Quintessence International, 10/2022

The rehabilitation of severely worn teeth is a complex challenge for dental practitioners. There are many different types of dental materials and restorative techniques, and there is not a single way to achieve the desired result. This clinical report demonstrates a complete oral rehabilitation with composite resins when using an indirect application and direct techniques, with the support of the Lucia Jig technique, the Willis technique, and diagnostic waxing for the vertical dimension correction. The wide clinical improvement was achieved with the recovery of the function, the esthetics, and the increase of vertical dimension of occlusion through the planned treatment. The proposed treatment maintained the natural teeth, without the intense wear by the application of the composite resins instead of ceramics, together with excellent conditions for the patient to control the posttreatment and extend the durability, with the correct follow-up of appointments. Young patients with extensive dental wear and the loss of vertical dimension should not be directly submitted to ceramic treatments, with preparations for full crowns. Oral rehabilitation using composite resins, either directly or indirectly, allows for the recovery of the function and esthetics, without the intense predictable dental wear, and reduced financial investment. Keywords: direct resin, esthetic, indirect resin, occlusion, oral rehabilitation

Objective: To evaluate the five-year results following regenerative periodontal surgery of intrabony defects using an enamel matrix derivative (EMD) in patients with different smoking status. Method and materials: The dental records of patients treated with regenerative periodontal surgery with EMD between 2001 and 2011 were screened. The clinical parameters at baseline (T0) and 6 months (T1) and 5 years (T2) after surgery were collected and analyzed in relation to patient’s smoking status (smokers, former smokers, and nonsmokers). Results: A total of 71 sites were initially assessed in 38 patients. In total, 56 sites could be evaluated at T1, and 34 after 5 years (T2). At 6 months after surgery, a statistically significant mean probing pocket depth (PPD) reduction of 2.91 ± 1.60 mm and a mean clinical attachment level (CAL) gain of 1.89 ± 1.90 mm were measured. Nonsmokers revealed a greater, statistically not significant CAL gain compared to smokers (2.38 ± 2.12 mm vs 1.50 ± 1.71 mm). Although at 5 years the site-specific PPD values remained stable in nonsmokers, smokers showed an increase of 1.60 ± 2.41 mm. Conclusions: The present study provides evidence that regenerative periodontal surgery with EMD may lead to clinically relevant improvements even in smoking patients. However, the positive effect of EMD seems to be limited in time and can only partially compensate for the negative influence of smoking. Keywords: enamel matrix derivative (EMD), intrabony defects, long-term results, periodontal regeneration, regenerative periodontal surgery, smoking

Objective: Clinical research in the field of regeneration presents challenges for regulating inflammation and speeding up healing and regenerative processes, which are lacking in individuals with diabetes. Platelet-rich fibrin (PRF) has shown promising results in regeneration. Variations in its properties are attributed mainly to the centrifugation method and other parameters. Hence, the present in vitro study on leukocyte-PRF (L-PRF) and advanced-PRF (A-PRF) membranes, with varying protocols amongst diabetes, was conducted. Method and materials: Sixty-four PRF membranes from 30 individual’s venous blood samples (16 nondiabetic and 16 diabetic) were assessed for platelet parameters, tensile strength, strain, and growth factor release. The resulting data were statistically analyzed. Results: The A-PRF membrane had better tensile strength, strain, and growth factor level in comparison with the L-PRF membrane in healthy individuals. Significantly (P < .05) higher strain and growth factor levels in the A-PRF membrane and marginally higher tensile strength in the L-PRF membrane were seen in diabetic individuals. Conclusions: The nondiabetic A-PRF membrane had better tensile strength, strain, and growth factor release. Well-controlled diabetic individuals had higher growth factor release, suggesting the use of A-PRF membrane as a suitable autogenous regenerative material. Keywords: diabetes, platelet-rich fibrin, regeneration, strain, tensile strength, wound healing

Objective: To evaluate the association of Fusobacterium nucleatum and Capnocytophaga species in dental plaque, cord blood, pericrevicular vaginal samples, and adverse pregnancy outcomes in gestational diabetic mellitus (GDM) women with and without periodontitis stage II. Method and materials: In this prospective cohort study, 415 pregnant women were screened and 60 primigravidae with diagnosis of GDM were recruited. Glycosylated hemoglobin (HbA1c) was recorded at weeks 24, 28, and 32, and at parturition. Subgingival plaque sample, cord blood, and pericrevicular vaginal swab were taken immediately postpartum from both the groups. Identification of F nucelatum and Capnocytophaga species was done using polymerase chain reaction. Adverse pregnancy outcomes such as preterm birth, low birth weight, and macrosomia were prospectively checked in all the recruited individuals. Results: Incidence of adverse pregnancy outcomes was significantly higher in the GDM with periodontitis group (48%) than the nonperiodontitis GDM group (14%) with P < .07. There was a moderate positive correlation (r = 0.429) between Gingival Index and HbA1c and microorganisms in the three samples at parturition. Macrosomia was seen in equal percentages in both groups. Conclusion: Concomitant existence of F nucleatum and Capnocytophaga species in all three samples was shown to be associated with increased incidence of adverse pregnancy outcomes in the GDM with periodontitis group. Of the adverse outcomes, preterm birth and low birth weight were more closely related to the periodontitis group than macrosomia. Keywords: Capnocytophaga, Fusobacterium, gestational diabetes, low birth weight, periodontitis, preterm birth

Objectives: Burning mouth syndrome is an intraoral chronic pain condition characterized by a moderate to severe sensation of burning from the oral mucosa. No clinical signs are found and there is no efficient treatment. Method and materials: This pilot study included 10 women that were resistant to other previous treatments or noncompliant to systemic medications. Patients were asked to apply tretinoin gel 0.05% on their tongues twice daily for 14 days. Treatment effectiveness was assessed by completing a pre-study psychologic questionnaire and recording a daily wellbeing and pain log. Results: Significant pain-score decrease in 50% of the patients (delta numerical rating score –3.15 ± 3.02, P value = .005) was recorded. This finding was in concordance with the verbal statements including major quality-of-life improvement (P value = .05), without any treatment positive or negative predictive factors. Conclusions: Topical tretinoin exhibits potential efficacy in patients with treatment resistant burning mouth syndrome and may also be used as a primary treatment modality. Keywords: burning mouth syndrome, tretinoin, retinoids, vitamin A

Objective: Idiopathic lingual mandibular sequestration is an uncommon condition that affects the lingual aspect of the mandible and may result in a necrosis of the jaw that is clinically indistinguishable from medication-related osteonecrosis of the jaw. This condition, however, is not associated with the intake of antiresorptive medication and may not require the same safeguards for extended periods of time. The etiology of idiopathic lingual mandibular sequestration is still unknown although trauma has been shown to play an important role. Method and materials: PubMed and the Cochrane Library were used to retrieve papers written in English through the years 1970 to 2021 using the key words “idiopathic osteonecrosis,” “lingual sequestration,” and “idiopathic jaw sequestration.” In addition, clinical presentation of the lesion was included. Results: Idiopathic lingual mandibular sequestration is a benign, mostly self-limiting condition distinct from medication- related osteonecrosis of the jaw. Conclusion: The dental clinician should be familiar with this condition and include it in their differential diagnosis when exposed bone is present with no history of radiation to the area or intake of antiresorptive medication. The course of the condition is usually very mild and may be self-limiting and usually does not require surgical intervention. Keywords: bone, medication, oral lesions, osteonecrosis of the jaw, sequestration

Objective: The anterior loop, the mandibular incisive canal, and the lingual symphyseal foramen are important structures in the anterior mandible. The purpose of this study was to assess the prevalence of these structures using CBCT. Method and materials: A total of 170 projections were analyzed in different sectional planes. The study analyzed the prevalence and extension of the anterior loop and the prevalence of both the mandibular incisive canal and the lingual symphyseal foramen by using the GALAXIS software by Sirona. Results: In 98.2 % (n = 167) a lingual symphyseal foramen was detected. An anterior loop was present in 31.2% (n = 53) with statistically significant higher detection rate in younger patients (P = .001). The median length was 1.26 mm (range 0.53–3.70 mm). No statistically significant differences regarding patient side or sex were found in either case. In 72.4% (n = 123) a mandibular incisive canal was detected. There was a statistically significant dependence of the mandibular incisive canal on patient sex (P = .007): female patients had a mandibular incisive canal significantly more often than male patients. Among male patients a significant difference of the mandibular incisive canal regarding the mandibular side (P = .031) was found; it was significantly less frequent on the right than on the left side. Conclusion: Anterior loop, mandibular incisive canal, and lingual symphyseal foramen are often present. Furthermore, the anatomical, neurovascular variability in the interforaminal area of the mandible emphasizes the importance of 3D imaging like CBCT in preoperative assessment, and confirms that a general safe zone should not solely be relied upon when performing surgery in this region. Keywords: anterior loop, CBCT, interforaminal mandible, lingual foramen, mandibular incisive canal

The outcome in the treatment of furcation defects is often unsatisfactory. The reasons are morphologic and pathologic peculiarities as well as extensive changes in shape caused by resective treatment of periodontal lesions in multi-rooted teeth. Therefore, augmentative strategies are suggested to improve the prognosis. However, the success rate decreases with increasing severity of the disease. In contrast, if the affected roots are not extracted but are extruded after hemi- or trisection, this leads to a coronal displacement of the disease process and a significantly improved situation for hygiene. At the same time, the resection of inflammatory tissue of the periodontal pockets is accompanied by vertical and horizontal bone apposition. The results are predictable and stable in the long term. The burden for the patient is low. ((Quintessence Int 2022;53: 884–891; Originally published (in German) in Quintessenz Zahnmedizin 2020; 71(9): 1024–1032; doi: 10.3290/j.qi.b3418205) Keywords: extrusion, fibrotomy, furcation defects, replantation of root segments, regeneration, long-term stability

Objective: The study aims to identify specific determinants of dental care utilization during the perinatal period (prenatal and 1-year postnatal) among underserved US women residing in Upstate New York. Method and materials: The prospective cohort study included 186 low-income US pregnant women. Demographic-socioeconomic parameters and medical-dental conditions were obtained from questionnaires, electronic medical-dental records, and dental examinations. Multivariate regression analyses were used to assess factors associated with perinatal dental care utilization. As an exploratory effort, a separate logistic model assessed factors associated with adverse birth outcomes. Results: The results demonstrated unmet oral health needs among the underserved US pregnant women residing in Upstate New York. Despite an average of 2.7 ± 3.6 untreated decayed teeth per person during pregnancy, only 39.3% and 19.9% utilized prenatal and 1-year postnatal dental care, respectively. Previous dental care utilization was a notable factor contributing to a higher uptake of perinatal dental care at a subsequent period. Prenatal dental care utilization was significantly lower among African American women (odds ratio 0.43 [95% CI 0.19, 0.98], P = .04) and positively associated with dental caries severity (OR 2.40 [1.09, 5.12], P = .03). Postnatal utilization was associated with caries severity (OR 4.70 [1.73, 12.74], P = .002) and prevalent medical conditions (hypertension, diabetes mellitus, and emotional conditions). Pregnant women who achieved prenatal caries-free status had a lower odds of experiencing adverse birth outcomes; however, this was an insignificant finding due to limited adverse birth cases. Conclusion: Racial and oral health disparity is associated with perinatal oral health care utilization among underserved US pregnant women in New York. While both prenatal and postnatal dental care utilization was positively associated with oral health status, specifically, postnatal utilization was driven by existing medical conditions such as emotional condition, hypertension, and diabetes mellitus. The results add to existing information on inherent barriers and postulated needs to improve access to perinatal oral care, thereby informing statewide recommendations to maximize utilization. Considering this is a geographically restricted population, the findings are particularly true to this cohort of underserved pregnant women. However, future more robust studies are warranted to assess effective strategies to further improve perinatal dental care utilization among underserved pregnant women. Keywords: birth outcomes, caries, dental care utilization, pregnancy, prenatal oral health