Quintessence International, 01/2025

Objectives: The objective was to explore associations between periodontal disease severity and cardiometabolic risk factors, including body mass index, age, Type 2 diabetes mellitus risk, sex, and hypertension in patients at an urban dental school clinic. Method and materials: A cross-sectional study design was used to analyze electronic health record data, including periodontal status, demographic characteristics, cardiometabolic risk factors and the American Diabetes Association Diabetes Risk Test (DRT) score. Chi-square tests and ordinal logistic regression were conducted using SAS 9.4. Results: Of those with available data (n = 6,778), 44% were male, 70.2% were overweight/obese, and the mean age was 50.9 (SD = 16.6) years. Associations between PD severity and body mass index, sex, age, DRT score, and hypertension were statistically significant (all P .0001) in bivariate analyses. Using logistic regression, hypertension (P = .0006), sex (P .0001), and age (P .0001) were significant predictors of severe periodontal disease, which was most common in those with hypertension (35.9%), males (31.7%), and those > 60 years (36.6%). The odds of having severe periodontal disease for those with hypertension were 1.2 times that of those without hypertension. Males were 1.7 times more likely to have severe periodontal disease than females. Those aged 40 to 49 years, 50 to 59 years, and > 60 years were 2.9, 4.2, and 4.3 times more likely to have severe periodontal disease than those who were 18 to 39 years, respectively. Conclusion: All cardiometabolic risk factors were associated with periodontal disease severity in bivariate analyses. In the logistic regression model, being older, male, and having hypertension were significant predictors of periodontal disease severity. Future research is needed with a more diverse sample. Keywords: body mass index, cardiometabolic risk factors, diabetes risk, hypertension, periodontitis

Objectives: This study aimed to investigate the impact of photobiomodulation and/or azithromycin therapy in combination with full-mouth subgingival instrumentation on receptor activator of nuclear factor κB ligand (RANKL) and osteoprotegerin levels and RANKL/osteoprotegerin ratios in gingival crevicular fluid on patients with stage III–IV grade C periodontitis. Method and materials: The study was conducted on 77 stage III–IV grade C periodontitis patients and 20 periodontally healthy controls. Patients with stage III–IV grade C periodontitis were categorized into four treatment groups: 1) only full-mouth subgingival instrumentation (FSI) group; 2) full-mouth subgingival instrumentation + azithromycin (AZM) group; 3) full-mouth subgingival instrumentation + photobiomodulation (PBM) group; and 4) full-mouth subgingival instrumentation + photobiomodulation + azithromycin (AZM+PBM) group. Clinical periodontal parameters and RANKL and osteoprotegerin levels and RANKL/osteoprotegerin ratios in gingival crevicular fluid were measured at baseline and at the third month of therapy. Results: Compared with the periodontally healthy controls, all the baseline clinical parameters were higher in the stage III–IV grade C periodontitis groups (P .05); however, there were no statistically significant differences between the stage III–IV grade C periodontitis groups (P > .05). At month 3, the lowest values in all clinical parameters were generally observed in the antibiotics groups, whereas the highest values were observed in the FSI group. Furthermore, the highest RANKL and osteoprotegerin values in antibiotic groups and the highest RANKL/osteoprotegerin ratio in the PBM group were observed in month 3. RANKL/osteoprotegerin ratios did not change in the FSI and antibiotics groups after the treatment, but increased significantly in the PBM group. Conclusion: While photobiomodulation treatment combined with full-mouth subgingival instrumentation increases the RANKL levels, azithromycin increases osteoprotegerin levels. Also, AZM + PBM treatment shows additional clinical and immunologic beneficial efficacy. Keywords: antibacterial agents, laser, medicaments, periodontitis, periodontology

Objective: This case report describes a multidisciplinary approach using a digital wax-up to fabricate a gingivectomy and crown lengthening guides, to reshape a lateral incisor into a central incisor and improve overall esthetics. Clinical considerations: Comprehensive treatment planning is crucial when executing a multidisciplinary workflow, with digital tools proving to be invaluable aids. In the present case, a digitally designed wax-up was employed to generate a digital surgical guide for reshaping the gingival architecture of a lateral incisor into that of a central incisor, followed by composite restorations. Conclusion: The application of a digital wax-up for the design of a surgical guide and the fabrication of a silicone index led to a predictable and successful outcome in reshaping a lateral into a central incisor. Clinical significance: Post-orthodontic reshaping using direct composite is widely accepted by patients due to its cost-effectiveness and minimally invasive nature. This approach highlights the efficacy of digital technology in achieving precise dental restorations, highlighting its growing importance in modern dental practice. Keywords: 3D printing, composite veneers, crown lengthening, digital dentistry, minimally invasive dentistry

Objectives: The aim of the study was to observe whether immediate implant placement into damaged extraction sockets is a successful modality for treating hopeless teeth that require extraction. Data sources: An electronic search was carried out through four databases (PubMed/MEDLINE, Web of Science, Scopus, and ScienceDirect) to identify randomized controlled trials (2013 to 2023) to understand whether immediate implant placement in damaged sockets is a successful treatment. The focus question was, “In a patient with a hopeless tooth that needs extraction with the indication for dental implant treatment, is immediate implant placement in damaged extraction sockets, compared to undamaged sockets or healed sites, an effective method for the replacement of hopeless teeth and achieving a favorable clinical result?” The risk of bias was appraised and a meta-analysis using random effect was applied. Results: Five studies with 135 patients and 138 implants were included. The implant survival rate was 100% for all studies and period evaluated; the pink esthetic score (PES) scores had no statistically significant result for all articles that evaluated this parameter; the soft tissue changes was reported by two studies: one found no significant differences and the other showed that the test group experienced reduced soft tissue loss at the 1-year evaluation (measured with digital intraoral scanners); another two studies assessed the marginal bone loss, presenting no differences between groups. The meta-analysis showed homogeneity between the studies. There was an equilibrium among the groups in the various studies included, and age tended to be lower in the test group. The buccal bone tissue and pink esthetic score showed favoritism for the test group but without statistical significance. Conclusion: This study suggests that immediate implant placement in the presence of buccal bone defects can achieve comparable clinical and radiologic outcomes to traditional methods in the short term of the limited studies available. It was not possible to evaluate the buccal aspect through radiographs. Bone regeneration was essential to reach optimal results. It is important to emphasize that immediate implant placement requires adherence to rigorous criteria to ensure functionally acceptable results. Keywords: buccal bone defect, compromised extraction sockets, dental implants, fresh sockets, immediate implant placement

Objectives: This retrospective study analyzed zygomatic implant survival and implant success (based on ORIS criteria) in patients treated for maxilla atrophy or after reconstruction failure. Method and materials: Implants were placed as quads (four zygomatic implants) or hybrids (zygomatic implants and conventional implants in premaxilla) in edentulous patients using various surgical approaches, evolving from the sinus slot to Chow extended sinus elevation technique with or without Bichat fat pad. The procedure was followed by immediate loading, while clinical and radiographic evaluations spanned at least 1 year after implantation. The primary outcome was the implant survival at follow-up, and the secondary outcome was the implant success, assessed as complications according to ORIS criteria: prosthetic offset, sinus status, peri-implant soft tissue health, and implant stability. Results: A total of 73 consecutive patients, treated with 217 zygomatic implants and 76 conventional implants, were included, with mean follow-up of 3.5 years (range 1.0 to 9.8 years). Four zygomatic implants failed in three patients, including one patient with a zygomatic bone fracture. The cumulative survival rate was 98.16%. Although in two additional cases, implants lost stability, they achieved delayed osseointegration. Other complications included 21 sinus reactions (excluding the four failures) and 28 peri-implant inflammatory reactions. Conclusion: Zygomatic implants offered a predictable treatment option for extreme maxillary jawbone atrophy with a relatively low complication rate and no severe injuries. The Chow technique with the Bichat fat pad positively impacted zygomatic implant success and survival, whereas smoking, implantation in fresh sockets, and the limited experience of the surgeon negatively affected the outcomes. Keywords: complications, maxillary atrophy, oral rehabilitation, retrospective study, risk factors, zygomatic implant

Objective: While a bidirectional relationship between sleep health and musculoskeletal pain has been established among chronic pain patients, few studies explored it among dental students. This cross-sectional study assessed the relationship of self-reported musculoskeletal pain with sleep health and psychological outcomes among dental students, and whether differences existed as a function of number and location of painful body-sites. Method and materials: Validated questionnaires were sent through REDCap to dental students at a predoctoral dental school, assessing presence, location (head, shoulder/neck, jaw, back, body), and intensity of musculoskeletal pain, sleep health (risk of sleep apnea, insomnia severity symptoms, sleep quality, daytime sleepiness, and chronotype), and psychological outcomes (anxiety/depression). Differences between those with and without musculoskeletal pain, and across participants with different number and location of painful sites were tested with t tests and ANOVA, adjusting for age/gender. Results: Out of 80 participants (82.5% women), 76.3% reported musculoskeletal pain (68.9% in neck/shoulders). Those with musculoskeletal pain scored significantly worse in sleep quality (P .001) and daytime sleepiness (P .001). Those with more than three painful body-sites reported worse sleep quality (P = .006) and daytime sleepiness (P = .003) than pain-free controls. There were no differences on sleep and psychological outcomes as a function of number of painful body-sites. Those reporting back pain scored worse in insomnia (P = .037), daytime sleepiness (P = .002), and sleep quality (P = .006) than those without back pain. Conclusion: Musculoskeletal pain is prevalent among dental students and associated with worse sleep health. While number of painful sites may not influence sleep/psychological health, specific locations (eg, back pain) were associated with worse sleep functioning. Keywords: back pain, dental students, musculoskeletal pain, sleep, symptoms

Objective: The objective was to evaluate the anatomical relationship between the mandibular foramen and surrounding structures using CBCT and to investigate the potential causes of inferior alveolar nerve block (IANB) failure. Method and materials: In this retrospective study, CBCT images of 222 mandibular sides from 111 patients (55 men, 56 women; aged 18–45 years) who underwent CBCT examination at the Shenzhen University General Hospital between January 2018 and December 2020 were analyzed. Three-dimensional models were reconstructed, and measurements of angles and distances related to the mandibular foramen were performed. The presence of a bony protuberance on the medial side of the mandibular ramus was evaluated. Differences between sexes were assessed using paired t tests or Wilcoxon rank-sum tests (α = .05). Results: The angle between the anterior–posterior line of the mandibular ramus and the line connecting the innermost point to the mandibular foramen (angle AP–IF) was significantly greater than zero (P .05), indicating the presence of a bony protuberance. The angle between the midline and the line connecting the mandibular premolar contact point to the mandibular foramen (angle F45MnLP-ML) was 49.69 ± 2.17 degrees in men and 48.19 ± 2.20 degrees in women (P .001). The distance from the occlusal plane to the mandibular foramen was 9.45 ± 3.40 mm in men and 8.28 ± 3.41 mm in women (P = .011). Conclusion: The presence of a bony protuberance on the medial side of the mandibular ramus may contribute to IANB failure. Adjusting the needle insertion angle and height/vertical distance according to the reported measurements may improve IANB success rates. These findings may help clinicians optimize IANB techniques and improve success rates by adjusting needle insertion angles and heights/vertical distances based on individual patient anatomy. Keywords: anatomical landmarks, CBCT, inferior alveolar nerve block, mandibular foramen

Dental caries is one of the most common diseases globally. It affects children and adults living in poverty, who have the most limited access to dental care. Left unexamined and untreated in the early stages, treatments for late-stage and severe caries are costly and unaffordable for socioeconomically disadvantaged families. If detected early, caries can be reversed to avoid more severe outcomes and a tremendous financial burden on the dental care system. Building upon a dataset of 50,179 intraoral tooth photos taken by various modalities, including smartphones and intraoral cameras, the present study developed a multi-stage deep learning-based pipeline of artificial intelligence algorithms that localize individual teeth and classify each tooth into several classes of caries. This study initially assigned International Caries Detection and Assessment System (ICDAS) scores to each tooth and subsequently grouped caries into two levels: level 1 for white spots (ICDAS 1 and 2) and level 2 for cavitated lesions (ICDAS 3 to 6). The system’s performance was assessed across a broad spectrum of anterior and posterior teeth photographs. For anterior teeth, 89.78% sensitivity and 91.67% specificity for level 1 (white spots) and 97.06% sensitivity and 99.79% specificity for level 2 (cavitated lesions) were achieved, respectively. For the more challenging posterior teeth due to the higher variability in the location of white spots, 90.25% sensitivity and 86.96% specificity for level 1 and 95.8% sensitivity and 94.12% specificity for level 2 were achieved, respectively. The performance of the developed AI algorithms shows potential as a cost-effective tool for early caries detection in nonclinical settings. Keywords: artificial intelligence, caries, convolutional neural network, deep learning, dental public health, machine learning