Quintessence International, 04/2021

Objective: The objective of this study was to systematically review the literature regarding the effect of root coverage procedures on tooth survival and periodontal outcomes. Data sources: A systematic search of the literature was performed according to the PRISMA guidelines. A PICO-based search strategy was performed in six databases. Eligibility criteria included studies comparing tooth survival and periodontal outcomes of teeth treated with root coverage procedures versus teeth that had no treatment. The search resulted in 3,646 articles; 212 articles were downloaded for review, and six articles (three studies) were included. Only a single study reported on tooth survival and found no difference between teeth that underwent root coverage procedures versus those that did not. Although the surgeries described in each study were mostly successful in reducing recession and increasing keratinized gingiva, teeth which did not undergo surgery did not seem to have a clinically significant change in recession. The study with the longest follow-up (18 to 35 years) showed an average increase in recession of 0.5 ± 0.9 mm and a decrease in keratinized tissue of 0.3 ± 0.8 mm in the control group. Conclusion: This systematic review highlights the need for randomized controlled trials to assess the influence of root coverage surgeries on tooth longevity in order to better inform evidence-based practice. When compared to no surgical intervention, there is presently no evidence to suggest that root coverage surgeries increase tooth longevity. Furthermore, the amount of recession does not appear to increase a clinically significant amount over time without surgical intervention in the presence of proper maintenance and home care. Keywords: gingival graft, periodontitis, plaque, prevention, recession, root coverage

Objectives: Recent data show that teeth prepared with horizontal finishing lines supporting crowns and fixed partial dentures present more periodontal disorders than untreated control teeth. Several studies have shown that NitrAdine (bonyf) induces a significant reduction of dental biofilm. The aim of this study was to demonstrate that 10-day use of PerioTabs (bonyf), a NitrAdine-based gingiva brushing solution, is effective in treating gingival inflammation of prosthodontic patients. Method and materials: Forty-nine subjects were instructed to brush their teeth, gingivae, and prostheses with the PerioTabs solution for 10 days (treatment group) and 49 with any toothpaste (control group). The initial and 11-day Plaque Index and Bleeding Index were recorded. A five-point Likert scale was used to evaluate the level of patient satisfaction. The Shapiro-Wilk statistical test was used to compare the results for the two groups. Results: Highly significant differences between the treatment and control group (P < .001) for the Plaque Index and Bleeding Index resulted. The treatment group patients’ satisfaction was high: 31 (63.3%) reported the highest level, 5, on the Likert scale, and 18 (36.7%) declared they were satisfied (level 4). Conclusions: The use of a NitrAdine-based gingiva brushing solution (PerioTabs) was effective in reducing the gingival inflammation in periodontally affected patients treated with fixed partial dentures. Clinical relevance: The NitrAdine-based gingiva brushing solution (PerioTabs) was highly accepted by the patients and seems to be a promising alternative to the solutions widely used. Keywords: Bleeding Index, fixed prostheses, inflammation, NitrAdine, periodontal disease, periodontitis, PerioTabs, Plaque Index

Objective: To evaluate implant and patient characteristics 4 to 8 years after implant installation in a study involving immediate fixed restoration of dental implants. Method and materials: The study was a follow-up of treated generalized chronic periodontitis patients who received immediate restorations on dental implants as part of a previous study. The patients were examined clinically and radiographically at implant placement, 6 months, 1 year, and 4 to 8 years later. Supportive periodontal therapy (SPT), teeth and implant probing pocket depth (TPPD and IPPD), bleeding on probing (BOP [teeth, TBOP; implant, IBOP]), and bone level (BL) measurements around implants were documented. Cases were divided into three groups according to annual SPT rate: 0.00 to 0.99/year (SPT0), 1.00 to 1.99/year (SPT1), 2.00 or more/year (SPT2). Results: Twelve patients, with 26 implants and 242 teeth, were included. The mean ± standard deviation follow-up period was 6.08 ± 1.25 years (range 4.04 to 7.94 years). All implants in the follow-up group were osseointegrated and survived during the follow-up period. The mean number of SPT appointments was 6.17 ± 5.65. A weak negative correlation was found between SPT rate and ΔTPPD (−0.24, P = .0005), whereas a strong negative correlation was found between SPT rate and ΔIPPD (−0.76, P = .0005). Negative correlations were found between SPT rate and ∆TBOP (−0.20, P = .003), and between SPT rate and ∆IBOP (−0.5, P = .009). A moderate correlation was found between SPT rate and ΔBL (0.46, P = .02). Conclusion: SPT has a significant positive effect on PPD, BOP, and on implant BLs in long-term follow-up and should be an essential part of implant therapy. Keywords: dental implants, immediate loading, implant bone level, long-term follow-up, maintenance, periodontitis

Objectives: In-vitro data have shown that cross-linked hyaluronic acid (HA) enhances the proliferative and migratory properties of cells involved in periodontal wound healing/regeneration, stabilizes the blood clot, reduces the inflammatory response, and facilitates angiogenesis. The aim of this study was to histologically evaluate the effects of cross-linked HA alone or combined with a collagen matrix (CM) on the periodontal wound healing/regeneration in intrabony defects. Method and materials: Two-wall intrabony defects (5 mm wide, 5 mm deep) were surgically created at the distal and mesial aspects of mandibular premolars in six beagle dogs. The 24 defects were randomly treated as follows: open flap debridement (OFD) + HA, OFD + CM, OFD + HA + CM (HA/CM), and OFD alone (control). At 2 months, the animals were euthanized for histologic evaluation. Results: The HA (2.43 ± 1.25 mm) and HA/CM (2.60 ± 0.99 mm) groups yielded statistically significantly (P < .05) greater formation of new attachment (ie, linear length of new cementum adjacent to newly formed bone, with inserting collagen fibers) compared with the OFD (0.55 ± 0.99 mm) group. Among the four treatment groups, the HA/CM group demonstrated the highest amount of regenerated tissues, although no statistically significant differences in any of the histometric parameters were observed between the HA and HA/CM groups. Conclusion: Within their limits, it can be concluded that cross-linked HA alone or combined with CM promotes periodontal wound healing/regeneration in two-wall intrabony defects in dogs. Keywords: animal study, biomaterials, hyaluronic acid, intrabony defect, periodontal wound healing/regeneration

Objective: This study aimed to examine and compare the anti-caries effects of slightly acidic 1% NaF-HF gel when applied once or twice (7-day or 6-month interval) to mandibular first molars in 6- to 7-year-old children. Method and materials: This was a 1-year, multi-arm, placebo-controlled, double-blind, parallel-group randomized trial. In total, 1,077 schoolchildren from eight primary schools were allocated to one of the four study groups (group 1, single application; group 2, two applications with a 7-day interval; group 3, two applications with a 6-month interval; group 4, placebo control). The occlusal surfaces of permanent mandibular first molars were examined by three calibrated examiners who were blind to the group allocation at baseline and the end of the study. Caries reduction and prevented fraction was assessed. Results: A total of 986 children completed the study. There was a statistically significant difference in the mean D1MFT increment across the groups (P < .001). The mean D1MFT increment was 0.37 in group 1 (single application), 0.18 in group 2 (two applications with a 7-day interval), 0.21 in group 3 (two applications with a 6-month interval), and 0.56 in the control group. The mean D2MFT increments (0.22 in group 1, 0.06 in group 2, 0.18 in group 3, and 0.50 in the control group) also showed a statistically significant difference across the groups (P < .001). Conclusion: Subacidic 1% NaF-HF gel exerts a high preventive effect on caries (more than 40%) when applied twice at a 7-day interval in 6- to 7-year-old schoolchildren who do not use fluoride toothpaste in areas where drinking water is not fluoridated. Keywords: anti-caries effect, caries, fluoride, randomized controlled trial, subacidic NaF-HF gel

Objective: The purpose of the present study was to present vertical ridge augmentation (VRA) with the use of cross-linked resorbable membrane, tenting screws, and a combination grafting technique. Report: Three cases are presented. Case 1: A 67-year-old ASA II patient required VRA at the areas of the mandibular left second premolar and first molar. Flap management was performed with the use of periosteal release on the buccal aspect and 23 mm of mylohyoid muscle release on the lingual aspect. VRA was completed with the use of four self-tapping tenting screws, and 1:1 mix of anorganic bovine bone matrix (ABBM) and particulate mineralized bone allograft. A cross-linked resorbable membrane was placed over the buccal and lingual aspect, and a double line of suturing was performed to secure the tension-free closure. Twelve months postoperatively, 4 mm of VRA was confirmed with CBCT. Two implants were placed with >35 Ncm primary stability. Case 2: A 64-year-old ASA I patient required VRA at the area of the maxillary first premolar. Flap management was performed with the use of periosteal release on the buccal aspect and VRA was performed with a 9-mm self-tapping screw, 1:1 mix of ABBM and particulate mineralized bone allograft, a cross-linked resorbable membrane, and a double line of suturing. Twelve months postoperatively, VRA of 6.2 mm on the buccal aspect and 7.9 mm on the lingual aspect were confirmed with CBCT. An implant was placed with >35 Ncm primary stability in combination with horizontal ridge augmentation. Case 3: A 70-year-old ASA II patient required horizontal and VRA at the area of the mandibular left canine. Following extraction, a lateral pedicle sliding flap was completed to enhance the soft tissue volume of the site. After 6 weeks, flap management was performed with the use of buccal periosteal release, VRA was completed with two self-tapping screws, 1:1 mix of ABBM and particulate mineralized bone allograft, a cross-linked resorbable membrane, and a double line of suturing. Eight months postoperatively there was 5.3 mm of bone regeneration on the vertical dimension and 3.9 mm on the horizontal dimension. An implant was placed with primary stability of 45 Ncm. Conclusion: Successful VRA can be achieved with proper flap management to achieve tension-free closure, a cross-linked collagen membrane, tenting screws, and a combination grafting technique. The VRA ranged from 4.0 to 7.9 mm. Keywords: cross-linked resorbable membrane, flap management, tenting screw, vertical ridge augmentation

Oral squamous cell carcinoma (OSCC) is an extremely rare occurrence during pregnancy. OSCC accounts for less than 2% of all malignancies in pregnant women, with an average mortality rate of 36%. Understanding the features of this tumor during pregnancy is important; however, the paucity of reports in the literature makes this challenging. Case presentation: The following is a case presentation of a woman who was diagnosed with SCC of the tongue (TSCC) at 13 weeks gestation. The article also provides a review of the literature of TSCC affecting pregnant women aged 30 years and under. Conclusion: Although OSCC in young women of reproductive age is rare, recent literature suggests an increased risk for this age group. The rarity of OSCC in pregnancy may potentially lead to low clinical index of suspicion, misdiagnosis, and delay in treatment. Additionally, treatment modalities, prognosis, and the long-term impact on the developing fetus are not well established, due to rarity of OSCC in pregnancy. Further studies to identify specific etiologic factors are needed to establish the association of OSCC with pregnancy, aid in prevention, and improve treatment and outcome. Keywords: etiopathogenesis, oral squamous cell carcinoma, pregnancy, tongue, young patients

Objective: Calcified carotid artery atheroma (CCAA) detected by panoramic radiographs has been suggested as an accurate biomarker for cerebrovascular accidents (CVAs). However, there has not been agreement on the relationship between CCAA and risk for stroke or other CVA. Method and materials: The question asked was, “Are patients with CCAA detected on panoramic radiographs more likely to get a stroke or CVA in the future compared to those who do not have CCAA and, further, would Doppler ultrasonography of the neck obtained secondary to panoramic radiography in suspected individuals add value to this association with stroke or CVA?” This meta-analysis was conducted by searching PubMed, Ovid Medline, Dentistry & Oral Sciences Source, CINAHL, Web of Science, Google Scholar, and ClinicalTrials.gov. Six studies that met the inclusion criteria were included in the final analysis; three used panoramic radiography and the rest used panoramic radiography and ultrasonography. Multiple random effect meta-analyses were conducted using RevMan 5.2 software. Conclusion: Evidence from this meta-analysis shows that although detection of CCAA via panoramic radiography to predict risk for stroke may be comparable to Doppler ultrasonography, risk prediction is somewhat more significant when diagnostic confirmation is made using Doppler ultrasonography than panoramic radiography alone. Clinical implications: Because stroke risk assessment is complicated and comprises many additional systemic factors beyond calcification of the carotid artery, CVA prediction is more reliable when Doppler ultrasonography is used after panoramic radiography. Managing hypertension, diabetes, and smoking habit are far more important in risk management of patients with CCAA detection on panoramic radiography. Keywords: calcified carotid artery atheroma, cerebrovascular accident, Doppler ultrasonography, panoramic radiography, risk assessment, stroke

Objectives: The prevalence of “dental anxiety” (DA) is often underestimated and numerous diagnostic methods are available for dental practitioners. It is difficult to differentiate between a dental phobia requiring an interdisciplinary approach and DA, which can be managed by dental practitioners alone. The appropriate use of diagnostic tools is key for the successful management of highly anxious and/or phobic patients. The aim was to provide a guideline to recognize dental fear and to differentiate DA from patients who are highly anxious or even have a phobia. Data sources: In total, 8,929 articles that were selected for the development of the German guidelines for “Dental anxiety in adults” in PubMed, Web of Science, Embase, and MedPilot were filtered for diagnosis of DA disorder. The focus for this review was on the use of scales to measure DA levels. The methods and tools used in the 51 reviewed articles to assess DA levels were evaluated in terms of their practicability and suitability in daily practice to differentiate between phobia (ie, DA disorder) and nonpathologic anxiety. In addition, the internal consistency (Cronbach alpha) of the questionnaires/tools was determined. Conclusion: All identified DA questionnaires validated in the German language had an acceptable to excellent internal consistency (0.7 to 0.986). The only validated questionnaire-free method was galvanic skin reaction measurement. For the assessment of DA and diagnosis of a DA disorder in adults, the survey by means of any suitable questionnaire or even several questionnaires in combination with a behavioral observation of the patient is currently the method of choice. Keywords: dental anxiety, dental phobia, diagnosis, probability, scale