Quintessence International, 05/2025

Objectives: The purpose of this study was to evaluate differences in marginal bone level and survival rates of implants placed in lateral-window sinus floor elevation (LSFE) sites compared to other sites. Method and materials: Patients with a history of LSFE and subsequent implant placement were identified. Clinical and radiographic data were collected by two calibrated examiners and divided into three cohorts for the analysis, including (1) implants placed in the LSFE-grafted sinus, (2) implants placed in the maxilla at sites other than grafted sinus, and (3) implants placed in the mandible. Implant survival rate and marginal bone level were recorded and calculated. The potential influences of several host-, implant-, and surgery-related factors on implant survival rate and marginal bone level were analyzed using generalized estimating equations. Results: 427 implants from 99 patients (63.8 ±12.5 years) with an average follow-up period of 32.3 ± 29.2 months were analyzed. The cumulative implant survival rate at the grafted sinuses was 93.63%. Mean marginal bone level was 0.44 ± 0.79 mm, 0.84 ± 1.21 mm, and 0.85 ± 1.16 mm for implants in group 1 (n = 142), group 2 (n = 129), and group 3 (n = 147) (P = .01). The majority of marginal bone loss occurred within the first 12 months after implant placement. The status of smoking and periodontal disease did not impact implant survival rate or marginal bone level for any group (P > .05). Neither sinus membrane perforation nor grafting materials affected marginal bone level (P > .05) in group 1. Conclusion: The utilization of LSFE and the presence of sinus membrane perforation during LSFE had no negative impact on implant outcomes. (Quintessence Int 2025;56:344–353; doi: 10.3290/j.qi.b6120624) Keywords: dental implants, implantology, marginal bone level, oral surgery, sinus, sinus elevation

Objectives: To describe the second and third years of “Smiles,” with the objective of demonstrating feasible, practical, and realistic aspects of enhancement of daily toothbrushing skills and integration of a supportive environment of daily supervised toothbrushing in kindergartens. Method and materials: In total, 36 out of 180 kindergartens (20%) across Israel that participated in the first year of the program, took part in the second and third years of the program. Eighteen kindergartens served as the study group with a supervised toothbrushing routine, and 18 kindergartens served as controls without a supervised toothbrushing routine. Toothbrushing skills were recorded using the Simmons Index at baseline among 3-year-old children, after 1 year, and finally after 2 years among 5-year-old children. Early childhood caries was evaluated by decayed, missing, and filled tooth (dmft) Index among 5-year-old children at the end of the program. Statistical analysis included the chi-square test, Mann–Whitney test, and a generalized linear model. Results: 1,028 preschool children (503 of them in the daily toothbrushing kindergartens), their parents, and their educational staff took part in the program. The average number of brushing days per week at the daily supervised toothbrushing kindergartens met the desired threshold of 3 days a week. The average daily percentage of preschool children brushing their teeth exceeded 80%. High levels of program cooperation and satisfaction (> 80%) were recorded. Children in toothbrushing kindergartens demonstrated statistically significant three-fold higher levels of toothbrushing skills improvement as compared to children in control kindergartens (33% compared to 11%, respectively; P .001). Being in the Jewish sector and participation in the daily toothbrushing program were revealed as predictors of low dft scores among 5-year-old children (odds ratio [OR] = 0.320, OR = 0.552, respectively; P .001). Conclusion: The successful performance and positive atmosphere of “Smiles” at all its levels (the organization, the staff, the parents, and the children) made this endeavor an example of a large-scale demonstration program with practical and realistic enhancement of daily toothbrushing skills and integration of daily supervised toothbrushing among preschool children in kindergartens. Following the introduction of the “Smiles” program results to the Ministry of Health in 2017, this service became part of the dental health service for pupils in Israel in 2018. (Quintessence Int 2025;56:354–363; doi: 10.3290/j.qi.b6156591) Keywords: caries, community program, kindergarten, oral health, toothbrushing

Objective: This study aimed to evaluate the effect of recombinant human bone morphogenic protein type-2 (rhBMP-2) on the alveolar ridge in the post-extraction socket in humans. Method and materials: 20 subjects with 25 teeth of the maxilla were included (11 sockets in the control [blood clot] and 14 in the test group [rhBMP-2]). The teeth were minimally and traumatically extracted. CBCT images were obtained 2 (T0) and 120 (T1) days after extraction. The buccal bone wall height, palatal bone wall height, and alveolar area were compared between both groups, as well as the volumetric contraction through overlapped images (T1 − T0) using Mimics software. The data were compared using the Mann–Whitney test (P .05). Results: The intragroup evaluation showed a significant buccal and palatal crest height resorption in the control group (P .05). In the intergroup assessment, the test group was superior to the control group in maintaining the average alveolar ridge area since the control group showed an area loss of approximately 39% between T0 and T1, whereas this reduction was approximately 15% in the test group (P .05). Conclusion: It is possible to conclude that using rhBMP-2 after tooth extraction resulted in better socket preservation, maintaining 2.5 times greater bone availability in the alveolar ridge than that of the control group. Keywords: alveolar ridge preservation, dental implant, graft, growth factor, rhBMP-2

Multiple myeloma is a well-known hematologic malignancy. Development of multiple myeloma usually follows a spectrum of patterns over the course of the disease. Multiple myeloma is associated with higher relative mortality rates. Early diagnosis and management might help limit the disease process, reduce the associated morbidities, improve prognosis, survival, and quality of life among these patients. Multiple myeloma remains a diagnostic challenge owing to its diverse clinical presentation. Common symptoms associated with multiple myeloma are bone pain, anemia, generalized weakness, and weight loss. Numb chin syndrome characterized by numbness of lip and/or chin might be an initial presentation symptom in multiple myeloma patients. This manuscript presents two cases of multiple myeloma with numb chin syndrome and mandibular radiolucency. Correlation of CBCT findings with clinical symptoms of numb chin syndrome were instrumental in prompting diagnostic work up for multiple myeloma in these patients. The diagnosis was confirmed by bone marrow biopsy and other investigations. Early identification of these presentations might help reduce if not eliminate the delay encountered in the diagnosis of multiple myeloma. (Quintessence Int 2025;56:376–380; doi: 10.3290/j.qi.b6217927) Keywords: diagnostic delay, hematologic malignancy, multiple myeloma, numb chin syndrome, punched out radiolucency

Objectives: This systematic review and meta-analysis aimed to evaluate and compare the comfort levels of custom-made mouthguards and self-adapted mouthguards used by athletes. Key parameters assessed included fit, speech interference, and breathing difficulties. Method and materials: The review was registered with the Prospective International Registration of Systematic Reviews (PROSPERO). A comprehensive literature search was conducted across PubMed, EBSCOhost, Scopus, and Google Scholar, supplemented by additional citation searches. Two independent reviewers assessed the relevance of the studies, and studies were included based on predefined eligibility criteria. Nine studies were included for qualitative analysis, with the risk of bias assessed using standard NIH and revised JBI tools. Meta-analysis was performed with three studies to synthesize the results. Results: The analysis demonstrated that custom-made mouthguards significantly outperformed self-adapted types in comfort metrics, particularly in fit (P = .0002) and reducing speech difficulty (P .00001). At the same time, breathing difficulty was also less in custom-made mouthguards (P .00001). Conclusions: Custom-made mouthguards provide superior comfort (fit and speech) compared to self-adapted alternatives, enhancing their potential for widespread adoption. The findings highlight the need for further research as limited clinical studies were available for meta-analysis. (Quintessence Int 2025;56:382–392; doi: 10.3290/j.qi.b6184319) Keywords: athlete comfort, breathing difficulties, custom-made mouthguards, self-adapted mouthguards, speech interference

Morgellons disease is a rare controversial illness in individuals which is characterized by having a fixed, false belief (delusion) in which they are infested by non-living organisms, despite medical evidence which proves the contrary. The symptoms can appear solely in the oral cavity, a condition that had not previously been described in the dental literature. The underlying mechanisms behind these findings remain unclear; moreover, established diagnostic criteria or effective treatments were unsuccessful. This case report highlights the sensations of feeling hair and threads between the teeth of patients with Morgellons disease, as well as an unusual perception of the tongue and saliva that was self-reported. Conventional medical treatments have not been effective in alleviating those oral symptoms. Taking into account the scarcity of cases in the dental literature, the article underscores the importance of interdisciplinary approaches, in order to enhance diagnosis and treatment by integrating oral and mental health care. (Quintessence Int 2025;56:394–400; doi: 10.3290/j.qi.b6156580) Keywords: Ekbom syndrome, Morgellons disease, oral cenesthopathy, oral manifestation, psychiatry

Objectives: Adolescents with intellectual and developmental disabilities are at increased risk of oral diseases due to physical limitations, poor oral health awareness, and inadequate dental hygiene practices. The aim of this study was to evaluate the oral health status of adolescents with intellectual and developmental disabilities and to analyze changes in their dental hygiene habits following subsequent visits and oral hygiene education. Method and materials: This pilot longitudinal observational study involved students with mild to moderate intellectual and developmental disabilities from a special needs school. Oral health was assessed using the decayed, missing, and filled teeth (DMFT) index, International Caries Detection and Assessment System (ICDAS-II), Basic Erosive Wear Examination (BEWE), Developmental Defects of Enamel (DDE), and Simplified Oral Hygiene (OHI-S) indices. Participants received oral hygiene training, and their brushing techniques were evaluated using the Oral Hygiene Skills Survey. Data on brushing frequency, skills, toothpaste use, and OHI-S scores were collected at baseline and at 1-, 3-, and 6-month follow-ups. Results: Twenty-three participants aged 14 to 19 years were evaluated, showing high DMFT scores (mean 10.91 ± 6.06), advanced caries in 78.3%, and enamel defects and erosive tooth wear in 65.2%. Significant improvements were observed in toothbrushing frequency (P = .008), with reductions in OHI-S scores (P = .001) and enhanced brushing skills (P = .016) during follow-ups. Conclusion: The findings indicate a high prevalence of dental caries, enamel defects, and erosive tooth wear among adolescents with intellectual and developmental disabilities. Despite poor baseline oral hygiene practices, regular follow-ups and oral hygiene education significantly improved oral hygiene habits and outcomes. (Quintessence Int 2025;56:402–410; doi: 10.3290/j.qi.b6156604) Keywords: dental caries, developmental enamel defects, erosive tooth wear, intellectual disability, oral hygiene, special care needs

Objective: To examine the changes in dental practice in response to the COVID-19 pandemic 6 to 12 months after its outbreak. Method and materials: An electronic survey was disseminated among dental practitioners from Brazil, India, and Israel between August 2020 and April 2021. The questionnaire comprised two sections: 1) participant demographics and participant characteristics, and 2) working conditions during the COVID-19 pandemic. Results: In total, 979 respondents (72.6% females) completed the questionnaire (56.9% Brazilian, 24.6% Israeli, 18.5% Indian). About two-thirds of Brazilian (62.1%) and Indian respondents (68.4%) and 54.8% of Israeli respondents provided emergency care during the first wave of the pandemic; a fifth or lower treated patients with COVID-19. Most respondents reported changes in their appointment management, along with decreased income compared to the period before the pandemic, attributed to the decrease in the number of treatments together with increased expenses, mainly on equipment, protection, and disinfection. More than half of Indian and Israeli respondents reported that guidelines provided by the Ministry of Health were very clear, compared to 31% of Brazilian dental practitioners. Only 35.8% of Brazilian respondents reported that they had received clear instructions regarding conduct in the clinic compared to 69% and 72% of Indian and Israeli respondents, respectively. Conclusions: Dental practitioners from three very different countries around the world faced similar challenges in their practices during the first months of the COVID-19 pandemic. Although most participants adjusted to the alterations in their professional routines necessitated by pandemic-related restrictions, these modifications also resulted in shifts in clinicians’ workloads, elevated expenditures, and reduced income. Public health guidelines provided to dental practices by the authorities were not always clear. Understanding these challenges and how to deal with them should help cope better with future worldwide crises. (Quintessence Int 2025;56:412–423; doi: 10.3290/j.qi.b6153663) Keywords: COVID-19, dental clinic, dental practice, guidelines, protection