Quintessence International, 06/2023

Objective: This in vitro study evaluated the color differences when discolored tooth substrates were restored with CAD/CAM monolithic ceramics depending on ceramic type and thickness, and the try-in paste shade. Method and materials: Six ceramic types were tested: high-translucent lithium disilicate (LD-HT); medium-translucent lithium disilicate (LD-MT); low-translucent lithium disilicate (LD-LT); low-translucent leucite (LC-LT); feldspathic ceramic (FC); and BL1 low-translucent lithium disilicate, stained to A1 shade (LD-BL1-LT). The ceramics were tested in disk-shaped specimens with 0.5-, 1.0-, and 1.5-mm thickness (n = 10; N = 180; shade A1). The try-in pastes were tested to simulate luting materials and corresponded to colors A1 and Opaque White. Six substrates were used: A1 (reference), B2, B3, A3, C2, and C3. Color differences (∆E00) and translucency parameter (TP00) were assessed with the CIEDE2000 formula. The results were compared with acceptability (1.77) and perceptibility (0.81) thresholds. Results: Ceramic type, thickness, and the try-in paste shade influenced the color differences. LD-LT and LC-LT ceramics and Opaque White try-in paste provided, in general, lower ∆E00 values. The most adequate ceramic thickness varied according to the substrate discoloration. With 1.0 mm of ceramic thickness, it was possible to obtain ∆E00 lower than the perceptibility threshold for substrates C2 and A3, and ∆E00 lower than the acceptability threshold for C3 and B3. ∆E00 lower than the acceptability threshold were obtained with 0.5 mm of ceramic thickness for B2, A3, and C2. Conclusion: The use of low-translucent glass-ceramics and Opaque White try-in paste are useful to reduce color differences. The most adequate ceramic thickness depends on the substrate discoloration. Keywords: color difference, dental ceramics, discolored substrates, prosthodontics, translucency

Objective: The present study compared interleukin 1-beta (IL-1β) and soluble urokinase plasminogen activation factor receptor (suPAR) levels in peri-implant sulcular fluid of patients with cement-retained and screw-retained implants. Method and materials: Patients with cement-retained and screw-retained implants were included. Demographic data were collected, and implant-related characteristics (geometry, insertion torque, loading and retention protocol, arch location, duration in function, and depth of insertion) were retrieved from records. Modified Plaque Index, crestal bone loss, probing depth, and modified Bleeding Index were measured. suPAR and IL-1β levels were assessed in peri-implant sulcular fluid. Statistical comparisons were done and correlation between clinicoradiographic parameters and peri-implant sulcular fluid IL-1β and suPAR were assessed. Statistical significance was judged at P < .05. Results: Clinical and radiographic parameters showed no difference among screw-retained and cement-retained implants. There was no difference peri-implant sulcular fluid volume among patients with cement-retained (0.22 ± 0.00 μL) and screw-retained (0.19 ± 0.005 μL) implants. Levels of IL-1β and suPAR in patients with cement-retained and screw-retained implants were 50.08 ± 0.6 ng/mL and 44.6 ± 0.08 ng/mL, and 0.28 ± 0.05 ng/mL and 0.22 ± 0.006 ng/mL, respectively. Conclusion: Implants with cement-retained or screw-retained restorations are comparable to one another in terms of clinicoradiographic status and demonstrate IL-1β and suPAR levels within the normal range in the peri-implant sulcular fluid provided oral hygiene is stringently maintained. Keywords: crestal bone loss, dental implant, interleukin 1-beta, retention, screw, soluble urokinase plasminogen activation factor

Objectives: The aim of the present study was to evaluate the effect on systemic inflammation of subgingival instrumentation (SI) with or without antibiotics. Moreover, systemic parameters were compared between periodontally healthy (PH) individuals and periodontitis patients. Method and materials: Patients with generalized periodontitis: stage III and PH individuals were recruited. Forty eight periodontitis patients were randomly allocated to each treatment group; systemic antibiotics for seven days after completion of SI (AB group), or SI alone (SI group). Periodontal parameters, serum high-sensitivity C-reactive protein (hsCRP), and hematological parameters were assessed at baseline and at week 8. Multivariate analysis was applied to analyze predictive effect of treatment allocated and improvement in periodontal parameters on change in systemic parameters. Results: At baseline, hsCRP, total leukocyte count (TLC), neutrophil, and monocyte count were significantly higher in periodontitis patients. There was comparable reduction in neutrophil count in both treatment groups. At week 8, change in periodontal parameters was similar in treatment groups, except for probing pocket depth (PPD). Improvement in both PPD and clinical attachment level (CAL) and CAL alone was predictive of change in TLC and lymphocyte count, respectively. Conclusion: This study failed to demonstrate the significant benefit of systemic antibiotics as an adjuvant to SI on improvement in periodontal inflammation and systemic inflammatory parameters, despite significantly higher reduction in PPDs. Keywords: C-reactive protein, inflammation, lymphocyte count, root planing

Objective: The present study aimed to assess the clinical and radiographic effect of a bone graft material (β-tricalcium phosphate + hydroxyapatite) alone and in combination with platelet-rich fibrin in intrabony defects of periodontitis patients. Method and materials: This 6-month randomized controlled clinical trial was carried out in 42 intrabony periodontal defects (average age 40 years). Intrabony defects ≥ 3 mm along with associated probing depth of ≥ 5 mm following phase 1 periodontal therapy were treated either with open flap debridement with bone graft (β-tricalcium phosphate + hydroxyapatite; control group) or open flap debridement with bone graft plus platelet-rich fibrin membrane (test group). Individual customized acrylic stents with grooves were used to ensure reproducible and repeatable measurements of clinical and radiographic parameters, including probing pocket depth (PPD), relative clinical attachment level (RCAL), gingival marginal level (GML), vertical bone defect fill (VHD), and area of intrabony defects (AOD) on intraoral periapical radiographs. Clinical attachment level (CAL) gain was considered as primary outcome and PPD reduction and radiographic bone fill as secondary outcomes. Results: The preoperative Plaque Index, RCAL, GML, PPD, VHD, and AOD in the control group were 1.06 ± 0.08, 11.57 ± 2.29 mm, 5.24 ± 1.89 mm, 6.29 ± 1.52 mm, 14.36 ± 2.65 mm, and 7.79 ± 4.39 mm2, respectively. After 6 months these were 1.08 ± 0.14, 9.34 ± 2.54 mm, 5.81 ± 2.20 mm, 3.52 ± 0.93 mm, 12.64 ± 2.34 mm, and 5.34 ± 3.2 mm2, respectively. The preoperative PI, RCAL, GML, PPD, VHD, and AOD in the experimental group were 1.14 ± 0.05, 12.19 ± 2.86 mm, 4.38 ± 1.63 mm, 7.81 ± 2.6 mm, 13.46 ± 3.42 mm, and 10.31 ± 8.71 mm2, respectively. After 6 months these were 1.09 ± 0.12, 8.62 ± 2.62 mm, 4.90 ± 1.79 mm, 3.71 ± 1.68 mm, 10.10 ± 2.07 mm, and 4.38 ± 2.67 mm2, respectively. After 6 months of evaluation both the groups showed a significant reduction in PPD (P < .001) and a significant gain in CAL (P < .001), as well as significant improvement in radiographic VHD fill and AOD changes. Again, the test group showed significant changes (P < .001) over the control group considering the same outcomes. Conclusion: With the study limitations in mind, it can be concluded that for the treatment of intrabony defects with the bone graft material (β-tricalcium phosphate + hydroxyapatite; Biograft, IFGL Bio Ceramics) or the same bone graft with platelet-rich fibrin membrane results in statistically significant improvement in clinical (CAL and PPD) and radiographic (VHD and AOD) parameters, the latter having highly significant benefits. However, the bone graft material requires improvement. Keywords: calcium phosphate, periodontitis, platelet-rich fibrin, randomized controlled clinical trial

Objective: To evaluate the effectiveness of root coverage surgery in reducing dentin hypersensitivity (DH) through a systematic review and meta-analysis. Data sources: Unrestricted search of four indexed databases up to September 2022 was performed to identify randomized controlled trials (RCTs) evaluating the effect of root coverage surgery on DH frequency and/or intensity presurgically (baseline) and at least 3 months postsurgically. Two authors independently conducted study screening and data extraction. Subgroup meta-analyses were performed separately for stimulated and unstimulated DH frequency and intensity at different timepoints. The risk of bias and quality of the available evidence were assessed. Results: Nineteen RCTs presenting data from 7 days to 30 months after root coverage surgery with various treatment modalities were included from the 662 identified studies. A total of 486 patients contributed 784 recession defects. Results from the subgroup meta-analyses showed that, overall, root coverage surgery reduced the risk for DH by 67% (RR, 0.33; 95% CI, 0.21 to 0.53) and 53% (RR, 0.47; 95% CI, 0.38 to 0.58) upon unstimulated and stimulated DH assessment, respectively. The DH intensity was also significantly reduced (mean visual analog score difference, 2.37; 95% CI, 2.02 to 2.71) upon stimulated DH assessment. No significant changes in DH intensity were observed upon unstimulated DH assessment. The included studies did not have high risk of bias and the quality of evidence was low to high. Conclusion: Existing evidence suggests that root coverage surgery may effectively reduce the DH frequency and intensity. Keywords: dentin hypersensitivity, gingival recession, surgical flaps

Objective: To explore the feasibility of screening for type 2 diabetes (T2DM) and the prevalence of adult patients seen in a dental clinic at risk for T2DM based on American Diabetes Association (ADA) diabetes risk test (DRT) scores and point of care hemoglobin A1C (A1C) values. Method and materials: This was a cross-sectional analysis of data from adults 18 to 89 years old seen in an academic dental clinic between November 2019 and April 2022 without prior history of diabetes. Clinical and demographic data were obtained from electronic health records and odontograms. Frequency distributions, chi-square, and Mann–Whitney U tests were used for data analysis. Results: Of the 13,519 patients whose data were included, 54.7% (n = 7,389) were women. Of those with race and ethnicity data, 53.6% (n = 2,871) were white, 40.2% (n = 2,153) were African American, and 29.5% (n = 1,559) were Hispanic/Latino. Mean ± SD age was 47.0 + 17.0 years; mean ± SD body mass index was 28.0 ± 6.1 kg/m2. Thirty-five percent (n = 4,774) had diabetes risk test scores reflecting T2DM risk. Those at risk were more likely to be older, male, and overweight/obese than those not at risk (P < .001). Of those at risk who consented to a point of care A1C (9.8%, n = 470), 40.2% (n = 189) had values consistent with dysglycemia (A1C ≥ 5.7%); 34.9% (n = 164) reflecting prediabetes (A1C = 5.7% to 6.4%) and 5.3% (n = 25) diabetes (A1C ≥ 6.5%). Conclusions: Diabetes screening in a dental clinic identified that over one-third of adults without T2DM were at risk based on diabetes risk test scores. Of those who had point of care A1Cs conducted; 40% had dysglycemia. Diabetes screening in an academic dental clinic can help identify patients at risk for T2DM. Keywords: dental setting, diabetes risk, diabetes risk test, diabetes screening, glycated hemoglobin, hemoglobin A1C, prediabetic state, type 2 diabetes

COVID-19 is a serious global infectious disease impairing the quality of life of people across the world. SARS-CoV-2 may reside in nasopharyngeal and salivary secretions of COVID-19-infected patients and spreads mainly through respiratory droplets and fomites. It has presented a challenge to dentistry, as many dental procedures generate aerosols that could lead to cross-contamination. It also presents many post-infection complications that may continue to debilitate patients, even after successful management of the virus. One such complication may be osteomyelitis of the jaw. Two cases of post-COVID-19 osteomyelitis of the jaw are presented that were determined to be unrelated to mucormycosis in otherwise healthy individuals with no prior dental complaints. An attempt is made to shed light on clinical signs in post-COVID cases that may point to a diagnosis of the condition. The pathophysiology is also discussed, which may help in formulating guidelines to prevent and manage post-COVID osteomyelitis of the jaw. Keywords: bacterial infections and mycoses, case report/series, incidental findings, jaw destruction, mandible, post-COVID

Objectives: In early life, children are exposed to microorganisms from maternal and environmental sources, which influence the development of their microbiome throughout life. Several studies have demonstrated the influence of the delivery mode and breastfeeding on the oral microbiome of children, mostly regarding bacterial colonization. However, their influence on the oral fungal carriage is still underexplored. This study aimed to assess the association of the delivery and feeding mode with the oral carriage of yeasts in adulthood. Method and materials: Fungal oral carriage was evaluated by collecting unstimulated saliva in 185 healthy dental students (mean age of 21.51 ± 1.55 years old; 81.6% women). Yeast identification was performed by culture in ChromAgar Candida medium and sequencing of the 18S genes and ITS regions for determination of the species. Demographic and clinical data of each participant were recorded through questionnaires, and oral examinations were performed in a subgroup of participants (n = 49). Results: Candida species were isolated in 37.5% of all participants. The prevalence of yeasts in the oral cavity was significantly higher in those who were born by vaginal delivery compared to those born by caesarean section (P = .035), whereas no statistically significant differences were observed regarding breastfeeding (P = .398). Low salivary flow rate and frequency of dental visits also were associated with oral yeast carriage (P < .05). Conclusion: The results suggest a possible impact of the type of delivery on fungal colonization, which is sustained throughout life due to oral health-related factors. Keywords: breastfeeding, Candida, mode of delivery, oral carriage, saliva, yeasts