Quintessence International, Pre-Print

Objectives: Tooth wear (TW), also referred to as tooth surface loss (TSL), occurs due to causes other than caries. This involves the loss of hard tissues, namely enamel, dentin and/or cementum. Types of TW/TSL are abrasion, abfraction, attrition and erosion. These multifactorial conditions can be caused things such as lifestyle, diet or even habits and may not be symptomatic. The focus of this article is to provide clinicians with detailed examples and explanations of the causes of tooth loss to aid in early diagnosis. Through early identification, the preventive measures outlined can be implemented to avoid excessive TW. The provision of a treatment flowchart and general treatment recommendations aims to help clinicians determine when to restore these lesions and the most appropriate treatment measures for the 4 types of wear. Materials and Methods: The PubMed (MEDLINE) search engine was used to gather information on TW restricted to a five-year period (26 August 2018 – 25 July 2022). Only English-language studies and reviews with the best balance of sensitivity and specificity were considered. A Boolean search of the PubMed dataset was implemented to combine a range of keywords: ("tooth wear" OR tooth attrition OR tooth erosion OR tooth abrasion OR tooth abfraction). Additional articles were also selected through Google Scholar. Results: By this process, many articles and studies were obtained, and the 48 most relevant published studies were chosen and used in the current review. The selected articles are in the reference list. Conclusion: TW affects an increasing number of individuals and can have detrimental effects physically, mentally and emotionally. It is important to stress early diagnosis and management of tooth wear through monitoring, prevention and treatment where indicated. Schlagwörter: tooth wear, tooth surface loss, abrasion, abfraction, attrition, erosion, gastroesophageal reflux, bruxism, prevention

Background: Pre-eruptive intra-coronal radiolucency (PEIR) is a rare dental anomaly often incidentally detected during routine radiographic examinations. This condition manifests as a radiolucent lesion beneath the enamel-dentinal junction of unerupted teeth, particularly in lower molars, posing diagnostic and management challenges due to its asymptomatic nature. The treatment of PEIR depends on the extent of the lesion and the degree of pulp involvement. Case series: This case series reports on four patients with progressive pre-eruptive intra-coronal radiolucency. In case 1 and 2, lesions were incidentally discovered in an OPG during orthodontic planning (lower permanent 2nd molars), and additional surgical exposure to access the lesion was required as teeth were only partially erupted. Interestingly in case 3, the PEIR was not visible in earlier x-rays though the crown of the tooth was already mineralized (lower permanent 2nd molar). For case 4, the tooth presented with symptoms of reversible pulpitis (lower permanent 1st molar). All lesions were treated with indirect pulp capping using biocompatible material. The patients were followed-up for a period of up to 8 years to evaluate treatment success. Indirect pulp capping and restorations were found to be successful in all four cases in the last follow-up: 1 year (case 2), 1.4 years (case 1), 1.5 years (case 4), and 8 years (case 3). Conclusion: This case series demonstrates the effectiveness of early intervention via surgical exposure and indirect pulp capping and restoration for managing severe cases of PEIR. However, further research with larger samples and long follow-up is necessary. Schlagwörter: pre-eruptive intracoronal radiolucency/resorption, hidden caries, occult caries, pulp capping

Objectives: The frenum is a mucous membrane fold that attaches the lip and the cheek to the alveolar mucosa, the gingiva, and the underlying periosteum. Frenectomy is the surgical removal of the whole frenum, including the area connected to the bones. This study's purpose was to compare the healing period and postsurgical pain experienced by patients operated with diode and erbium:yttrium-aluminium-garnet (Er:YAG) lasers. Methods: Twenty referred patients need to excision of the abnormal upper labial frenum were included in this study. Patients were randomly assigned into two groups; Diode group (810 nm, 2W, continuous emission, initiated tip) and Er:YAG group (2940 nm, 2W, 200 mJ, 10 Hz). Both lasers were applied in contact mode. Post-operative pain was assessed with Numerical Rating Scale (NRS) at post-operative 3rd hour and every day during the first week. Epithelialization process of the wound surface was evaluated by hydrogen peroxide solution applied to the wound on days 7, 14, 30, 60 and 90 following operations. Results: The result shows mean values in Pain index after 3 hours (Diode Group 2.1±2.0, Er:YAG Group 2.6±1.4), 1st day (Diode Group 1.1±1.1, Er:YAG Group 1.9±1.4), and 2nd day (Diode Group 0, Er:YAG Group 0.9±1.1) and shows no significant difference after (3-7 days); p =1.00). In Healing index the results shows a significant difference between the Diode Group and the Er:YAG Group (after 7 days; p = 0.029 and 14 days; p = 0.001) and show no significant difference after (30-60-90 days; p = 1.00). Conclusions: The Er:YAG laser has better clinical results in healing wounds, whereas the diode laser is better in decreasing pain after frenectomy during follow-up periods. Schlagwörter: diode laser, erbium:yttrium-aluminium-garnet laser, frenectomy, papillary, papilla penetrating

Objectives: This study examines the impact of injectable platelet-rich fibrin (iPRF) and concentrated growth factor (CGF) on postoperative pain, edema, trismus, and quality of life in impacted mandibular third molar surgery. The primary aim of this study was to minimize common sequelae following third molar surgery by using iPRF and CGF. Our secondary objective was to compare the postoperative effects of these products. Method and Materials: This study represents a single-center, randomized prospective clinical trial conducted at the Ordu University Faculty of Dentistry. It involved patients who underwent third molar surgery for various reasons between July and October 2022. The predictor variable was the implementation of CGF, and i-PRF which was categorized as CGF, i-PRF and control groups. The outcome variables include pain levels and analgesic consumption measured on a VAS scale, distances between predetermined anatomical points, maximum mouth opening capacity, and data from the postoperative symptom severity (PoSSe) scale. Some statistical tests were performed with a 95% confidence interval, which was considered significant. Results: Total analgesic use was notably lower in the CGF group (p = .044). CGF and iPRF outperformed the control group in all edema measurements by the 7th day (T-Pog, L-A, T-C; p<.05). CGF significantly reduced trismus on the 2nd and 7th days. Quality of life was notably higher in the CGF group than in the control group (p = .026), although iPRF group differences were not significant. Conclusion: The results of this study indicate that CGF has a limited impact on postoperative pain, but significantly reduces edema, trismus, and enhances quality of life. The iPRF group experienced positive effects on pain, edema, and trismus, although the statistically significant differences observed with CGF highlight its potential for use instead of iPRF after third molar surgery. An increased sample size is essential for more comprehensive results. Schlagwörter: CGF, iPRF, inflammation, mandibular third molar

Objectives: To evaluate the clinical effectiveness of regenerative treatment of intra-bony defects in combination with consecutive orthodontic therapy (OT) with clear aligners in stage IV (type 2) periodontitis. Method and Materials: Ten patients with a total of 103 intra-bony defects were analyzed after regenerative surgery using collagen-deproteinized bovine bone mineral with or without collagen membrane or enamel matrix derivative followed by OT with clear aligners. Changes in radiographic bone level (rBL) and probing pocket depths (PPD) were evaluated after 1 year (T1) and at final splinting (T2) after orthodontic tooth movement. Results: Mean rBL gain was significant with 2.13 mm (±1.64 mm) after 1 year (T1) and 3.02 mm (±2.00mm) at final splinting (T2). Mean PPD was significantly reduced from 5.40 mm (±1.80 mm)at baseline to 3.78 mm (±1.73 mm) at T1 and remained stable with 3.73 mm (±1.70 mm)at T2. Pocket closure (PPD< 4mm) was accomplished in 76% of all defects. Tooth loss amounted to 2.9%. Conclusion: Within the limitations of the retrospective study design, the findings suggest that the interdisciplinary treatment of periodontitis stage IV by regenerative periodontal surgery and consecutive OT with clear aligners can lead to favorable results. Schlagwörter: bovine bone mineral, clear aligner, orthodontic tooth movement, pathologic tooth migration, regenerative periodontal therapy, stage IV periodontitis

Objective: Photobiomodulation (PBM) therapy is recommended by multiple international societies for managing oral mucositis (OM). These recommendations are based on extensive evidence. However, the search for an optimal PBM protocol continues. This mapping review focuses on a novel aspect of PBM therapy which is the immediate effect on pain levels associated with oral ulcerative conditions. Data sources: This literature review systematically compiles and evaluates the evidence about OM, alongside other oral ulcerative conditions, as the protocols that achieved pain relief for these oral conditions may have potential applicability to OM management. The scientific database used was PubMed. Conclusion: Whereas most of the randomized controlled trials about PBM therapy for OM and other ulcerative oral diseases reported delayed pain relief, certain PBM therapy protocols reported immediate pain relief. The results of this review highlight the concept of preemptive PBM therapy, in which PBM therapy is delivered early in the development of OM throughout the oncotherapy and may achieve immediate pain relief consistently in most of the patients and close to a negligible pain level. PBM therapy, as a powerful non-pharmacologic tool for immediate pain relief, has a great beneficial value in patients suffering from OM and other painful oral ulcerative diseases such as recurrent aphthous stomatitis and chronic graft-versus-host disease. Schlagwörter: Aphthous stomatitis, Cancer, Graft vs host disease, Laser, Oral mucositis, Pain relief, Photobiomodulation

Objective: This pilot study aimed to evaluate, for the first time, the changes in facial tissues following the placement of a single dental implant. Methods and Materials: Patients were scanned with a 3D facial scanner (3dMD) before implant surgery, immediately after surgery (T1), at 7 days post-operatively (T2), and at the impression stage (T3). Acquired images were processed using 3dMDVultus software program and volume differences and linear depth measurements were calculated to determine the morphometric changes over time. A total of 11 patients were included in the analyses. Descriptive statistics were employed to analyze the data. Results: The volumetric changes and maximum depth differences indicated an initial increase, followed by a progressive decrease in tissue volume after implant placement in the area of the surgery. The volume change values ranged between 2.5 to 3.9 cc for T1, whereas for T2, the volume change decreased to a range of 0.8 to 1.8 cc. Maximum depth differences ranged between 2.06 to 2.80 mm in the soft tissues right after the implant surgery and reduced to around 2.01 mm to 0.55 mm in the impression stage. The amount of painkiller used was not related to the magnitude of linear depth measurements at any assessed time point. Conclusion: The results from this report documented that there is a longitudinal decrease in soft tissue volume and depth difference in extra-oral soft tissues in the region of implant placement after surgery to 6 weeks. The use of a facial scanner is a promising non-invasive method to monitor 3D morphometric changes after implant surgery. Schlagwörter: dental implants, stereophotogrammetry, facial scan

Objectives: This systematic review compares the impact of ball and locator attachments on marginal bone loss in implant-retained overdentures in completely edentulous patients. Method and Materials: Following PRISMA guidelines, health science librarians completed literature searches from inception to March 17, 2023 in seven databases. There were 15,686 items exported to EndNote from Embase.com, CINAHL (EBSCO), Cochrane Library, Ovid MEDLINE-ALL, PubMed, Scopus, and Web of Science. Hand-searching added four more articles. After deduplication, 6756 items were screened for eligibility. Twenty-nine studies were assessed by full text, of which ten studies, involving 424 subjects, were included in the review. Risk of bias assessment was conducted using the Cochrane Risk of Bias tool and the Newcastle Ottawa Scale. A meta-analysis was performed to synthesize and analyze the collective data from the selected studies. Results: The included studies used diverse methodologies, implant systems, and loading protocols. Most studies reported no significant difference in marginal bone loss between ball and locator attachments. The meta-analysis revealed high heterogeneity. Conclusion: The results of this systematic review suggest that ball and locator attachments exhibit similar performance in terms of marginal bone loss in implant-retained overdentures. However, the limited number, risk of bias, and heterogeneity of studies highlight the need for standardized research designs and larger sample sizes in future investigations to draw more definitive conclusions. Schlagwörter: edentulous, complete, dental implantation, prosthesis retention, denture, overlay, dental prosthesis, implant-supported, denture attachment, ball, locator, self-align, non-splint, marginal bone loss

Objective: The goal was to identify the lifestyle risk factors associated with benign and potentially malignant oral disorders. Method and Materials: The study enrolled first-time patients from the Oral Pathology Section, volunteers from Oviedo, and first-time patients from University of Oviedo dental clinic. Patients underwent a survey that included sociodemographic information, lifestyle habits, and medical history. Then, a comprehensive examination of the oral mucosa was conducted. Univariate and multivariate logistic regression were conducted using R software. Results: Among the 183 participants, the most prevalent lesions were varicose veins (43.2%), cheek/lip biting (34.97%) and coated tongue (33.3%). Among the OPMDs (16.4%), oral lichen planus (OLP, 12.64%) and leukoplakia (3.3%). Tobacco was associated with melanotic pigmentation (OR 3.87, p= 0.001) and coated tongue (OR 5.90, p= 0.001). Longer intervals since last check-up were associated with traumatic keratosis (OR 2.05, p=035). Age and heavy smoking were found to have higher risk of developing an OPMD (OR 1.04, p=0.035 and OR 7.35, p=0.028 respectively). Conclusions: Our data should be considered when organizing public health programs focused on the detection and screening of heavy smokers. It is also important to strengthen the oral pathology units in universities as reference centres for students to acquire the necessary knowledge for their diagnosis and treatment, while simultaneously promoting awareness of this risk factor for oral precancer among the general population. Schlagwörter: Leukoplakia, Mouth neoplasms, Oral lichen planus, Oral potentially malignant disorders, Prevention and control, Risk factors

Objectives: This case series aimed to assess the efficacy of a novel horizontal ridge augmentation modality using histology. Combinations of “sticky bone” and tenting screws without autologous bone were used as augmentative materials. Methods and Materials: Five individuals presenting healed, atrophic, partially edentulous sites that required horizontal bone augmentation before implant placement were enrolled. Patients underwent the same augmentation type and five months of postoperative reentry procedures. The first surgery served as implant site development, while the biopsy and corresponding implant placement were performed during reentry. The bone was qualitatively analyzed using histology and histomorphometry and quantitatively evaluated using cone-beam computed tomography (CBCT). Results: Four individuals healed uneventfully. Early wound dehiscence occurred in one case. Histology showed favorable bone substitute incorporation into the newly formed bone and intimate contact between de novo bone and graft material in most cases. Histomorphometry revealed an average of 48 + 28% newly formed bone, 19 + 13% graft material, and 33 + 26% soft tissue components. The CBCT-based mean alveolar ridge horizontal increase was 3.9 + 0.6 mm at five months postoperatively. Conclusions: The described augmentation method appears suitable for implant site development resulting in favorable bone quality according to histology. However, clinicians must accommodate 1–2 mm resorption in augmentative material width at the buccal aspect. Schlagwörter: autologous platelet concentrates, histology, histomorphometry, horizontal augmentation, sticky bone, tenting screw

Objective: To compare effect of planning interventions on self-reported changes in parents supervised oral health related behaviours (OHRBs) and associated clinical oral health parameters for ‘primary school age’ children. Methods: 110 parent-child pairs (children aged 3-8 years) were randomly assigned to either of the two groups. In ‘Action planning’ group (AP), parent participants of the pair were asked to make ‘action plan’ within “how, when, where” format for their child OHRBs. In ‘Implementation Intention’ (IMI) group, parents were asked to form an ‘if-then plan’ to improve OHRBs for their child. Self-reported changes on target OHRBs, change in plaque scores, change in plaque stagnation areas and change in caries status of tooth surfaces were observed at 2, 8, 12 weeks. Results: Overall OHRBs scores changed significantly from baseline to 12 weeks for both interventions. But the scores were significantly better with ‘if-then’ planning than ‘action planning’ (z=4 p=<0.001) at 12 weeks. Plaque scores also changed significantly from baseline to 12 weeks for both interventions but improved significantly with ‘if-then’ planning (16.20±5.24) than ‘action planning’ (50.655±11.24) at 12 weeks. Number of plaque stagnation areas also changed significantly from baseline to 12 weeks for both interventions but improved significantly with if-then’ planning at 12 weeks (12.80±5.33) than ‘action planning’ (42.76±10.34) (t=-11.55 p=<0.001). There was significant change in caries status of sound tooth surfaces with ‘action planning’ at 12 weeks (z=116.5 p=0.023). There were no new carious lesions reported with ‘ifthen’ planning at 12 weeks. Conclusion: The study observed significant improvement in OHRBs and associated oral health parameters with planning interventions preferring 'if-then' planning over 'action planning'. It also elicited significant barriers to behaviours in action. Schlagwörter: oral health-related behavior, health-related behavior, volitional intervention, planning intervention, action planning, implementation intention

Background: Glossopharyngeal neuralgia due to vertebrobasilar dolichoectasia is a rare form of neuropathic pain and presents with diagnostic and therapeutic challenges. Clinical Presentation: A 67-year-old man presented with severe burning pain in the left oral cavity, with no explanatory findings during dental and ENT evaluations. TMJ examination revealed tenderness, and panoramic radiographs showed a non-contributory periapical radiolucency. MRI/MRA revealed abnormally tortuous vertebral arteries compressing the glossopharyngeal nerves and the brainstem. Topical lidocaine reduced pain, confirming glossopharyngeal neuralgia (GPN). Carbamazepine was initially ineffective, but at 200 mg pain reduced from 90 to 20 on the visual analog scale. The patient requested and underwent microvascular decompression (MVD) surgery, which eliminated his pain. Conclusion: When the vertebral artery compresses the glossopharyngeal nerve, the pain is more intense, attributed to its thicker vascular structure. Local anesthetic testing aids in identifying GPN. Dentists must be skilled in diagnostics and possess anatomical knowledge for accurate evaluation and referral of throat and ear pain. Schlagwörter: temporomandibular disorder, Glossopharyngeal neuralgia, orofacial pain, Pain, Vertebrobasilar Dolichoectasia

Objectives: Autoimmune activation by COVID-19 infection/vaccination has been postulated to be responsible for initiating or reactivating multiple types of oral mucosal immune disorders. These include oral lichen planus (OLP); oral pemphigoid, either bullous pemphigoid (BP) or mucous membrane pemphigoid (MMP) with oral involvement; pemphigus vulgaris (PV) with oral involvement; or Sjögren’s disease. In addition, chronic conditions such as oral burning, xerostomia or changes in taste and/or smell have also been linked to COVID-19 infection/vaccination. Data Sources: Part 1 (mucosal conditions): an English-language literature review of Pubmed, Web of Science, Scopus, and Embase was performed searching cases of OLP, oral BP, MMP, PV and COVID-19 infection/vaccination, with additional cases from the authors’ clinical practice presented. Part 2 (non-mucosal conditions): Cases of initiated or flared Sjögren’s disease, chronic oral burning, or xerostomia after COVID-19 infection/vaccination from the authors’ clinical practice were aggregated. Our literature review discovered 29 cases of OLP following COVID-19 infection/vaccination. For BP, 10 cases were identified after infection/vaccination. The number of PV cases following infection/vaccination were 28. The majority of mucosal cases were reported after vaccination. Most reported initial disease, but a substantial amount included recurrences of existing diseases. Non-mucosal disease: Sjögren’s disease, chronic oral burning, or xerostomia after COVID-19 infection/vaccination cases totaled 12 cases identified from the authors’ clinical practice, with the majority occurring after infection. Conclusions: Chronic conditions after infection with COVID-19 or vaccination remain relatively rare and self-limited, yet reinforce the importance of comprehensive history taking involving COVID-19 to differentiate potential etiologic factors for these conditions. Schlagwörter: COVID-19, oral burning, Oral Lesions, oral lichen planus, Oral medicine, oral pemphigoid, oral pemphigus, Review (narrative), Sjogren disease, xerostomia

Background: This retrospective study analyzed radiographic bone levels of 10871 dental implants in a cohort of 4247 patients over a 22-year period. The objectives of the study were to assess and explore risk factors associate with the radiographic bone level of dental implants. Methods: A longitudinal observational cohort study based on data collected from 1995 to 2019 was conducted on implants placed by a single periodontist. Inclusion criteria included both partially and fully edentulous sites. Exclusion criteria were patients who were considered ASA 3 or greater. Information on medical and dental status prior to implant placement such as diabetes and smoking were included in the analysis. Implant factors such as the implant characteristics (length and diameter), and surgical site, were recorded. The outcome assessed was the prevalence of bone loss around implants and any associative factors related to the bone loss. Results: Overall, dental implants lost an average of 0.05±0.38mm of bone 2-3 years after placement and 0.21±0.64mm 8 years after placement. The soft tissue condition was evaluated using the Implant Mucosal Index (IMI) and bone loss around dental implants was significantly higher when bleeding on probing was multi-point and moderate, multi-point and profuse, and when infection with suppuration was recorded. The mean difference in bone level between smokers and non-smokers was 0.26mm (P<0.01) over a 4-year period. A mean difference of 0.10 mm (P=0.04) in bone loss over 4 years was found between those with an auto immune disease compared to those without. The diameter of the implant and immediate loading of the dental implant did not influence the radiographic bone levels over time. Conclusions: This large data set of dental implants highlights predictive risk factors for bone loss around dental implants and the impact these risk factors have on the implant bone level. Consideration of these risk factors by both the dental team and the patient prior to dental implant placement will promote success of the treatment. Schlagwörter: Bone graft, Bone substitute, Dental implants, implant, Implantology

Objective: This clinical case outlines a comprehensive digital workflow for a minimally invasive multidisciplinary treatment. The process utilizes one open-source software for digital wax-up and one low-cost software to address esthetic concerns related to teeth misalignment. The patient's function is stabilized with a digitally made occlusal splint. Clinical considerations: The case report illustrated the achievement of immediate and highly esthetic restoration, ensuring proper teeth alignment through a complete digital workflow. Conclusion: The application of the described digital workflow technique, incorporating open-source, low-cost, and closed software, played a pivotal role in attaining a straightforward and predictable outcome with minimally invasive treatment. Furthermore, the continual evolution of technology contributes to the growing precision of dental procedures. Clinical Significance: The presented digital workflow helped formulate a predictable treatment plan, replicate a diagnostic digital wax-up, and achieve precise teeth alignment. This approach satisfactorily addressed the patient's aesthetic concerns, providing an outstanding approximation of the definitive result. Schlagwörter: close software, Diagnostic procedure, digital workflow, lowcost software, open-source software, Orthodontics, Restorative Dentistry, wax-up

Objectives: To evaluate polymerization efficiency of different bulk-fill resin-based composites (BFRBCs) cured by monowave and polywave light curing units (LCUs), by assessment the degree of conversion (DC) and Vickers microhardness (VMH) at different depths. Method and Materials: Two commercially available BFRBCs were used; Filtek One Bulk Fill Restorative (3M ESPE) (FOBF) and Tetric N-Ceram Bulk Fill (Ivoclar Vivadent) (TNBF). LCUs utilized were two light-emitting diodes (LEDs) LCUs; a monowave LED LCU (BlueLEX LD-105, Monitex) and a polywave LED LCU (Twin Wave GT-2000, Monitex). For each test, twenty cylindrical specimens (4 mm diameter, 4 mm thickness) were prepared from each BFRBC using a split Teflon mold. Ten specimens were light cured by monowave LCU and the other ten were light cured by polywave LCU according manufacturer's recommendations. Attenuated total reflectance-Fourier transform infrared spectroscopy (ATR-FTIR) was used to assess DC. VMH tester was used to assess VMH. Statistical analysis was performed using three-way ANOVA and Tukey’s post-hoc tests (P <.05). Results: DC and VMH in BFRBC containing only camphorquinone as photo-initiator were similar when cured with either monowave or polywave LCU. However, BFRBC containing a combination of photo-initiators exhibited significantly higher DC and VMH when cured with polywave LCU. Although all groups showed statistically significant differences between top and bottom surfaces regarding DC and VMH, all of them showed bottom/top ratios >80% regarding DC and VMH. Conclusion: Polywave LCU enhances polymerization efficiency of BFRBCs especially when the later containing a combination of photo-initiators, but does not prevent the use of monowave LCU. Schlagwörter: Bulk-fill resin-based composites, Degree of conversion, Light curing units, Photo-initiators, Vickers microhardness

The evidence base for the use of space maintainers (SMs) is relatively sparce despite being used for decades after the premature loss of primary molars. Thus, this study aims to increase the dental evidence base via investigating retrospectively the success rates of prefabricated fixed and removable space maintainers inserted from 2019 to 2021 and followed up until 02/2023 at a specialized university clinic and to identify reasons of any reported minor and major failure. Authors hypothesized that there is no significant difference in failure rates between fixed and removable SMs inserted after the premature loss of a single primary molar per quadrant. Patient’s digital records were searched yielding 645 space maintainers. After the application of inclusion criteria, 157 (67%) fixed prefabricated SMs in 112 children and 77 (33%) removable SMs in 61 children were analyzed for an average of 18.4 months (±9.5). Kaplan-Meier survival analysis with Mantel- Cox statistics showed an overall cumulative survival time of 31.6 months (SE=1.15, 95% CI=29.4-33.9). Major failure occurred significantly more in removable maintainers (n=40/67, 59.7%) mostly due to loss of the appliance compared to fixed space maintainers (n=27/67, 40.3%; P<0.001). The present study indicates that space maintainers were mainly placed in young children with high caries experience, where treatment was mostly possible using advanced behavior management. Fixed Space maintainers had a significantly lower failure rate than their removable counterpart. However, both require continual repairs, preservation or even replacement till the eruption of the permanent tooth. Schlagwörter: band & loop, failure rate, removable appliance, space maintainer, survival rate

Background: This study aimed to evaluate the effectiveness of biomaterials in bone healing of critical bone defects created by piezoelectric surgery in rats calvaria. Material and Methods: Histomorphological analysis was performed to assess bone regeneration and tissue response. Fifty animals were randomized into 5 groups with one of the following treatments: Control group (CO, n=10), spontaneous blood clot formation with no bone fill; BO group (Bio-Oss®, n=10), defects were filled with bovine medullary bone substitute; BF group (Bonefill®, n=10), defects were filled with bovine cortical bone substitute; hydroxyapatite group (HA, n=10), defects were filled with HA; calcium sulfate group (CS , n=10), defects were filled with CS. Five animals from each group were euthanized at 30 and 45 days. The histomorphometry calculated the percentage of the new bone formation in the bone defect. Results: All data obtained were evaluated statistically considering P<0.05 as statistically significant. The results demonstrate the potential of all biomaterials for enhancing bone regeneration. The findings showed no statistical differences between all the biomaterials at 30 and 45 days including the control group without bone grafting. Conclusion: In conclusion, the tested biomaterials presented an estimated capacity of osteoconduction, statistically non-significant between them. In addition, the selection of biomaterial should consider the specific clinical aspect, resorption rates, size of the particle and desired bone healing responses. It is important to emphasize that in some cases, using no bone filler might provide comparable results with reduced cost and possible complications questioning the very frequent use of ridge presentation procedures. Schlagwörter: alveolar ridge, bone, Dental implants, extraction, implant

Orofacial pain is a worldwide pain problem with many patients unable to find appropriate diagnosis and treatment. Orofacial pain includes pain arising from the odontogenic and nonodontogenic structures in the head and neck region. Dental clinicians need to have a thorough knowledge and skill to diagnose, manage and treat patients with odontogenic pain or refer patients for treatment of non-odontogenic pain to specialists such as Orofacial pain specialist, neurologist, otolaryngologist, rheumatologist, etc. More often, dentists diagnose patients with a temporomandibular disorder and when treatment is ineffective, term it “atypical facial pain”. The first requirement for effective treatment is an accurate diagnosis. Dental clinicians must be aware of Giant Cell Arteritis (GCA), a chronic large-vessel vasculitis, primarily affecting adults over the age of 50 years, as it frequently mimics and is misdiagnosed as “temporomandibular disorders”. GCA is associated with loss of vision, and stroke and can be a life-threatening disorder. Therefore, diagnostic testing for GCA and differential diagnosis should be common knowledge in the armamentarium of all dental clinicians. Historically, Temporal artery biopsy was considered the definitive diagnostic test for GCA. Temporal artery ultrasound (TAUSG), a safe and non-invasive imaging modality has replaced the previous diagnostic gold standard for GCA, the temporal artery biopsy, owing to its enhanced diagnostic capabilities and safety profile. This case report describes a patient with GCA and the role TAUSG played in the diagnosis. A 72-year-old female, presented with left-sided facial pain, jaw claudication, dysesthesia of the tongue, and episodic loss of vision of two years duration. She was diagnosed with, and treated for a myriad of dental conditions including endodontia and TMJ therapy with no benefit. A thorough history and physical examination, combined with serological analysis led to the diagnosis of GCA and TAUSG, which confirmed the diagnosis. This paper underscores the responsibility of differential diagnosis and early recognition of GCA facilitated by TAUSG in optimizing treatment outcomes as a viable, non-invasive diagnostic tool. Schlagwörter: Diagnostic procedure, Giant Cell Arteritis, Headache, Misdiagnosis, Temporomandibular disorders

Radiation treatment plays a mainstream role in the management of head and neck cancers (HNSCC). Adverse effects from radiation therapy include osteoradionecrosis of the jaw, and rarely, pathological fracture. Immune checkpoint inhibitors (ICI) such as pembrolizumab are of growing relevance to the management of metastatic and recurrent HNSCC. Adverse impact on bone secondary to medications such as pembrolizumab and nivolumab have been sporadically documented in the literature. The objective of this manuscript is to raise awareness of possible increase in risk for adverse jaw outcomes in patients with HNSCC exposed to both radiation treatment to the jaws and ICI therapy. This manuscript documents adverse jaw outcomes including osteonecrosis and pathological fracture of the mandible in two patients receiving pembrolizumab for management of HNSCC and had received prior radiation treatment. A potential link between immunotherapy and adverse jaw outcomes is consistent with our growing understanding of osteoimmunology, investigating the closely interrelated processes in bone remodeling and immune system function, in health and disease. It is important to ascertain if pembrolizumab poses an incremental risk for such outcomes, beyond the risk from prior radiation, for patients managed with radiation treatment and ICI therapy for HNSCC. The general dentist may encounter such patients either in the context of facilitating dental clearance prior to initiation of chemotherapy, or rarely, with poorly explained jaw symptoms and must be alert to the possibility of occurrence of such adverse jaw events to facilitate timely diagnosis and optimal patient management. Schlagwörter: Cancer, Case-report/series, immunotherapy, Oral surgery , Osteonecrosis, Pathology, Radiation Therapy

Objective: Currently, there is no established treatment protocol to treat Interdental papillary loss. This research aimed to evaluate the outcomes of interdental papillary reconstruction using minimally invasive surgery, with injectable hyaluronic acid (HA) gel. Materials and Methods: Seventeen patients were included, each with five sites of class 1 papillary recession; (forty sites in the upper jaw and forty-five sites in the lower jaw). Subperiosteal tunneling was performed through a horizontal incision made apical to the base of the papilla without penetrating it. The free gingival sulcus was sealed by 000 retraction cord. After that a total of 0.2-0.6 mL HA was injected gradually. The incision was sutured with polyglycolic sutures. Treated sites underwent clinical and digital evaluation at three follow up time points (1 month, 3 months and 6 months). Results: The interdental papillary defect height in the upper jaw sites significantly reduced by 60%, 66%, and 42% at 1 month, 3 and 6 months, respectively. Also, in lower jaw sites, the reduction was of about 54%, 55%, and 40% at the same follow up time points. Regarding interdental papillary defect surface area in the upper jaw the reduction was about 65%, 71%, and 45% at 1 month, 3 and 6 months. In the lower jaw, a reduction of about 60%, 64%, and 48% was noticed at the same time points. Regarding patients’ pain level score, during the day of surgery, sixteen patients reported pain, the average pain score out of 10 was 3.94, and eleven patients (64.7%) needed to take analgesics. The pain generally subsided in the following days. Also, at the day of the treatment twelve out of the seventeen patients (70.6%) reported mild difficulty in speaking and eating. No complication, hypersensitivity or allergy was noted in any patient. Conclusion: Subperiosteal tunneling with HA injection demonstrates clinical improvements in papilla height and papillary recession surface area reduction after 3 months of follow-up with reduction in improvement after 6 months. Schlagwörter: black triangle, dental papilla augmentation , hyaluronic acid, minimal invasive surgery, periodontal surgery, Periodontology

Objectives: To assess the effect of Community Water Fluoridation (CWF) in the prevalence of dental caries and dental fluorosis in 12-year-old children living in Israel. Considering that CWF is important in the prevention of dental caries. Between 2002 and 2014, the water in communities of at least 5000 individuals was fluoridated. In 2014 CWF in Israel stopped. Methods: Data on 12-year-old children from all areas in Israel from the national crosssectional epidemiological survey conducted in 2011-2012 were stratified by city water fluoridation and by city and school socio-economic status (SES). Two dependent variables were defined: (1) DMFT index -caries experience in the permanent dentition; (2) dental fluorosis in central incisors using the Thylstrup-Fejerskov (TF) classification of fluorosis. Results: Data from 2181, 12-year-olds was analyzed. the average DMFT was 1.17+1.72 and 49% were caries free. Based on DMFT, the caries experience was significantly higher in nonfluoridated cities (1.38 vs. 0.98 in fluoridated cities) and there were more caries free children 56.4% in fluoridated cities vs. 40.6% in non-fluoridated. DMFT was higher in cities with lower SES than high SES (1.29 vs. 1.05 respectively, p<0.001) and there were less caries free children in low SES (44.5% vs. 53% in high SES cities, p<0.0001). Almost all the 10.3% of children with signs of fluorosis (scoring at least 1 in TF index), had questionable to mild fluorosis (9.3%). Conclusions: CWF is a cheap, simple method of dental health protection that reaches all socio-economic levels and cessation of water fluoridation reduced the health of Israel's children. Clinical Significance: Water fluoridation provides substantial caries prevention, by reaching a substantial number of people. The relevance of this work is for policymakers to consider CWF as clinically proven method for reducing health inequalities. Schlagwörter: Caries detection, DMFT, Epidemiology, Fluoride, Public health