Quintessence International, 08/2021

Although the use of intraoral scanners is becoming more popular, dental professionals are still presented with the challenge of obtaining precise imaging of the preparation margins. Deep preparation margins, saliva contamination, or bleeding during the scanning procedures can impair the accuracy of the digital scan. Dental dam placement can significantly improve the quality and efficiency of the digital scan, while simultaneously providing a clean restorative field and serving as a barrier to the spread of infections for the protection of dental professionals. This article describes a technique of intraoral scanning by using dental dam isolation to ensure maximum accuracy of the digital scan of the dental preparations. Schlagwörter: bonded restorations, CAD/CAM, dental dam, intraoral scanning

3D technology has been applied in both surgery simulation and guidance in endodontic microsurgery. Treatment options are still limited for vertical root fracture (VRF) in inaccessible areas that require accurate resection, especially in single-rooted teeth. This case illustrates successful treatment based on 3D technology. The literature on endodontic microsurgery of VRF is summarized. A 27-year-old woman presented with periapical lesions and apical root resorption of a maxillary premolar. After endodontic microsurgery was arranged, unexpected VRF was discovered through CBCT. Using a 3D-printed template, the root fracture was precisely removed with minimal damage. A literature review revealed a total of 12 articles published since 1946 on this topic. The 3D-printed template facilitated endodontic microsurgery, indicating reliable location of the root fracture and reduction in iatrogenic injury. Schlagwörter: 3D-printing technology, computer-guided surgery, endodontic microsurgery, external apical root resorption, vertical root fracture

Objective: The purpose of this randomized, controlled, split-mouth clinical trial was to clarify the clinical efficacy of using injectable platelet-rich fibrin (i-PRF) as an adjunctive subgingival irrigation to scaling and root planing (SRP) in the treatment of periodontitis. Method and materials: The study was conducted in 15 patients suffering from stage II to III with grade B to C periodontitis with bilateral periodontal pockets (≥ 5 mm) on a minimum of two teeth without degree II or III of furcation involvement or tooth mobility. The evaluated clinical parameters were: Plaque Index (PI), bleeding on probing (BOP), probing pocket depth (PPD), clinical attachment level (CAL), and gingival recession at baseline and after 3 months. After full-mouth supra- and subgingival SRP, the sites were randomly divided into test sites receiving the subgingival application of i-PRF and controls treated with saline. The Wilcoxon test and Mann-Whitney U test were used for intra- and inter-group comparisons, respectively. Results: In total, 726 sites were treated (388 test group and 338 control group) with no uneventful healing effects. Statistically significant decreases in PI (P = .001), BOP (P = .001 for both groups), PPD (P = .001 and P = .000 for test and control groups, respectively), CAL (P = .015 and P = .001 for test and control groups, respectively) between pretreatment and 3 months posttreatment were noted in both test and control groups. For inter-group comparisons, there was no statistically significant difference in all clinical indices (P > .05). Conclusion: In this study, both groups were clinically effective as nonsurgical periodontal treatments, without any clinical benefits of using i-PRF. Schlagwörter: blood platelets, fibrin, injectable platelet-rich fibrin, nonsurgical periodontal therapy, periodontal pockets, periodontitis

Objectives: The aim of this retrospective study was to evaluate the long-term effectiveness of coronally advanced flap (CAF) in combination with connective tissue graft (CTG) in the treatment of gingival recessions. Method and materials: Periodontal charts of 13 patients with single and multiple gingival recessions treated by means of CAF and CTG with a follow-up of 7 years were selected for the study. Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), gingival recession depth (GRD), gingival recession width (GRW), height of keratin­ized gingiva (KG), probing depth (PD), and clinical attachment level (CAL) were assessed at baseline, and after 1 and 7 years of follow-up. Complete root coverage (CRC) was evaluated at 1 year and after 7 years of follow-up. A comparison of gingival recessions with or without non-carious cervical lesions (NCCL) was also performed. Results: All clinical variables showed a significant improvement (P < .05) between baseline and after 7 years of follow-up. CRC was achieved in 69.2% and 53.8% of sites after 1 and 7 years of follow-up, respectively. The comparison between gingival recessions with and without NCCL did not show statistically significant differences (P > .05) in terms of all parameters. Conclusions: Within limits of the present study, the combination of CAF and CTG for the treatment of single and multiple recessions yielded positive outcomes in terms of GRD reduction and CRC after 7 years. These findings were independent of the presence of NCCLs. Schlagwörter: connective tissue, esthetic surgery, gingival recession, long-term effect, periodontal disease, tooth erosion

Ectodermal dysplasia (ED) is one of the congenitally syndromic diseases with dental anomalies. This syndrome manifests in various forms and usually requires early restorative therapy to restore esthetics and function in young patients. The restorative approaches vary greatly and range from minimally invasive shape corrections using composite build-ups and removable partial or complete dental prostheses, to implantologic solutions, always based on the syndromic expression, the age of the patient, the residual growth, as well as the dentition itself. The present case report presents an innovative prosthetic management of a young patient suffering from ED with permanent tooth aplasia and persistent primary teeth using maxillomandibular individually veneered tooth-colored CAD/CAM polycarbonate splints. The CAD phase has been significantly improved by including the analysis of 3D face scans. This advanced technical development makes it possible to avoid any time-consuming try-in and start directly with the splint production, ensuring a much faster complete rehabilitation and support for the young patient. Schlagwörter: CAD/CAM workflow, case-report/series, complex diseases, ectodermal dysplasia, overdenture, polycarbonate splint, prosthetic rehabilitation, restorative dentistry

Objective: Few studies have examined pain levels for the injection of local anesthesia in children, though it is a routine technique in pediatric dentistry. The objective of the study was to evaluate the difference in the assessment of procedural pain by the child, parent, dental practitioner, and independent observers during injection of local anesthesia for dental treatment in pediatric dentistry. Method and materials: In total, 27 male and 22 female children (5 to 17 years of age, mean ± SD 9.8 ± 4.0 years) received local anesthesia (LA) via infiltration or mandibular alveolar blocks according to a standard protocol. After the dental treatment, the children assessed the pain levels for the procedures on a visual analog scale (VAS), while their parents and the dental practitioner used a numeric rating scale (0 to 10). Independent observers also assessed pain via video tape for an evaluation after blinding. The heart rate was monitored continuously during the procedure. The Bland–Altman method was used to quantify the comparison between pain ratings. Results: The assessed level of pain by dental practitioner, parent, and child during injection of LA differed clearly (child: 3.94 ± 2.71; parent: 3.31 ± 2.60; dental practitioner: 3.02 ± 1.98; video observer 1: 1.76 ± 2.56; video observer 2: 1.89 ± 2.55). In 42.9% of cases the dental practitioner’s rating and the self-­reported pain by the child during injection of LA differed by ≥ 2 on the numeric rating scale, which is clinically a highly different and relevant assessment. Conclusion: As pain perception in children during the injection of local anesthetic and its assessment varies considerably depending on the assessing person and the treated child, dental practitioners and researchers should be cautious in interpreting the patient’s pain perception. Schlagwörter: children, dentistry, local anesthesia, pain assessment

Objective: Candida albicans in considered to be a marker of immunosuppression in serious chronic condition such as HIV and cancer patients on immunosuppresion medications. The new COVID-19 pandemic has caused acute respiratory distress syndrome in many patients, which poses a risk of super-infections including Candida strains causing oral candidiasis as well as invasive fungal infections. The aim of the study was to examine the association between COVID-19 and oral and general candidiasis. Method and materials: The i2b2 data repository platform was used to analyze the interrelations between COVID-19, oral candidiasis, and total candidiasis in a hospital population. ICD diagnoses codes were used to generate queries on total numbers and demographic data on COVID-19, oral candidasis, total candidasis, and COVID-19 with each form of candidasis. Results: From the 889 patients diagnosed with COVID-19, 106 (12%) were diagnosed with candidiasis at large and 14 (1.6%) had oral candidiasis. The odds ratio (OR) for COVID-19 in the presence of oral candidiasis was 2.01 (95% CI 1.1870 to 3.4143, P = .094) and the OR for COVID-19 in the presence of candidiasis was 3.73 (95% CI 3.0419 to 4.5847, P < .0001 ). African American were disproportionally affected and comprised about 40% of the COVID-19/candidiasis groups. Conclusions: Total candidiasis was significantly associated with increased risk for COVID-19, whereas oral candidiasis showed an insignificant trend. The dental practitioner should be aware of the importance of unexplained oral and systemic candidiasis as a potential harbinger of T and B cell immunosuppression associated with viral in­fections. COVID-19 may be a risk factor for total candidiasis. Schlagwörter: candidiasis, COVID-19, odds ratio, oral candidiasis, thrush

Objectives: Due to the growing popularity of body modifications, dental practitioners are increasingly confronted with oral piercing and its implications. Successful consultation and subsequent change of patient behavior require an understanding of the patient’s personality and the deep reasons that explain this self-injurious behavior. This is the first study evaluating personality traits and aspects of body perception in a cohort of adults with oral piercing. Method and materials: Sixty-two individuals with labial and/or tongue piercing completed three validated questionnaires assessing body perception and personality traits (Questionnaire for assessing one’s own body; Sensation Seeking Scale; Big Five Inventory Scale). Fisher Exact probability test and Mann-Whitney U test were used to determine differences in frequency data and in psychologic parameters between subgroups. Results: Eighteen single- and 44 multiple-pierced individuals completed the study (53 women, 9 men). The odds for being multiple pierced was significantly higher for tongue than for labial piercing (3.89 and 0.63, respectively; P = .003). In all psychologic parameters measured, the sample showed score distributions within reference norms. However, multiple-pierced individuals displayed a significantly lesser feeling of attractiveness, less self-confidence, and more uncertainty/anxiety towards their body than single-pierced probands (P < .05). Conclusion: Psychologic characteristics of individuals with oral piercing do not fundamentally differ from those of the average population. Therefore, dental practitioners should focus on the medical and dental implications of oral piercing in the counseling of patients who have or intend to have such done. Schlagwörter: body perception, lip piercing, personality characteristics, sensation seeking, tongue piercing

Sialography combined with cone beam computerized tomography (sialo-CBCT) is an imaging technique that demonstrates the ductal system of the major salivary glands and allows evaluation of gland function. This review describes the sialo-CBCT technique, terminology, common pitfalls and limitations, as well as radiographic features and suggested pathogenicity of various salivary gland disorders, based on 1,758 sialo-CBCT examinations conducted over the last decade in one institution, and the current literature. The adoption of standardized terminology is proposed to prevent miscommunication, facilitate formulation of differential diagnoses, and thereby promote patient management: (1) Sialo-CBCT requires specific training, and operator experience is required for adequate glandular filling with minimal extravasation; (2) Limit injection-to-scan time to avoid pre­mature emptying; (3) The sialo-CBCT report should include a description of the morphology of the primary duct as well as the secondary, tertiary, and descending branches, the maximal branching level, the presence of sialectasis, overall glandular size, and parenchymal findings; (4) Functional evaluation is based on assessment of iodine clearance in the post evacuation image; (5) Sialectasis and ductopenia are the main findings in Sjogren syndrome and recurrent juvenile parotitis; (6) Sialodochitis with or without fillings defects or hyperdense calcifications characterize obstructive sialadenitis and sialolithiasis; (7) The findings following radioactive-iodine-induced damage are similar to obstructive sialadenitis, with atrophy in late stages; (8) In chronic graft-versus-host disease (cGVHD), variable presentations of ductopenia, sialectasis, and sialodochitis may be evident; (9) The red flags indicating a space-occupying lesion include areas of no filling, splaying of ducts, and primary duct deviation. Schlagwörter: cone beam computed tomography, parotitis, salivary glands, sialadenitis, sialography, Sjogren syndrome