Quintessence International, Pre-Print

Introduction: Dentists provide treatment of anatomical structures innervated by the trigeminal system such as the teeth, gingiva etc., which can be subject to injury even following routine and well performed dental procedures. As a result, the dental clinician is often presented with patients with neuropathic pain or unusual sensory distortions. In addition, the dental clinician treats patients following facial and oral trauma which may result in chronic pain. Therefore, recognition of posttraumatic trigeminal neuropathic pain (PTTNP) and its management must be considered essential for the dental clinician. Painful neuropathies, including PTTNP, can present as a debilitating form of neuropathic pain that often defies treatment normally effective for other types of somatic pain disorders. Treatment of PTTNP typically involves the use of various classes of medications including antiseizure medications (AEDs) and tricyclic antidepressants (TCAs)1. Many patients suffering with PTTNP may have contraindications for these medications due to comorbidities, occupational responsibilities, or medication side effects. An alternative to AEDs and TCAs is the use of low-dose naltrexone (LDN)2. Methods: This study is a retrospective extended case series of patients with PTTNP. The records of twenty-one patients diagnosed with painful post-traumatic trigeminal neuropathic pain at the Center for Temporomandibular Disorders and Orofacial Pain of the Rutgers School of Dental Medicine. They met the criteria of PTTNP according to the ICOP and were prescribed LDN. Though a total of twenty-one patients were included, twelve with all the data present were included into the final analysis. The sex distribution was equal with 6 females and 6 males, with a combined average age of 59.33 ± 13.96 years. Results: LDN significantly reduced the patients’ report of pain using a Visual Analogue Scale (VAS) 0-10 subjective pain ratings at the follow-up visits compared to the initial VAS. Interestingly, the small group of patients who used LDN in combination with Serotonin Norepinephrine Reuptake Inhibitors (SNRI), demonstrated a lower average VAS score at the first follow-up visit, compared to those who took LDN with other medications. There were no significant side effects reported by the patients. No adverse effects of LDN therapy were reported. Side effects of the medication are rare and as reported the literature, include mild abdominal distress or vivid dreams. None were reported among this group of subjects. Based on our retrospective extended case series, LDN appears to be a safe and effective medication for use in chronic PTTNP. These results, highlight the need for future studies to elucidate LDN’s analgesic mechanism of actions and to decisively demonstrate the analgesic effect of LDN in larger cohorts using randomized, double blinded, placebo controlled clinical studies. Schlagwörter: trigeminal neuropathic pain, low dose naltrexone, chronic pain, opioid antagonist

Background: Silver diamine fluoride (SDF) is increasingly recognized as a minimally invasive and effective treatment for early childhood caries (ECC). However, the dark discoloration from its application significantly limits its acceptability among parents, especially for anterior teeth. Zinc, with known antimicrobial and biofilm-modulating properties, has recently been proposed as a potential adjunct to reduce SDF-induced staining. Aim: This study aimed to evaluate the effectiveness of zinc pretreatment in reducing SDF-induced discoloration on primary tooth carious lesions that involved dentin. This study also aimed to examine surface morphology and elemental composition changes associated with Zinc adjunct SDF treatments. Methods: Extracted human primary teeth were allocated into three groups: untreated control, positive control (38% SDF alone), and experimental group (20M zinc pretreatment followed by 38% SDF). Tooth color changes were assessed using grayscale intensity analysis via standardized photography at baseline, immediately post-treatment, and up to 14 days. Scanning Electron Microscopy (SEM) and Energy-Dispersive X-ray Spectroscopy (EDS) were employed to investigate morphological and compositional changes in both sound and naturally carious dentin areas. Statistical analyses included two-sample t-tests, linear regression, and likelihood ratio tests. Results: Teeth pretreated with zinc demonstrated less discoloration compared to the SDF-only group. Although this difference was not statistically significant (p = 0.125), it may have potential clinical relevance. SEM images revealed modified silver deposition patterns characterized by dispersed and less densely packed silver aggregates in zinc-pretreated groups. EDS analysis confirmed the presence of zinc, suggesting its interaction with silver deposition processes. Conclusion: Zinc pretreatment effectively reduces SDF-induced discoloration in primary dentition, potentially improving aesthetic outcomes and parental acceptance. This approach represents a promising advancement in minimally invasive pediatric dental care and warrants further clinical exploration. Schlagwörter: Silver diamine fluoride, zinc pretreatment, tooth discoloration, primary teeth, dentin, early childhood caries, scanning electron microscopy (SEM), energy-dispersive X-ray spectroscopy (EDS)

Background: Various salivary cytokines are overexpressed in the saliva of Sjögren’s syndrome (SjS) patients. In addition, the levels of salivary cytokines can differ according to local and systemic conditions, besides SjS itself. Objectives: This study aimed to analyze the associations and correlations of caries experience, sialometry, and systemic co-morbidities with levels of the following salivary cytokines: Interleukin (IL): IL-1β, IL-6, IL-8, IL-10, TNF-α and IL-17A among SjS patients. Methods: Upon ethical approval and signed informed consent, 20 women with SjS were recruited. Clinical examinations included Decayed, Missing, and Filled Teeth (DMFT) index measurements, sialometry, and saliva sampling. Levels of salivary cytokines: IL-1β, IL-6, IL-8, IL-10, TNF-α, and IL-17A were measured by Enzyme- Linked Immunosorbent Assay (ELISA). Statistical analysis was performed using the Independent-Samples Mann-Whitney U Test for the associations between the categorial parameters, and Spearman's correlation test to analyze the correlations between continuous variables. Results: We report that Salivary cytokines are inter-correlated in a statistically significant manner (p<0.05). Age is correlated with IL-17A levels (p<0.05), and decayed teeth were cor-related with IL-6, IL-8, and IL-10 (p<0.05). The liquid fraction in the unstimulated salivary flow rate significantly correlates with all salivary cytokines that were measured. Cardiac disease is correlated with IL-10 levels, and Rheumatoid Arthritis is correlated with IL-1β levels (p<0.05). Conclusions: These results suggest that local factors such as caries experience and salivary flow rates as well as systemic factors such as co-morbidities should be taken into consideration when testing the levels of salivary cytokines in SjS. Schlagwörter: Cytokines, Interleukin-1β, Interleukin-6; Interleukin-8, Interleukin-10, Tumor necrosis factor-α, Interleukin-17A, ELISA, Sjögren’s syndrome, Xerostomia, Sialometry, DMFT, Comorbidities

Objectives: This retrospective study assesses the long-term effects of implants on alveolar and basal bone to determine if a patient’s sex affects dimensional changes in the jaw and evaluate whether dental implants halt the atrophy of bone when compared to no post-extraction intervention. Methods and materials: IRB approval was obtained for this study. Of the 125 patients (432 sites) in the study, 53% were female. All had two CBCTs taken, an average of 4.7 years apart. The scans were divided into three groups. In the control group, the extraction site (first CBCT or T1) was not replaced when the second scan was taken (T2). Group 2 had no implant at T1 and an implant at T2. Group 3 had an implant at T1 and T2. Measurements were made from landmarks at predetermined levels (superior cortex of the IAN or the most inferior point in the nasal floor (NF) in the direction of the crest of bone height (Group C, 2, and 3). To avoid osseous changes due to placement, measurements were made from the inferior alveolar nerve for mandibular implants or the nasal floor for maxillary implants. Recognizing gender-based disparities in jaw size, we monitored percentage changes in bone. Results: Loss of alveolar bone width across all groups was common. When bivariate analysis was performed after Bonferroni correction (p<0.025), changes in alveolar bone width were significantly greater in females (p = 0.004). Although the loss in the basal bone was present, it was not significant between the sexes nor as great as alveolar bone resorption (p=0.880). When comparing groups using bivariate analysis, differences were not statistically significant between treatment groups and the control group (p=0.050) for basal bone and for alveolar bone (p=0.052). In the regression analysis for sex or groups, neither was statistically significant for either basal or alveolar bone (p >0.05). Conclusion: Dental implants do not arrest post-extraction atrophy in either alveolar or basal bone. Females exhibited a statistically greater rate of alveolar bone loss. Stable long-term implant success necessitates precise placement. Schlagwörter: CBCT, Dental implants, Etiology, extraction, Gender, Implantology

Objectives: Tooth mobilization is a challenging orthodontic treatment. Inadequate interdisciplinary communication between surgery and orthodontics, as well as limited knowledge of the topography of the surgical field, can lead to unfavorable positioning of the appliance. This can result in dangerous force vectors for tooth movement. Comprehensive digital planning and customized tools could reduce these sources of error. Two cases of impacted canines were treated using cutting guides (CG) and customized attachments (CA). Methods and Materials: A CBCT and intraoral scan were taken for planning. A CAD process was used to design a CG and a CA according to the required force vectors (OnyxCeph3™, Image Instruments GmbH, Chemnitz, Germany). Using various CAM processes, the CG (Biomed Clear Resin, Formlabs GmbH, Berlin, Germany) and a CA dummy (Permanent Crown Resin, Formlabs GmbH, Berlin, Germany) were fabricated in a 3D printer (Form 3b, Formlabs GmbH, Berlin, Germany). The CA was fabricated from titanium using the SLM process (OrthoLIZE GmbH, Nienhagen, Germany). The teeth were surgically exposed using the CG and CA dummies. The CA was conventionally cemented using Transbond XT (3M Unitek, Monrovia, CA, USA). Results: All teeth were successfully exposed with the CG. The CA could only be placed in the predetermined position according to the digital planning. Conclusion: The 3D planned CG can help to shorten the surgical procedure and keep the surgical field as small as possible. The 3D planned CA allows precise positioning. The digitally planned force vectors should prevent side effects on adjacent teeth and allow targeted mobilization. However, studies are needed for further validation. Schlagwörter: Computer-aided Design and Manufacturing, Customized Appliance Design, Impaction, Orthodontics, Surgical procedure

Objective: The aim of this study was to quantitatively calculate and compare the changes in regenerated bone around the implant in graftless and grafted sinus lift procedures using fractal dimension (FD) analysis, and to provide an additional criterion for clinical preference. Methods and materials: The study included 65 patients (29 graftless and 36 grafted) at the Faculty of Dentistry in xxxxxxxxxxxxxxxxxxxxxx. Graftless and grafted sinus lift techniques were compared in terms of FD and bone density (BD) on panoramic radiographs. Student's t-test was used to compare the mean values of FD and BD in patients with graftless and grafted sinus lifting. Pearson's correlation coefficient was used to analyse the correlation of FD and BD data with age. Statistical significance was accepted at a p < .05. Results: The FD and BD were not statistically significant between two groups (p>.05). The FD and BD parameters were higher in men for both sinus lift techniques. Conclusions: This study has shown that the graftless and grafted sinus lift techniques have similar FD and BD outcomes. Therefore, we conclude that the graftless technique is preferable for maxillary sinus lift because of its relatively simple technique. Schlagwörter: bone density, fractal analysis, grafted sinus elevation, graftless sinus elevation, panoramic radiography

Purpose: To evaluate parents’ knowledge of the Israeli Ministry of Health guidelines on basic oral health practices and appropriate toothpaste usage for different pediatric age groups. Method: Anonymous questionnaires were distributed to parents attending the Pedodontics Department. The questionnaire included two sections: general questions and questions that were completed for all children in the family, categorizing them into three age groups—under 2 years, 2–6 years, and over 6 years. Results: A total of 242 questionnaires and 410 responses across different age groups were collected. Most respondents knew that teeth should be brushed as soon as the first tooth appears and believed that the first dental visit should be at age two (60.5% and 26.9%, respectively). However, only 15% of parents answered boths questions correctly. Toothpaste selection was primarily based on age (46.6%), with no significant differences across age groups for correct answer (p = 0.130). Awareness of the recommended fluoride concentration was low (16.1%), though parents of older children showed better knowledge (p = 0.040). Appropriate toothpaste amounts were used in 30.2% of the cases, with the 2–6 year age group demonstrating the highest awareness (p < 0.001). Only 3.7% of parents correctly answered all three toothpaste-related questions. Overall, the knowledge score for toothpaste guidelines was highest in the middle-aged group (31.21%, SD = 28.66, p < 0.001). Conclusion: A minority of parents are familiar with recommended early dental care practices and correct toothpaste usage. The findings emphasize the need to improve parental awareness from the very beginning of a child’s development. Schlagwörter: Toothpaste selection, Fluoride concentration, Toothpaste amount, Dental prophylaxis, Parents’ knowledge

Aim: The aim of the present study is to compare the effectiveness of photobiomodulation therapy versus local 1.2% atorvastatin gel as an adjunct to subgingival instrumentation in the treatment of stage II or III periodontitis. Materials and methods: In this randomized study, a total of 60 individuals with pocket depths of 4-7mm bilaterally in both sexes (Males and Females) who were 25 years old or older, diagnosed with stage II or III periodontitis were selected. 60 Patients with at least 4 teeth demonstrating pocket depth of ≥ 4–7mm were selected. Exclusion criteria included patients with systemic conditions, smokers, pregnant or lactating women, and those who had received periodontal therapy or antibiotics within the previous six months. Baseline clinical parameters which include full mouth plaque scores, full mouth bleeding scores, probing pocket depth and clinical attachment level were recorded. All the eligible patients underwent supra and subgingival instrumentation. The patients were then randomly divided into two groups: GROUP-A: 30 Patient (120 pocket sites) received photobiomodulation (PBM) therapy with 680 nm for 60 sec(6J/cm2) with 0.1watt power GROUP-B: 30 Patient (120 pocket sites) received 1.2% Atorvastatin (ATV) gel as local drug delivery After the applications of local drug, the treated periodontal pockets were secured with N-butyl-2- cyanoacrylate. Patient were recalled at baseline and after 1 month and 3 months andClinical periodontal parameters were recorded. Results: On intergroup comparison, this trial demonstrated notable improvements in all clinical parameters at the 3 month interval after Subgingival instrumentation in combination with PBM or LDD. While in intragroup comparison, at 3 months interval, the reductions in probing depth and clinical attachment gain is more significantly evident in group-B (1.2%Atorvastatin gel) compared to group-A (PBM). These findings are consistent with the available literature, which recognizes subgingival instrumentation as an effective non-surgical therapy for periodontitis. Adjunctive treatment modalities are widely investigated to determine whether they can further enhance the clinical outcomes achieved by subgingival instrumentation. Conclusion: The principal results of this study showed improved periodontal status and a significant improvements in clinical parameters in patients in GROUP-B (1.2% Atorvastatin gel). Within the limitations of the study, it was concluded that both Photobiomodulation and 1.2% Atorvastatin gel can be effectively used as adjuncts to subgingival instrumentation in the treatment of periodontitis. Schlagwörter: Low level light therapy, Atorvastatin, Periodontitis, Drug delivery systems, Periodontal regeneration

Objectives: To assess blood flow alterations after horizontal Guided Bone Regeneration (GBR) and to evaluate correlations between blood flow and hard tissue changes. Method and Materials: Twelve mandibular surgical sites were involved in the current case series. GBR was carried out using a split-thickness flap design. Blood circulation was assessed with Laser Speckle Contrast Imaging at baseline as well as 1, 4, 6, 11, 13, 20, 27, and 34 days after the surgery, subsequently on a monthly basis until 6 months. Hard tissue alterations were measured horizontally and vertically using linear measurements. The first measurement point was 2 mm distal to the distal surface of the last tooth; additional measurement points were placed every 3 mm up to the 15th mm. Volumetric hard tissue loss and gain were also assessed. Results: Baseline blood circulation was statistically significantly higher on the buccal side. On the first postoperative day, all regions presented a statistically significant decrease in blood flow circulation. The buccal-inner region presented significant ischemia on day 6. Mean volumetric hard tissue gain and loss were 712.62 ± 317.08 mm3 and 222.431 ± 103.19 mm3, respectively. Mean baseline alveolar ridge width was 4.82 ± 1.02 mm, 6 months ridge width averaged 7.21 ± 0.99 mm. Vertical resorption measured 1.24 ± 0.5 mm. Correlations between blood flow changes and hard tissue alterations were only found on Day 34 and Day 60. Conclusion: Laser Speckle Contrast Imaging is an efficient method to measure flap microcirculation. No correlation was found between flap microcirculation changes hard tissue and alterations. Schlagwörter: Bone graft, Case-report/series, Guided Bone Regeneration, Membranes, Ridge augmentation