Quintessence International, 01/2020

Objectives: Tooth preparation is one of the factors that affect the bond strength of composite to teeth, and the method of preparation affects dentin morphology. Several disadvantages have been observed for the conventional technique. Currently, Er:YAG laser is a good treatment option and has been used to prepare hard dental tissue; it enables conservative preparation without damage to the pulp. Though Er:YAG laser is a promising alternative for preparation of the dentin surface, the bond strengths of Er:YAG-lased tooth substrates to composite reported in the literature have been confusing and even contradictory. The aim of the present study was to investigate the effect of Er:YAG laser irradiation, compared with conventional methods, on the shear bond strength of enamel and dentin. Method and materials: The databases PubMed, EMBASE, Springer, Wiley-Blackwell, EBSCO, and the China Academic Journals Full-text Database were searched for relevant studies in English or Chinese. Full-text articles were selected that involved shear bond strength after using the Er:YAG laser and conventional methods. Review Manager 5.0 was used to estimate the effects of the results among selected articles. Forest plots, sensitivity analyses, and bias analyses were also conducted for the articles. Results: Both in dentin and in enamel, the shear bond strength after using Er:YAG laser was significantly higher than that of the blank control (conventionally treated) group. Differences were not significant between studies that used burs in comparison with phosphoric acid. There was high heterogeneity of shear bond strength between different groups, and low numbers of studies and contradictory results may be the main reasons for this. A funnel plot indicated that some publication bias existed. Conclusion: The shear bond strength after Er:YAG laser preparation was significantly higher than that of the blank control (conventionally treated) group. Er:YAG laser is a safe and convenient alternative procedure, and has some advantages over traditional methods. Keywords: dentin, enamel, Er:YAG laser, meta-analysis, shear bond strength

Objective: This study aimed to investigate the Epstein-Barr virus (EBV) prevalence and viral load in subgingival sites of human immunodeficiency virus type 1 (HIV-1) positive (HIV+) individuals, correlating subgingival EBV load to the clinical periodontal condition, HIV systemic load, EBV systemic load, and use of antiretroviral therapy (ART). Method and materials: Ninety individuals were recruited and divided into three categories: those without periodontal disease (G1), with gingivitis (G2), and with periodontitis (G3). Subgingival biofilm and blood samples were analyzed by quantitative polymerase chain reactions (qPCR). A questionnaire was administered to collect general information about patients, and data regarding HIV and use of ART were accessed from their medical records. Results: EBV was detected in 85.6% of the samples. Comparing subgingival and systemic load of EBV in G1, G2, and G3, there was a statistical difference only in G3 (3.93 log10 copies/mL and 5.47 log10 copies/mL, respectively; P = .014), where EBV load was higher in periodontal pockets than in the blood. All groups had high EBV loads in subgingival sites (> 2,000 copies/mL). A positive linear correlation between systemic HIV load and EBV subgingival load was found in G1 and G2 (r = 0.647; P < .001), but not in G3. Only G1 individuals using ART had lower subgingival EBV loads than those not using it (5.03 log10 copies/mL, and 7.14 log10 copies/mL, respectively; P = .0348). Conclusions: Subgingival sites, especially the periodontal pockets, are suggested to act as a reservoir of EBV in HIV+ individuals. Therefore, the identification of latent EBV infections in this easily accessible site might help to improve quality of life in patients with HIV by maintaining oral/periodontal health. In addition it might encourage new approaches in investigating EBV-associated disorders in HIV+ patients. Keywords: antiretroviral therapy, Epstein-Barr virus (EBV), HIV-1, human herpesvirus-4, periodontal diseases, periodontal pocket

Objectives: To assess the stability of soft tissues around implants by comparing mucosal recessions in patients with keratinized mucosa (test) with patients without keratinized mucosa (control) around osseointegrated dental implants. Method and materials: The PICO criteria used were as follows: Population, patients with osseointegrated dental implants; Intervention/exposure, presence of a keratinized mucosa; Comparison/control, absence of keratinized mucosa; Outcome, presence or absence of peri-implant mucosal recessions (mm). Data sources: An electronic search of Medline, Embase, and Cochrane Oral Health Group specialist trials supplemented by manual searching was conducted to identify studies reporting outcomes of at least 5 years on the presence of mucosal recessions at implants with or without attached mucosa. Mucosal recession (MR) was set as primary outcome. Prospective cohort studies published in English language up to October 2018, with a mean follow-up period of at least 5 years, reporting keratinized tissue height ≥ 2 mm and < 2 mm or presence/absence of keratinized tissue, with fixed implant-supported prostheses. The homogeneity of studies was assessed by DerSimonian and Laird test (Q test). The differences in terms of gingival recession around implants reported between test groups (keratinized mucosa ≥ 2 mm) and control (keratinized mucosa < 2 mm or no keratinized mucosa) were compared. Two studies reporting 201 patients with 514 tissue level implants were selected for the final analysis. Results: Due to the high heterogeneity between the selected studies, no statistical test could be performed. However, in both studies a deeper mucosal recession occurred when keratinized mucosa was < 2 mm: 0.61 ± 0.10 (−0.90; −0.32) and −1.92 ± 0.12 (−2.16; −1.68), respectively. Conclusion: Within their limitations, the findings indicate that after a mean observation period of at least 5 years, the presence of keratinized mucosa may lead to less mucosal recession at dental implants. Keywords: dental implants, keratinized mucosa, mucosal recession, systematic review

Objectives: This study aims to evaluate the success rate of formocresol and ferric sulfate through meta-analysis with trial sequential analysis (TSA). Method and materials: The protocol of the review was registered in the PROSPERO database (CRD 42018090044). Two independent reviewers used PubMed, Scopus and EBSCOhost databases to identify randomized clinical trials published from inception to June 2019. Patients undergoing pulpotomy therapy in vital primary molars with pulp exposure due to caries treated with formocresol and ferric sulfate were evaluated for clinical and radiographic success. Meta-analysis was conducted to evaluate the success at 6, 12, 18, and 24 months and TSA was performed for success at 24 months. Quality of evidence was determined by Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) analysis. Results: Eight clinical trials were included in meta-analysis. No difference was observed in the clinical and radiographic success rate between formocresol and ferric sulfate at 6, 12, 18, and 24 months. TSA identified required information size of 687 teeth for clinical success and 568 teeth for radiographic success. In addition, it demonstrated evidence for radiographic success rate at an anticipated intervention effect of 10% for formocresol over ferric sulfate. Conclusion: Formocresol and ferric sulfate show comparable clinical and radiographic success rates as pulpotomy material in primary molars at 24 months based on the studies with low to moderate quality of evidence. Keywords: ferric sulfate, formocresol, pulpotomy, systematic review, trial sequential analysis

Diffuse large B-cell lymphoma is an aggressive, fast-growing form of non-Hodgkin disease with rare manifestation in mandible as a primary site. Absence of pathognomonic features in this localization often leads to misdiagnosis as an odontogenic process or its delayed diagnosis. The present case report is of a patient in whom non-odontogenic jaw pain mimicked a toothache prompting multiple dental interventions before persistence of pain and atypical findings led to consideration of a primary malignant etiology. Keywords: diagnostic challenge, jaw malignancy, oral medicine, pathology, radiology

Background: Non-odontogenic toothaches often present as a diagnostic dilemma to clinicians. Myofascial pain with referral from the trigger points in the masticatory muscles are one of the common causes of non-odontogenic toothaches. However, there are limited reports of myofascial pain from the anterior digastric muscle referring pain to the mandibular anterior teeth and mimicking odontogenic pain. Case presentation: A case of non-odontogenic toothache in the mandibular anterior teeth due to myofascial pain with referral from trigger points in the anterior digastric muscle is presented. The patient had significant relief with a trigger point injection of the anterior digastric muscle. Amitriptyline 10 mg once daily was prescribed for 1 month. In addition, she was advised home care instructions to control predisposing, perpetuating, and precipitating factors, and given home care exercises, a hard joint stabilization splint, physiotherapy, and postural re-education. Conclusion: Non-odontogenic toothaches may be multifactorial. The case presented emphasizes the importance of a comprehensive evaluation to differentiate odontogenic pain from non-odontogenic pain. Irreversible dental procedures should be instituted after an accurate diagnosis and multidisciplinary management may be required in complex cases. Keywords: anterior digastric muscle, myofascial pain, pain, temporomandibular disorder, trigger point

Objectives: Although health care practitioners have become more cognizant of the hazards of opioid use, opioid misuse has emerged as a leading public health problem in the United States, accounting for 20% of all deaths among older adolescents and young adults. Opioid analgesics are an important component of dental pain management following dental procedures. The aim of this study was to assess the status of literature on dental opioid prescriptions, their misuse, and relevant prevention strategies in the US. Data sources: A keyword search of MEDLINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL (EBSCO), and Web of Science was conducted in July 2018. The search criteria were carefully selected to include all practitioners treating patients presenting with dental issues and was not restricted to dentists. All peer-reviewed publications in the US written in English about patients with dental problems were included. Results: The initial search led to 267 publications; after removing duplicates, the set consolidated to 196. After an appraisal of the title and abstract for relatedness, 82 publications were selected. Three major themes were identified: epidemiology of dental opioid prescriptions; recognition of the dental providers' contribution to opioid prescription practice; pain management protocols and guidelines in dentistry. Conclusions: There is moderate recognition of the contribution of dental prescriptions to the opioid epidemic. Several tools are available to increase patient education and practitioner knowledge about the safe use of opioids with a focus on patients at greatest risk. Keywords: dental pain, dentistry, misuse, opioids, patients, prescription, scoping review

Objectives: Video sharing sites are a popular and useful way to spread information. The aim of this study was to evaluate information about oral care for leukemia patients and quality of information related to videos available on YouTube. Method and materials: In this cross-sectional study, YouTube videos were analyzed according to the information content. The search was performed in English and using the search term: leukemia/oral care. The following information was registered: date of upload, source of upload, duration, total views, number of likes, number of dislikes, number of comments, overall quality. The overall quality of videos was assessed using the following quality criteria presented in the Global Quality Scale (GQS): poor, generally poor, moderate, good, and excellent. In addition, videos were classified as useful, misleading, and patient personal experience. Videos were assessed in terms of definition, etiology, pathogenesis, symptoms, treatment, and oral care for leukemia. Results: Sixty-three videos (78.8%) were classified as useful, 6 (7.5%) as misleading and 11 (13.8%) as a patient's personal experience. Thirteen videos (16.3%) discussed the definition of leukemia, 8 (10.0%) discussed etiology, 6 (7.5%) discussed pathogenesis, 7 (8.8%) discussed symptoms of leukemia, 50 (62.5%) discussed treatment choices, and 15 videos (18.8%) discussed oral care of leukemia. Thirteen videos (16.3%) were assessed as poor, 17 (21.3%) as generally poor, 39 (48.8%) as moderate, 10 (12.5%) as good quality, and 1 (1.3%) as excellent. There was a significant difference between the content of videos and the number of views, number of likes, number of dislikes, and number of comments (P < .05). There was a significant difference between the content of videos and number of views, number of likes, number of dislikes, and number of comments (P = .007, P = .006, P = .049, and P = .011 respectively). There was no significant difference between demographic parameters and quality of video. There was no significant difference between demographic parameters (except duration, P = .025) and source of information. Conclusions: YouTube is a useful source of information on leukemia. Health care professionals should take into consideration that YouTube is an effective information tool for the patient. Keywords: health, leukemia, oral care, video, YouTube

Objective: To compare the clinical performance of two glass-ionomer cements in combination with two light-cured coatings in Class II cavities. Method and materials: In total, 43 Equia Fil/Equia Coat and 42 Fuji IX GP Fast/Fuji Coat LC restorations were placed, in 34 patients. Only Class II cavities with two- or three-surface restorations were included. The clinical performance was evaluated at baseline, after 1, 2, and 3 years using the FDI criteria. For the statistical analysis, Fisher exact test, Wilcoxon signed-rank test and Mann-Whitney U test were applied. The success and survival of the restorations were calculated with the Kaplan-Meier method and a log-rank test was used to detect significant differences between the tested materials. Results: At the 3-year recall, no significant differences could be detected between the two glass-ionomer cements for any of the evaluated criteria (Mann-Whitney U test, P > .05). When comparing the baseline with the recall data at 3 years for each material separately, significant changes could be observed in both materials for the criteria "surface luster," "fracture of material and retention," and "approximal anatomical form" (Wilcoxon signed-rank test, P < .05). Additionally, the Equia Fil restorations showed a notable change for the criteria "marginal adaptation" (Wilcoxon signed-rank test, P = .039). At the 3-year follow up, the Equia Fil and the Fuji IX GP Fast restorations exhibited an overall survival rate of 89.3% and 88.0%, respectively. Three fillings in each group failed. Conclusion: The two glass-ionomer cements tested performed similarly in Class II cavities in adult patients, with a moderate failure rate after 3 years. (Quintessence Int 2020;1:e1-e11; doi: 10.3290/j.qi.a43755. Original article published in Quintessence Int 2019;50:592-602; doi: 10.3290/j.qi.a42692) Keywords: amalgam alternatives, Class II restorations, clinical study, Equia, FDI criteria, glass-ionomer cement, permanent teeth