Dentistry Journal最新文献

Background: The World Health Organisation (WHO) included silver diamine fluoride (SDF) in the WHO Model List of Essential Medicines for the management of early childhood caries. SDF is typically available as a 38% aqueous solution, which is watery to apply. A 38% SDF gel has recently been developed, but its caries-arrest effectiveness remains unsubstantiated. The objective of this study is to determine whether the efficacy of a 38% SDF gel is non-inferior to a 38% SDF solution in arresting early childhood caries. Methods: This is a 30-month, randomised, active-controlled, parallel-group non-inferiority pragmatic clinical trial with two arms. The hypothesis is that the 38% SDF gel is not worse than the 38% SDF solution by a non-inferiority margin of 10% caries-arrest rate when applied semi-annually to preschool children. This trial will recruit 630 3-year-old kindergarten children through block randomisation to receive either an application of SDF gel or SDF solution on cavitated carious lesions in their primary teeth every 6 months. The primary outcome is the proportion of soft (active) carious tooth surfaces that turn hard (arrested) at the 30-month follow-up. The same calibrated dentist will conduct 6-monthly dental examinations in the kindergartens to assess the status of carious lesions over 30 months. The examiner, the children, and parents will be blinded to treatments. The parents will be surveyed on their child's oral health-related behaviours and socioeconomic background to allow adjustment for effect modification. Results: If the anticipated results are obtained, clinicians can use the 38% SDF gel as an alternative of the 38% SDF solution in arresting early childhood caries. Conclusions: As SDF gel is cost-effective, non-invasive, and non-aerosol-generating, it can be widely recommended for caries control. Trial registration: ClinicalTrials.gov NCT06241261. Registered on 7 February 2024.

Introduction: In recent years, erbium-doped yttrium aluminum garnet (Er:YAG) and erbium, chromium/yttrium-scandium-gallium-garnet (Er,Cr:YSGG) lasers have been introduced as another possibility to perform less-invasive flapless (FL) crown-lengthening (CL) procedures.

Objectives: The aim of this review is to describe the outcomes and complications of this approach.

Materials and methods: A literature review was conducted to retrieve clinical studies and case reports that analyze different variables related to laser-assisted flapless crown lengthening and report their outcomes in terms of gingival margin level stability (GMLS), and postoperative complications.

Results: A total of five studies were included in the final qualitative analysis; two of them were randomized controlled trials (RCTs) and the rest were case reports. The common variable measured in all studies was the GMLS, finding good stability in the FL groups at 3 months follow-up, but more tissue rebound was observed in patients with the thick biotype. Other variables were reported in different articles as the plaque index (PI), gingival index (GI), bone margin level, biotype, bleeding on probing (BP), probing depth (PD), and postoperative pain by the numeric rating scale (NRS).

Discussion: There are a wide range of heterogenous clinical variables used to evaluate outcomes, as well as variations in the type of laser used and its parameters in terms of the applied technique. However, most analyzed studies showed better GMLS for the flapless technique, as well as less postoperative inflammation.

Conclusions: The included studies showed promising clinical outcomes in the FL laser-assisted CL groups concerning GMLS at the 3-month postoperative period. However, more RCTs are needed with respect to fixed laser parameters and patient biotype selection to reach a definitive clinical protocol.

Objectives: Potential adverse effects and pH-related effectiveness of bleaching agents have raised some concerns. The aim of this study was to compare three bleaching agents containing hydrogen peroxide (HP) and carbamide peroxide (CP) in terms of whitening effectiveness, pH variation, and changes in enamel surface roughness. Methods: After controlled staining with a black tea solution, 42 human enamel specimens underwent bleaching treatment using the following agents: HP 40%; HP 35%; CP 16%. Color changes were evaluated according to the CIEDE2000 system. Gel pH was measured before and after each application. Surface roughness (Sa) was assessed through optical 3D profilometry before and after bleaching treatment. Results: The whitening effectiveness was similar for HP 40% and HP 35% while CP 16% had significantly lower results. HP 40% showed a remarkable pH acidification (-0.41), while HP 35% and CP 16% showed a mild increase in pH values (+0.26 and +0.03, respectively), and the differences between HP 40% and HP 35% and between HP 35% and CP 16% were statistically significant. Sa slightly decreased in all groups after bleaching, with no significant differences among them and a significant difference in HP 40% before and after treatment. Conclusions: Similar bleaching results were achieved regardless of pH and HP concentration for HP-based agents, while a lower bleaching effect was observed for the less concentrated CP-based agent, as anticipated. Higher HP and greater tendency to pH instability induced more pronounced modifications of surface roughness. This in vitro study suggests that bleaching gels with neutral and stable pH ensure good bleaching effectiveness and are less likely to cause enamel surface changes.

Objective: In everyday dentistry, lithium disilicate is a valid option for single-fix partial dentures, and this material crystallization process is available with two protocols: long and short. This study's aim was to assess the effects of these two different crystallization protocols, long and short, on the marginal gap of lithium disilicate single crowns. Methods: A total of 24 abutment plastic teeth were scanned using an intra-oral scanner. For each plastic tooth, an identical pair of lithium disilicate crowns was milled (a total of 48 crowns) by a four-axis machine. Each paired sample was categorized into two groups: long crystallization (24 crowns) and short crystallization (24 crowns). To assess precision, each unit's marginal gap (including abutments and crowns) was meticulously measured at four specified regions using a scanning electron microscope. A Kolmogorov-Smirnov test performed on the study variables indicated a normal distribution (p > 0.05), and it was followed by independent t-tests (α = 0.05). Results: For the long crystallization group, the mean total marginal gap values were 42.91 ± 9.67 μm, and for the short crystallization group, the values were 43.25 ± 8.14 μm, with no significant difference between the groups (p = 0.894). In addition, no significant differences were found between the groups regarding the mean marginal gap measurements for all four surfaces (distal (p = 0.310), mesial (p = 0.732), palatal (p = 0.655), and buccal (p = 0.535)). Conclusions: Both the long and short crystallization methods used for lithium disilicate single crowns demonstrated marginal gap values of less than 120 μm, which are within the clinically acceptable range, with no significant differences across any parameters between the two groups. Regarding the marginal gap value, it is recommended to use the short crystallization protocol as it is more time-efficient.

Objectives: Mandibular molar distalization is a complex orthodontic movement due to anatomic and biomechanical limitations. The opportunity to use a custom-made appliance with skeletal anchorage should be an advantageous alternative to traditional solutions: multiple extractions, interproximal reductions, vestibular inclination of incisal group. Methods: A 14-year-old female patient with Class II malocclusion and ectopic upper and lower canines was treated in the lower arch with a custom-made appliance anchored on a mini-screw in the right buccal-shelf where the ectopy and crowding was severe. The miniscrew was connected to a rigid arm with a rail equipped with a coil that activated promoted the distalization of first and second molars bonded with metallic bands. Results: After 8 months of treatment with activations repeated every 4 weeks, an effective distalization has been reached. Conclusions: Mandibular molars' distalization is a challenging orthodontic result to achieve. When the need to obtain space cannot be beneficially obtained with conventional approaches, and distalization of the lower molars could be desirable, a custom distalization device with skeletal anchorage and biomechanics based on a pressed coil sliding on a rigid arm is an efficient solution.

Objectives: This systematic review evaluated concomitant trends in microbial (total biofilm load and pre-dominant pathogens' counts) and clinical, radiographic, and crevicular variations following (any) peri-implantitis treatment in partially vs. totally edentulous, systemically healthy, non-smoking adults and compared them to peri-implant mucositis treated sites. Methods: The study protocol, compliant with the PRISMA statement, was registered on PROSPERO (CRD42024514521). Findings from six randomized controlled trials (RCTs), evaluated through the ROBINS-2 tool, were qualitatively synthesized. Results: No data concerning total edentulism and treated peri-implant mucositis sites were retrieved from the included RCTs. Instead, as expected, in the partially edentulous subjects, peri-implantitis treatments effectively provided biofilm control, although Plaque Index (PI) tended to increase again over time. Notably, Bleeding on Probing (BoP) rose slightly after treatment but decreased markedly by three months, indicating, at least, a partial resolution of the infective-inflammatory process. Probing Depth (PD) showed a slower but consistent improvement throughout. Despite a return of PI levels by twelve months, BoP and PD continued to improve, underscoring the successful long-term outcomes of peri-implantitis treatment. Over time, variations in PI did not consistently reflect changes in predominant pathogenic species, especially at the 1-month follow-up; BoP aligned with predominant pathogens rather than total microbial biofilm load at the 1- and 3-month follow-ups, and PD did the same at the 3- and 6-month follow-ups, likely affecting peri-implantitis-associated microbiota. No data concerning crevicular parameters were retrieved in the included RCTs, and the extracted radiographic outcomes were not comparable. Conclusions: The impact of the microbial variations after peri-implantitis treatment on peri-implant clinical parameters highlight the critical role of dysbiosis, rather than total microbial load, in influencing inflammation and tissue destruction, emphasizing the need for targeted approaches to manage persistent pathogens and improve treatment efficacy.

Background: Anesthetic irrigation is an effective treatment for postoperative pain suppression in patients after molar extraction, but exerts a short period of extraction. The study aimed to evaluate the effect of lidocaine with epinephrine irrigation on acute pain relief in healthy volunteers with inferior alveolar nerve block (IANB) injection for the surgical removal of mesioangular (MA)-impacted third molars.

Methods: A total of 28 patients (56 samples) with bilateral MA-impacted third molars were recruited. This study was a split-mouth, double-blind, randomized clinical trial. Surgical procedures were conducted over two separate appointments. Each patient randomly received 2% lidocaine with 1:100,000 epinephrine for the irrigation of the extraction site after surgery on one side of the mouth and normal saline solution on the other side. The postoperative visual analog scale (VAS) as a pain indicator was recorded and statistically analyzed for both treatments.

Results: The VAS levels at 3 and 4 h after surgery in the lidocaine group were significantly lower than those of the normal saline group. Increases in pain scores were recorded five hours after surgery in both groups. No complications were recorded during this study.

Conclusions: Continuous local anesthetic irrigation appears to be effective in reducing acute postoperative pain in patients with IANB for MA-impacted third molar surgery.

Clinical trial registry: Reference number ISRCTN13866362, Date: 1 October 2024.

Objective: The objective of this study was to evaluate the facial profile changes of patients treated for class II skeletal malocclusions with an elastodontic appliance compared to those treated with the Herbst appliance and a control group. Methods: Forty class II patients were treated using an elastodontic appliance (Group EA) and were compared to 40 patients treated with the Herbst appliance (Group H) and to 40 untreated class II children (Group C). Aesthetic profile variables were analysed using Arnett's analysis. Cephalograms were compared pre-treatment (T0) and post-treatment (T1). The Wilcoxon signed-rank test or paired-samples t-test was used for pairwise comparison of cephalometric measurements taken at T0 and T1. One-way ANOVA and Tukey's post hoc test were performed to assess differences between the groups. Results: In the elastodontic group, the inclination of the upper incisors increased by 4.05°. In addition, the Pog-TVL and B-TVL distances decreased by 2.84 mm and 1.79 mm, respectively. In patients treated with an elastodontic appliance, the inclination of the upper incisors increased by 4.05°. In addition, the Pog-TVL and B-TVL distances decreased by 2.84 mm and 1.79 mm, respectively. In patients treated with the Herbst appliance, the inclination of the lower incisors increased by 6.11°. Furthermore, the treatment resulted in reductions in the Pog-TVL distance (2.58 mm), the B-TVL distance (2.26 mm), and the LL-TVL distance (2.31 mm). Conclusions: The profile changes achieved by both devices are favourable for correcting class II skeletal malocclusion.

Background: The measurement of Hounsfield units (HU) during implant treatment planning is important. Currently, various manufacturers' implant planning software programs offer HU capabilities; however, their accuracy remains unverified. In this study, we aimed to validate the accuracy of HU values measured by implant planning software programs. Methods: This study used one type of multidetector computed tomography (MDCT), two types of cone-beam computed tomography (CBCT), and four implant planning software packages. Three specimens were prepared for the evaluation of HUs, and the standard values of the HUs were measured. Digital Imaging and Communications in Medicine (DICOM) data obtained from MDCT and CBCT were loaded into four implant planning software packages to measure the HU values. The HU and reference values of the four implant planning software programs obtained from MDCT and CBCT were compared. Additionally, the HU values between each implant planning software program were compared. Results: The HU values of the three specimens, as measured using the four implant planning software programs utilizing MDCT, did not exhibit a significant difference from the standard values. Conversely, those obtained from CBCT were significantly different. The measured HU values after the MDCT imaging of the specimens were not significantly different between the implant planning software programs; however, they differed after CBCT imaging. Conclusions: The results of this study indicate that it is not possible to measure HU values using CBCT with implant planning software programs. However, HU values can be measured by any implant planning software using MDCT.

Modern dentistry is turning towards natural sources to overcome the immunological, toxicological, aesthetic, and durability drawbacks of synthetic materials. Among the first biomaterials used as endosseous dental implants, mollusk shells also display unique features, such as high mechanical strength, superior toughness, hierarchical architecture, and layered, microporous structure. This review focusses on hydroxyapatite-a bioactive, osteoconductive, calcium-based material crucial for bone healing and regeneration. Mollusk-derived hydroxyapatite is widely available, cost-effective, sustainable, and a low-impact biomaterial. Thermal treatment coupled with wet chemical precipitation and hydrothermal synthesis are the most common methods used for its recovery since they provide efficiency, scalability, and the ability to produce highly crystalline and pure resulting materials. Several factors, such as temperature, pH, and sintering parameters, modulate the size, purity, and crystallinity of the final product. Experimental and clinical data support that mollusk shell-derived hydroxyapatite and its carbonated derivatives, especially their nanocrystaline forms, display notable bioactivity, osteoconductivity, and osteoinductivity without causing adverse immune reactions. These biomaterials are therefore highly relevant for specific dental applications, such as bone graft substitutes or dental implant coatings. However, continued research and clinical validation is needed to optimize the synthesis of mollusk shell-derived hydroxyapatite and determine its applicability to regenerative dentistry and beyond.