Quintessence International, 01/2024

Objective: Inflammatory pathogenesis is common to periodontitis and oral lichen planus. This study was conducted to assess and compare the periodontal status of patients with and without oral lichen planus. Method and materials: 108 patients comprising 54 with oral lichen planus and 54 age-matched systemically healthy participants without oral lichen planus were selected. Periodontal parameters, ie Plaque Index, Gingival Index, bleeding on probing, probing pocket depth, clinical attachment level, and periodontal phenotype were measured. Results: On comparing the test and control groups, statistically significant differences were observed in respect to Plaque Index (P = .00), Gingival Index (P = .00), and bleeding on probing (P = .00). A higher proportion of sites with deeper pockets was observed in the test group (P = .00). On comparison of various oral lichen planus subtypes, significant difference was observed in respect to Gingival Index (P = .00) and bleeding on probing (P = .00). A higher proportion of sites with deeper pockets (P = .01) and greater CAL (P = .00) was observed in the erosive/atrophic subgroup compared to the reticular group. However, the differences between the reticular (a less severe form of oral lichen planus) and control group in terms of Gingival Index (P = .94), Plaque Index (P = .05), bleeding on probing (P = .17), probing pocket depth (P = .56), and clinical attachment level (P = .23) were not statistically significant. Statistically significant differences were observed in terms of Gingival Index (P = .01) and bleeding on probing (P = .00) between thin and thick periodontal phenotypes in the oral lichen planus group. Statistically significant positive correlations in periodontal parameters with increased gingival involvement and severity were observed using Spearman rank correlation coefficient. Conclusion: Significantly greater periodontal inflammation in the test group means there is a risk of greater attachment loss in future. Thus, increased attention towards periodontal health in these patients might reduce the rate of disease progression. Keywords: cytokines, inflammation, oral lichen planus, periodontitis

Objectives: Microneedling and injectable platelet-rich fibrin (i-PRF) have been proposed as relatively less invasive alternatives to surgical procedures for augmentation of thin periodontal phenotype. The present study was conducted to evaluate the effect of microneedling and i-PRF alone on gingival thickness in thin periodontal phenotype individuals. Method and materials: Systemically healthy individuals with thin periodontal phenotype in mandibular anterior teeth (n = 21) were treated with microneedling on one side and i-PRF on the contralateral side. Assessment of gingival thickness, keratinized tissue width, and periodontal parameters was done at baseline, and at 1, 3, and 6 months. Results: In intergroup comparison, a statistically significant increase in gingival thickness was observed with microneedling as compared to i-PRF at 6 months (P < .02). Intragroup comparison from baseline to 6 months showed a statistically significant increase in gingival thickness within both the groups: microneedling from 0.78 ± 0.12 mm to 1.00 ± 0.14 mm (P < .000), and i-PRF from 0.77 ± 0.10 mm to 0.93 ± 0.12 mm (P < .000). Intragroup comparison showed a statistically significant increase in keratinized tissue width in the microneedling group (P < .000). A statistically significant decrease in periodontal parameters was observed on intragroup comparison (P < .000). Conclusion: Considering the higher gain in gingival thickness and the added advantage of eliminating need for autologous blood withdrawal, microneedling is potentially better than i-PRF for phenotype modification in thin periodontal phenotype individuals. Keywords: gingiva, phenotype, platelet-rich fibrin

Objectives: The consecutive case series accesses the results and experiences of ridge augmentation using an umbrella screw tenting technique. Method and materials: In total, 279 patients were treated between 26 May 2015 and 16 June 2021, including horizontal and vertical ridge defects. Sex, age, smoking behavior, jaw, graft material, soft tissue thickness, extent of horizontal/vertical augmentation, resorption rate, and occurrence of early/late exposure were evaluated. Bone gain was determined by resorption at the screw head. Only cases without premature screw removal were evaluated metrically (n = 201). All other augmentations were evaluated according to whether implantation was possible with or without further augmentation (n = 27). A target performance index was calculated, which should enable evidence-based comparability of different augmentation methods in future. Results: In total, 54 wound dehiscences (39 early, 15 late exposures) occurred, which corresponds to 24.08% of the augmented sites; 42 umbrella screws were removed prematurely. In all cases an implantation was possible at the desired position afterwards. Cases with a vertical augmentation component showed a higher prevalence of exposure (early, P = .000; late, P = .024). The extent of the vertical augmentation was only relevant for early exposure (P = .048). Mean bone gain of 4.23 ± 1.69 mm horizontally and 4.11 ± 1.99 mm vertically could be achieved. Regression analysis showed that there was no limit in horizontal/vertical direction. Mean percentage target performance index was 75.90 ± 20.54 for vertical and 82.25 ± 16.67 for horizontal portions. Conclusion: The umbrella technique is an effective augmentation method, which can be applied to any defect morphology. Keywords: horizontal ridge augmentation, implantation, ridge augmentation, target performance index, tenting technique, umbrella screws, umbrella technique, vertical ridge augmentation

Objectives: The aim of the present study was to evaluate clinical and radiographic outcomes of implants placed in alveolar sockets treated by means of alveolar ridge preservation after 10 years of follow-up. Method and materials: Eleven patients treated with 11 implants placed after alveolar ridge preservation using bovine-derived xenograft particles and collagen membrane were selected. Full-mouth plaque score, full-mouth bleeding score, probing depth at four sites per implant, and radiographic marginal bone level at mesial and distal aspects for each implant were recorded at baseline and after 10 years of follow-up. The primary outcome was the radiographic marginal bone loss. The marginal bone loss was considered as the difference between marginal bone level at baseline and after 10 years of observation time. Results: After 10 years of follow-up, full-mouth plaque score increased significantly (P < .05), while no statistically significant differences were found in the change in full-mouth bleeding score (P ≥ .05). At the 10-year observation period, a significant increase in probing depth was observed at all sites (P < .05), except at the mesial aspects (P ≥ .05). Radiographic marginal bone loss was 1.1 ± 0.1 mm and 1.0 ± 0.1 mm at mesial and distal sites, respectively. Conclusion: Whitin the limitations of the present study, implants placed in post-extraction sockets treated with alveolar ridge preservation yielded stable clinical and radiographic results after 10 years of follow-up. Keywords: alveolar bone loss, biomaterials, bone regeneration, dental implant, dental prothesis, tooth socket

Objective: The aim of the present study was to investigate whether psoriasis disease constitutes a risk factor for OLP, by assessing the prevalance of psoriasis in a test group with OLP and the control group without. Method and materials: A cohort of consecutive patients diagnosed clinically and histologically with OLP between 2014 and 2022 was analyzed. The results were contrasted with those obtained in control series matched for age and sex. The correlations between OLP and sex, age, tobacco, alcohol consumption, and psoriasis were assessed using Pearson chi-square test. Multivariate regression analysis was performed to evaluate the association between psoriasis and OLP. For the assessment of the quality of the statistical models, the Akaike information criterion was used. Results: The study involved 1,016 patients; 738 women (72.6%) and 278 men (27.4%). The average age was 59.38 ± 12.55 years. Of 508 patients with OLP, 16 (3.15%) had comorbid psoriasis, and this was 5 (0.98%) in the control group. Age, sex, smoking, and alcohol habits were not predictive variables in the relationship between psoriasis and OLP in these patients. There were statistically significant differences in relation to the number of locations, with greater extension in patients with OLP and psoriasis (P = .002). According to the multivariate analysis, the odds ratio of OLP for psoriasis was 3.13 (95% CI 1.20–9.68). Conclusions: This is the first study showing the potential association between psoriasis and OLP, and the results should be considered to improve knowledge of comorbidity of OLP. Based on the results, it is recommended that clinicians collect data regarding history of psoriasis in patients with OLP, and consider possible multiple intraoral locations. Keywords: anxiety, comorbidity, depression, drugs, oral lichen planus, psoriasis, relationship, risk factor

Oral dysesthesia (OD) is a diagnosis of exclusion that manifests as an unpleasant and abnormal sensation of the oral mucosa without any noticeable oral lesions. Burning sensation is one of the manifestations of OD which may advocate for similar pharmacotherapeutic options to burning mouth syndrome (BMS), resulting in possible adverse events. The aim of these case reports was to illustrate the significance and rationale for the use of oral devices as a mechanical/physical barrier and a safe approach in the management of OD, without experiencing any antagonistic effects from pharmacotherapeutic agents. Two patients with spontaneous and evoked (following dental procedures) OD symptoms in the right posterior mandibular quadrant and anterior hard palatal areas were evaluated. Additionally, their OD symptoms were associated with hyposalivation and taste changes. A thorough history and complete head and neck examination, with the exclusion of oral lesions and systemic conditions, were performed. These patients were previously prescribed topical clonazepam rinses. An in-office trial, with application of orthodontic wax to the affected area, was performed as a preliminary test in order to justify the fabrication of an oral device for possible symptomatic relief. Conclusion: The case reports demonstrated significant improvement of OD symptoms and amelioration of pain following fabrication of oral devices in two patients with no undesirable effects from pharmacotherapy. Additionally, the oral devices aided as a mechanical/physical barrier, potentially exerting a placebo effect while facilitating an improved quality of life. Furthermore, the cost-effectiveness and ease of fabricating the oral device has been advantageous over other systemic medications. This encourages the need for a detailed prospective study. Keywords: burning mouth syndrome, central and peripheral sensitization, mechanical/physical barrier, oral devices, oral dysesthesia, somatization

Bariatric dentistry is the branch of dental medicine focused on preventive and comprehensive oral health care of overweight or obese patients. Obesity is an increasing US and international health problem and is a condition characterized by abnormal or excessive fat accumulation in the adipose tissue and is categorized by body mass index (BMI) according to the World Health Organization (WHO). With the increase of morbid obesity worldwide and the unfavorable effect on the overall health and life expectancy, it is necessary that proper accommodations are made for accessible dental care of this vulnerable population of patients. The following case report details the emergency and the subsequent elective dental treatment of a patient with a morbid obesity and demonstrates the importance of necessary equipment, a multidisciplinary approach, and broad networking communication needed to treat bariatric patients. The aim of the present case report was to bring awareness and start professional discussions on the importance of dental practitioners in the community and dental academic programs working together to assure access for primary oral health for bariatric patients. Keywords: bariatric dental bench, bariatric medicine, bariatric surgery, Class III obesity, dentistry, morbid obesity, obesity

Objectives: The prevalence and the economic burden of periodontal disease are high. To save or replace diseased teeth, an objective prognosis assessment using the long-term predictability of the various treatment options should be performed. As dental implants have become a treatment of choice for replacing missing teeth, the number of implant failures and complications has also increased. The objective of this review was to compare the cost-effectiveness of saving and maintaining the teeth vs replacing them with dental implants in patients with severe periodontal disease (with hopeless or questionable teeth). Method and materials: A database search was conducted using Medline (OVID), Embase, Web of Science, and CINAHL electronic sources until July 2023. Two reviewers reviewed the papers in accordance with the specific selection criteria after choosing the abstracts that met the initial selection criterion for full article retrieval. Results: Twelve articles were included, of which nine articles discussed the cost-effectiveness of preserving teeth in severe periodontal disease and three articles discussed the effectiveness of implants that replaced the periodontally compromised teeth. It was found that placing and maintaining implants was more costly than properly treating and maintaining periodontally compromised teeth. Supportive periodontal treatment contributed the most to the cost during the periodontal treatment. Conclusions: Implants are an effective choice to replace missing teeth; however, these are not permanent, present complications, and require strict maintenance. Thus, when deciding whether to maintain a periodontally compromised tooth or to replace it with a dental implant, in terms of cost-effectiveness, implant maintenance cost as well as the cost associated with treating implant complications should be considered. This cost seems to surpass the cost of treatment and maintenance of periodontally compromised teeth. Keywords: bone graft, extraction, plaque, success, survival