Quintessence International, 10/2024

Objective: To evaluate two methods for assessing the changes in periodontitis grading in patients undergoing supportive periodontal therapy 10 years (T10) after retrospective baseline grading. Method and materials: The periodontitis grade of 51 supportive periodontal therapy patients was assessed using indirect evidence as the primary criterion for periodontitis progression at baseline and T10 (radiographic bone loss/age index, periodontitis phenotype). Grading at T10 was also performed using the direct evidence for periodontitis progression (clinical attachment loss over the previous 5 years). The use of indirect evidence for periodontal progression at baseline and T10 was defined as method 1 to assess the changes in periodontitis grading. The use of indirect evidence at baseline and direct evidence at T10 was defined as method 2. Changes in periodontitis grading using methods 1 and 2 were evaluated (Wilcoxon signed-rank test). Agreement between methods 1 and 2 was assessed (Cohen kappa). Results: Indirect baseline grading revealed five grade B and 46 grade C patients. The indirect grading at T10 revealed 17 grade B and 34 grade C patients. The direct T10-grading classified all patients as grade C. Method 1 led to an overall improvement in periodontitis grading after 10 years of supportive periodontal therapy (P = .0030), whereas method 2 led to a deterioration (P = .0369). The comparison between methods 1 and 2 showed that they led to different results in terms of grading (Cohen kappa = 0.116208). Conclusions: Periodontitis grading may change during supportive periodontal therapy. Using indirect or direct evidence as the primary grading criterion during supportive periodontal therapy may lead to different results. Keywords: periodontal diseases, periodontitis, periodontitis classification, periodontitis grade, prognosis

Objectives: The aim was to investigate the impact of smoking on pocket closure at 6 months after treatment of severe periodontitis, in relation to residual clinical inflammation. Method and materials: The clinical records of deep pockets (probing depth ≥ 6 mm, n = 984) in 46 individuals with periodontitis were analyzed. Following baseline clinical assessments (Plaque Index, probing depth, clinical attachment level, and bleeding on probing), nonsurgical periodontal treatment was performed. Clinical assessments were repeated at 2 and 24 weeks after periodontal therapy. A logistic regression model using generalized estimation equations adapting the cluster robust standard errors was performed to investigate potential associations between bleeding on probing and pocket closure at posttreatment 24 weeks. Results: Absence of bleeding at 2 weeks after nonsurgical treatment related to pocket closure after 6 months. Pockets that do not bleed either at baseline or at 2 weeks (OR = 2.7; P .005) and pockets of nonsmokers (OR = 6.32; P .001) and females (OR = 1.79; P = .022) associated with pocket closure at 6 months. Conclusion: Pocket closure is associated with being a nonsmoker and the absence of inflammation after nonsurgical periodontal treatment, which indicates the importance of smoking cessation and inflammation control in achieving optimal clinical outcomes. Keywords: bleeding, inflammation, initial treatment, maintenance, periodontitis, smoking

Objectives: Combined oral contraceptives are used for the management of hyperandrogenism and menstrual abnormalities in polycystic ovary syndrome (PCOS). There is a dearth of literature addressing the effect of ethinyl estradiol/norethisterone acetate (EE/NETA) on gingival and systemic inflammation in these patients. This randomized trial aimed to evaluate the effect of EE/NETA with and without scaling on periodontium and high-sensitivity C-reactive protein (hsCRP) levels in women with PCOS having gingivitis. Method and materials: Women having PCOS along with gingivitis were randomly divided into two groups: test group (n = 30) received EE/NETA + scaling with oral hygiene instructions, and control group 1 (n = 30) received EE/NETA with oral hygiene instructions. Another control group (control group 2, n = 30) consisting of systemically healthy females having gingivitis and who were age- and BMI-matched with the test group participants received scaling along with oral hygiene instructions. Periodontal and anthropometric parameters were measured at baseline, and 3 months and 6 months follow-up. Serum hsCRP levels were also estimated. Results: Serum hsCRP levels and periodontal parameters were significantly decreased in all the groups after 6 months (P ≤ .05). The decrease in hsCRP levels was similar among the groups (P > .05). Significantly more reduction in gingival inflammation was observed in the test group compared to control group 1 (P ≤ .05). Conclusion: EE/NETA used alone and with scaling showed no detrimental effect on gingiva and could reduce systemic and gingival inflammation in women with PCOS having gingivitis. Keywords: C-reactive protein, dental scaling, gingivitis, inflammation, norethisterone acetate, polycystic ovary syndrome

Objective: This prospective case series aimed to clinically evaluate the bleaching effect, spontaneous tooth sensitivity, and variation in the thermal sensation threshold of different groups of teeth undergoing in-office bleaching. Method and materials: Ten patients received conventional bleaching treatment: 35% hydrogen peroxide with three bleaching sessions of 45 minutes, evaluating color change (∆E and ∆E00), Whitening Index (WID), and tooth sensitivity (visual analog scale). Thermal stimulus-generating devices were used to simulate sensitivity caused by low temperatures through quantitative sensory tests. Analyses were conducted individually on different teeth groups (n = 20) (mandibular incisors, maxillary incisors, canines, maxillary first premolars). Results: Regarding color change, mandibular and maxillary incisors did not statistically differ from each other but showed significant difference and greater bleaching potential compared to canines and maxillary first premolars (P = .018). Regarding sensitivity, mandibular and maxillary incisors presented the highest spontaneous sensitivity values (P = .032), while maxillary first premolars did not display painful symptoms, also observed in provoked sensitivity analysis (P = .025). Conclusions: The general analysis of the results indicates that the tooth type affects the response to the whitening treatment, both in relation to the esthetic benefit and the occurrence of tooth sensitivity. It was observed that mandibular incisors reach the degree of chromatic saturation before canines and premolars, in addition to presenting greater bleaching sensitivity. Personalizing the treatment, based on prior knowledge of the degree of saturation, anatomical factors, and the risk of sensitivity, can provide considerable advantages in the whitening technique. Keywords: color analysis, dentistry, hydrogen peroxide, tooth bleaching, tooth sensitivity, Whitening Index

Objective: The aim of this study was to elucidate the nuanced interactions between antihypertensive medications and the risk of periodontitis using the Mendelian randomization analysis method. Method and materials: The study adopted a drug-target Mendelian randomization method to assess the long-term effects of nine antihypertensive drug categories on the risk of periodontitis in both acute and chronic cases. Genetic variants located in or near genes relevant to the targets of these drugs and associated with systolic blood pressure (SBP) were selected to simulate the influence of antihypertensive treatments. Genetic information on SBP and periodontitis susceptibility was extracted from extensive genome-wide association studies for both acute and chronic conditions. Additionally, a secondary analysis was conducted using expression quantitative trait loci for the genes of interest as alternative proxies. Colocalization analysis was performed to explore shared variants between antihypertensive drugs and periodontitis. Results: The analysis revealed that the use of angiotensin-converting enzyme inhibitors with an increased risk of acute periodontitis (odds ratio (OR) [95% confidence interval] 1.43 [1.11, 1.85] per 1 mmHg reduction in SBP; P = 5.93 × 10-3) and loop diuretics with a decreased risk of chronic periodontitis (OR 0.94 [0.90, 0.98]; P = 2.94 × 10-3). Moreover, genetically mimicking the use of a suggestive protective effect of thiazides and related diuretics on acute periodontitis was observed in both acute (OR 0.95 [0.90, 0.99]; P = .021) and chronic (OR 0.98 [0.97, 1.00]; P = .045) periodontitis. Colocalization analysis revealed antihypertensive drugs and periodontitis shared causal variants in ACE and SLC12A2 locus. Conclusion: The research indicates that loop diuretics might decrease the risk of periodontitis, while angiotensin-converting enzyme inhibitors could heighten the risk. Further investigations are required to evaluate the potential of reusing antihypertensive drugs for periodontitis prevention. Keywords: angiotensin-converting enzyme inhibitor, antihypertensive drugs, loop diuretics, Mendelian randomization, periodontitis, thiazide

Objective: Occlusal splints are commonly used in the management of temporomandibular joint disorders. However, it is unclear if it should be used after a second-line therapy like arthrocentesis. The evidence on the efficacy of post-arthrocentesis splint therapy in the management of temporomandibular joint disorders was systematically reviewed. Method and materials: PubMed, Embase, Scopus, Web of Science, CENTRAL, and Google Scholar were searched for studies published until 5 August 2024. The outcomes assessed were pain and maximal mouth opening. Results: Eight studies were included. Five studies reported data for the meta-analysis. The pooled analysis found that there was no statistically significant difference in pain scores in the arthrocentesis + splint group vs arthrocentesis group at 1 month (mean difference [MD] −0.01, 95% CI −0.46 to 0.44), 3 months (MS −0.02, 95% CI −0.67 to 0.63), and 6 months (MD 0.06, 95% CI −0.25 to 0.37). The pooled analysis also showed that splint therapy after arthrocentesis may not significantly improve maximal mouth opening as compared to no splint therapy at 1 month (MD 0.08, 95% CI −2.11 to 2.27), 3 months (MD 0.76, 95% CI −0.84 to 2.35), and 6 months (MD 0.56, 95% CI −0.65 to 1.78). Descriptive analysis of three studies showed that two supported the use of splints while one found no added improvement in outcomes. Conclusions: Limited evidence from low-quality studies shows that the use of splint therapy after arthrocentesis may not improve pain and maximal mouth opening in patients with temporomandibular joint disorders. High-quality randomized controlled trials are needed to improve evidence. Keywords: arthralgia, disc displacement, lavage, mouth opening, occlusal splint, temporomandibular joint

Objective: To evaluate the ability of near-infrared light transillumination (NIR-LT) to detect interproximal enamel and dentinal caries lesions compared to clinical-visual inspection aided by fiber-optic transillumination (FOTI). Method and materials: From 170 Finnish adolescents aged 15 to 17 years, 5,294 interproximal surfaces of premolars and molars were examined first clinical-visually aided by FOTI (VI+FOTI) using the International Caries Detection and Assessment System (ICDAS) classification. Subsequently, the surfaces were examined using NIR-LT. The extent of lesions was determined using the modified NIR-LT classification based on the Söchtig criteria. For the analyses, data on maxillary and mandibular premolars and molars were combined. Distributions of lesions were presented as frequencies. Differences between VI+FOTI and NIR-LT at the tooth and tooth surface levels were analyzed by chi-square and Fisher exact tests. Sensitivity and specificity of the NIR-LT method to detect any lesion was performed using VI+FOTI as the gold standard. Results: By VI+FOTI, 92.4% surfaces were classified as sound and by NIR-LT, 88.2%. Enamel caries lesions were found on 7.0% of the surfaces by VI+FOTI and on 11.6% by NIR-LT. Nearly double the number of enamel lesions were identified by NIR-LT for all examined teeth groups, except for mandibular molars where this was 1.3-fold. In 66% of the surfaces, the differences between NIR-LT and VI+FOTI findings were statistically significant (P .001). The sensitivity for all teeth of NIR-LT was 48.4% and the specificity was 91.1%. Conclusion: Radiation-free NIR-LT method shows considerable potential as a supplementary method for early detection of caries lesions among low-caries prevalence adolescents. Keywords: adolescent, caries detection, enamel caries, interproximal caries, NIR-LT, radiation-free

Stabilization appliances (Michigan splints) are well studied and widely adopted for managing bruxism and temporomandibular disorders (TMDs). Traditionally, these appliances have been fabricated by wax modeling and pressing resin onto casts made from irreversible hydrocolloid or silicone impressions. This article provides a detailed description of an all-digital workflow that uses intraoral scanning and computer-aided design (CAD) software to design a stabilization splint on a digital cast that can be manufactured autonomously by a computer-aided manufacturing (CAM) grinding machine in a subtractive procedure. The workflow is applicable to both dental practitioners and technicians. Special attention is given to aspects and procedures that are important for the successful fabrication of the splint. Working without a cast can save time and money, and the use of CAD/CAM technology provides a homogenous splint material quality. Keywords: bruxism, CAD/CAM, digital, occlusal device, stabilization splint, temporomandibular disorders