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An orthodontic extraction technique with a ramus mini-screw was used to remove a deeply impacted mandibular third molar contacting the inferior alveolar nerve, avoiding damage to the inferior alveolar nerve and relieving postsurgery inflammation. Case presentation: A 24-year-old man was required to extract impacted third molars for orthodontic treatment. Panoramic radiographs and CBCT images showed that his mandibular left third molar penetrated into the inferior alveolar nerve canal and a distomolar was inverted and impacted distally to the third molar. The distomolar was directly removed and the impacted third molar was extruded with the aid of a ramus mini-screw. After 4 months of traction, the mandibular left third molar was successfully moved away from the inferior alveolar nerve canal. No nerve injury occurred after the surgical extraction and the patient was very satisfied with the treatment outcome. Conclusion: Orthodontic extraction, with the aid of ramus mini-screws, is a safe, effective, and efficient technique for the removal of high-risk impacted molars contacting the inferior alveolar nerve. (Quintessence Int 2021;52:538–546; doi: 10.3290/j.qi.b1244345) Schlagwörter: impacted tooth, nerve injury, orthodontic extraction, ramus mini-screw, third molar, traction

Objective: To determine the association of high occlusal force (HOF) with the signs of occlusal trauma and periodontal conditions in periodontitis patients, and elaborate the relevant clinical implications. Methods: Periodontal parameters and signs of occlusal trauma were recorded for 807 teeth in 30 subjects with untreated chronic periodontitis. The T-scan II occlusal analysis system determined the HOF during maximum intercuspation, lateral excursion and protrusive excursion. The correlation of HOF with periodontal parameters and signs of occlusal trauma was analysed. Results: Overall, the teeth with HOF existed mainly in molars and presented with deeper probing depth (PD) and higher frequency of bleeding on probing (BOP) than those without HOF. The fixed-effect analysis showed that HOF was positively correlated with PD and BOP (P < 0.05) in posterior teeth; widened periodontal ligament space on radiographs in upper (r = 0.179, P < 0.01) and lower posterior teeth (r = 0.205; P < 0.05); as well as functional mobility in upper posterior teeth (r = 0.168; P < 0.05). Conclusion: This study suggests that the posterior teeth with HOF in subjects with chronic periodontitis may reflect occlusal trauma-associated periodontal conditions that could probably increase the risk of further periodontal destruction. These findings may improve the clinical assessment of occlusal trauma and related periodontal conditions for better patient management and treatment outcomes. Schlagwörter: chronic periodontitis, occlusal trauma, T-scan occlusal analysis system

This literature-based OPINION PAPER reflects in an introductory historical perspective on the rapid advancement of dental adhesive technology. Past and current techniques to bond to tooth tissue, in particular to dentin as the most challenging bonding substrate, are critically appraised. Including the historical perspective in (1), this paper focuses on fourteen items thought to be of primary importance with regard to the current status of dental adhesive technology. In (2) the primary mechanisms involved in adhesion to enamel and especially dentin are dealt with having (3) also revisited the previously introduced adhesion-decalcification concept (AD concept) as basis of biomaterial-hard tissue interaction; the worldwide accepted classification of today's adhesives into etch&rinse (E&R) and self-etch (SE) adhesives are presented in (4), along with presentation of their respective PLUS-MINUS balances in (5) and (6); nomination of the GOLD-STANDARD E&R (7) and SE (8) adhesives is based on evidence of successful laboratory and long-term clinical performance, resulting in a recommended 3-step full E&R bonding route in (9) and the preferred 3-step combined selective enamel E&R with 2-SE bonding route in (10); (11) description of the main bond-degradation pathways and eight strategies to preserve bond stability; (12) coverage of the PROS and CONS of the newest generation of UNIVERSAL adhesives. Looking into the future, some expected future developments in dental adhesive technology have been suggested in (13), along with (14) a first status determination of the latest research-and-development towards self-adhesive restorative materials that no longer require any pre-treatment. Schlagwörter: review, bonding, dentin, adhesion, self-adhesive

Purpose: To assess the association of various factors including education level and oral health with type 2 diabetics’ awareness of periodontitis and periodontitis/diabetes relationship, and to evaluate the importance of integrated healthcare in this association. Materials and Methods: 288 type 2 diabetics were evaluated through a validated structured questionnaire about oral hygiene habits, access and attendance to dental treatment, the presence of periodontitis and previously received information of periodontitis and periodontitis/diabetes relationship. Descriptive data were explored and both simple and multiple logistic regressions were performed. Results: The average age of participants was 62.24 (±10.93) years, 81.6% were previously treated for periodontitis and approximately 70% have never received information on periodontitis and its relationship with diabetes. A higher chance of participants having previously received information regarding periodontitis was associated with more than 8 years of schooling, daily flossing habit, presence of periodontitis and prior treatment for periodontitis (p  Schlagwörter: diabetes mellitus, periodontal diseases, health promotion, public health/community dentistry, primary healthcare

Abstract: Tooth-cavity preparation contributes to a large extent to the quality of the direct posterior composite restoration, the so-called hidden quality of the restoration. Indeed, the effect of a poor cavity design is not immediately visible after placement of the restoration. To correctly prepare a cavity for a posterior composite restoration, the tooth to be restored should first be profoundly biomechanically analyzed. Here, the forces that work on the tooth during occlusion and articulation, and the amount and quality of the remaining tooth structure determine the cavity form. In addition, the dental tissues must be prepared in order to receive the best possible bond of the adhesive and subsequent restorative composite. A well-finished cavity preparation enables the restorative composite to adapt well, providing a good marginal ?seal to the direct benefit of the clinical lifetime of the posterior composite restoration. Finally, it is highly recommendable to isolate the teeth with rubber-dam before starting with the cavity preparation, as this increases the visibility of the operating field and allows the operator to work in a more precise way.

Purpose: Orthodontic treatment may introduce a risk to the integrity of enamel due to plaque accumulation and colonisation by oral microbes. This prospective cohort study observed the effect of fixed, self-ligating orthodontic appliances on saliva properties and oral microbial flora. Materials and Methods: Thirty adolescent patients were recruited (13 female, 17 male, mean age 13.97 ± 2.07 years). Saliva samples were collected before placement of fixed orthodontic appliances (T0), and 4 (T1) and 12 (T2) weeks later. Salivary pH, flow rate and buffering capacity were recorded. All saliva samples were cultured on agar plates for 2 days. Salivary prevalence of Neisseria spp., streptococci, Staphylococcus aureus, coagulase-negative staphylococci and Candida albicans were assessed. Results: High buffering capacity was reported in 21 patients at T0, 22 patients at T1 and in 28 patients at T2. Saliva flow rate also increased over time (7.08 ml/5 min at T0, 7.93 ml/5 min at T1 and 8.35 ml/5min at T2). Mean pH was 7.63 at T0, 7.67 at T1 and 7.78 at T2. There was no evidence that either pH or the number of colonies of any of the microbial species changed over time. Conclusion: The increased buffering capacity of saliva as well as the salivary flow rate after initial bonding might be protective against the development of dental caries. Current microbial findings indicate that initiation of orthodontic treatment may not be associated with significant changes in oral microbial flora. Schlagwörter: microbial flora, orthodontics, saliva

Purpose: Several studies demonstrated compromised oral health and periodontal diseases as risk factors for adverse pregnancy outcomes. However, consideration of oral health by pregnant women remains elusive. The aim of this study was to evaluate knowledge and behaviour of French pregnant women towards relationship between oral conditions and pregnancy outcomes and to evaluate influencing factors. Materials and Methods: A self-reported questionnaire was given to women between 1 and 3 days after delivery in three specialised clinics in France. The questionnaire aimed to evaluate demographic characteristics, self-perceived oral health, type of pregnancy follow-up and knowledge regarding oral conditions during pregnancy and risk of adverse pregnancy outcomes. A multivariate analysis was performed to evaluate correlation between knowledge and behaviour. Results: The questionnaire was completed by 212 women. Among them, 92% considered prevention of oral diseases during pregnancy important. Despite knowledge of potential negative influence of periodontal diseases on pregnancy outcomes, only 47% of pregnant women received dental diagnosis or treatment during pregnancy. Only 18% of the women discussed oral health consideration during pregnancy with health professional in charge of pregnancy follow-up. Interestingly, absence of dental consultation during pregnancy was associated with low rate of dental consultation prior to pregnancy (p < 0.01). Conclusions: Pregnant women were aware of the association between oral health and pregnancy and of need of prevention. However, consideration of importance of oral health was not adequate to the rate of dental consultation and seems to be influenced by individual dental follow-up habits prior to pregnancy. Clinical Relevance: Dental evaluation should be considered systematically during pregnancy follow-up. Schlagwörter: oral health, questionnaire, prevention, risk factor

Purpose: The aim of the present research was to analyse the effects of two bleaching agents, on the enamel crystallography by means of X-ray diffraction. Material and Methods: Twelve human sound posterior teeth, were collected for the present study (n = 12) and from each tooth two enamel slabs were obtained and randomly assigned to one of two different bleaching protocols. The first protocol involved an in-office bleaching agent (hydrogen peroxide 37.5%/ SDI Polaoffice+), and the second an at-home whitening product (carbamide peroxide 16%/ PHILIPS Zoom! NiteWhite). X-ray diffraction readings were made before and after applying the treatments in order to analyse the peak intensity and crystal domain size. Additionally, scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDX) were carried out to identify the composition correctly. Statistical analysis included repeated measures analysis of variance (p ≤ 0.05). Results: Peak intensity in spectra obtained by X-ray diffraction had a tendency to diminish, mostly in the at-home bleaching group. The analysed data approximate a decrease in the crystal domain size among the samples treated for longer periods of time. Statistical analysis depicted no statistically significant differences among the experimental groups (p ≥ 0.05). Conclusions: Crystal domain size had a tendency to decrease, mostly when the enamel was treated by bleaching gels that had to be applied by prolonged periods of time. Schlagwörter: bleaching agent, enamel crystallography, X-ray diffraction

Purpose: Currently, there is no consensus on recommendations for manual toothbrushing techniques between dentists, oral health therapists and dental companies. The aim of this systematic review is to identify and assess the quality of evidence of the effectiveness of manual toothbrushing techniques in the existing literature. Methods: A broad search was conducted on the electronic databases Medline via Ovid, PubMed and EBSCO Dentistry & Oral Sciences. Included studies examined manual toothbrushing technique efficiency. Articles were assessed utilising the Cochrane Collaboration's tool for assessing risk of bias. Thirteen studies met the inclusion criteria and were included in this review. These included five randomised controlled trials (RCT), seven experimental non-randomised control studies and one in vitro study. Results: Of the 3190 articles identified, 40 were relevant to manual toothbrushing and 13 were included in the final review. Studies indicating statistically significantly superior plaque removal for a given technique were Bass (one), modified Bass (one), Charter's (two), Fones (two), scrub (two), roll (one), modified Stillman (one), toothpick method (one). Four studies exhibited no statistically significant difference in effectiveness of plaque removal. Unfortunately, considerable variation was found between studies, making a definitive conclusion impossible in terms of an ideal manual toothbrushing technique that would promote plaque removal and reduce gingivitis. Conclusion: There is still insufficient evidence for suggesting that one toothbrushing method is more effective than another in plaque removal and reduction of gingivitis. Excessive variability in many aspects of the design and methodology of the selected studies hinder conclusions on an ideal manual toothbrushing technique. Experimental randomised controlled trials that follow the CONSORT guidelines are required to provide adequate-quality evidence and make any definitive conclusions on the relative effectiveness of manual toothbrushing techniques. Schlagwörter: evidence-based medicine, oral hygiene, systematic review, toothbrushing

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

Purpose: The aim of this study was to review the literature and chart the clinical studies that have focused on periodontal diseases and adverse pregnancy outcomes since 1996. Materials and Methods: Medline, Cinahl, and Cochrane databases were searched for original studies focused on pregnancy outcomes and periodontal status in humans. The most recent search was conducted on April 30, 2020. Results: Of the 633 articles identified, 232 articles (n = 119,774 participants) were selected for analysis. The majority of studies highlighted a statistically significant association between periodontal diseases and preterm birth (71 of 111 articles; 63.96%), low birth weight (46 of 64 articles; 71.87%), preterm low birth weight (29 of 49 articles; 59.18%), preeclampsia (31 of 45 articles; 68.89%) and other pregnancy complications, such as preterm, prelabor rupture of membranes (17 of 26 articles; 65.38%). Geographical analysis revealed that clinical studies were conducted in 51 countries, primarily in the United States (42 studies, 18.10%), Brazil (33 studies, 14.22%) and India (25 studies, 10.78%). Irrespective of geographical location, analysis showed various degrees of evidence of a relationship between periodontal diseases and adverse pregnancy outcomes. Conclusion: The majority of the studies found a statistically significant link between periodontal diseases and some complications of pregnancy. The strength of such a link varies according to type of study, type of variable and outcome measure selected. Schlagwörter: periodontal diseases, pregnancy, adverse pregnancy outcomes, mapping

Purpose: To investigate the subgingival microbiological profiles of patients with periodontitis, to determine their stage and grade scores and to evaluate the differences in the microbiota among different stages and grades. Materials and Methods: Sixty-seven (n = 67) periodontitis patients were selected. Periodontitis staging and grading, following the 2018 classification system, were defined. Following a clinical examination, subgingival samples were taken from the deepest periodontal pocket of each quadrant for cultivation, identification and quantification. The prevalence, proportion and counts of nine selected periodontal pathogens were determined, and differences between periodontitis stages III and IV and grades B and C were assessed. Results: All nine cultivable periodontal bacteria were detected, of which the most prevalent was P. intermedia (91.0%) and the least prevalent were E. corrodens (9.0%) and C. ochracea (9.0%). The frequency of detection of the two main target pathogens, A. actinomycetemcomitans and P. gingivalis, was 41.8% and 76.1%, respectively. The prevalence (grade B: 80.6%, grade C: 55.6%, p = 0.035) and total counts (grade B: 19.8 colony forming units – CFU/ml-4 (1.9–52.8); grade C: 4.0 CFU/ml-4 (0.0–26.4); p = 0.022) of F. nucleatum were statistically significantly higher in grade B than in grade C periodontitis patients, whereas the counts of P. gingivalis and A. actinomycetemcomitans were similar between grades and stages. Conclusion: Our study suggests that relevant differences between the various grades of periodontitis exist only in the numbers of F. nucleatum. Prevalence and quantities of other cultivable species between different stages and grades of periodontitis seem to be similar. Schlagwörter: periodontitis, stage, grade, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Fusobacterium nucleatum

Purpose: The goals of this review are (1) to describe the evidence behind the use of ceramics vs composite resin to restore teeth with anterior veneers using a minimally-invasive strategy; and (2) to discuss the choice of materials and techniques for anterior veneer restorations. Overview: In recent years new adhesive restorative materials and techniques have been introduced in dentistry, including nanofilled composite resins for direct restorations, new ceramic materials that combine esthetics and strength, and polymer/ceramic materials for indirect restorations that are fabricated chairside using CAD/CAM technology, allowing the dentist to design, mill, and cement the restoration in one session. In spite of the novelty and new technology behind the introduction of new materials, the available evidence that backs some of these materials does not justify their use over similar materials or techniques that have been used by dentists for some years. Notwithstanding the success of laminate veneers and the popularity of new materials and digital techniques, the classical direct composite resin veneer is still very popular among clinicians and taught in dental schools and continuing education courses. Direct composite resin veneers are usually more affordable than indirect veneers, less invasive of the tooth structure, and easier to repair. Current composite resin materials can be finished to a tooth-like appearance, but they are susceptible to alterations of the surface gloss and potential discoloration of the composite resin. On the other hand, the preparation for indirect veneers is generally more invasive and the respective restorations are more difficult to repair. In addition, the esthetic outcome of bonded ceramic restorations still depends on the clinical behavior of the dentin adhesive and resin luting cement used to bond the restoration to the tooth structure. Conclusions: The ultimate goals of any restorative treatment are to restore function and esthetics, prevent recurrent caries lesions and bacterial leakage into the pulp space, save tooth structure, and promote the well-being of our patients. The armamentarium of new dental materials for esthetic clinical procedures has increased exponentially in the last few years. The use of different materials and techniques for anterior veneer restorations must be based on sound evidence rather than on the marketing hype or testimonials. Schlagwörter: adhesion, ceramics, clinical, composite resin, MID, restorative materials, veneers

Objective: Persistent idiopathic facial pain (PIFP) is a condition in the absence of clear pathology. Pathogenesis is still enigmatic, although comorbidity with mood/affective disorders is observed. The aim of this study was to investigate the association between personality traits, mood and sleep disorders, and PIFP; and to compare them with posttraumatic chronic orofacial pain. Method and materials: A cross-sectional, single-center study was designed to evaluate patients diagnosed with PIFP according to ICOP (International Classification of Orofacial Pain) diagnostic criteria through Hospital Anxiety and Depression Scale, Pittsburgh Sleep Quality Index, Five Factor Model, and visual analog scale indexes. Data were analyzed and compared with patients suffering from organic pathology – unilateral chronic mandibular fracture pain. Results: A total of 67 respondents enrolled as the experimental group and 28 participants as a control group. Pain scores were higher in the experimental group (P < .001) and had positive correlation with depression (r = .44, P < .001) and sleep index scores (r = .415, P < .001). Personality trait scores did not differ between the groups. However, neuroticism correlated with depression (r = .466, P < .01) and anxiety (r = .634, P < .01) scores in the experimental group. Depression (P = .002) and anxiety scores (P = .007) were higher in the experimental group, as well as sleep indexes (P = .038). Depression (r = .609, P < .001) and anxiety (r = .655, P < .001) scores had positive correlation with sleep index scores. Sleep scores in the experimental group positively correlated with neuroticism score (r = .442, P < .001). PIFP increases the chance of experiencing depression (OR 10.688; 95% CI 1.355–84.309, P = .006) as well as poor quality of sleep (OR 3.389; 95% CI 1.023–11.228, P = .006). Conclusions: The results suggest that personality traits (neuroticism), anxiety, depression, and sleep disorders are associated with PIFP. Schlagwörter: anxiety, depression, persistent idiopathic facial pain, personality traits, sleep disorder

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

Purpose: The aim of this study was to describe oral health knowledge, attitudes and behaviours of parents and caregivers of preschool children in order to inform an oral health promotion strategy. Materials and Methods: A sample of parents and caregivers of children attending nine randomly selected preschools in central Trinidad were invited to complete a self-administered questionnaire on early childhood oral health. Results: A total of 309 parents and caregivers participated: 88% were female, 74.4% were of Indian ethnicity, with 50.4% in manual employment, and 50.2% educated to secondary level. 59.1% felt a child's first dental visit should be when all primary teeth are present. 64% had not taken their child for a dental visit. 81.6% rated their child's oral health as good or better and 28% would want an asymptomatic, decayed primary tooth extracted rather than filled. Over 80% used fluoride toothpaste. 52.8% always supervised their child's toothbrushing, and 44% claimed to be using the recommended pea-size amount. 26.2% reported having used a sweetened feeding bottle or infant feeder at night. Conclusion: Parents and caregivers of preschool children in this sample had reasonable oral health knowledge. However, despite generally positive attitudes towards preventive oral healthcare, confusion regarding dental attendance, supervised toothbrushing, fluoride use and sugar intake suggests that these items require particular emphasis in oral health promotion programmes aimed at improving early childhood oral health. Schlagwörter: early childhood caries, parents, caregivers, oral health promotion

Bone regeneration and remodeling are crucial to healing after surgical interventions. Local and systemic factors impact healing. Some well-known medications actively alter bone remodeling. The objective of this report was to increase awareness of less commonly recognized medications that may delay the integration of bone grafts. This case report presents the delayed integration of a bone graft after tooth removal, socket preservation, and ridge augmentation procedures in a patient taking various medications that may have affected bone remodeling. The literature review enables the discussion of evidence regarding delayed bone remodeling associated with selective serotonin reuptake inhibitors (SSRIs), sodium-glucose cotransporter 2 (SGLT2) inhibitors, metformin, and nonsteroidal anti-inflammatory drugs (NSAIDs), and the clinical implications for patients taking these medications. Schlagwörter: bone grafting, bone remodeling, delayed osseointegration, dental implant, medication

The injectable composite resin technique is an indirect/direct method that uses a transparent silicone index for accurate and predictable translation of a diagnostic wax-up into composite restorations without the need for tooth preparation. This case report involves a 22-year-old man who presented with esthetic and functional problems associated with diastemas and insufficient tooth visibility. Clinical examination revealed inadequate canine guidance in lateral excursion. The treatment plan included the fabrication of composite veneers for the maxillary incisors and canines. A wax-up was prepared by simulation of functional movements on an articulator, and a transparent silicone index was prepared after checking a mock-up in the oral cavity. The teeth were restored with flowable composite injected and polymerized through the transparent silicone index. The conventional technique was modified by cutting the silicone index at the gingival margin, using individual mock-ups as space holders, and the use of gingival retraction cords. The final outcomes were elongated teeth for increased visibility, closed diastemas, and reshaped canines for adequate guidance in lateral excursion. A protective splint for night-time wear was fabricated and delivered to ensure long-term stability. The patient did not exhibit any soft tissue inflammation or significant wear during a 24-month follow-up period. The technique described is minimally invasive and inexpensive, and it can be used for definitive as well as translational restorations. The treatment goals are to establish adequate function and esthetics, with advantages including minimal tooth structure loss and cost-effectiveness. Stable and predictable results can be achieved with proper planning and a careful workflow. Schlagwörter: composite resin injection, composite veneer, esthetic rehabilitation, functional rehabilitation, transparent silicone index

Purpose: A previous clinical study showed that the prevalence of erosive toothwear in vegetarians is statistically significantly higher than in nonvegetarians, due to the consumption of vinegar and other acidic foodstuffs. To adequately inform patients, this study investigated the erosive potential of bottled salad dressings available in Switzerland and compared it with that of orange juice. Materials and Methods: One hundred enamel samples of bovine teeth were divided into ten groups. Samples were placed in 1 of 9 bottled salad dressings or orange juice (Granini) for 2 min. Afterwards, they were rinsed with Zürich tap water for 30 s, followed by abrasion with a toothbrush for 20 brush strokes and a toothpaste-saliva mixture. Erosive/abrasive enamel wear was determined with contact profilometry after 40 cycles. Results: The enamel wear (median/IQR) caused by Tradition Sauce Balsamique (9.5 µm/5.3 µm), M-Classic Dressing Italiano (10.9 µm/12.3 µm), Betty Bossi Balsamico Dressing (9.4 µm/4.5 µm) and Thomy Balsamico Vinaigrette Dressing (14.2 µm/6.5 µm) was statistically significantly higher than that caused by orange juice (2.4 µm/0.8 µm). Enamel wear caused by M-Classic Dressing French Joghurt (0.2 µm/0.2 µm) and Coop Qualité & Prix French Dressing (1.2 µm/1.0 µm) was statistically significantly lower compared to that of orange juice. Conclusions: The pure balsamico vinegar-based dressings (Italian type) showed a statistically significantly higher erosive potential than orange juice, whereas dressings containing calcium-rich products (enriched with milk and/or cream) (French-type) caused lower enamel wear than orange juice. The study shows that some bottled dressings have erosive potential even higher than orange juice and patients should be informed accordingly. Schlagwörter: erosion, tooth wear, salad dressings

Purpose: The topical fluoride treatment of teeth can lead to a formation of CaF2-like material, which is considered to play a significant role in caries prevention. Different types of fluoride sources are applied. The aim of this study was to analyse the in vitro fluoridation effect of the lesser known organic fluoride compound nicomethanol hydrofluoride (NH) regarding fluoride accumulation and morphological changes on dental enamel surfaces. Materials and Methods: The fluoridation effect was investigated by scanning electron microscopy (SEM) and energy dispersive x-ray analysis (EDX) after treatment with fluoride solutions at a concentration of 1350 ppm F - and a pH value of 5.5. NH was tested against inorganic sodium fluoride (NaF) as reference. Fluoridation was done on pellicle-free and pellicle-covered enamel. Results: Formation of globular CaF2-like material was observed for both fluoride types. However, NH led to considerably higher calcium fluoride accumulation on the enamel surface as shown by both EDX and SEM. The globule diameters varied between 0.2 and 0.8 µm. Cross-sectional analysis revealed that the globular precipitates lay directly on the enamel surface; only the very surface-near volume was affected. No statistically significant difference of the fluoridation effect was measured with vs without saliva pre-treatment. Conclusion: The experiments showed a 6 times greater F - surface uptake on dental enamel with NH compared to sodium fluoride, thus suggesting an important role of NH during remineralization phases, fostering equilibrium between de- and remineralization. Schlagwörter: amine fluorides, calcium fluoride precipitation, enamel, energy dispersive x-ray analysis, scanning electron microscopy

Purpose: The aim of this study was to verify how the prevalence of viridans-streptococci is changed by two appointments of professional prophylaxis and after the subgingival instrumentation via scaling and root planing (SRP). Material and Methods: Samples of the subgingival biofilm were collected from 19 individuals with periodontitis receiving two appointments of professional prophylaxis and SRP before and after the treatment procedures and the presence of viridans-streptococci was analysed by microbiological cultivation. Non-parametric statistical testing using Friedman/Wilcoxon tests and chi-square testing was used for statistical analysis. Results: No statistically significant changes over time were found for the mutans-group. The prevalence of Streptococcus mitis decreased after two appointments of professional prophylaxis (p = 0.013). The prevalence of S. mitis decreased again after SRP (p <0.001). The prevalence of Streptococcus anginosus decreased after two appointments of professional prophylaxis (p = 0.002). After SRP five positive results for S. anginosus were detected (p = 0.026). For Streptococcus oralis and Streptococcus gordonii tendencies to statistical significance were found. The number of positive results for S. oralis increased after the first appointment of professional oral prophylaxis (p = 0.055). The number of positive results for S. gordonii increased after the first appointment of professional oral prophylaxis (p = 0.055). Conclusion: The step-wise periodontal therapy influences the prevalence of viridans-streptococci, especially S. mitis and S. anginosus. No tremendous increase of streptococci especially related to the carious process occurs in the subgingival biofilm. Clinical Relevance: The study reveals knowledge on changes of the composition of the subgingival biofilm due to different steps of periodontal therapy. Schlagwörter: periodontitis, professional dental prophylaxis, subgingival instrumentation, subgingival biofilm, viridans-streptococci

Purpose: To evaluate the comprehensive effects of photobiomodulation (PBM) therapy on teeth after active orthodontic treatment. Materials and Methods: This systematic review was conducted according to the PRISMA guidelines. Six databases were electronically searched and screened for eligible human and animal studies published up to August 2020. The risk of bias was assessed based on the Cochrane Handbook for Systematic Reviews of Interventions and Systematic Review Centre for Laboratory Experiment Tool. Two independent reviewers performed all procedures in duplicate. Any disagreement was resolved by discussion or consultation with a third reviewer. Results: A total of 395 records were identified from the initial search up to August 2020. Following screening, 16 full-text articles were reviewed for eligibility (κ > 0.90), and ultimately 9 studies (3 clinical studies and 6 animal studies) were included in this review. The key outcomes observed were ‘tooth position maintenance’ and ‘root resorption rehabilitation’. Two controlled clinical trials and two animal studies supported the preventive effects of PBM therapy on the relapse of post-orthodontic tooth positions, while the other two animal studies reported opposing findings. Regarding root resorption, all evidence supported the rehabilitation potential using PBM therapy for teeth that had undergone orthodontic tooth movement. There was a high risk of bias among studies, except for one randomised controlled trial. Due to the substantial heterogeneity among studies in terms of their types, participants, designs, PBM therapy settings and variables of interest, it was not possible to conduct a meta-analysis; therefore, a qualitative synthesis is presented. Conclusion: The quality of evidence for PBM therapy contributing to the maintenance of tooth position or improved dental health after orthodontic treatment remains low. There is considerable controversy over the effects of PBM therapy on orthodontic relapse. However, the use of PBM therapy after orthodontic treatment has promising effects for root resorption rehabilitation and is generally recommended. Schlagwörter: orthodontic retention, orthodontically induced inflammatory root resorption, photobiomodulation therapy, systematic review

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 analyse factors associated with the susceptibility of early childhood caries (ECC), populations with a high risk of ECC were screened and guidance for ECC prevention was proposed. Methods: A total of 392 children aged 24 to 71 months were selected for oral examination in Qingdao. Parents or guardians of the participants completed the questionnaires and decayed missing filled surface (dmfs) were recorded. Differences in caries condition and oral health behaviour in different families were compared. Risk factors related to ECC were screened. The subjects were finally grouped based on the obtained dmfs into three groups: caries-free, ECC and S-ECC (severe ECC). Association of risk factors with the caries status was analysed using the Kruskal-Wallis test, the chi-square test and logistic regression analysis. Results: There were significant differences among the caries-free, ECC and S-ECC groups in three parameters: eating too many sweets each day, brushing before and after sleeping, and whether parents helped to brush (P < 0.01). Combined factors such as the parents' level of education, oral health knowledge, attitudes, the family's annual income, the age of children when they start to brush and not brushing regularly were also significantly related to ECC (P < 0.05). No significant differences were observed among the three groups for these factors, including birth condition and nursing state, physical condition of the mother during pregnancy, feeding situation, if a pacifier was used during sleep, duration of brushing, frequency of mouth rinsing after meals each day and brushing with fluoride toothpaste (P > 0.05). Conclusion: Eating a lot of sweets, an incorrect brushing method, starting brushing at a later stage and not brushing regularly are susceptible factors for ECC. Emphasising oral health knowledge to parents and guardians, conducting proper brushing methods, limiting the frequency of sweets being eaten and avoiding an inappropriate habit of eating sweets are very important factors in the prevention of ECC. Schlagwörter: children, decayed missing filled surface (dmfs), early childhood caries (ECC), prevalence, susceptibility

Purpose: To assess the effect of age on the mean percentage of bleeding on probing (BOP) during supportive periodontal therapy (SPT) in patients enrolled in SPT for at least 5 years. Materials and Methods: This study was performed as a retrospective analysis of data collected from SPT patients initially diagnosed with gingivitis or mild to severe periodontitis. Two groups of patients were selected: in group A, younger adults (age ≤ 35 years) were included while group B consisted of older SPT patients (age ≥ 65 years). BOP in the two groups was compared according to both disease severity and % compliance with SPT visits. Results: BOP in all patients (n = 236) was 19.2% (± 12.4). Group A (n = 110) presented mean BOP levels of 19.7% (± 11.8), while lower BOP levels of 18.7% (± 13.0) were found in group B (n = 126; p = 0.5272). Older patients demonstrating high % compliance had lower mean BOP levels (14.2% ± 9.5) than younger patients (18.0% ±  11.7; p = 0.0841). Similarly, BOP was lower in older patients with moderate (group B: 18.4% ± 12.1, group A: 19.3% ± 14.6, p = 0.0541) or severe periodontitis (group B: 22.4% ± 11.4, group A: 23.2% ±  14.0; p = 0.3440). In patients with moderate or severe periodontitis and higher % compliance with SPT, the mean BOP was statistically significantly lower in older patients than in younger patients (moderate: 14.4% ± 11.9 vs 19.4% ± 15.1, p  Schlagwörter: bleeding on probing, elderly, compliance, supportive periodontal therapy

Purpose: To evaluate through a systematic review and meta-analysis whether the immediate and long-term bonding performance of universal adhesives would be improved by prior acid etching. Materials and Methods: Two reviewers performed a literature search up to April 2018 in eight databases: PubMed, Web of Science, Cochrane Library, SciELO, Scopus, LILACS, IBECS, and BBO. Only studies that evaluated the dentin or enamel bond strength of universal adhesives using a self-etch or etch-and-rinse strategy were included. Analyses were carried out using RevMan 5.3.5 (The Nordic Cochrane Centre, The Cochrane Collaboration, Copenhagen, Denmark). A global analysis comparing self-etch or etch-and-rinse strategies and the influence of aging on bonding performance was performed with random-effects models at a significance level of p < 0.05. Results: A total of 59 in vitro studies were included in the meta-analysis. The enamel bond strength of universal adhesives was improved by the etch-and-rinse approach (p < 0.05). In dentin, this effect was observed for ultra-mild and intermediately strong universal adhesives (p < 0.05). Irrespective of the strategy employed, intermediately strong adhesives showed a decrease in bond strength after all types of aging. This effect was also observed for ultra--mild universal adhesives used in the etch-and-rinse approach (p < 0.05). Mild universal adhesives showed bond strength stability in both strategies (p > 0.05). Conclusions: The in vitro evidence suggests that bonding performance of mild universal adhesives can be improved by using the selective enamel-etch strategy. Mild universal adhesives seem to be the more stable materials, in both etch-and-rinse or self-etch strategies. Schlagwörter: adhesive, dental bonding, dental materials, universal adhesives, systematic review

Objectives: While air polishing with abrasive powders has been proved efficient for sub- and supragingival application, only few studies concerning the quality of supragingival biofilm removal using the low-abrasive erythritol powder (EP) exist. The aim of the present randomized controlled trial was to clinically compare the efficacy of supragingival air polishing using EP in comparison with the rubber cup method, and to juxtapose the corresponding biofilm regrowth rates. Method and materials: Thirty-two young adults, suspending oral hygiene for 48 hours, were enrolled in the present double-blind short-term investigation. Using a split-mouth design, tooth polishing was conducted by means of either air polishing or rubber cups with prophylaxis paste (control). While 16 participants received air polishing in the second and fourth quadrants (and rubber cup prophylaxis in the first and third ones), the reverse sequence was applied with the remaining 16 subjects. Biofilms were assessed using the modified Quigley-Hein index (QHI), and QHI sum scores achieved both prior to and immediately after the polishing procedure, as well as 24 hours later, were assessed using a two-way analysis of variance (ANOVA), followed by Tukey’s HSD to test multiple pairwise comparisons. Results: Both methods revealed a significant reduction of QHI scores (P < .001). Compared to the rubber cup method, air polishing resulted in significantly lower scores, both after tooth cleaning and after 24 hours (P < .001). Conclusions: Supragingival biofilm removal by means of air polishing combined with low-abrasive erythritol seems to be more efficacious than the traditional polishing method, and should improve oral health care. Schlagwörter: air polishing, biofilm, erythritol, low-abrasive powder, oral hygiene, plaque, professional tooth cleaning, rubber cup polishing

The extraction of a tooth with root resorption can be a complicated procedure and can result in the removal of a significant amount of alveolar bone. In the anterior maxilla, esthetic rehabilitation of damaged sites with implant-supported crown could require multiple surgeries. Patients often ask for an alternative, and minimally invasive treatments are generally preferred. In this paper, a clinical case of implant-supported crown in a site affected by root resorption is described. Immediate implant was placed leaving some root fragments in the osteotomy site, thus avoiding invasive extractive surgeries. A minimally invasive flapless technique with a computer-guided implant placement procedure was used. After ?8 years, clinical and radiologic data were stable, gingival tissues around the implant appeared healthy, no dark translucency appeared through marginal gingiva around the implant, and there was no pathologic probing pocket depth ?or bleeding on probing. In the presence of root resorption and ankylosis, computer-guided surgery could be helpful to prepare a precise implant site through various tissues, such as partially resorbed root remnants. (Quintessence Int 2021;52:132–137; doi: 10.3290/j.qi.a45432) Schlagwörter: digital dentistry, implants, prosthodontics, tooth erosion, tooth wear

Purpose: The present study aimed to investigate the resistance and failure mode of broken-down endodontically treated incisors without ferrule restored with CAD/CAM endocrowns. Materials and methods: Endodontically treated bovine incisors (N = 30) without ferrule were divided into two groups and restored with two types of CAD/CAM endocrowns: lithium disilicate (Eld) or resin nanoceramics (Erc). The preparations included a 4-mm–deep ‘internal ferrule’ and immediate dentin sealing. The samples were subjected to accelerated fatigue testing. Cyclic isometric loading was applied to the incisal edge at a 30-degree angle at a frequency of 5 Hz, beginning with a load of 100 N (5,000 cycles). A 100 N load increase was applied every 15,000 cycles. Specimens were loaded until failure or to a maximum of 140,000 cycles. Previously published data from the same authors regarding lithium disilicate crowns over post-and-core buildups without ferrule (NfPf), core buildups without post without ferrule (NfNpFR), and with a 2-mm ferrule (FNp) using the same experimental setup were included for comparison. Groups were compared using the Kaplan Meier survival analysis for cycles (log rank pairwise post hoc test comparisons at P = 0.05) and Life Table survival analysis for load at failure, followed by the Wilcoxon pairwise comparison at P = 0.05. Results: All specimens failed before 140,000 load cycles. There was no statistically significant difference between the endocrown materials (Eld: 53,448 mean endured cycles; Erc: 52,397 mean endured cycles; P = 0.844). Endocrowns outperformed the group with lithium disilicate crowns on incisors without ferrule and post-and-core buildup (NfPf with mean endured 35,025 cycles), showed no statistical difference compared with the group with no-post fiber-reinforced composite resin core buildup (NfNpFR with 45,557 mean endured cycles), and had a lower survival rate compared with the group with ferrule (FNp with mean endured 73,244 cycles). Endocrowns generated a majority of non-catastrophic failures (with an advantage for Erc), while 100% of catastrophic failures were found in the group with a post. Conclusions: CAD/CAM endocrowns of nonvital incisors without ferrule improved the resistance and optimized the failure mode when compared with traditional bonded crowns with adhesive post-and-core and no-post buildups.

Objective: The study aimed to evaluate the influence of ocular dominance, clinical experience, and sex on the accuracy of visual color matching. Method and materials: A total of 104 selected participants consisting of dental students and dental practitioners were allocated into two groups based on their clinical experience of using visual shade matching tabs for the selection of tooth shade. Both the inexperienced (IXP), as well as experienced participants (EXP), were then asked to correctly match the shades of five tabs (A2, A3.5, B1, C2, and D3) of a commonly used visual shade guide (Vitapan Classical shade guide, VITA Zahnfabrik) that were kept constant throughout the study. The participants documented the shade of those tabs using another set of shade guide using the right eye (left eye covered), left eye (right eye covered), as well as both eyes. Test for ocular dominance was performed using the Dolman method. The results were statistically analyzed using the chi-square test with a level of significance set at < .05. Results: The percentage of correct shade matching with the monocular dominant vision (53%) was significantly better as compared to the monocular non-dominant vision (12%) (P < .001) or binocular vision (44%) (P < .05). Sex had an influence in shade selection (P = .031). However, clinical experience was an insignificant aspect in shade matching (P = .078). Conclusions: Knowing the clinician’s dominant eye can be clinically relevant, as it can influence the accuracy of shade selection, irrespective of sex and clinical experience. Schlagwörter: binocular vision, clinical experience, monocular vision, ocular dominance, visual shade match

Objective: This study aimed to compare the accuracy performance of five different intraoral scanning systems for a full-arch scan on an edentulous cadaver maxilla. Method and materials: Five digital intraoral impression systems were used to scan a fully edentulous cadaver maxilla. A master scan obtained with an ATOS Capsule industrial grade scanner provided the point of comparison. Experimental scans were compared to the master scan using a metrology software that allows images to be overlayed on one another and deviations interpreted. Once aligned, three comparisons were made between the experimental scans and the reference: the entire maxilla, the ridge area only, and the palate area only. Results: Trueness deviations between the experimental scans and the master digital model were up to 0.1 mm in the 75th percentile. For the whole maxilla, only the Medit scanner had statistically significantly inferior trueness compared to other scanners. When only the palate was considered, Medit was significantly different from Element (P = .0025) and Trios 4 (P = .0040), with no differences found between other scanners. For the ridge region the results replicate the trend observed for the whole maxilla. In regard to precision, differences were found only in the whole maxilla and the ridge area. In both areas, only Medit’s precision was significantly different compared to other scanners, with the exception of Element. However, Element performance was similar to all other scanners. Conclusion: Most intraoral scanners exhibited similar performance. Although several statistically significant differences were identified, the clinical impact of these variances is probably not meaningful. (Quintessence Int 2021;52:488–495; doi: 10.3290/j.qi.b1244373) Schlagwörter: digital dentistry, digital impressions, edentulous

The present article describes a treatment planning clinical strategy based on a flowchart developed to facilitate the treatment of teeth with severely compromised clinical crowns. The study comprised a group of 978 patients presenting with 2327 teeth needing clinical crown reconstruction. The patients were screened, diagnosed, and treated with a multidisciplinary approach according to a flowchart structure. A subgroup of 75 teeth in 62 patients was considered irrational to treat when a composite risk-evaluation model was applied. Another subgroup of 168 teeth in 126 patients required periodontal surgery and received a minimally invasive crown lengthening (MICL) procedure. Endodontic treatment was necessary for 73 teeth, and retreatment for 51. Most of the teeth (124 in 94 patients) received a full crown, while the remaining 44 teeth received a direct (24 teeth) or an indirect (20 teeth) reconstruction. Six teeth were orthodontically extruded before surgery. The 1-year average probing depth and clinical attachment level at the treated teeth was 2.5 ± 0.5 mm and 2.7 ± 0.6 mm, respectively. Bleeding on probing was detected in 19 sites (11.3%). No side effects or short-term recurrences were detected in 168 treated sites. Patients described function and esthetics as extremely satisfactory, very satisfactory, or satisfactory. In conclusion, an accurate screening based on a flowchart supported the clinical decision to treat 168 teeth with MICL and to replace 75 out of 2327 teeth presented at our clinic for restorations. The use of MICL and the high-quality restorations resulted in a healthy periodontal and dental condition of all the treated teeth as well as patient satisfaction at the 1-year follow-up.

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

Purpose: To evaluate the association between orthodontic treatment with fixed appliances and periodontal health during treatment by examining gingival inflammation indices and saliva properties. Materials and Methods: Thirty consecutive orthodontic patients, aged 11–18 years old, who were eligible for fixed orthodontic appliances, were included in the study. Plaque index (PI), gingival index (GI), salivary pH and flow rate were recorded at three timepoints: immediately before placement of orthodontic fixed appliances (T0), and 1 (T1) and 3 months (T2) after bonding. Results: The hypothesis that PI would remain constant across timepoints was rejected. PI increased over time (0 to 1 scale, T1-T0: mean diff. = 0.10, 95% CI = 0.03, 0.18, p = 0.01; T2-T0: mean diff. = 0.16, 95% CI = 0.08, 0.24, p < 0.001). On the other hand, GI changed statistically significantly over time (p = 0.05). Patients’ age was not a predictor for PI change (p = 0.93), but it was for GI (p = 0.01). As anticipated, average PI was found to be higher for the mandibular dentition by 0.10 (95% CI = 0.04, 0.16) and the labial surfaces of teeth of both jaws by 0.51 (95% CI = 0.45, 0.57). Conclusions: Within the framework of the current study, orthodontic treatment appeared to affect the periodontal health of patients, but the changes were clinically negligible and not consistently statistically significant. Schlagwörter: fixed orthodontic appliances, gingival index, periodontal health, plaque index

Background: The characteristics of the periodontium in anterior teeth influence the outcomes and prognosis of different periodontal, implant, and restorative procedures. In the present study, CBCT images were used to determine alveolar bone thickness and, to a lesser extent, gingival thickness. The aim was to evaluate the use of CBCT to measure the dentogingival complex in the anterior maxilla. Materials and methods: CBCT scans from 25 healthy patients were taken and the maxillary anterior teeth (n = 138) analyzed in the radial plane. The study provided descriptive data on gingival thickness, alveolar bone thickness (horizontal measurements), and vertical measurements related to biologic width. Results: The mean distance from gingival margin to bone crest (BC) was 3.4 ± 0.7 mm, and that between the cementoenamel junction and BC was 2.6 ± 1.0 mm. The average mid-labial gingival thickness 1 mm apical of the gingival margin was 1.0 ± 0.3 mm; a thinner gingiva was observed in females (P = 0.01) and canines (P < 0.001). The average crestal labial bone thickness was 0.8 ± 0.3 mm. In total, 62% of the tooth sites had a thin gingiva (< 1 mm), and 72% had thin labial bone plates; a moderate positive correlation was found between these parameters (P < 0.001). Conclusions: CBCT was effective in providing data on the thickness of the labial plate and gingiva as well as on the relationship among BC, CEJ, and gingival margin. The majority of tooth sites had thin labial bone and thin gingiva, with thinner gingiva observed in females and at canine sites.

Background: The palatal surface of the maxillary anterior teeth in conjunction with the incisal edge represents the mechanical area, which is of great importance for lateral and anterior guidance. Therefore, in terms of restorative dentistry, it is crucial for the clinician to have a detailed knowledge of the palatal surface anatomy (PSA) of the different maxillary anterior teeth in order to reestablish a definitive correlation between form, function, and esthetics. The aim of the present study was to analyze the variations in the PSA of the maxillary central incisors (CIs) and their correlation with tooth form and gender. Materials and methods: Impressions of the maxillary arch of 500 study participants were taken and then classified according to PSA and tooth form. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software. The chi-square test was utilized for comparisons among PSA, tooth form, and gender of the participants. Results: The results showed Type 5 to be the most common PSA in maxillary CIs and the square tooth form to be the most common tooth form among both genders; Type 5 was also found to be the most common PSA within the square tooth form.

Objectives: Due to the growing popularity of body modifications, dental practitioners are increasingly confronted with oral piercing and its implications. Successful consultation and subsequent change of patient behavior require an understanding of the patient’s personality and the deep reasons that explain this self-injurious behavior. This is the first study evaluating personality traits and aspects of body perception in a cohort of adults with oral piercing. Method and materials: Sixty-two individuals with labial and/or tongue piercing completed three validated questionnaires assessing body perception and personality traits (Questionnaire for assessing one’s own body; Sensation Seeking Scale; Big Five Inventory Scale). Fisher Exact probability test and Mann-Whitney U test were used to determine differences in frequency data and in psychologic parameters between subgroups. Results: Eighteen single- and 44 multiple-pierced individuals completed the study (53 women, 9 men). The odds for being multiple pierced was significantly higher for tongue than for labial piercing (3.89 and 0.63, respectively; P = .003). In all psychologic parameters measured, the sample showed score distributions within reference norms. However, multiple-pierced individuals displayed a significantly lesser feeling of attractiveness, less self-confidence, and more uncertainty/anxiety towards their body than single-pierced probands (P < .05). Conclusion: Psychologic characteristics of individuals with oral piercing do not fundamentally differ from those of the average population. Therefore, dental practitioners should focus on the medical and dental implications of oral piercing in the counseling of patients who have or intend to have such done. Schlagwörter: body perception, lip piercing, personality characteristics, sensation seeking, tongue piercing

Ideally, orthognathic surgery is indicated to treat skeletal Class III malocclusion with severe open bite in adults. In this borderline case, however, camouflage treatment without any skeletal anchorage was chosen. This report describes the orthodontic treatment of a 23-year-old man who presented with multiple orthodontic problems including severe open bite of the anterior and posterior teeth up to the first molars, bilateral posterior crossbite, bilateral Class III molar relationship, severe crowding, increased vertical dimension, and dental and facial midline deviation. The treatment included the extraction of four wisdom teeth, uprighting and distalisation of the mandibular arch with molar intrusion using curved NiTi wires with intermaxillary elastics. After 36 months of treatment, satisfactory improvements in the vertical overlap, horizontal overlap and sagittal malocclusion were achieved. The design of the mechanical system used in this case confirmed stable results at the 4-year follow-up. Schlagwörter: anchorage, molar distalisation, open bite, skeletal class III malocclusion

Objectives: Effects of modern cellular technology on our lives is a relatively new topic of interest. The aim of the present study was to investigate the effect of smartphone use on daytime sleepiness, temporomandibular disorders (TMD), and bruxism (sleep and awake) among young adults in Israel. Method and materials: Questionnaires on demographic variables, mobile phone use characteristics, anxiety, depression, daytime sleepiness, bruxism (sleep and awake), and diagnosis of TMD were filled in by ultra-Orthodox young adults (18 to 35 years of age) using a simple mobile device with no internet connection, religious young adults who use an internet-connected smartphone solely for work purposes, and secular young adults with an internet-connected smartphone for unlimited use. Results: Various aspects of smartphone use, including being awakened at night by the phone, stress caused by information delivered by the phone, and stress from phone overuse increased the risks of daytime sleepiness, TMD, and bruxism. Those sequelae are associated with substantial negative effects on both the individual and society. High risks of motor vehicle accidents, chronic orofacial pain, and irreversible damage to hard dental tissue structures are some of those negative consequences. Conclusions: The adverse effects of smartphone use on daytime sleepiness, TMD, and bruxism are substantial. Their influence on public health and health care costs are causes of concern. (Quintessence Int 2021;52:548–559; doi: 10.3290/j.qi.b1244431) Schlagwörter: awake bruxism, daytime sleepiness, sleep bruxism, smartphone use, temporomandibular disorders (TMD)

Ziel: Diese Studie untersucht den therapeutischen Effekt des RelaxBogens im Vergleich zur alleinigen Schienentherapie bei Patienten mit Schlafbruxismus und CMD in Bezug auf myogene Beschwerden und Schmerzen. Probanden und Methoden: 32 Probanden mit Schlafbruxismus und CMD-Symptomen wurden in einer einfach verblindeten, randomisierten, kontrollierten, monozentrischen klinischen Studie untersucht. Die Wirksamkeit des Bogens plus Stabilisierungsschiene wurde mit der alleinigen Schienentherapie verglichen. Die Therapiedauer betrug acht Wochen. Die Untersuchungen entsprechen dem RDC/TMD-Standard. Ergebnisse: Bei der Bogen-Gruppe zeigte sowohl die Auswertung der SL-NRS-Fragebögen als auch die Palpation der Muskeln eine signifikante Schmerzreduktion der Mundschließer. Gleichzeitig empfanden die Probanden weniger Schmerz bei der Mundöffnung. Ein lindernder Effekt auf Kopfschmerzen in Kombination mit muskulären CMD-Symptomen, häufig auch als Spannungskopfschmerzen bezeichnet, konnte ebenfalls beobachtet werden. Schlagwörter: Craniomandibuläre Dysfunktion, Bruxismus, Kiefer, Kopfschmerz, Faszie, RelaxBogen, CMD, TMD, Myalgie

Artificial intelligence (AI) encompasses a broad spectrum of emerging technologies that continue to influence daily life. The evolution of AI makes the analysis of big data possible, which provides reliable information and improves the decision-making process. This article introduces the principles of AI and reviews the development of AI and how it is currently being used. AI technology has influenced the health care field because of the need for accurate diagnosis and superior patient care. In order to understand the trend of AI in dentistry, electronic searching was carried out, combined with approaching individual companies to obtain the details of AI-based services. The current applications of AI in clinical dentistry were introduced and summarized. In the future, the AI-based comprehensive care system is expected to establish high-quality patient care and innovative research and development, facilitating advanced decision support tools. The authors believe that an innovative inter-professional coordination among clinicians, researchers, and engineers will be the key to AI development in the field of dentistry. Despite the potential misinterpretations and the concern of patient privacy, AI will continue to connect with dentistry from a comprehensive perspective due to the need for precise treatment procedures and instant information exchange. Moreover, such developments will enable professionals to share health-related big data and deliver insights that improve patient care through hospitals, providers, researchers, and patients. Schlagwörter: artificial intelligence, big data, caries detection, future dentistry, machine learning

This report describes the cases of two patients with a maxillary lateral incisor with palatogingival groove and extensive endodontic-periodontal lesions. Although it is reported that acceptable periodontal status is of great importance in case selection in intentional replantation, it is suggested in this report that intentional replantation could be chosen instead of immediate extraction if extensive endodontic-periodontal lesions exist in a tooth with palatogingival groove. The gingival margin position and gingival papilla were well preserved and the bone defect was almost completely repaired. This was beneficial to the aesthetic prosthodontic treatment and implantation, although external root resorption was observed. Schlagwörter: bone repair, endodontic-periodontal lesion, external root resorption, intentional replantation, palatogingival groove

When implementing a direct composite resin (CR) restoration, the determination of color can be a challenging step. The reproduction of tooth shade is often a source of frustration for the practitioner. Dental color can be complex, and its accurate reproduction requires not only a good understanding of color by the practitioner but also the use of appropriate methods to achieve it. It is important to remember what tooth color parameters one is able to mimic with CRs. The purpose of this article is to demystify the errors attributable to standard tools, ie, shade guides, and above all to suggest a number of measures to avoid such errors.

Systemic scleroderma is a relatively rare, autoimmune, chronic, and debilitating disease, and its etiology is unknown. The disease is characterized by vasomotor disturbances causing skin and mucosa hardening, hand stiffness, excess production of collagen fibers, and impairment of the internal organs associated with the immune system. Extreme mouth-opening limitation is one of the symptoms in the oral cavity, and compromises dental intervention. One of the fundamental steps when performing a dental procedure is dental arch impression. In the presented clinical case, limited mouth opening hindered the impression accuracy. The objective was to present an alternative impression technique for a patient affected by scleroderma, with limited mouth opening and the need for oral rehabilitation with a removable partial prosthesis in the maxillary arch. An individualized tray was developed with design characteristics that allowed access to the oral cavity and removal, after which it was possible to perform the oral impression, reproducing the areas of interest without causing injury to the oral tissues. The orientation plan was elaborated after obtaining the cast. The teeth were assembled, tested in the mouth, and sent to the laboratory for acrylization. The prosthesis was placed once ready. The alternative impression technique enabled oral rehabilitation of the patient despite the mouth-opening limitation, and provided an accurate impression and a good prosthetic result. Schlagwörter: dental impression technique, microstomia, mouth rehabilitation, removable partial denture, systemic scleroderma

Objectives: Severe atrophied edentulous posterior mandible with inadequate bone height superior to the inferior alveolar canal may require transposition of the inferior alveolar nerve in order to insert dental implants. Mandibular fractures are considered a rare complication of this procedure. Implant-related spontaneous fractures of the mandible represent 0.2% of patients with inserted implants in an edentulous mandible. This report presents two cases of mandibular fractures that occurred 3 to 4 weeks after inferior alveolar nerve transposition, and were managed successfully by conservative nonsurgical treatments. Method and materials: Overall, 132 procedures of inferior alveolar nerve transposition in 98 patients were performed over a period of 10 years with 379 dental implants inserted in one stage with the procedure. Patients were examined every 2 weeks. The inferior alveolar nerve function was evaluated with various sensory tests. Panoramic radiographs were obtained immediately, at 3 months, and at 1 year after the surgery. The patients received implant-supported fixed prostheses after 3 to 5 months. Results: The healing process was uneventful in 96 patients; however, in two patients (1.5%) spontaneous fracture of the treated site was observed 3 and 4 weeks postoperatively. The fractures lines occurred at a failed implant site. Both cases were treated conservatively. Conclusions: Spontaneous fractures following inferior alveolar nerve transposition are an important but rare complication. Conservative treatment modalities might be useful and indicated in some of those cases. Schlagwörter: atrophic mandible, implant complications, inferior alveolar nerve, mandibular fracture

Objectives: To describe the step-by-step procedure of a novel surgical technique consisting of a combination of the laterally closed tunnel (LCT) and the modified coronally advanced tunnel (MCAT) (ie, LCT/MCAT), designed to treat multiple mandibular adjacent gingival recessions (MAGR) and to present the clinical outcomes obtained in 11 consecutively treated patients. Method and materials: Eleven systemically and periodontally healthy patients (7 females, mean ± SD 33.62 ± 14.6 years, min. 19 years max. 67 years) with a total of 40 adjacent mandibular RT1 (ie, Miller Class 1 and 2) gingival recessions with a minimum depth ≥ 3 mm, were consecutively treated with LCT/MCAT, in conjunction with an enamel matrix derivative (EMD) and subepithelial palatal connective tissue graft (SCTG). Treatment outcomes were assessed at baseline and at 12 months postoperatively. Prior to surgery and at 12 months postoperatively, recession depth (RD) and recession width (RW) were evaluated. The primary outcome variable was complete root coverage (CRC, ie 100% root coverage), the secondary outcome was mean root coverage (MRC). Results: Postoperative pain and discomfort were low and the healing was uneventful in all cases without any complications. At 12 months, statistically significant (P < .05) root coverage (RC) was obtained in all patients. CRC was obtained in five patients with a total of 21 recessions, while MRC measured 92.9% (ie, 3.75 mm). In seven patients (ie, 63.6%), RC amounted to > 93% while the minimum RC per patient measured 83.76%. Conclusion: The results of the present case series suggest that the LCT/MCAT is a valuable technique for the treatment of mandibular RT1 MAGR. Schlagwörter: laterally closed tunnel, modified coronally advanced tunnel, multiple adjacent mandibular gingival recessions, recession coverage, subepithelial palatal connective tissue graft, surgical technique

The partial anterior ceramic restoration is a predictable and durable treatment modality that reestablishes not only esthetics but also strength and function. Bio-emulation, minimally invasive dentistry, and adhesive technology are key to a successful restoration. Partial restorations are only indicated when teeth have enough hard tissue on which to bond veneers. When there is more than 50% of dentin exposure, many clinicians still rely on macromechanical retention by performing a full-crown preparation. However, new research has shown good survival rates for partial restorations with extensive dentin exposure. The present article describes two cases in which a step-by-step protocol was applied to bond a laminate veneer to a tooth with dentin exposure.

Objective: The primary objective of this study was to compare the accuracy and time efficiency of an indirect and direct digitalization workflow with that of a three-dimensional (3D) printer in order to identify the most suitable method for orthodontic use. Method and Materials: A master model was measured with a coordinate measuring instrument. The distances measured were the intercanine width, the intermolar width, and the dental arch length. Sixty-four scans were taken with each of the desktop scanners R900 and R700 (3Shape), the intraoral scanner TRIOS Color Pod (3Shape), and the Promax 3D Mid cone beam computed tomography (CBCT) unit (Planmeca). All scans were measured with measuring software. One scan was selected and printed 37 times on the D35 stereolithographic 3D printer (Innovation MediTech). The printed models were measured again using the coordinate measuring instrument. Results: The most accurate results were obtained by the R900. The R700 and the TRIOS intraoral scanner showed comparable results. CBCT-3D-rendering with the Promax 3D Mid CBCT unit revealed significantly higher accuracy with regard to dental casts than dental impressions. 3D printing offered a significantly higher level of deviation than digitalization with desktop scanners or an intraoral scanner. The chairside time required for digital impressions was 27% longer than for conventional impressions. Conclusion: Conventional impressions, model casting, and optional digitization with desktop scanners remains the recommended workflow process. For orthodontic demands, intraoral scanners are a useful alternative for full-arch scans. For prosthodontic use, the scanning scope should be less than one quadrant and three additional teeth. Schlagwörter: 3D printed models, accuracy, CBCT model scan, desktop model scanner, digitalization, full-arch scans, intraoral scanner

Objective: To describe and report on the use of virtual clinical competency examinations (VCCEs) for D3 dental students in a radiology clinic during the COVID-19 pandemic and relate the technology to other clinical and educational applications. Method and materials: Paper-based clinical competency examinations (CCEs) were converted to three different VCCEs to closely replicate the CCEs. Existing grading rubrics were used to assess students’ abilities to evaluate technical issues and interpret intraoral full-mouth series and panoramic radiographs. The grading rubrics were modified from their clinical versions to eliminate non-reproducible skills, such as patient management and application of selection criteria. Radiographs were selected from clinic records and anonymized. VCCEs were conducted via WebEx conferences that were scheduled via an appointment app. These experiences can be extended to virtual patient contacts, teleradiology, and telemedicine, as well as continuing dental education experiences. Results: Approximately 200 VCCEs were administered by four oral and maxillofacial radiology faculty over a 10-week period. Both students and faculty managed the technology well, with few missed appointments. All students were successful in challenging the examinations and appeared to be satisfied with the experience. Conclusions: Although direct comparisons between the CCEs and the new VCCEs are difficult, as there was no time to pilot the VCCEs, students were successful in challenging the examinations and informally reported satisfaction with the experience. Although components of CCEs that could not be replicated on the VCEs could not be assessed, it is felt that the students had adequate experience in selection of radiographs and patient management prior to the COVID-19 lockdown. Additional benefits of the VCCEs included contact with students to check on their well-being. The experience indicates that VCCEs can be used in the future in hybrid models of oral & maxillofacial radiology education, clinical care, patient screening, and telemedicine. Moreover, the success of this demonstration points to potential for personalized distance learning in continuing dental education. Schlagwörter: assessment, clinical exam, competency examinations, computer-assisted instruction, oral radiology, radiographic interpretation, radiographic technical assessment, teledentistry, telemedicine, undergraduate dental education