Quintessence International, 07/2025

Objective: The aim of the present study was 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. Method and materials: In this randomized study, a total of 60 individuals with pocket depths of 4 to 7 mm bilaterally in both sexes (men and women) who were 25 years old or older, diagnosed with stage II or III periodontitis were selected. In total, 60 patients with at least four teeth demonstrating pocket depth of ≥ 4 to 7 mm 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 6 months. Baseline clinical parameters including 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 patients (120 pocket sites) received photobiomodulation therapy with 680 nm for 60 sec (6 J/cm2) with 0.1 W power. Group B: 30 patients (120 pocket sites) received 1.2% atorvastatin gel as local drug delivery. After application of the local drug, the treated periodontal pockets were secured with N-butyl-2-cyanoacrylate. Patients were recalled at baseline and after 1 month and 3 months, and clinical periodontal parameters were recorded. Results: On intergroup comparison, there were notable improvements in all clinical parameters at the 3-month interval after subgingival instrumentation in combination with photobiomodulation or local drug delivery. In the intragroup comparison, at the 3-month interval, the reduction in probing depth and clinical attachment gain were more significantly evident in group B (1.2% atorvastatin gel) compared to Group A (photobiomodulation). These findings are consistent with the available literature, which recognizes subgingival instrumentation as an effective nonsurgical 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 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. Keywords: atorvastatin, drug delivery systems, low-level light therapy, periodontal regeneration, periodontitis

A technique for designing and manufacturing a single-visit temporary removable partial denture is described. This immediate provisional prosthesis is made of a newly introduced esthetic 3D-printed thermoplastic material. The arch to be restored, the antagonist, and the maxillomandibular relationship were optically scanned using an intraoral scanner (Medit i700, Medit). The removable partial denture was designed using the Exocad software program (Dental CAD). The denture base was 3D printed in flexible gingiva-colored resin, while the teeth were 3D printed in permanent tooth-colored resin. This digitally fabricated prosthesis will provide partially edentulous patients with a time- and cost-effective esthetic temporization with adequate retention and high patient acceptance. This technique demonstrates free-form designing of the flexible clasps and their geometry. It also highlights the need to develop specialized dental software programs to include ready-made flexible clasps to cope with the continuous development of flexible 3D-printed resinous materials. Keywords: 3D printing, digital flexible denture, Exocad, same-day denture, temporary denture, thermoplastic resin

Objectives: This retrospective study assesses the long-term effects of implants on alveolar and basal bone to determine if a patient’s sex affects dimensional changes in the jaw and evaluate whether dental implants halt the atrophy of bone when compared to no post-extraction intervention. Method and materials: Institutional Review Board approval was obtained for this study. Of the 125 patients (432 sites) in the study, 53% were women. All had two CBCTs taken, an average of 4.7 years apart. The scans were divided into three groups. In the control group, the extraction site (first CBCT, T1) was not replaced when the second scan was taken (T2). Group 2 had no implant at T1 and an implant at T2. Group 3 had an implant at T1 and T2. Measurements were made from landmarks at predetermined levels (superior cortex of the inferior alveolar nerve or the most inferior point in the nasal floor in the direction of the crest of bone height (control group and groups 2 and 3). To avoid osseous changes due to placement, measurements were made from the inferior alveolar nerve for mandibular implants or the nasal floor for maxillary implants. Recognizing sex-based disparities in jaw size, percentage changes in bone were monitored. Results: Loss of alveolar bone width across all groups was common. When bivariate analysis was performed after Bonferroni correction (P .025), changes in alveolar bone width were significantly greater in women (P = .004). Although the loss in the basal bone was present, it was not significant between the sexes nor as great as alveolar bone resorption (P = .880). When comparing groups using bivariate analysis, differences were not statistically significant between treatment groups and the control group (P = .050) for basal bone and for alveolar bone (P = .052). In the regression analysis for sex or group, neither was statistically significant for either basal or alveolar bone (P > .05). Conclusion: Dental implants do not arrest post-extraction atrophy in either alveolar or basal bone. Women exhibited a statistically greater rate of alveolar bone loss. Stable long-term implant success necessitates precise placement. Keywords: CBCT, dental implants, etiology, extraction, implantology, sex

Objectives: With little evidence and controversial guidelines on space maintainers, this cross-sectional population-based study aimed to analyze the prevalence and distribution of space loss after premature extraction of primary molars and the potential effect for space maintainers. Method and materials: Within the compulsory dental examinations in all primary schools in Greifswald, Germany, 6- to 12-year-old children were screened for premature loss of primary molars. The mesiodistal dimension at the site of extraction and the contralateral tooth were measured with Zürich calipers by two calibrated examiners. Results: Out of 1,596 students, 190 (11.9%) exhibited early loss of primary molars (47.9% females, mean age 8.73 ± 1.02 years). In total, 152 of 291 missing molars that were lost unilaterally were suitable for comparison with the intact side. Only 26 students had a space maintainer (8.9%). There was a statistically significant difference in space loss after premature extraction of primary molars with and without space maintainer (mean 0.59 ± 0.94 mm vs 1.66 ± 1.66 mm, respectively, P = .037). This was especially true for second primary molars (2.62 ± 1.93 mm; first molars 1.17 ± 1.30 mm; P .001). Space loss in the maxilla (1.75 ± 1.68 mm) was slightly higher than in the mandible (1.40 ± 1.58 mm, P = .187). In total, 53.3% of the children exhibited minimal space loss (≤ 1 mm), and 22.4% experienced 2.5 to 7.0 mm space loss. Conclusion: More than 10% of a low caries-risk population exhibited premature extraction of at least one primary molar. Space loss was greater in the region of second primary molars, while space maintainers significantly reduced space loss. Due to the complexity and variation of space loss, decision making on space maintainers should be individualized. Keywords: children, pediatric dentistry, premature extraction, primary teeth, space maintenance, tooth loss

Objective: Silver diamine fluoride (SDF) is increasingly recognized as a minimally invasive and effective treatment for early childhood caries. However, the dark discoloration from its application significantly limits its acceptability among parents, especially for anterior teeth. Zinc, with known antimicrobial and biofilm-modulating properties, has recently been proposed as a potential adjunct to reduce SDF-induced staining. This study aimed to evaluate the effectiveness of zinc pretreatment in reducing SDF-induced discoloration on primary tooth caries lesions that involved dentin. This study also aimed to examine surface morphology and elemental composition changes associated with zinc adjunct SDF treatments. Method and materials: Extracted human primary teeth were allocated into three groups: untreated control, positive control (38% SDF alone), and experimental group (20 mol/L zinc pretreatment followed by 38% SDF). Tooth color changes were assessed using grayscale intensity analysis via standardized photography at baseline, immediately posttreatment, and up to 14 days. Scanning electron microscopy and energy-dispersive x-ray spectroscopy were employed to investigate morphologic and compositional changes in both sound and naturally carious dentin areas. Statistical analyses included two-sample t tests, linear regression, and likelihood ratio tests. Results: Teeth pretreated with zinc demonstrated less discoloration compared to the SDF-only group. Although this difference was not statistically significant (P = .125), it may have potential clinical relevance. Scanning electron microscopy images revealed modified silver deposition patterns characterized by dispersed and less densely packed silver aggregates in zinc-pretreated groups. Energy-dispersive x-ray spectroscopy analysis confirmed the presence of zinc, suggesting its interaction with silver deposition processes. Conclusion: Zinc pretreatment effectively reduces SDF-induced discoloration in primary dentition, potentially improving esthetic outcomes and parental acceptance. This approach represents a promising advancement in minimally invasive pediatric dental care and warrants further clinical exploration. Keywords: dentin, early childhood caries, energy-dispersive x-ray spectroscopy (EDS), primary teeth, scanning electron microscopy (SEM), silver diamine fluoride, tooth discoloration, zinc pretreatment

Objectives: Tooth mobilization is a challenging orthodontic treatment. Inadequate interdisciplinary communication between surgery and orthodontics, as well as limited knowledge of the topography of the surgical field, can lead to unfavorable positioning of the appliance. This can result in dangerous force vectors for tooth movement. Comprehensive digital planning and customized tools could reduce these sources of error. Two cases of impacted canines were treated using cutting guides and customized attachments. Method and materials: A CBCT and intraoral scan were taken for planning. A CAD process was used to design a cutting guide and a customized attachment according to the required force vectors (OnyxCeph3, Image Instruments). Using various CAM processes, the cutting guide (BioMed Clear Resin, Formlabs) and a customized attachment dummy (Permanent Crown Resin, Formlabs) were fabricated in a 3D printer (Form 3B, Formlabs). The customized attachment was fabricated from titanium using the selective laser melting process (OrthoLIZE). The teeth were surgically exposed using the cutting guide and customized attachment dummies. The customized attachment was conventionally cemented using Transbond XT (3M Unitek). Results: All teeth were successfully exposed with the cutting guides. The customized attachments could only be placed in the predetermined position according to the digital planning. Conclusion: The 3D planned cutting guide can help to shorten the surgical procedure and keep the surgical field as small as possible. The 3D planned customized attachment allows precise positioning. The digitally planned force vectors should prevent side effects on adjacent teeth and allow targeted mobilization. However, studies are needed for further validation. Keywords: canine, computer-aided design and manufacture, customized appliance design, impaction, orthodontics, surgical procedure

Objective: The aim of this study was to quantitatively calculate and compare the changes in regenerated bone around the implant in graftless and grafted sinus elevation procedures using fractal dimension analysis, and to provide an additional criterion for clinical preference. Method and materials: The study included 65 patients (29 graftless and 36 grafted) at the Faculty of Dentistry in Van Yüzüncü Yıl University. Graftless and grafted sinus elevation techniques were compared in terms of fractal dimension and bone density on panoramic radiographs. The Student t test was used to compare the mean values of fractal dimension and bone density in patients with graftless and grafted sinus elevation. The Pearson correlation coefficient was used to analyze the correlation of fractal dimension and bone density data with age. Statistical significance was accepted at P .05. Results: The fractal dimension and bone density were not statistically significant between the two groups (P > .05). The fractal dimension and bone density parameters were higher in men for both sinus elevation techniques. Conclusions: The results showed that the graftless and grafted sinus elevation techniques had similar fractal dimension and bone density outcomes. Therefore, it was concluded that the graftless technique is preferable for maxillary sinus elevation because of its relatively simple technique. Keywords: bone density, fractal analysis, grafted sinus elevation, graftless sinus elevation, panoramic radiography

Objectives: Various salivary cytokines are overexpressed in the saliva of Sjögren disease patients. In addition, the levels of salivary cytokines can differ according to local and systemic conditions, besides Sjögren disease itself. This study aimed to analyze the associations and correlations of caries experience, sialometry, and systemic comorbidities with levels of the following salivary cytokines: interleukin (IL) 1β, IL-6, IL-8, IL-10, TNF-α, and IL-17A among Sjögren disease patients. Method and materials: Upon ethical approval and signed informed consent, 20 women with Sjögren disease were recruited. Clinical examinations included decayed, missing, or filled teeth (DMFT) Index measurements, sialometry, and saliva sampling. Levels of salivary cytokines IL-1β, IL-6, IL-8, IL-10, tumor necrosis factor-α (TNF-α), and IL-17A were measured by enzyme-linked immunosorbent assay (ELISA). Statistical analysis was performed using the independent-samples Mann–Whitney U test for the associations between the categorical parameters, and Spearman correlation test to analyze the correlations between continuous variables. Results: Salivary cytokines were inter-correlated in a statistically significant manner (P .05). Age correlated with IL-17A levels (P .05), and decayed teeth correlated with IL-6, IL-8, and IL-10 (P .05). The liquid fraction in the unstimulated salivary flow rate significantly correlated with all salivary cytokines that were measured. Cardiac disease correlated with IL-10 levels, and rheumatoid arthritis correlated with IL-1β levels (P .05). Conclusions: These results suggest that local factors such as caries experience and salivary flow rates as well as systemic factors such as comorbidities should be taken into consideration when testing the levels of salivary cytokines in Sjögren disease. Keywords: comorbidity, cytokines, decayed, missing, or filled teeth (DMFT), enzyme-linked immunoabsorbent assay (ELISA), interleukin-1β (IL-1β), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), interleukin-17A (IL-17A), sialometry, Sjögren disease, tumor necrosis factor-α (TNF-α), xerostomia