Quintessence International, Pre-Print

Molar-Incisor Hypomineralization (MIH) is a qualitative developmental defect of the enamel that affects one or more permanent first molars, with or without incisor involvement. This condition often requires esthetic treatment, and therapeutic approaches may vary considerably. The purpose of this case report is to describe a step-by-step clinical protocol for a 20-year-old female patient who presented with dissatisfaction regarding the appearance of her smile due to hypomineralized spots on the maxillary and mandibular anterior teeth. After anamnesis and clinical examination, the diagnosis of MIH was established. Treatment consisted of in-office bleaching followed by resin infiltration for the maxillary teeth, and microabrasion combined with resin infiltration for the mandibular teeth. This sequence of minimally invasive techniques effectively resolved the esthetic alterations caused by MIH, showing satisfactory results that remained stable over one year. Schlagwörter: molar incisor hypomineralization, resin infiltration, dental bleaching, microabrasion, esthetic dentistry

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: Pathological root resorption in primary teeth affects dental health and future orthodontic needs. This study aimed to evaluate the prevalence and associated factors of pathological root resorption in a paediatric population. Method and Materials: A retrospective cross-sectional analysis was performed using panoramic radiographs from 691 pediatric patients aged 4–11 years at a university hospital in Türkiye. Teeth were evaluated for internal (IRR) and external pathological root resorption (ERR) by two calibrated observers, adhering to the 2023 European Society of Endodontics (ESE) Position Statement. Tooth status was categorized as healthy, carious (with or without pulp involvement), filled, or endodontically treated, and dental crowding was also recorded. Statistical analyses included chi-square tests, multiple logistic regression, and post-hoc analyses, with significance set at p < 0.05. Results: A total of 7,729 primary teeth (5,075 molars and 2,654 canines) were evaluated, with interobserver reliability of 82% and intraobserver reliability of 98.8%. The study cohort included 691 children (mean age: 7.05 ± 1.45 years; 49.8% boys, 50.2% girls). Pathological root resorption was observed in 21.2% of cases (n = 1,638), with ERR accounting for 81% and IRR for 19%. Among 2,654 healthy teeth, 3.76% exhibited pathological resorption, with no significant association with dental crowding. Significant relationships were identified between pathological root resorption and age (p = 0.000), tooth status (p = 0.049), and gender (p = 0.042). Conclusion: Reducing high caries levels in Türkiye is critical to lowering pathological root resorption and associated complications. Further studies should explore dental crowding and pathological root resorption relationships in larger samples. Schlagwörter: Panoramic radiography, pathological root resorption, pediatric dentistry, primary teeth

Objectives: In-vitro study to investigate the influence of different pre-treatments and surface coatings on the wear of different zirconia and their antagonists. Method and Materials: Zirconia specimens (3-, 4- and 5-mol yttria tetragonal zirconia; n=160/material) were subjected to pre-treatment (sandblasting 50 μm Al2O3 1 bar; 120 μm Al2O3 3 bar; polishing) and surface coating (spray glazing, micro-layering, layering, veneering). References comprised no pre-treatment or coating. Wear tests were performed (50 N, 120,000 cycles). Wear (mean, maximum, antagonist) and arithmetic mean roughness Ra and average roughness depth Rz were determined. Statistics: ANOVA, Bonferroni, Pearson correlation (α=0.05). Results: Ra/Rz showed significant (p < .001) differences (Ra: 0.01 ± 0.01 μm to 0.71 ± 0.06 μm, Rz: 0.31 ± 0.09 μm to 4.33 ± 0.44 μm). Two groups could be distinguished by mean and maximum wear with significant (p < .001) differences: I.) glaze sprayed and without coating (mean wear: 9.4 ± 2.6 μm to 57 ± 21.3 μm, max. wear: 24.1 ± 6.9 μm to 125.4 ± 18.2 μm) and II.) All coating procedures (mean wear: 129.2 ± 22.8 μm to 236.5 ± 62.0 μm, max. wear: 188.7 ± 21.4 μm to 444.2 ± 110.6 μm). Antagonist wear (9.2 ± 4.5% to 29.7 ± 5.0%) showed a significant (p < .001) correlation to surface coating, mean and maximum wear, Ra and Rz. Mean wear significantly (p < .001) correlated with surface coating, maximum wear, and antagonist wear. Conclusion: Under clinical conditions, layering or veneering can lead to increased wear of the restoration, but in return reduce the abrasion of antagonists. Excessively rough surface treatments should be avoided, as they might increase antagonist wear. Schlagwörter: (micro-)layer, roughness, spray glaze, veneer, wear, zirconia

Objectives: To analyze the effects of three osteotomy drill designs (conventional [CON], reverse helix [REX], and densification [DEN]) and running directions on heat generation, primary implant stability (PS), block-to-implant contact (BIC)%, peri-implant block volume (BV), and resistance to unscrewing forces in a low-density alveolar bone model. Method and Materials: Eighty-eight dental implants were inserted into artificial bone blocks using manual and computer-controlled osteotomies. Temperature changes (Δ°C), insertion torque value (ITV), resonance frequency analyses (ISQ), BIC%, and BV were measured. Statistical analyses used ANOVA and Kruskal-Wallis tests (p<0.05). Results: DEN drilling produced the lowest Δ°C (17.52±2.57°C and 28.06±4.35°C for 2nd and 3rd drills), while CON had the highest (27.53±5.17°C and 38.03±8.08°C). Counter-clockwise (CCW) CON drilling significantly reduced Δ°C compared to clockwise (CW). DEN achieved highest PS (38.01±1.87 N/cm, 65±4.69 ISQ) and removal torque (25.4±5.08 N/cm), while CON CW had lowest (33.23±2.91 N/cm, 61.83±4.28 ISQ). DEN showed the highest BV (87.71±4.23 mm³) but the lowest BIC (49.12%±2.93%). CCW CON drilling improved ITV over CW (36.21±3.63 vs 33.23±2.91 N/cm). Conclusion: DEN drilling demonstrated superior performance in heat reduction, PS, and BV, but had lower BIC%. CCW running of CON drills showed improvements over CW in several parameters. While DEN excelled in most aspects, its lower BIC% and the positive outcomes of CCW CON drilling warrant further investigation. Schlagwörter: Bone Density, Dental Implants, Osteotomy, Temperature, Torque, osseodensification

Objectives: This study aimed to evaluate the physical-mechanical behavior of resin composites when subjected to different prolonged heating protocols. Method and materials: A total of 150 specimens were divided into 15 groups (n = 10 per group) based on the restorative materials (Filtek Supreme, Viscalor, and Grandioso) and heating protocols: room temperature (22 ºC), 24 hours at 68 ºC, 7 days at 68 ºC, 30- and 100- cycles of artificial aging by thermocycling (5 and 68 ºC for 10 minutes each). The materials were inserted into a PVS matrix, cured for 20 seconds using a 1000 mW/cm² LED light-curing unit, stored for 24 hours in. The response variables measured were flexural strength and Knoop microhardness. Results: The flexural strength evaluation showed that Grandioso exhibited higher strength compared to Filtek Supreme and Viscalor, with no significant differences observed across the heating protocols. This indicates that prolonged heating did not affect the flexural strength of any of the tested resins. Knoop microhardness testing revealed significant differences among resins and heating protocols. Grandioso demonstrated the highest surface hardness across all protocols, while Filtek Supreme showed a decrease in hardness after 100 thermocycling cycles. Prolonged heating reduced surface hardness for Grandioso and Viscalor compared to room temperature, whereas Filtek Supreme maintained its hardness under extended heat exposure. Conclusion: These findings suggest that while flexural strength remains unaffected by heating, surface hardness varies depending on the resin type and the heating duration. Schlagwörter: Flexural strength, Mechanical properties, Physical properties, Preheating, Resin composite

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