Quintessence International, 03/2018

Periodontitis is one of the leading causes of tooth loss in the adult population. This disease can be classified into various categories, and one of the most destructive amongst them is aggressive periodontitis (AgP). The incidence of AgP is lower than other types of periodontitis. However, it affects young individuals and can cause severe destruction of tooth-supporting structures including tooth loss if left untreated. The current classification for diagnosing periodontal disease was established by the American Academy of Periodontology (AAP) in 1999. This classification provided strict guidelines to aid in AgP diagnosis. These include three main factors: systemically healthy individual, rapid loss of clinical attachment, and familial aggregation. In spite of these specific guidelines, AgP diagnosis is often missed clinically due to various reasons. There is still a vast variation in the diagnostic criteria for identifying AgP and not all practitioners utilize the AAP guidelines for their diagnosis. Furthermore, the definition of the disease might be changing in the future to better represent the current understanding of the disease. Since early diagnosis and prompt treatment is key in treating these patients, it is important to have calibration in the diagnosis process. This review aims to identify sources of variation and ambiguity in diagnosing AgP among dental practitioners. For this purpose, we have conducted an extensive literature search and outlined the various diagnostic aids for AgP patients reported in the literature. Understanding and correcting these variations can simplify the diagnostic process leading to faster treatment of patients affected with AgP. This review also emphasizes the importance of minimizing the bias in identifying patients with AgP and highlights the best tools for this purpose. Keywords: bone loss, epidemiology, oral hygiene, periodontal pocket, plaque, prevalence

Objective: Interdental soft tissues play a critical role in pink esthetics. The presence and preservation of the interdental papillae in the esthetic zone is as crucial as the shape and contour of the anterior teeth in achieving an esthetically pleasing smile. The present study determines the association of central papilla recession with gingival and interdental smile line in periodontally healthy patients of different age groups. Method and Materials: The present study included 200 patients equally divided into 21 to 40 years and 41 to 60 years age groups. The clinical and photographic evaluation of the central papilla, with midfacial gingiva, and its relationship with the vermilion border was performed. Results: In total, 137 patients exhibited presence of central papilla, whilst 63 patients had central papilla recession with variable extent. The male patients predominantly had presence of central papilla in both the age groups, with 86% and 64%, compared with 74% and 50% in females, respectively. High gingival smile line was seen in the majority of the patients (62%), and this trend was similar to high interdental smile line (82% of the patients). Conclusion: Esthetics is affected in individuals having papilla recession along with high gingival smile line and interdental smile line as compared to individuals with low or cupid bow gingival smile line and interdental smile line. Keywords: central papilla, esthetics, gingival recession, gingival smile line, interdental smile line, midfacial gingiva

Objective: Adaptation of the surgical protocol and implant selection depending on bone quality has been advocated. It was the goal of this in-vitro study to quantify the effect of implant geometry and implant site preparation on micromotion at the implant-bone interface. Method and Materials: A parametric study was conducted with implants differing in shape, length, and diameter placed in polyurethane foam material differing in density and structure following various methods of implant site preparation. Measurement parameters included bone quality in the cervical and apical area, insertion torque, implant stability, and implant displacement under load application. Statistical analysis was based on ANOVA and Pearson's product moment correlation with the level of significance set at α = .05. Results: Compressive testing of bone allowed different bone densities (P = .000) to be distinguished. Minor changes in bone density caused by implant site preparation with osteotomes could not be detected (P > .05). Undersized drilling (P = .001), the presence of a cortical layer (P = .000), and the use of osteotomes (P = .000) led to a significant increase in implant insertion torque. Thread cutting reduced insertion torque (P = .000) whereas the use of short (P = 1.000) and wide diameter (P = .235) implants had no effect. Implant stability measurements did not always allow for differentiation of implants varying in shape and placed with different protocols. Increasing bone density led to a general reduction in maximum implant displacement under loading. Significant correlations between all parameters were found, with the exception of residual implant displacement, which only correlated with compressive bone testing in the cortical (P = .0341) and trabecular (P = .0359) areas. Conclusion: Compressive testing of bone seems to allow the prediction of implant performance. Keywords: bone quality, compressive testing, implant-bone interface, micromotion, primary stability

Objective: The present article reports how a dental implant with an internal port dental implant valve approach (DIVA) can be utilized as oroantral port to treat chronic rhinosinusitis (CRS) in a minimally invasive manner. Method and Materials: Eleven patients (age mean 68.1 years) with CRS were subjected to the transimplant lavage technique. For three patients the CRS treatment was performed via previously installed dental implants, and for another eight patients the implantation procedure was combined with the CRS treatment. The moment the implant was fully installed, the sinus membrane was punctured via the implant channel. Upon completion of the pus drainage the sinus was irrigated with normal saline, followed by the injection of a steroid solution (100 mg hydrocortisone). Results: Patients began to report symptomatic improvement from the first day after the first-session procedure. Nine patients had complete relief of most of their symptoms (nasal obstruction/discharge, anosmia/hyposmia) at day 30. The follow- up nasal endoscopy demonstrated no evidence of active sinus disease. All the implants used were found to be well-osseointegrated and still in use for prosthetic purposes. Clinical and radiologic results showed stability and no recurrence in the follow-up period. Conclusion: The dental implant with an internal central port and integral dedicated sealing screw may be used for irrigation, observation, and further treatment of the maxillary sinus in cases of CRS. Keywords: chronic rhinosinusitis, dental implant, lavage, maxillary sinus

Objective: There is a growing body of evidence to substantiate that cutaneous psoriasis is associated with an increased risk for a multitude of systemic disorders. Although there is an extensive array of medical publications regarding psoriasis, the dental literature has almost exclusively been focused on erythema migrans and occasionally, with oral psoriatic mucositis, chronic periodontitis, and psoriatic arthritis of the temporomandibular joint. This report will review the diversity of systemic comorbidities, namely cardiovascular, neurologic, renal, liver, gastrointestinal, pulmonary, endocrine, ocular, arthritic (including temporomandibular joint), nail, cutaneous, and psychologic (including suicide) disorders; neoplasia; infection; dyslipidemia; vitamin D deficiency; substance abuse; higher mortality; and oral mucosal involvement. A discussion of the oral and maxillofacial relevance of these comorbidities is also provided. Method and Materials: The author conducted a PubMed search from 1975 through August 2017 for articles on comorbidities associated with psoriasis. For select topics, some relevant case reports were examined. Results: A search on PubMed yielded almost 44,000 articles on psoriasis and nearly 1,300 with the keywords psoriasis and comorbidities. Articles selected for discussion consisted mostly of recent systematic reviews and meta-analyses. Case reports were included when there was a restricted number of psoriatic patients with a particular comorbidity. Conclusion: When a patient presents with a history of psoriasis, the dental practitioner should expand the medical history process to ascertain possible correlated diseases. Information gleaned from this interview process may prompt the attending dental clinician to seek consultation with the patient's physician to gain greater insight to the severity of any prevailing comorbidities and engage in discussions for possible modifications in dental management. Knowledge of psoriatic comorbidities and their possible impact on dental care may improve clinical outcomes. Keywords: comorbidities, dentistry, management, oral, psoriasis

Chronic non-suppurative osteomyelitis (CNSO) is a chronic bone disease and may be associated with a reparative periosteum entity called proliferative periostitis (PP). This condition rarely affects the maxillofacial region. Mandibular cases were already described for an infectious dental cause, often with an "onion skin" radiographic aspect, but some rare reported cases showed no obvious etiology. They represent a challenge for diagnosis because of possible misdiagnosis leading to unsuccessful or inappropriate treatment attempts. An uncommon case of mandibular CNSO associated with PP in a 9-year-old boy with no obvious infectious or inflammatory causes is reported. Clinical and radiographic examinations revealed a swelling in the left hemimandible, associated with multiple osteolytic areas inside both medullary and newly formed periosteal bone and cortical bone perforations. Recovery signs were seen after a 22-month follow-up period, and radiographic signs of bone healing were observed. From this new case report, a review of the literature was performed on reported cases of mandibular CNSO with PP, and discussed the etiological, clinical, radiologic, and therapeutic aspects of this pathology. This work highlights the importance of considering CNSO with PP in the differential diagnosis of one-sided painless mandibular swellings, even in the absence of an obvious cause. Keywords: children, chronic non-suppurative osteomyelitis, mandible, periostitis ossificans, proliferative periostitis

Objective: Bone and soft tissue calcifications can often be visualized on panoramic radiographs, thus leading to presumptive diagnoses requiring further examinations. This cross-sectional study determined the prevalence of suspected carotid artery calcifications, tonsilloliths, calcified submandibular lymph nodes, sialoliths of the submandibular glands, and idiopathic osteosclerosis in a Lower Austrian subpopulation. Method and Materials: Digital panoramic radiographs (DPR) taken from 1,042 subjects for other clinical purposes between the years 2013 and 2015 were evaluated, using a standardized template. Chi-square tests and Fisher's exact test were used to evaluate the relationship between the detected calcifications and patient age as well as sex. Results: Radiographic data from 490 men and 552 women (mean age of 49.2 [range 21 to 87] years) were analyzed. Two hundred and twenty calcifications were recorded in 198 subjects (19.0%), of which 100 (50.5%) were female. The mean age of participants with calcifications was 55.8 [SD 14.1] years. Radiopaque structures included carotid artery calcifications (5.7%), tonsilloliths (5.7%), calcified submandibular lymph nodes (3.6%), sialoliths of the submandibular gland (0.9%), and idiopathic osteosclerosis (5.3%) as presumptive diagnoses. In total, 196 calcifications (89.1%) were recorded in patients older than 40 years; no gender-dependent relationship could be revealed. Multiple calcification types were detected in 20 patients (11 women, 9 men). Conclusions: With a prevalence of 19.0% in the study population, calcifications observed on DPR are more spread than previously reported. Thus, with patients of increasing age, DPR should be regarded as an important tool for basic screening of suspicious calcifications necessitating further diagnostic assessments.

Rehabilitation of missing decoronated permanent incisors in growing children and adolescents is a major challenge. The psychologic impact of the loss of an incisor is significant due to its immediate influence on facial appearance. Final restoration is planned only after skeletal growth cessation. Consequently, the fabrication and installation of an immediate temporary restoration, which is expected to remain in place for a long period, must meet the patient's esthetic demands and be durable in the oral environment. Several proposed removable and fixed restorations have presented significant shortcomings. The purpose of this report is to suggest a comfortable dental device for restoring the missing permanent tooth with improved esthetic, functional, and psychologic benefits. An alternative fixed orthodontic laboratory fabricated appliance for permanent tooth restoration is described among children with posttraumatic tooth decoronation. Unlike removable restorative appliances, this fixed device is not dependent on the child's compliance. Esthetically, no metal part is exposed in the anterior region and the architecture is more sturdy and stable, with minimum interruption to the alveolar ridge's vertical development. Case Report: An alternative fixed orthodontic laboratory appliance is described for intermediate restoration of a missing permanent tooth. Clinical Relevance: A posttrauma intermediate fixed orthodontic appliance is a beneficial solution from esthetic, psychologic, functional, and economic perspectives for replacing missing anterior maxillary teeth. This device may be worn by patients for a long period until final restoration is indicated. Keywords: ankylosis, decoronation, intermediate fixed appliance, permanent incisor, trauma