Quintessence International, 03/2020

Objective: The effect of the hyaluronic acid (HA) on laser-assisted frenectomy wound healing has not been tested. This controlled, randomized, examiner-blinded clinical study aimed to compare the outcomes of laser-assisted frenectomy with and without an HA-containing gel application. Method and materials: The study included 40 patients aged 18 to 40 years, with high labial frenulum attachment requiring frenectomy. Following laser-assisted frenectomy, HA-gel was applied topically to the wound surface at the day of frenectomy and on days 3, 7, and 14 postoperatively in the test group, and no application was made to the control group. The photographs were taken at the day of frenectomy and on days 3, 7, and 14 postoperatively. A total of 160 images were uploaded to the software. The changes in the area measurements from baseline values were calculated. A visual analog scale (VAS) was used to evaluate patients' satisfaction. Results: The primary outcome variable was the change in the wound area from baseline to postoperative 3, 7 and 14 days. The area measurements and VAS scores were significantly lower in the test group than in the control group at all postoperative assessment time points (P < .001). According to the percentage changes calculated at postoperative assessment points, the highest percentage was found on day 14 in the test group, and the lowest value was identified on day 3 in the control group. Conclusion: HA was observed to be a viable option for decreasing the surface area of the wound and to act as a wound dressing following frenectomy. HA application also increased patient satisfaction postoperatively. Keywords: frenectomy, hyaluronic acid, laser, visual analog scale, wound healing

Objectives: Presence of clinical attachment loss on the distal aspect to the second molar may be associated with malposition of the third molar. The aim of this study was to evaluate the reduction of clinical attachment loss at the distal aspect of the second molar after third molar extraction and application of leukocyte- and platelet-rich fibrin (L-PRF). Method and materials: Eighteen subjects with a clinical attachment loss on the distal site to the second molar associated with impacted third molar in both sides of the jaw were recruited for the study. For each subject the teeth were randomly allocated in test and control groups. After surgical removal of the impacted third molar, the L-PRF was inserted in the fresh alveolar socket of test sites; in the control sites no graft was inserted after extraction. Full-mouth plaque score, full-mouth bleeding score, clinical attachment level (CAL), probing depth, and gingival recession were assessed at baseline and 6 months later. Results: After 6 months, mean CAL change was 1.99 ± 1.18 mm in the test group and 1.15 ± 1.01 mm in the control group; probing depth change was 1.33 ± 0.87 mm in the test group and 0.50 ± 0.63 mm in the control group. Statistically significant differences (P < .05) were observed between groups in terms of CAL and probing depth changes. No differences were found in gingival recession changes. Conclusion: Within the limits of the present study, the sites treated by means of application of L-PRF after impacted third molar extraction showed better results in terms of CAL gain and probing depth reduction when compared with control sites. Keywords: clinical attachment level, periodontal defects, platelet-rich fibrin, third molar

Objective: The aim was to investigate the presence of Entamoeba gingivalis and Trichomonas tenax in peri-implantitis lesions. Method and materials: A total of 141 individuals were included in this study, of which 40 had clinically healthy implants (group H); the remaining were associated with peri-implantitis (group P). Gingival crevicular fluid was collected using absorbent paper, followed by a dental plaque sample from the peri-implant sulcus/pocket using a titanium curette. The samples were transferred into an Eppendorf tube. Each specimen was divided into two parts. One part was examined under a light microscope at a 10 × and 40 × magnification to detect parasites. The other part was spread on a microscope slide, stained with Giemsa stain, and examined under a microscope at 100 × magnification. Pearson chi-square test was used in the statistical analysis of data, with a significance level of P < .05. Results: Although there was no presence of parasite around the healthy implants, two parasites were detected in peri-implantitis lesions. Out of 101 lesions, 31 (30.7%) showed E gingivalis, and 34 (33.6%) presented with T tenax. There was a statistically significant difference between the presence of E gingivalis and demographic data including gender, education status, frequency of dental visits, and brushing frequency. Presence of T tenax in lesions was correlated with frequency of dental visits (P < .05). It was observed that E gingivalis and T tenax were mostly detected in the mandible (P = .004 and .014, respectively) in comparison with the maxilla. Conclusion: This study showed that peri-implantitis lesions were involved with E gingivalis and T tenax, in contrast to the healthy areas. Keywords: dental implants, direct microscopy, Giemsa staining, microbiology, parasite, peri-implantitis

Objectives: Tooth extractions are suspected to be a major trigger for the development of bisphosphonate-related osteonecrosis of the jaw (BRONJ). Preventive measures like perioperative antibiotic therapy and primary wound closure have been found to be effective in preventing the development of BRONJ following tooth extraction. The aim of this study was to present long-term results of a treatment protocol for patients under bisphosphonate therapy requiring tooth extraction. Method and materials: Between January 2008 and December 2012, 232 tooth extractions were performed in 84 patients under current or previous bisphosphonate treatment. Extractions were performed applying an atraumatic technique under prolonged intravenous antibiotic therapy. The bony edges were rounded off meticulously and the extraction sockets were covered with a mucoperiosteal flap. Results: Out of 84 patients, two developed osteonecrosis of the jaw (ONJ), resulting in an incidence-rate of 2.4%. Both ONJ patients had received radiation therapy to the head and neck region following tooth extraction. The remaining 82 patients had uneventful healing and did not present any signs or symptoms of BRONJ during the follow-up period of 41.5 months. Conclusion: Tooth extractions, if performed under certain circumstances, would not seem to constitute a major risk factor for the development of BRONJ. The treatment protocol presented in this article seems to be highly effective in preventing development of ONJ after tooth extraction in patients under current or previous bisphosphonate therapy. Keywords: bisphosphonate, bisphosphonate-related osteonecrosis of the jaw (BRONJ), tooth extraction

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. Keywords: atrophic mandible, implant complications, inferior alveolar nerve, mandibular fracture

Objectives: Replacing conventional round intraoral collimators with rectangular collimators provides a considerable radiation dose reduction in adult patients. This study aimed to determine the radiation dose reduction via mathematical phantom when converting from round to appropriately sized rectangular collimation in children ages 5 to 15 years. Method and materials: Virtual full mouth series (FMX) were simulated using a commercially available radiation dose software. This software is designed to calculate patient radiation doses from x-ray exams for various age pediatric and adult mathematical phantoms. For this pediatric study an 18-image FMX was simulated for the 15-year-old and a 12-image FMX was simulated for the 5-year-old and 10-year-old pediatric phantoms. An area of 12.0 to 16.8 cm2 represented rectangular collimation, while a 20.4 to 31.7 cm2 area represented typical round collimation. Results: Effective doses decreased in all ages by nearly 60% when switching from 31.7 cm2 round to 12.0 cm2 rectangular collimation. Reduction in absorbed doses to the thyroid (70% to 73%), salivary glands (62% to 78%), and active bone marrow (60% to 62%) were also noted when switching from the largest to smallest collimation. Conclusion: This study suggests the use of rectangular collimators provides clinically relevant dose reduction for pediatric patients, even when altering from smaller round to rectangular collimation with equivalent beam quality, and this information can be utilized in all dental practices. Keywords: American Dental Association, full mouth series, intraoral x-ray collimator, mathematical phantom, pediatric x-ray dose, rectangular collimator, round collimation

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. Keywords: artificial intelligence, big data, caries detection, future dentistry, machine learning