Dent. J., Volume 10, Issue 2 (February 2022) – 18 articles

This study examined the success rates of single immediate implants and their associated biological, hardware and aesthetic complications. Using a developed search strategy, randomized controlled trials (RCTs) on single-unit immediate implants with at least six human participants, a minimum follow-up time of 12 months and published between January 1999 and January 2021 were identified. Data was extracted independently using pre-designed data extraction forms. Information on success rates and associated biological, hardware and aesthetic complications were obtained and assessed. Out of 191 potentially eligible studies, 26 RCTs assessing 1270 patients with a total of 1326 single implants were included and further evaluated. In this review, success rate was reported to be 96.7–100% over a total of 9 studies. However, there was a lack of consensus on a universal success criterion between authors emphasizing the need for agreement. The average follow up was 29 months and most reported complications were aesthetic (63 cases, 4.7%), whilst there were relatively fewer biological, (20 cases, 1.5%), and hardware complications (24 cases, 1.8%). Success rate is an uncommon clinical outcome with 9 out of 26 of the selected RCTs reporting it. In these studies, single immediate implants showed a high success rate with low numbers of biological and hardware complications, and high patient satisfaction with aesthetics were reported in the short-term follow-up of one year. Full article

Background: The aim of this study was to comprehensively evaluate the cyclic fatigue strength of ProGlider, Edge Glide Path, and R-Pilot instruments. Methods: Sixty-three instruments were submitted to a multimethod evaluation. Their design was analyzed by stereomicroscopy and scanning electron microscopy, including the number of blades, helical angle means, cross-sectional design, surface finishing, and symmetry. Energy-dispersive X-ray spectroscopy was used determine the nickel/titanium elements ratio, and differential scanning calorimetry determined the instruments’ phase transformation temperatures. The cyclic fatigue tests were conducted in an artificial canal with a 6 mm radius and 86 degrees of curvature. The Mood’s median test and one-way ANOVA were used to determine differences, with the significance level set at 0.05. Results: The ProGlider presented the highest number of blades (n = 21), while R-Pilot had the highest helical angles (26.4°). Differences were noted in the instruments’ cross-sections and surface finishing. The ProGlider and R-Pilot showed some similarities regarding the phase transformation temperatures but differed from the Edge Glide Path. All alloys showed an almost equiatomic nickel/titanium ratio. The R-Pilot instruments showed a significantly higher (p < 0.05) time to fracture than both the other files. Conclusion: Reciprocating R-Pilot instruments showed a higher cyclic fatigue time to fracture than the ProGlider and Edge Glide Path rotary files. Full article

Background: The maintenance of ridge volume following tooth extraction has gained more importance in the last few years. This clinical study aimed to assess the impact of autologous dentin particles mixed with injectable platelet-rich fibrin (i-PRF) on a sticky tooth mixture for socket preservation in terms of consecutive need for horizontal guided bone regeneration and histological findings. Methods: Eight extraction sockets in seven patients were included in this study. Autologous dentin particles were mixed with PRF, filled in the sockets, and covered with a cross-linked collagen membrane exposed to the oral cavity and fixated by crisscross sutures. An orthopantomogram was taken before the first surgical procedure and a CBCT prior to static computer-aided implant surgery. At the time of implant placement, cores were harvested with the aid of a trephine for histological examinations for every preserved socket. Results: No further horizontal GBR intervention was required in any cases, and the histological findings were unremarkable. The new bone was mostly cancellous and in direct contact with the remaining dentin granules. Conclusions: Within the limits of this clinical study, it may be concluded that this method is valuable for socket preservation and obtaining vital and good quality bone structure. The sticky tooth technique seems to be very efficient despite the more complex equipment. Full article

This research work presents an analysis of the process of an implant’s osseointegration to the jawbone tissue. The purpose of this work was to describe the processes of assimilation and the biochemical dynamics which occur during dental implantation using implants with different macro-microstructure surfaces at the level of stable free radicals using the electron paramagnetic resonance (EPR) method. The experimental investigation was conducted on seven Vietnamese minipigs over twelve months old and weighing up to 30 kg using implants with various macro-microstructure surfaces (SLA, RBM, and HST^TM) and implantation systems, namely the Adin, Sunran, Biomed, and Osstem systems. The integration of the implant into the bone triggered biochemical processes with the formation of stable free radicals. The EPR method was used to identify the formed paramagnetic species and to study the dynamics of the interaction between the surface of the implant and the bone after one and two months. The concentration of carbonate surface centers increased with the time that the implant was connected to the hard tissue. The “Sunran” and “HST^TM” were established as the most suitable implantation system and surface type, respectively, thanks to the highest rate of osseointegration (assimilation) with the bone (hard) tissue. Thus, the EPR method provides the opportunity to study implantation processes. Full article

The aim of this study was to investigate and compare the leaching of four different clear aligner systems (Invisalign^®, Eon^®, SureSmile^®, and Clarity^®). Three sets of aligners as obtained from the four manufacturers were cut and immersed in glass vials containing ethanol with different solutions. The first was 100% ethanol, the second was 75% ethanol to 25% water, the third was 50% ethanol to water, the fourth was 25% ethanol to 75% water, and the last was 100% water. The samples were incubated for two weeks at 37 °C. Leached substances were detected by the gas chromatography–mass spectrometry (GC-MS). Eleven different chemical compounds were detected and confirmed. Benzene1,3-bis(1,1-dimethylethyl) was the only compound detected in all four systems at levels of 100% and 75% ethanol. Statistically, insignificant differences were detected among the different systems where leaching was confirmed. Eon^® system was the only material to show statistically significant differences when comparing the number of leached substances among the immersion solution concentrations. The four included systems showed variable degrees of leaching. The lowest amount of leached chemicals was observed in relation to the Invisalign^® system, while the highest number was found in the Eon^® system. None of the included clear aligner systems leached detectable amounts of bisphenol-A (BPA). Full article

Background: The COVID-19 pandemic caused many universities to expand their use of videoconferencing technology to continue academic coursework. This study examines dental students’ experience, comfort levels, and preferences with videoconferencing. Methods: Of 100 s-year US dental students enrolled in a local anesthesia course, 54 completed a survey following an online synchronous lecture given in August 2020. Survey questions asked about prior experience with videoconferencing, comfort levels with online and traditional classes, and reasons for not turning on their video (showing their face). Results: Overall, 48.2% had little or no experience with videoconferencing prior to March 2020. Students were more comfortable with in-classroom parameters (listening, asking questions, answering questions, and interacting in small groups (breakouts)) than with online synchronous learning, although differences were not significant (p’s > 0.10). Regression analyses showed there were significant positive associations between videoconferencing experience and comfort with both answering questions and interacting in breakouts (B = 0.55, p = 0.04 and B = 0.54, p = 0.03, respectively). Students reported being more comfortable during in-classroom breakouts than in breakouts using videoconferencing (p = 0.003). Main reasons for students not turning on their cameras were that they did not want to dress up (48.1%), other students were not using their video features (46.3%), and they felt they did not look good (35.5%). Conclusions: Dental students were somewhat more comfortable with traditional in-person vs. online classroom parameters. Prior experience with videoconferencing was associated with increased comfort with synchronous learning, suggesting that after the pandemic, it may be beneficial to structure dental school curricula as a hybrid learning experience with both in-person and online synchronous courses. Full article

Soluble tumor necrosis factor receptors 1 and 2 (sTNF-R1 and sTNF-R2) are reported to protect against excessive TNF-α, a primary mediator of systemic responses to infection. This study aimed to investigate the levels of TNF-α, sTNF-R1, and sTNF-R2 in saliva and to verify whether their dynamics are associated with periodontal health. The study population comprised 28 adult patients. Probing pocket depth, clinical attachment level, and bleeding on probing were assessed, and periodontal inflamed surface area (PISA) was calculated. Stimulated saliva was collected before the oral examinations. The levels of TNF-α, sTNF-R1, sTNF-R2, and total protein (TP) in saliva samples were determined. There were significant positive correlations between TNF-α, sTNF-R1, and sTNF-R2 to TP (/TP) in stimulated saliva. Moreover, there were significant positive correlations between PISA and sTNF-R2/TP. Stepwise multiple regression analysis revealed that PISA was significantly associated with sTNF-R2/TP in saliva; however, TNF-α/TP was not significantly associated with PISA. In conclusion, this study demonstrates that significant relationships exist between the salivary levels of TNF-α and sTNF-R1, and that salivary sTNF-R2 is associated with the expansion of inflamed periodontal tissue. Full article

Background: 3D models are nowadays part of daily clinical practice. Photogrammetry is a brand-new method for transforming small objects into 3D models while keeping their original shape and size. The aim of this study was to evaluate the accuracy, in terms of precision and trueness, of a digital dental model acquired with photogrammetry compared with those obtained using extraoral scanners and intraoral scanners, starting from the same plaster model. Methods: A plaster model was converted into a digital model using photogrammetry, an extraoral scanner and an intraoral scanner. Different references were measured twice at a distance of 30 min for each model, on the digital models using the software Blender and on the plaster model using a calibre. The Interclass Correlation Coefficient was calculated for each pair of measurements. A volumetric analysis was performed by superimposing the digital models. The coefficient of variation was calculated. A two-way ANOVA test was conducted. Results: For each reference, the coefficient of variation was less than 3%, and the two ANOVA tests resulted in a non-significant value in both cases (p > 0.05). The volumetric analysis demonstrated good agreement between the models derived from the different acquisition methods. Conclusions: Photogrammetry seems to be a good method for acquiring digital models starting from a plaster model, all the methods tested seem to be good for obtaining an accurate three-dimensional digital model. Other studies are needed to evaluate clinical efficacy. Full article

Introduction: Assessment of maxillary transverse discrepancy requires an accurate tool in order to implement the appropriate treatment plan. Aim: To evaluate the accuracy of Pont’s Index in confirming a transverse maxillary deficiency by comparing its results with the corresponding results yielded by the University of Pennsylvania CBCT analysis. Material and methods: The study was performed on dental casts and CBCT’s of 60 randomly selected patients by adopting a cluster sampling method. The results of Pont’s Index and University of Pennsylvania CBCT analysis were analyzed through McNemar’s test using Excel Data Analysis, and the accuracy indicators for Pont’s Index were computed using MedCalc Ltd. Results: Mc Nemar’s test revealed a p-value of 0.85. The accuracy indicators of Pont’s Index were: sensitivity: 69%; specificity: 16.6%; positive predictive value: 65%; negative predictive value: 18.75%; positive likelihood ratio: 0.83; negative likelihood ratio: 1.86; and accuracy: 53.28%. Conclusion: Due to the fact that CBCT is not used on a daily basis and Pont’s Index has a relatively high sensitivity (69%) making it suitable to detect patients with a narrow maxilla, assessment of the maxillary deficiency on CBCT can be recommended for cases were the midpalatal suture maturation should be evaluated. Full article

Background: To analyze the fracture resistance of zirconia implants within the anterior region and evaluate whether zirconia–zirconia implants can be a viable alternative to titanium implants. Methods: Four online databases (Cochrane Library, Ovid, PubMed, and Scopus) were searched for the period of January 2011 to July 2021. All studies that analyzed the in vivo clinical outcome of two-piece implants in the anterior region in English language were included. Results: The search strategy identified 242 studies. Of these studies, three studies were included for qualitative synthesis based on the pre-determined eligibility criteria. The results showed that there is significant difference in biological results, fractal behavior and other complications between one-piece and two-piece zirconia implants. Two-piece zirconia implants demonstrated favorable longevity and success rates within anterior maxillary in short-term trials. Conclusions: Although factors involved in fractures have been identified—sandblasting, implant diameter, occlusal load, age and implant coating—there is limited quantitative assessment to gauge the fracture resistance of two-piece zirconia implants. Hence, further research with long-term clinical evidence is required. Full article

This systematic review and meta-analysis studied the clinical outcomes with physics forceps compared to those with conventional forceps for closed dental extraction. A systematic literature search was performed to identify all the published randomized clinical trials that compared the relevant clinical outcomes with physics forceps to those with conventional forceps for closed dental extraction. A total of 11 studies were included. The adverse events were significantly lower with physics forceps (n = 48) compared to with conventional forceps (n = 120), with an odds ratio of 0.42 [0.25, 0.70], Z = 3.78 (p = 0.0002), and I² = 21%. There were statistically significant differences in the incidence of GL (p = 0.04), and tooth or root fracture (p = 0.0009). Operating time was significantly lower in physics forceps than that of conventional forceps, mean difference (−20.13 (−30.11, −10.15)), Z = 3.78 (p = 0.0001), I² = 79%. The available evidence is limited by a high risk of bias and low evidence certainty. Based on the current evidence, physics forceps might be better than the conventional extraction forceps in terms of the extraction duration, pain after extraction, trauma to both hard and soft tissue, and complications. Physics forceps are newer instruments that have not yet been introduced in the teaching of dental graduates. The introduction of physics forceps can be time saving, less invasive and reduce post-extraction complications. Full article

(1) Background: This systematic review aimed to evaluate the effects of laser therapy on radiographic bone level (RBL) changes in peri-implantitis defects. (2) Methods: A literature search with defined inclusion criteria was performed. PubMed, Web of Science, Cochrane Library, and Google Scholar were searched through September 2020. The evaluated primary outcomes were RBL changes. In studies that reported RBL data, corresponding secondary clinical outcomes were probing depth (PD), bleeding on probing (BOP), and clinical attachment level (CAL). (3) Results: Thirteen articles were selected for data extraction and risk of bias assessment. Eight studies showed evidence of RBL gain in the laser groups compared to baseline, but did not report the statistical significance. Eight of these 13 studies reported comparisons to control. Five of the eight studies did not show RBL gain in the laser groups compared to control. In the laser groups compared to baseline, 11 of 13 reported reduced PD, and 6 of 13 reported significantly reduced BOP. Compared to the control, eight of the eight reported reduction of PD, and three of six reported significantly reduced BOP. Statistical significance was not consistently reported. (4) Conclusions: Within the limits of this systematic review, laser treatment may promote bone gain in peri-implantitis defects, may reduce BOP and PDs, and may be comparable to mechanical therapy. However, definitive conclusions can only be made with statistically significant data, which were found lacking in the currently available studies. This systematic review was registered with the National Institute for Health Research, international prospective register of systematic reviews (PROSPERO): CRD42020207972. Full article

In the past, lip reconstruction after ablative surgery has been performed by primary closure and more recently by free flap transfer technique. Cheek’s skin flap has been used to reconstruct the lower lip cutaneous portion. This study presents a reconstructive method for the vermillion and the lip’s cutaneous portion using the Goldstein–Robotti techniques (for the vermillion) and the buccinator flap to reconstruct the cutaneous lip portion and the perioral muscles. This procedure allows a complete reconstruction with a double layer technique for defects of more than one-third of both lips, together or alone, including modiolus, showing satisfactory functionality and aesthetics. The procedure was carried out by splitting the buccinator muscle and elongating the upper and lower buccinator bundles, together or alone. Soft tissue blunt dissection prevented most facial nerves and vessels injuries, ensuring blood supply and an amount of lip sensitivity. Even in the case of facial vessel ligatures after neck dissection, the technique was possible basing the flap pedicle on the internal maxillary artery branches (buccinator) and contralateral facial vessels (orbicularis). We present a case series of six reconstructions of various defects of the upper and lower lips, including the commissure after ablative surgery for squamous cell carcinoma and polymorphous adenocarcinoma. The results showed satisfactory functional and aesthetic outcomes, with similar tissue texture, static and dynamic symmetry achieved for all the patients. Full article

Oral angiokeratoma is a rare vascular lesion that has various clinical presentations. It usually occurs as part of generalized angiokeratoma and rarely appears as a solitary lesion with no underlying systemic diseases. Only 33 cases were reported so far worldwide. In this case report, we present a rare case of isolated solitary oral angiokeratoma in a 22-year-old female patient, which is the first case to be reported in the labial mucosa that has been treated successfully by surgical excision. Full article

Several links between chronic liver disease and oral health have been described and are discussed in this narrative review. Oral manifestations such as lichen planus, ulcers, xerostomia, erosion and tongue abnormalities seem to be particularly prevalent among patients with chronic liver disease. These may be causal, coincidental, secondary to therapeutic interventions, or attributable to other factors commonly observed in liver disease patients. In addition, findings from both experimental and epidemiological studies suggest that periodontitis can induce liver injury and contribute to the progression of chronic liver disease through periodontitis-induced systemic inflammation, endotoxemia, and gut dysbiosis with increased intestinal translocation. This has brought forward the hypothesis of an oral-gut-liver axis. Preliminary clinical intervention studies indicate that local periodontal treatments may lead to beneficial liver effects, but more human studies are needed to clarify if treatment of periodontitis truly can halt or reverse progression of liver disease and improve liver-related outcomes. Full article

Coronavirus disease 2019 represents the pandemic of the 21st century that has negatively affected the lives of the whole of humanity. For many months, the only weapons to fight against this infection were protective masks and social isolation. During recent months, fear of the virus has led people to avoid crowded environments and events, and to reduce medical checks, limiting them only to emergencies. Outpatient clinics, doctors’ offices, and all closed-in environments were required to limit the patients’ access. Nowadays, the presence of specific protocols around the world, and the extended vaccination campaign, have allowed a reduction of many restrictions. Unfortunately, the virus is still widespread, and dental practice and dental treatments suffer the consequences. Dental therapies in general, and in particular orthodontics, are not considered lifesaving. Due to this, orthodontists, in this historical time, must find solutions for motivating patients to start or continue therapies, while providing a safe way for them to do so. There are orthodontists who have developed, during this period, different ways to help them in treating and communicating with patients. Aim: The aim of this study is to assess the influence of the pandemic on the choice to start orthodontic treatment, oral health care, and the importance placed on the appearance of dental occlusions. Materials and Methods: This study is a survey analysis of 159 people, which was posted in Facebook groups of adult orthodontic patients. The timestamps and answers of responses were analyzed to avoid duplicated or interrupted questionnaires. Conclusions: This study found that the current health emergency has not reduced the demand for orthodontic care, while some patients’ behaviors are changing in relation to oral hygiene and the importance that they attribute to dental health. It seems that dentists’ availability plays a key role in this period of sanitary emergency. Full article

Previously, bite force, occlusal contact and pain were investigated in orthodontic patients with moderate-to-severe malocclusion, but not in patients with minor malocclusion. The purpose of this study was to investigate changes in bite force, teeth in occlusal contact and pain in orthodontic patients with minor crowding before orthodontic treatment (T0), after bonding (T1), during treatment (T2), post-treatment (T3) and during retention (T4). In total, 27 patients (21 females, 6 males, median age 15.3 years) with neutral occlusion and normal craniofacial morphology were treated with non-extractions and fixed appliances. Differences in the registered data were analysed by a mixed linear model with repeated measures. Bite force and teeth in occlusal contact significantly decreased between T0 and T1 (p < 0.0001, respectively) and between T0 and T2 (p < 0.01, respectively). Bite force and teeth in occlusal contact significantly increased between T1 and T4 (p < 0.05, p < 0.0001, p < 0.001, respectively) and between T2 and T4 (p < 0.05, p < 0.0001, p < 0.01, respectively). No significant difference in pain was found. The results indicate that bite force and teeth in occlusal contact significantly decreased during treatment and reached baseline level at retention. The findings may prove valuable for informing orthodontic patients with minor malocclusion. Full article