Quintessence International, 04/2016

The condition of dental erosion is defined as acid-related loss of tooth structure which does not involve microorganisms. Depending on the origin of the acid, extrinsic (usually caused by acids in food) and intrinsic (caused by endogenous acid) erosion can be distinguished. The presence and severity of erosive defects depend on various parameters such as nutrition, saliva, general diseases, and mechanical stress by abrasion and attrition. As an example, dietary habits which involve frequent intake of acidic food and beverages, occupational acid exposure, as well as certain drugs or diseases that affect saliva flow rate are accompanied by an increased risk of erosive dental hard tissue defects. By a thorough clinical examination and an accurate anamnesis, various erosion-related risk factors can be identified and strategies to reduce or eliminate these factors be identified. Keywords: acid erosion, dental erosion, extrinsic acids, intrinsic acids, nutrition, reflux disease

Objective: This randomized, blinded, placebo-controlled clinical trial compared the levels of interferon γ (IFN-γ), prostaglandin E2 (PGE2), and interleukin 6 (IL-6) in the gingival crevicular fluid (GCF) from generalized aggressive periodontitis (GAgP) patients treated with nonsurgical therapy associated or not with amoxicillin/metronidazole adjunctive. Method and Materials: Thirty-nine GAgP patients were followed during 6 months. The patients were randomly allocated to one of the groups: experimental (scaling and root planing plus 375 mg amoxicillin and 250 mg metronidazole for 7 days) and control (scaling and root planing + placebo). Probing pocket depth (PPD), relative clinical attachment level (rCAL), gingival margin position (GMP), and IL-6, IFN-γ, and PGE2 levels in GCF were evaluated at baseline, and at 3 and 6 months after treatment. Results: Both therapies promoted PPD reductions, rCAL gains, and recession in GMP at the end of the study, with the experimental group presenting an additional PPD reduction in fullmouth analysis and deep pockets at the 3- and 6-month follow-ups (P < .05). During the period of the study, only the experimental group promoted a reduction in PGE2 levels in deep pockets at 3 and 6 months, while IFN-γ and IL-6 levels remained unchanged. However, the differences in the immunologic parameters were not statistically significant among the groups. Conclusion: It can be concluded that amoxicillin/ metronidazole associated with nonsurgical therapy promotes an additional PPD reduction in the treatment of GAgP; however, this therapy did not promote additional benefits in the evaluated immunologic parameters. Keywords: aggressive periodontitis, antimicrobials, interleukin-6, prostaglandin E2, interferon-γ, periodontal therapy

Air polishing was introduced as an alternative approach for the supra- and submucosal biofilm management at dental implants. An international expert meeting involving competent clinicians and researchers took place during the EUROPERIO 8 conference in London, UK, on 4 June 2015. Prior to this meeting a comprehensive systematic review dealing with the efficacy of air polishing in the treatment of peri-implant mucositis and peri-implantitis was prepared and served as a basis for the group discussions. This paper summarizes the consensus statements and practical recommendations on the clinical application of air polishing for the management of peri-implant mucositis and peri-implantitis. Keywords: air polishing, peri-implantitis, peri-implant mucositis, therapy

Objective: Narrow-diameter implants are indicated for narrow sites, small interdental/interimplant spaces, or sites with congenitally missing teeth. They also offer a substitute for invasive augmentation procedures. The authors retrospectively evaluated the performance of a new 3.0-mm diameter implant for rehabilitating small anterior spaces. Method and Materials: This observational multicenter retrospective case series included consecutive patients needing single-unit restoration for mandibular and lateral maxillary incisors. The outcome variables were: implant survival, Plaque Index, pocket probing depth (PPD), Jemt's papilla index, bleeding on probing (BOP), and marginal bone remodeling. Results: In total, 45 patients received 58 3.0-mm implants placed in healed sites (n = 22), extraction sockets (n = 16), or sites with congenitally missing teeth (n = 20). Average follow-up time was 15.1 ± 5.2 months. Prosthetic loading was immediate (n = 23), early (n = 16), or delayed (n = 19). Two implants were lost, and two prosthetic complications occurred. One-year bone remodeling averaged −0.36 ± 0.85 mm (n = 44). PPD averaged 1.75 ± 0.58 mm. Neither BOP nor plaque was detected around implants. Conclusions: At 1-year follow-up, narrow 3.0-mm diameter implants placed in mandibular and lateral maxillary incisor sites demonstrate a high survival rate and support stable marginal bone levels and healthy soft tissue. Keywords: congenitally missing teeth, dental implants, marginal bone remodeling, narrow-diameter implants, single tooth, survival rate

Objective: In this study, 12-month follow-up clinical results of a combined peri-implant plastic surgery approach for hard and soft tissue augmentation in implant rehabilitation in the esthetic zone are presented. Method and Materials: Ten individuals who required extraction due to severe periodontal destruction in the maxillary and mandibular area were included in the study. Implant surgery was performed in the same session as the combined peri-implant plastic surgeries, which involved guided bone regeneration and free periosteal grafts. Prosthetic treatment was administered in the sixth month following the surgeries. Results: Hard and soft tissue augmentation with sufficient keratinized mucosa width (≥ 2 mm) was achieved with the combined surgical approaches. Pleasing esthetic results were obtained by careful positioning of the implants. Conclusions: In implant rehabilitation, in cases where there are insufficient hard and soft tissues in the esthetic zone, a combined peri-implant plastic surgery approach not only enables the ideal implant position where both function and esthetics are ensured but also provides effective protection of peri-implant tissue health. Keywords: dental implants, esthetic zone, free periostal graft, guided bone regeneration, peri-implant plastic surgery technique

Objective: The purpose of this study was to evaluate the usefulness of topical sulfasalazine in the treatment of oral lichen planus (OLP) resistant to corticosteroid therapy. Method and Materials: Twenty-one unresponsive OLP patients were treated with topical sulfasalazine 3 times a day for 4 weeks. Each patient's symptoms and lesion size were evaluated at the beginning of therapy, and then after 4 weeks to determine the efficacy of topical sulfasalazine. Inflammatory cytokines levels in saliva were measured by ELISA. Results: Seventeen patients (81%) reported improvement of discomfort and 12 patients (57%) had lesions decrease in size over 50%. Patients who had higher levels of IL-1β and IL-8 were more responsive to topical sulfasalazine therapy. Conclusion: Topical sulfasalazine should be considered when OLP does not respond to corticosteroid therapy. Furthermore, high concentrations of IL-1β and IL-8 in the saliva are useful indicators for the application of topical sulfasalazine in OLP patients refractory to steroid treatment. Keywords: sulfasalazine, topical application, unresponsive oral lichen planus

Objective: To test the null hypothesis of no difference in the implant failure rates, marginal bone loss, and postoperative infection for patients receiving or not receiving bisphosphonates, against the alternative hypothesis of a difference. Method and Materials: An electronic search was undertaken in October 2015 in PubMed/Medline, Web of Science, and Embase, plus hand-searching and databases of clinical trials. Eligibility criteria included clinical human studies, either randomized or not. Results: A total of 18 publications were included in the review. Concerning implant failure, the meta-analysis found a risk ratio of 1.73 (95% confidence interval [CI] 1.21-2.48, P = .003) for patients taking bisphosphonates, when compared to patients not taking the medicament. The probability of an implant failure in patients taking bisphosphonates was estimated to be 1.5% (0.015, 95% CI 0.006- 0.023, standard error [SE] 0.004, P < .001). It cannot be suggested that bisphosphonates may affect the marginal bone loss of dental implants, due to a limited number of studies reporting this outcome. Due to a lack of sufficient information, meta-analysis for the outcome "postoperative infection" was not performed. Conclusion: The results of the present study cannot suggest that the insertion of dental implants in patients taking BPs affects the implant failure rates, due to a limited number of published studies, all characterized by a low level of specificity, and most of them dealing with a limited number of cases without a proper control group. Therefore, the real effect of BPs on the osseointegration and survival of dental implants is still not well established. Keywords: bisphosphonates, dental implants, implant failure rate, marginal bone loss, meta-analysis, postoperative infection

Objectives: Little information is available on the impact of different scan strategies on the accuracy of full-arch scans with intraoral scanners. The aim of this in-vitro study was to investigate the trueness and precision of full-arch maxillary digital impressions comparing three scan strategies. Method and Materials: Three scan strategies (A, B, and C) were applied each five times on one single model (A, first buccal surfaces, return from occlusal-palatal; B, first occlusal-palatal, return buccal; C, S-type one-way). The TRIOS Pod scanner (3shape, Copenhagen, Denmark) with a color detector was used for these digital impressions. A cast of a maxillary dentate jaw was fabricated and scanned with an industrial reference scanner. This full-arch data record was digitally superimposed with the test scans (trueness) and within-group comparison was performed for each group (precision). The values within the 90/10 percentiles from the digital superimposition were used for calculation and group comparisons with nonparametric tests (ANOVA, post-hoc Bonferroni). Results: The trueness (mean ± standard deviation) was 17.9 ± 16.4 μm for scan strategy A, 17.1 ± 13.7 μm for B, and 26.8 ± 14.7 μm for C without statistically significant difference. The precision was lowest for scan strategy A (35.0 ± 51.1 μm) and significantly different to B (7.9 ± 5.6 μm) and C (8.5 ± 6.3 μm). Conclusions: Scan strategy B may be recommended as it provides the highest trueness and precision in full-arch scans and therefore minimizes inaccuracies in the final reconstruction. Keywords: accuracy, digital impression, intraoral scan, precision, strategy, trueness