Quintessence International, 08/2020

Objective: Adjunctive antimicrobials improve probing depth and clinical attachment loss compared with subgingival debridement (SD) alone in patients with aggressive periodontitis. The microbiologic and clinical effectiveness of moxifloxacin (MOX) and amoxicillin plus metronidazole (AMOX+ME) as adjunctive therapies for generalized aggressive periodontitis were compared. Method and materials: This pilot randomized controlled clinical trial included 36 patients who were assigned to one of three therapy groups: SD plus systemic MOX (400 mg QD for 7 days), SD plus systemic AMOX+ME (500 mg TID each for 7 days), or SD plus placebo. Probing depth, clinical attachment loss, bleeding on probing, and plaque were recorded at baseline and 3 and 6 months after treatment. Subgingival plaque samples were analyzed. Results: All treatments resulted in significant probing depth and clinical attachment loss reduction compared with the baseline values (P .0001 for all), with the effects still present at 6 months posttreatment, but the patients taking antibiotic protocols presented the most significant gains (P .0001). There was a significant reduction in the occurrence of gingival pockets ≥ 6 mm at 6 months in all treatment groups (P .0001), favoring the MOX and AMOX+ME groups. Adjunctive MOX diminished subgingival Aggregatibacter actinomycetemcomitans to unnoticeable stages, after the follow-up period. Adverse events were noted only in some patients of the AMOX+ME group. Conclusions: This pilot clinical trial proposes that using MOX and AMOX+ME as adjuncts to SD improves the clinical and microbiologic parameters in comparison to mechanical therapy alone; however, the MOX protocol did not cause adverse events and decreased subgingival A actinomycetemcomitans to imperceptible levels. Keywords: amoxicillin, generalized aggressive periodontitis, metronidazole, moxifloxacin, randomized controlled clinical trial

Teeth with altered size and shape, incisal wear, and inadequate position affect the smile and dentofacial harmony. The aim of this article was to describe a simple and safe protocol for an additive technique with composite resin and cosmetic enameloplasty to improve a patient's smile. A 24-year-old man complained about the appearance of his smile regarding color, shape, and position of the maxillary anterior teeth. Relevant dental history included previous orthodontic treatment with inadequate completion. The clinical examination revealed a disharmony of the smile caused by size and shape alterations of the incisors, a white spot on the right central incisor, incisal wear of the canines, and uneven incisal edges between the maxillary anterior teeth. Treatment with direct composite restoration and enameloplasty was performed in line with the current conservative approach in dentistry. The patient was recalled for 54 months. The use of appropriate techniques in enameloplasty allowed the desired outcome to be observed over the 54 months of follow-up. With this method, it is possible to perform future repair and/or modification, and it may increase the longevity of the restoration. Esthetic and functional results were achieved by careful planning and execution as well as periodic recalls. This conservative approach is a useful alternative to conventional restorations, reducing invasive treatments, chairside time, and costs. Keywords: composite resin, dental restoration failure, dental restoration repair, esthetics, longevity

Objectives: The aim of the present study was to compare the clinical outcomes after using free gingival grafts (FGGs) and mucosal excision during exposure of submerged orthodontic implants. Method and materials: Bilateral sites in 28 subjects were divided into two groups: In the FGG group, FGG augmentation was performed around the orthodontic implants, and in the mucosal excision group, a periosteal bed was made after mucosal excision to promote attached mucosa with no additional soft-tissue augmentation. Outcomes measured during the course of the study were the width of attached mucosa, soft tissue regrowth, degree of inflammation, oral debris, and shrinkage of the attached mucosa around the orthodontic implants over a period of 3 months. Results: FGG was more effective in increasing the width of attached mucosa over simple excision of the mucosa alone (2.87 mm vs 1.5 mm; P = .001). In both the groups, there was minimal postoperative soft tissue regrowth over the orthodontic implants, with no statistical significance difference between them (P > .05). The AM in both the treatment modalities demonstrated significant shrinkage (44% in FGG group vs 68% in mucosal excision group; P = .001). However, sites receiving augmentation showed significantly less inflammation than sites treated with mucosal excision (0.63 vs 1.5; P = .001). There was no statistical difference in oral debri accumulation between both the treatment modalities (P = .43) at the end of study period. Conclusion: Over a simple mucosal excision, using a FGG results in an uninflamed and immobile band of attached mucosa around an orthodontic implant, which offers greater comfort and stability during its function. Keywords: orthodontic anchorage procedures, peri-implantitis, periodontium

Objectives: To determine the effect of audiovisual eyeglasses in terms of anxiety relief, hemodynamic changes, and intraoperative pain in patients undergoing surgical removal of a mandibular third molar. Method and materials: A randomized controlled clinical trial with two parallel groups was carried out in patients undergoing mandibular third molar extraction. Fifteen patients watched a video with multimedia eyeglasses during the surgical procedure, whereas 15 controls had their eyes covered during extraction. The patients completed anxiety questionnaires before and after surgery. Hemodynamic changes, intraoperative pain, duration of the surgery, and overall satisfaction were recorded. Results: Thirty patients were analyzed. Intraoperative pain and the need for supplemental anesthesia were significantly more frequent in the control group (53.3% versus 13.3%; P .05). The surgical procedure was also briefer when the eyeglasses were used (17.2 versus 28.1 minutes). Overall satisfaction was similar in both groups. No significant differences were found between the two study groups in terms of anxiety and hemodynamic parameters. Conclusions: The use audiovisual eyeglasses should be routinely considered during mandibular third molar extraction since these devices allow reduction of intraoperative pain and surgery time. However, patient anxiety level and hemodynamic parameters seem to remain unaltered. Keywords: anxiety, audiovisual eyeglasses, hemodynamic changes, intraoperative pain, multimedia eyeglasses, surgical procedure, third molar

Objectives: Nowadays, there is an increasing number of patients prescribed regular antithrombotics. With these long-term medications, complications like postoperative bleeding are extremely important. Despite available guidelines on this issue, disparities in approach have been noticed. The current study aimed to explore the knowledge, attitude, and practice of dental professionals associated with a dental school in Saudi Arabia regarding the management of patients with oral antithrombotic medications. Method and materials: A cross-sectional study was conducted on institutional-based dental professionals in Saudi Arabia. Fifty-six subjects, including 12 interns, 20 demonstrators, and 24 faculty members were included in the study. A modified semistructured questionnaire comprising 20 questions was used to gather respondents' knowledge, attitude, and practice related to oral antithrombotic medications. The chi-square test was applied for computing inferential statistics. Spearman correlation coefficient was performed for significant variables. Results: The faculty members had comparable knowledge (P = .010) as well as practice (P = .001) levels, and significantly outscored the other two groups. The interns displayed a significantly higher knowledge score over the demonstrators, whereas the reverse scenario was seen for practice scores. Interestingly, participants were frequently found to be significantly overestimating the bleeding risk for procedures falling into the "no risk" category. A significantly positive correlation regarding the professional level could be shown in all domains. Conclusion: Professionals need to regularly update about novel anticoagulants, and should strictly comply with the established practice guidelines, thus improving the quality, safety, and value of dental health care. Keywords: antithrombotic therapy, dental professionals, KAP (knowledge, attitude, and practice) study, novel oral anticoagulants, warfarin

Objective: The novel coronavirus that was first identified in Wuhan, China, in December 2019, created a pandemic that has the potential to change the paradigm of health care delivery. Of interest to the dental community is the presence of SARS-CoV-2 in the saliva of the affected patients that can potentially cause transmission of COVID-19 via droplets. The highly infectious nature of the pathogen has created a sense of urgency and a need for extra caution to prevent the spread of the disease and the potential infection of patients and the entire dental team. Spatter consists of droplets up to 50 µm in size that are effectively stopped by barriers such as gloves, masks, and gowns. Aerosols are defined as droplet particles smaller than 5 µm that can remain airborne for extended periods and that have been reported to be significant in viral respiratory infections. In this study, aerosol represented by particulate matter with a size of 2.5 µm (PM2.5) was measured. Method and materials: Eight dry-field isolation methods were tested in a setup that included a realistic dental manikin and a high-speed handpiece that generated air-water spray. Environmental noise generated by the suction devices, suction flow rate of each setup, and the amount of environmental spatter and aerosols, were measured. Results: The experimental setups showed significant variability in the suction flow rate, but this was not correlated to the level of sound generated. Some experimental setups caused a short-term level of noise that exceeded the NIOSH (National Institute for Occupational Safety and Health) guidelines and were close to the OSHA (Occupational Safety and Health Administration) recommended thresholds. It is also worth noting that the variability in the flow rate is not reflected in the efficacy of the experimental setups to mitigate spatter. All experimental setups, except the IsoVac system, provided statistically significantly better spatter mitigation compared to the control. All experimental setups also were efficient in mitigating aerosols compared with the positive control (P .0001) and most systems yielded results similar to the negative control ambient PM (P > .05). Conclusion: Results indicate that spatter reduction was significantly better amongst the setups in which an additional high-volume evacuator (HVE) line was used. All setups were efficient at mitigating PM2.5 aerosols in comparison to the control. The conclusions of this study should be interpreted with caution, and additional mitigation techniques consistent with the Centers for Disease Control and Prevention recommendations must be implemented in dental practices. Keywords: aerosol, COVID-19, high-volume evacuator (HVE), infection control, suction

At a time when access to health care and services for the global population is a concern due to the COVID-19 pandemic, health professionals and their teams are struggling to find a way to adapt their practices. Dental professional organizations and decision-makers are required to provide guidance in a rapidly evolving environment based on the current data, available research, and existing knowledge. Continuous progress in the information communication technology field and universal access to social communication platforms have allowed clinicians to creatively transcend some of the existing traditional barriers in clinical and technological workflows. The aim of this paper is to provide insight and propose future directions concerning the use of teledentistry for dental care in crisis situations such as the COVID-19 pandemic as well as the continuous implementation of teledentistry in noncrisis scenarios. This paper provides information to support the use of teledentistry as a promising avenue for dental professionals when possible, during and possibly beyond the outbreak. Keywords: crisis management, dental trauma, emergency, evidence-based practice, telehealth

Objective: Stress experienced as an intense and traumatic event can increase the odds of orofacial morbidities that may affect oral, periodontal, or masticatory system health. The aim of this study was to evaluate the dental, periodontal, oral, and bruxism situation among Israeli posttraumatic stress disorder (PTSD) war veterans. Method and materials: This retrospective cohort pilot study aimed to examine the oral and facial manifestations in 71 Israeli veterans with combat PTSD. All patients underwent full dental, oral, and periodontal examination. Signs of parafunctional activity were also evaluated, accompanied by a full set of periapical and/or panoramic radiographs. Results: The patients were 37 to 77 (mean 60.7 ± 10.15) years of age and presented a poor overall oral hygiene status (Plaque Index 0.75 ± 0.26). All patients (100.0%) suffered from periodontal disease, and most of them (66.0%) were severely affected. A significant correlation was found between signs of parafunctional activity and severe periodontal disease (P = .035). The patients had a high decayed, missing, and filled teeth (DMFT) score (20.06 ± 8.86), which was mainly attributed to the large number of "filled" (F) teeth (11.95 out of 20.06). The DMFT score was significantly lower among light smokers than among heavy, former, or nonsmokers (P = .012). Most patients (90%) had signs and symptoms of parafunctional activities. A significant positive and dose-dependent correlation was found between smoking and periodontal disease (P = .012). Conclusions: An association was found between combat PTSD and oral, dental, and periodontal morbidity. Keywords: combat PTSD, mandibular torus, oral hygiene, oral medicine, periodontal disease, tooth wear

The following amendments are made to the published article: Quintessence Int 2020;51(7):554–565; First published 5 June 2020; doi: 10.3290/j.qi.a44630