Quintessence International, 09/2021

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. Keywords: air polishing, biofilm, erythritol, low-abrasive powder, oral hygiene, plaque, professional tooth cleaning, rubber cup polishing

Objective: Due to the current global situation of refugees, Europe has experienced increased migration from African, Middle Eastern, and Eastern European countries. The objective of this study was to explore oral health, especially prosthetic status and treatment needs, in adult refugees, and to compare these findings with German cohorts. Method and materials: This representative, multicenter, cross-sectional survey on oral health and treatment needs among refugees was carried out in 10 registration centers for asylum seekers aged 18 to 75 years across Germany in 2016 to 2017. The clinical examination included past caries experience (DMFT) and both existing and necessary prosthetic measures. These measures were registered according to the National German Health Survey 2016 and compared to the German resident population. Results: A high untreated caries experience (DT 3.9 ± 4.6) was found among refugees (n = 288, age 37 ± 12), in addition to the expected increase of caries experience with getting older (DMFT 7.4 ± 5.7 to 14.9 ± 7.7). In contrast to the German resident population, extractions were the preferred past caries treatment, resulting in a considerable number of missing teeth (MT 7.6 ± 7.3, FT 3.6 ± 4.3, 45- to 64-year-olds). Existing prosthetic treatments such as partial and full removable dental prostheses were very rare among refugees (2% to 4%). Fixed dental prostheses were mostly required in the mandible of young adults (25%, 18- to 44-year-olds), while elderly refugees required more often removable dental prostheses (45 to 64 years, 39.7% maxilla, 38.4% mandible). Conclusions: Newly arrived refugees in Germany exhibit higher dental treatment needs in general and prosthetic treatment needs in particular due to former extractions, which were performed as a main caries treatment. Keywords: dental status, Germany, oral health, prosthetic treatment needs, refugees

Objective: The aim of this pilot randomized controlled trial was to assess the efficacy of macro- and microsurgical procedures in removing the epithelial tissue layer of subepithelial connective grafts (SCTGs) harvested by the parallel incision method. Method and materials: Sixteen patients were randomized to receive macro-SCTG harvesting (n = 10, control group) or micro-SCTG harvesting (n = 10, test group) by the parallel incision technique. Histologic and histomorphometric analysis of the SCTG evaluated the percentage remnant of epithelium and connective tissue. The presence of remnant portions of the epithelium was identified in eight samples (three in the macro- and five in the microsurgery groups). Results: Sixteen participants with 20 sites were included and 20 SCTG were collected and analyzed. SCTG harvested by microsurgical approaches displayed more portions of remnant epithelium compared to the conventional removal (50% versus 30%). There were no significant differences in mean remnant epithelial thickness for test (147.3 ± 89.3 μm) and control (209.0 ± 127.5 μm) groups (P = .57). Likewise, nonsignificant differences were identified in terms of the connective tissue thickness (macrosurgery: 1,511.0 ± 1,160.0 μm; microsurgery: 1,472.0 ± 1,063.0 μm) between groups (P = .96). Conclusion: The samples harvested by microsurgery had greater remaining epithelial portions than those harvested by macrosurgery, and similar connective layer thickness. Keywords: gingival recession, histology, microsurgery, plastic surgery

Objective: To compare and evaluate the efficacy, hemodynamic changes, and postoperative complications of 4% articaine using buccal infiltration and 2% lidocaine using inferior alveolar nerve block in mandibular primary molars of children aged 6 to 8 years. Method and materials: 100 participants were randomly distributed to receive either 4% articaine using infiltration anesthesia or 2% lidocaine using inferior alveolar nerve block on each side of the mandibular arch, in two different appointments, after a 1-week interval. The pain perception was evaluated using visual analog scale (VAS) and Wong-Baker Faces pain rating scale (WBFPRS). In both the appointments, the efficacy and onset of anesthesia were evaluated using an electric pulp tester. Hemodynamic parameters, which included pulse rate and oxygen saturation levels, were evaluated using a pulse oximeter. Postoperative complications were evaluated at 24-hour follow-up. Results: Pain score recorded with block was more painful compared to infiltration (P < .05). Anesthetic success was observed with both the local anesthetic agents, with no significant differences (P > .05). Shorter onset of action was observed with articaine (P < .05). Statistically significant differences between groups were noted with regard to heart rate (P < .05). Oxygen saturation levels did not show significant differences (P > .05). When postoperative complications were evaluated with either 4% articaine or 2% lidocaine, very few adverse effects were recorded (P > .05). Conclusion: Buccal infiltration using 4% articaine has the potential to replace 2% lidocaine using inferior alveolar nerve block in children.(Quintessence Int 2021;52:780–786; doi: 10.3290/j.qi.b1492247) Keywords: articaine, buccal infiltration, inferior alveolar nerve block, lidocaine, pain

Objectives: COVID-19 led to the adoption of containment measures including the temporary closure of dental clinics. However, dental emergencies have not ceased during this pandemic. Thus, the aim of this study was to analyze patient profiles and the offered management options to pediatric patients presenting with dental emergencies during a COVID-19 lockdown. Method and materials: Retrospective analysis was performed of patient records of children seeking emergency dental treatment during a 7-week lockdown period in 2020 in a university pedodontic clinic in Germany, and compared to a similar cohort from 2019. Data on patient, tooth, and session level were collected. Results: The 2020 cohort consisted of 83 patients, and the 2019 cohort included 46 patients, showing a 45% greater need for emergency treatment in 2020. The most common chief complaint was plaque-induced gingivitis/oral mucosal conditions in 2020 (26.4%), and irreversible pulpitis in 2019 (25.5%). Dental caries (without spontaneous pain) was the second most common chief complaint in both cohorts (20.7% and 23.4%, respectively). Most interventions in 2020 were minimally invasive treatments (eg, Hall Technique, silver diammine fluoride; 20.3%), which were in 2019 not considered at all; followed by pharmacologic treatment (16.9%), which was in 2019 also highly used (35.9%). Conclusion: The COVID-19 pandemic led to an increase in emergency pediatric dental visits and shifted treatment options towards less invasive procedures. Keywords: coronavirus disease (SARS-CoV-2), dental emergency treatment, minimally invasive treatments, pediatric dentistry

Objectives: To examine whether a surgeons’ position affects the axial angulation of dental implants placed freehand. Method and materials: Implants’ axial angulation was assessed on digital panoramic radiographs. An occlusal line was plotted based on the neighboring teeth/crowns. The mesial angle between the long axis of the implant and the occlusal line was measured. In addition, post-hoc ideal implant-positioning planning was done on the panoramic digital image, and the angle of the intersection between the long axis of the actual and post-hoc ideal implant was measured. Student t test for unpaired observations and the Kolmogorov-Smirnov nonparametric tests were utilized to compare the ipsi- and contralateral sides and between clinicians. Results: Seventy-seven patients (149 implants) were eligible for the study. Implants had slight mesial inclination (mean 97.7 ± 8.7 degrees) which was similar for both the ipsi- (98.2 ± 8.4 degrees) and contralateral sides (97.2 ± 9.1 degrees), P = .491. For the post-hoc planning versus actual placement comparison, the overall median (interquartile range) of implant angular deviation was minimal (−0.25 degrees [−2.98, +3.47]). This was true for both the ipsilateral (−0.5 degrees [−2.9, +2.9]) and contralateral (−0.2 [−4.2, +5.4]) sides, P = .55. For the actual versus post-hoc planning, most observations clustered around the midline (zero to minimal deviation), while for the implant to occlusal plane angle, a tendency towards slight mesial angulation was observed. Conclusions: Dental implants placed freehand by experienced clinicians have only slight axial deviation as measured from post-hoc optimal position. Implants placed in ipsilateral and contralateral sides and by left- and right-dominant-hand clinicians had similar angulations. Keywords: dental implants, freehand, handedness, implant angulation, positioning accuracy

Sodium hypochlorite (NaOCl) is the most common irrigant used in modern endodontics due to the antimicrobial properties against bacteria, the powerful oxidative activity, and the ability to dissolve organic soft tissues. When NaOCl extrudes the apex of the root, commonly referred as “sodium hypochlorite accident,” it can lead to devastating outcomes leading to long-term functional and esthetic deficits. Currently, no clear guidelines exist as to how these patients should be managed. The purpose of this paper is to present a case report and a review of literature and to propose an adequate surgical treatment protocol for this unfortunate event. Keywords: endodontics, irrigation, pharmacology, surgical procedure, toxicity

Objectives: The purpose of this study was to determine if liposomal bupivacaine 1.3% (LB), Exparel (Pacira Pharmaceuticals), is more effective than bupivacaine hydrochloride 0.25% (BH), Marcaine (Hospira), in reducing postoperative pain and opioid consumption in patients undergoing exploratory lingual nerve microsurgery. The investigators hypothesized that patients who received LB would have a greater reduction in acute postoperative pain, and therefore, a reduction in total opioid use over 72 hours postoperatively. Method and materials: This was a retrospective study. All patients had undergone outpatient lingual nerve microsurgery at University Hospital in Newark, NJ, by principal investigator (VBZ). The research design consisted of two groups. One group received BH, while the other received LB. Participants were administered a telephone questionnaire after obtaining verbal consent. Subjective pain intensity from 0 to 72 hours postoperatively was evaluated on a numeric rating scale (NRS). Additionally, total opioid consumption was evaluated. Results: Sample size was composed of 20 patients: 11 patients in the BH group, and 9 patients in the LB group. Less perceived pain was reported by subjects in the LB group, and more significantly, less opioid pill consumption. Conclusion: The purpose of this study was to conduct a retrospective analysis addressing the following question: “Does LB use decrease postoperative pain and opioid consumption in exploratory lingual nerve microsurgery?” Results showed that intraoperative use of LB was associated with decreased postoperative pain, and decreased opioid pill consumption, when compared to BH, through its prolonged duration of action. The results from this pilot study support LB use in lingual nerve microsurgery. Keywords: bupivacaine, lingual nerve injury, liposomal bupivacaine, local anesthesia, opioid, pain management

Objectives: This study was designed as a prospective randomized single-blind clinical trial to compare the anesthetic efficacy of inferior alveolar nerve block (IANB), IANB plus buccal infiltration, and IANB plus lingual infiltration of 4% articaine with 1:100,000 epinephrine in mandibular molars with irreversible pulpitis. Method and materials: Sixty healthy volunteers who had a first or second mandibular molar diagnosed with irreversible pulpitis participated in the present study. This study was composed of three arms for the first molar and three arms for the second molar. Subjects in test arm A received two IANB injections (3.6 mL). Subjects in test arm B received 1.8 mL IANB injection plus 1.8 mL buccal infiltration. Subjects in test arm C received 1.8 mL IANB injection plus 1.8 mL lingual infiltration. Articaine (4%) with 1:100,000 epinephrine was used for all injections. The subject’s pain during access preparation and pulp extirpation was recorded on the Heft-Parker visual analog scale. Success was defined as “none” or “mild” pain during treatment. Kruskal-Wallis test was used to compare pain categories in three groups of interventions for each mandibular molar. Results: IANB with a supplemented buccal infiltration provided more success than IANB alone or IANB plus lingual infiltration, in first molars (P = .019). There were no significant differences between the three injection techniques in second molars (P = .795). Conclusions: Adding a supplemental buccal infiltration to a standard IANB was more successful in providing pain-free treatment for patients experiencing irreversible pulpitis in mandibular first molars. Keywords: articaine, buccal infiltration, inferior alveolar nerve block, irreversible pulpitis, lingual infiltration, mandibular molar, pulpal anesthesia

Objectives: The COVID-19 pandemic poses a major challenge to health care worldwide. As a part of the virus containment strategy, health care services were limited to the treatment of essential emergencies. The aim was to evaluate the influence of COVID-19 pandemic on patients’ utilization of dental emergency services, focusing on patients vulnerable to severe courses of COVID-19. Method and materials: Files of 1,299 patients of the Dental School of the University Hospital Wuerzburg between 3 February and 7 June 2020 were retrospectively analyzed. The observation period was divided into pre-lockdown (Pre-L), during lockdown (Dur-L), and post-lockdown (Post-L). Patients’ demographics, diagnosis, and medical history including COVID-19 anamnesis were recorded. Results: The number of dental emergency patients decreased by approximately 50% (Pre-L, n = 576; Dur-L, n = 309). Proportions of risk patients among them did not change. Stationary admissions increased by approximately 4% (Pre-L, 12.3% to Dur-L, 16.2%). The most frequent diagnosis was uncontrollable pain (45.6%), originating in 25.2% of endodontic and periodontal diseases. Abscesses (23.0%), dental trauma (16.5%), facial trauma (9.4%), and uncontrollable bleeding (5.5%) followed consecutively. Conclusion: Patients with an increased risk for severe courses of COVID-19 infection did not refrain from consulting dental emergency care. Dental emergencies should be treated early to avoid stationary admissions to preserve hospital bed capacities. Keywords: COVID-19, dental emergency care, dental public health, dentistry, pandemic, SARS-CoV-2