Quintessence International, 07/2023

Objective: The present study aimed to evaluate the local effect of antimicrobial photodynamic therapy (aPDT) as adjunctive treatment for Grade C periodontitis in molars teeth. Method and materials: Thirty-eight molar teeth from 11 patients were included in this split-mouth randomized clinical trial. The teeth were randomly divided into two groups (n = 19 each) that were submitted to conventional scaling and root planing in addition to aPDT (test group) and to scaling and root planing in addition to aPDT simulation (control group). The following periodontal parameters were obtained prior to treatment (baseline) and at 3 months after the intervention: bleeding on probing, probing depth, gingival recession, clinical attachment level, and furcation level. A 5% significance level was adopted in the statistical analysis. Results: Both groups exhibited improvement in the clinical parameters (P < .001). However, the reductions in bleeding on probing and probing depth were greater in the test group (P < .001). There were no significant differences in the other clinical parameters between groups (P ≥ .130). Conclusions: Molar teeth treated with aPDT and scaling and root planing showed superior clinical improvement compared to those submitted only to scaling and root planing. aPDT may be used as adjunctive treatment for Grade C periodontitis affecting molar teeth since it seems to improve the clinical response to conventional debridement. Keywords: aggressive periodontitis, periodontal diseases, photochemotherapy, randomized controlled trial

Objective: This pilot, prospective interventional study aimed to analyze the influence of supracrestal tissue height when using the one abutment–one time concept at the time of implant placement, on peri-implant hard and soft tissue remodeling in esthetic areas. The definitive crown was placed 7 days later. Method and materials: Facial mucosal margin position, mesial and distal papilla levels, and mesial and distal marginal bone loss were assessed after 7 days (placement of the definitive crown), and 1, 2, 3, 6, and 12 months after implant placement. Patients were classified according to the supracrestal tissue height as thin (< 3 mm) and thick (≥ 3 mm). Results: Fifteen patients fulfilled the eligibility criteria and were included in the study. Eight presented a thick supracrestal tissue height and seven a thin supracrestal tissue height. After 12 months, the implant success rate was 100%. The mean recession at the facial mucosal margin position was −0.47 ± 0.57 mm and −0.19 ± 0.41 mm in thin and thick groups, respectively (P = .29). The mean mesial papilla level recession was −0.19 ± 0.06 mm in the thin group and −0.01 ± 0.07 mm in the thick group (P < .01), and the mean distal papilla level recession was −0.15 ± 0.09 mm in the thin group and 0.00 ± 0.15 mm in the thick group (P < .05). The mean bone loss was −0.21 ± 0.18 mm and −0.04 ± 0.14 mm in the thin and thick groups, respectively (P < .05). Conclusion: Single maxillary anterior implants with thin supracrestal tissue height (< 3 mm) at the time of implant placement had greater bone loss and papillary recession than implants with a thick soft tissue height (≥ 3 mm), even when using the one abutment–one time concept. Keywords: dental implants, marginal bone level, peri-implant tissue, single-tooth implants, supracrestal tissue height

With increasing age and edentulism, numerous esthetic changes occur to the perioral region. The upper lips lose definition, flatten, and lengthen, the cupid’s bow is lost, and the oral commissures descend. The nasolabial folds deepen, marionette lines become prominent, vertical rhytids around the lips form, and chin rhytids form. Chronic exposure to UVA radiation from the sun can lead to photodamage, characterized by wrinkles, lentigines, actinic keratoses, and other pigment changes. In addition, edentulism leads to jaw atrophy, which often compromises soft tissue support. Removable dentures, the conventional treatment to restore missing teeth, not only replace teeth, but also provide support to the lips via the labial flange. Implant-supported fixed prostheses are a very popular option to restore completely edentulous arches; these prostheses are flangeless, providing no bulk to the lips. Addressing changes in the perioral region due to aging and edentulism requires a combination of treatments, with each addressing different issues. Onabotulinum toxin A can be used to treat dynamic perioral and chin rhytids, and upturn the corners of the mouth. Hyaluronic acid filler can be used to treat deep nasolabial folds, marionette lines, and re-volumize the lips. Chemical peels can treat photodamaged skin, static rhytids, and other dermatologic pathologies. The subnasal lip lift, developed by Cardoso and Sperli in 1971, has become an increasingly common technique used to rejuvenate the upper lip in elderly and edentulous patients. This case report describes an elderly patient who was treated with a combination of subnasal lip lift, hyaluronic acid filler, onabotulinum toxin A, and chemical peel to achieve superior perioral esthetics. This case highlights the synergy of each procedure when done in combination to achieve highly effective results. Keywords: case-report/series, cosmetics, full edentulism, implantology, oral surgery, perioral esthetics, soft tissue management

Objectives: To assess the prevalence of peri-implantitis and identify risk and protective indicators of peri-implantitis in a population that underwent implant therapy in a university dental clinic. Method and materials: Randomly selected patients from a postgraduate university dental clinic were invited to participate. Clinical and radiographic examinations were recorded. Peri-implantitis was defined as the presence of bleeding and/or suppuration on probing, probing depths of ≥ 6 mm, and bone loss ≥ 3 mm. Patient-, implant-, and bone- related factors were recorded and analyzed using a multivariate logistic regression analysis. Results: A total of 355 dental implants placed in 108 patients and exhibiting at least 1 year loading time were included. The prevalence of peri-implantitis was 21.3% at patient-level, while 10.7% at implant-level. Simultaneous guided bone regeneration (OR 2.76, 95% CI 1.07–7.12, P = .035), recurrent periodontitis (OR 3.11, 95% CI 1.02–9.45, P = .045) and significant medical history (OR 2.86, 95% CI 1.08–7.59, P = .034) were identified as risk indicators for peri-implantitis. The mean peri-implant bone loss was estimated to be 2.18 ± 1.57 mm for the total number of implants, whereas implants diagnosed with peri-implantitis demonstrated 4.42 ± 1.12 mm in a time period between 12 to 177 months. Conclusion: Within the limitations of the study, the prevalence of peri-implantitis in a cohort receiving dental implant therapy at a university dental clinic was 10.7% at implant level and 21.3% at patient level. Patient-reported systemic comorbidities and recurrent periodontitis as well as implants placed in ridge augmented sites were associated with greater risk of peri-implantitis. Keywords: cross-sectional studies, dental implants, peri-implantitis, periodontal diseases, risk factors

Objectives: The technique of lysis and lavage has shown excellent success rates in treating internal derangement of the temporomandibular joint (TMJ). This procedure has been shown to reduce pain and improve joint mobility, sometimes even in patients suffering from advanced stages of degenerative joint disease (Wilkes IV to V). There are two different approaches to lavage and arthrolysis: arthrocentesis and TMJ arthroscopy. The objective was to assess both approaches’ efficacy in managing internal derangement of TMJ. Method and materials: In total, 92 patients with clinical and radiographic documentation of internal derangement of the TMJ unresponsive to nonsurgical therapy were randomized to one of two surgical groups: arthroscopic lysis and lavage level 1 (64 patients) and arthrocentesis (28 patients). Radiologic changes in the joint, pain (visual analog scale), interincisal distance, lateral and protrusive movements, and clicks and sounds of the joints were recorded. Data were compared presurgically (T0) and in postoperative periods of 1 week (T1), and 1 (T2), 3 (T3), and 6 (T4) months. Results: Both surgical modalities achieved a similar outcome. A gradual improvement was demonstrated during the follow-up periods with no reliance on radiologic changes to the joint or the TMJ diagnosis. More than that, significant differences were encountered in all parameters but protrusion between T0 and T4. Pain decreased from 7.16 ± 2.48 to 1.75 ± 1.98 for the arthroscopic group and from 7.53 ± 2.69 to 1.00 ± 1.86 for the arthrocentesis group (P = .000). Conclusion: Both the approaches of arthrocentesis and arthroscopic level 1 reduced pain and improved mouth opening and lateral and protrusive movements over time. Keywords: arthrocentesis, arthroscopic level 1, disc displacement without reduction, disc displacement with reduction, internal derangement, TMJ

Oral epitheliolysis or mucosal shedding is an infrequently described phenomenon characterized by epithelial desquamation, revealing mucosa of normal color and texture underneath. The condition has a predilection for middle-aged females and primarily affects nonkeratinized oral tissues. Although some cases are idiopathic, certain oral hygiene products have been implicated as the culprit, and resolution of the condition documented with their discontinuation. Severity of desquamation and symptoms vary with frequency and duration of contact with the irritant and its concentration. A case is presented of a dramatic case of shedding oral mucosa in an elderly female, which appeared to be caused by habitual chewing of an aspirin-containing over-the-counter analgesic. Keywords: chemical burn, oral desquamation, oral epitheliolysis, oral shedding

Objectives: Clozapine, an atypical antipsychotic used to treat people with schizophrenia, has been proposed as a possible treatment for salivary gland hypofunction. This scoping review investigated the available literature on clozapine’s impact on salivary flow, in order to determine whether it could be used by dental practitioners in low doses as a treatment for dry mouth. Data sources: An electronic search was completed using Ovid MEDLINE (1996 to Nov 2021). Key MeSH search terms included “clozapine,” “Clozaril,” “salivation,” “salivary flow rate,” “sialorrhea,” “hypersalivation,” and “drooling.” Two reviewers independently reviewed eligible articles and extracted the data based on the inclusion and exclusion criteria. Results: The initial search identified 129 studies, six of which were included in this review. Four of them (one cross-sectional and three interventional) described salivary flow rates in schizophrenic patients taking clozapine, while one of those and two others focused on the mechanism of clozapine-induced sialorrhea, with one study covering both. There were mixed findings, with one study observing a moderate association between clozapine dose and salivary flow, and the others reporting no differences. Findings on the putative mechanisms for clozapine-induced sialorrhea (CIS) were inconclusive. Conclusion: There is insufficient high-quality information to justify using low-dose clozapine to increase salivary flow in dental patients with salivary gland hypofunction. Well-designed interventional studies and randomized control trials are required. Keywords: clozapine, clozapine-induced hypersalivation, salivation, salivary gland, xerostomia

Vestibular schwannoma (VS) is a benign peripheral nerve sheath tumor involving the vestibulocochlear nerve. Affected patients typically experience a gradual emergence of episodic imbalance and unilateral hearing loss, tinnitus, and headache. Less often, VS may be associated with facial pain; ocular, otic, and taste disturbance; paresthesia of the tongue and face; and temporomandibular disorder-like presentations. There is limited information in the dental literature relating the myriad of oral and maxillofacial manifestations of VS. The objective of this article is to underscore the importance for dental clinicians to seek clinicopathologic correlations with VS-related symptomatology, potentially resulting in a timelier diagnosis and improved patient outcomes. To convey this clinical challenge, a detailed narrative of a 45-year-old patient with an 11-year delay in diagnosis has been reported. In addition, the typical radiographic appearance of an implanted cranial device placed following VS resection has been provided. Keywords: acoustic neuroma, case report, delay in diagnosis, head and neck, manifestations, vestibular schwannoma

Objectives: Evaluating gingival thickness is an essential factor for esthetics, function, and the maintenance of soft tissue health around natural teeth and dental implants. This study aimed to evaluate the accuracy of visual inspection procedures used to identify gingival phenotype by clinicians with different expertise and level of experience. Method and materials: The gingival phenotypes of a total of 200 cases were identified as either thick or thin via visual assessment with clinical photographs by eight clinicians. One periodontist examined the gingival phenotype of all subjects based on the translucency of the periodontal probe through the gingival sulcus. The accuracy between these two methods was evaluated using percentile agreement and k statistics. Results: The mean percentage of accurately identified cases was 75% irrespective of the clinician’s experience and expertise. Almost half of the thin phenotype cases were misclassified by clinicians. Inter-examiner agreement was generally fair to moderate and intra-examiner agreement was generally moderate. Conclusion: Within the limits of this study, the present findings demonstrated that the visual inspection method misclassified the cases, especially thin gingival phenotype, compared to the probe translucency method. Therefore, there is a need to identify a universally accepted, accurate method and clear clinical definitions. Keywords: experience, expertise, gingival phenotype, probe translucency, visual inspection