results: 12 articles were included, of which 9 articles discussed cost-effectiveness of preserving teeth in severe periodontal disease and 3 articles discussed the effectiveness of implants that replaced the periodontally compromised teeth. It was found that placing and maintaining implants was more costly than properly treating and maintaining periodontally compromised teeth. Supportive periodontal treatment contributed the most to the cost during the periodontal treatment. Conclusions: Implants are an effective choice to replace missing teeth, however, these are not permanent, present complications and require strict maintenance. Thus, when deciding whether to maintain a periodontally compromised tooth or to replace it with a dental implant, in terms of cost effectiveness, implant maintenance cost as well as the cost associated with treating implant complications should be considered. This cost seems to surpass the cost of treatment and maintenance of periodontally compromised teeth. Schlagwörter: bone loss, implants, Periodontitis, success, survival

Objectives: Microneedling(MN) and injectable-platelet rich fibrin(i-PRF) have been proposed as relatively less invasive alternatives to surgical procedures for augmentation of thin periodontal phenotype. The present study was conducted to evaluate effect of MN and i-PRF alone on gingival thickness(GT) in thin periodontal phenotype individuals. Method and Materials: Systemically healthy individuals with thin periodontal phenotype in mandibular anteriors (n=21) were treated with MN on one side and i-PRF on contra-lateral side. Assessment of GT, keratinised tissue width (KTW) and periodontal parameters was done at baseline,1,3 and 6 months. Results: In intergroup comparison, statistically significant increase in GT was observed with MN as compared to i-PRF at 6th month (p<0.02). Intragroup comparison from baseline to 6th month showed statistically significant increase in GT within both the groups, MN from 0.78mm±0.12 to 1.00mm±0.14 (p<0.000) and i-PRF from 0.77mm± 0.10 to 0.93mm±0.12(p<0.000). Intragroup comparison showed statistically significant increase in KTW in MN group (p<0.000). Statistically significant decrease in periodontal parameters was observed on intragroup comparison (p<0.000). Conclusion: Considering the higher gain in GT and the added advantage of eliminating need for autologous blood withdrawal, MN is potentially better than i-PRF for phenotype modification in thin periodontal phenotype individuals. Schlagwörter: Gingiva, Microneedling, Phenotype, Platelet rich fibrin, Randomized clinical trial

Objectives: The consecutive case series accesses the results and experiences of ridge augmentation using an umbrella-screw (US) tenting technique. Materials and Methods: 279 patients have been treated between 05/26/2015 and 08/16/2021 including horizontal and vertical ridge defects. Gender, age, smoking behavior, jaw, graft material, soft tissue thickness, extent of horizontal/vertical augmentation, resorption rate and occurrence of early/late exposure were evaluated. Bone gain was determined by resorption at the screw head. Only cases without premature screw removal were evaluated metrically (n=201). All other augmentations were evaluated according to whether implantation was possible with or without further augmentation (n=27). A target performance index (TPI) was calculated, which should enable evidence-based comparability of different augmentation methods in future. Results: 54 wound dehiscence (39 early, 15 late exposures) occurred, which corresponds to 24.08 % of the augmented sites. 42 US were removed prematurely. In all cases an implantation was possible at the desired position afterwards. Cases with a vertical augmentation component showed a higher prevalence of exposure (early (p=0.000), late (p=0.024)). The extend of the vertical augmentation showed only to be relevant for early exposure (p=0.048). Mean bone gain of 4.23 mm ± 1.69 horizontally and 4.11 mm ± 1.99 vertically could be achieved. Regression analysis showed that there was no limit in horizontal/vertical direction. Mean percental TPI was 75.90 ± 20.54 for vertical and 82.25 ± 16.67 for horizontal portions. Conclusion: The umbrella-technique is an effective augmentation method, which can be applied to any defect morphology. Schlagwörter: horizontal ridge augmentation, implantation, Ridge augmantation, target performance index, tenting technique, umbrella screws, umbrella technique, vertical ridge augmentation

Advanced digital technologies have rabidly been integrated into prosthodontics to improve the digital workflow for prosthetic rehabilitation. The integration of 3D datasets acquired from various imaging sources such as intraoral scanners and facial optical scanners allows the creation of virtual patients to perform presurgical simulation and prosthetic rehabilitation. The presented technique introduced a straightforward protocol for aligning intraoral scans (Trios 4, 3Shape) to optical face scans (Face Hunter, Zirkonzahn GmbH) using a global bestfit algorithm of 3D evaluation software (GOM Inspect). Nasal geometry data was used as a matching reference to produce virtual dental patients. This integration protocol proved that the intraoral scanner (Trios 4, 3Shape) was used not only to scan dental arches but also used effectively to scan the nose. These scans along with professional facial scans can be successfully aligned to produce virtual dental patients. Because only one single fully-dentate patient case with an alignment deviation of 243.6 μm was used, further research to evaluate the accuracy of this protocol is needed. Schlagwörter: Dental impression technique, face, imaging, nose, three-dimensional

Objectives: The aim of the present study was to evaluate clinical and radiographic outcomes of implants placed in alveolar sockets treated by means of alveolar ridge preservation (ARP) after a 10-years follow-up. Method and Materials: Eleven patients treated with 11 implants placed after ARP using bovine-derived xenograft particles and collagen membrane were selected. Full mouth plaque score (FMPS), full mouth bleeding score (FMBS), probing depth (PD) at four sites per implant and radiographic marginal bone level (MBL) at mesial and distal aspects for each implant were recorded at baseline and after 10-years follow-up. The primary outcome was the radiographic marginal bone loss (mBL). The mBL was considered as the difference between MBL at baseline and after 10-years observation time. Results: After 10 years follow-up, FMPS increased significantly (P>0.05), while not statistically significant differences were found in change of FMBS (P<0.05). After 10 years observation period, a significant increase of PD was observed at all sites (P>0.05) with except of the mesial aspects (P<0.05). Radiographic marginal bone loss (mBL) was 1.1±0.1 mm and 1.0±0.1 mm at mesial and distal sites, respectively. Conclusion: Whitin the limitations of the present study, implants placed in post-extraction sockets treated with ARP yielded stable clinical and radiographic results after 10-years follow-up. Schlagwörter: alveolar bone loss, biomaterials, bone regeneration, dental implants, dental prothesis, tooth sockets

Oral dysesthesia (OD) is a diagnosis of exclusion which manifests as an unpleasant and abnormal sensation of the oral mucosa without any noticeable oral lesions. Burning sensation is one of the manifestations of OD which may advocate for similar pharmacotherapeutic options to burning mouth syndrome (BMS) resulting in possible adverse events. The aim of these case reports is to illustrate the significance and rationale for the use of oral devices as a mechanical/physical barrier and a safe approach in the management of OD, without experiencing any antagonistic effects from pharmacotherapeutic agents. Two patients with spontaneous and evoked (following dental procedures) OD symptoms in the right posterior mandibular quadrant and anterior hard palatal areas were evaluated. Additionally, their OD symptoms were associated with hyposalivation and taste changes. A thorough history and complete head and neck examination, with the exclusion of oral lesions and systemic conditions were performed. These patients were previously prescribed topical clonazepam rinses. An in-office trial, with application of orthodontic wax to the affected area, was performed as a preliminary test in order to justify the fabrication of an oral device for possible symptomatic relief. The case reports demonstrated significant improvement of OD symptoms and amelioration of pain following fabrication of oral devices in two patients with no undesirable effects from pharmacotherapy. Additionally, the oral devices aided as a mechanical/physical barrier, potentially exerting a placebo effect while facilitating an improved quality of life. Furthermore, the cost-effectiveness and ease of fabricating the oral device has been advantageous over other systemic medications. This encourages the need for a detailed prospective study. Schlagwörter: Burning mouth syndrome, Central and peripheral sensitization, Mechanical/physical barrier, Oral devices, Oral dysesthesia, Somatization

OBJECTIVE: Inflammatory pathogenesis is common to periodontitis and oral lichen planus (OLP). This study was conducted to assess and compare the periodontal status of patients with and without oral lichen planus. METHOD AND MATERIALS: 108 patients comprising of 54 having OLP and 54 age matched systemically healthy participants without oral lichen planus were selected. Periodontal parameters i.e; plaque index, gingival index, bleeding on probing, probing pocket depth, clinical attachment level and periodontal phenotype were measured. RESULTS: On comparing test and control group, statistically significant difference was observed in respect to PI (p=0.00), GI (p=0.00), BOP (p=0.00). Higher proportion of sites with deeper pockets was observed in test group (p=0.00). On comparison of various OLP subtypes, significant difference was observed in respect to GI (p=0.00) and BOP (p=0.00). Higher proportion of sites with deeper pockets (p=0.01) and greater CAL (p=0.00) was observed in erosive/atrophic subgroup compared to reticular group. However, the difference between reticular (a less severe form of OLP) and control group in terms of GI (0.94), PI (0.05), BOP (0.16), PPD (0.55) and CAL (0.22) was not statistically significant. Statistically significant difference was observed in respect to GI (p=0.00) and BOP (p=0.00) between thin and thick periodontal phenotype in OLP group. Statistically significant positive correlation of periodontal parameters with increased gingival involvement and severity were observed using spearman rank correlation coefficient. CONCLUSION: Significantly higher periodontal inflammation in test group makes them at risk for higher attachment loss in future. Thus, increased attention towards periodontal health in these patients might reduce the rate of disease progression. Schlagwörter: inflammation, oral lesions, oral lichen planus, periodontal pocket, periodontitis