Quintessence international最新文献

Objectives: This retrospective study analyzed zygomatic implant (ZI) survival and implant success (based on ORIS criteria) in patients treated for maxilla atrophy or after reconstruction failure.

Material and methods: Implants were placed as quads (4 ZIs) or hybrids (ZIs and conventional implants in premaxilla) in edentulous patients using various surgical approaches, evolving from the sinus slot to Chow's extended sinus lift technique with or without Bichat fat pad. The procedure was followed by immediate loading, while clinical and radiographic evaluations spanned at least 1 year after implantation. The primary outcome was the implant survival at follow-up, and the secondary was the implant success, assessed as complications according to ORIS criteria: prosthetic offset, sinus status, peri-implant soft tissue health, and implant stability.

Results: A total of 73 consecutive patients, treated with 217 ZIs and 76 conventional implants, were included, with mean follow-up of 3.5 years (range, 1-9.8 years). Four ZIs failed in 3 patients, including 1 patient with a zygomatic bone fracture. The cumulative survival rate was 98.16%. Although in 2 additional cases, implants lost stability, they achieved delayed osseointegration. Other complications included 21 sinus reactions (excluding the 4 failures) and 28 peri-implant inflammatory reactions.

Conclusion: ZIs offered a predictable treatment option for extreme upper jawbone atrophy with a relatively low complication rate and no severe injuries. The Chow technique with the Bichat fat pad positively impacted ZI success and survival, whereas smoking, implantation in fresh sockets, and the limited experience of the surgeon negatively affected the outcomes.

Background: Craniofacial fibrous dysplasia (CFD) affecting the jaws can result in facial asymmetry, posing a unique challenge for dental implant placement in edentulous areas. This case report introduces an innovative approach for rehabilitating the posterior maxilla affected by CFD using a computer-guided technique for maxillary recontouring and substitution bone grafting at implant sites.

Case presentation: A 58-year-old edentulous female with a craniofacial fibrous dysplasia bone lesion affecting the right maxilla was referred for correction of asymmetry and dental implant placement. A computer guide was devised for shaving and contouring the right maxilla. Following virtual maxillary reduction, a second guide was created over the osteomized 3D model to plan the location of future dental implants and guide bone ostectomies for allograft substitution. Particulate bone substitute was applied to ostectomy sites in the affected maxillary alveolar ridge. Four implants were placed successfully four months post-operation, with integration confirmed by clinical examination after one year of follow-up.

Conclusion: This treatment approach emerges as a reliable and effective modality for simultaneous dental implant rehabilitation in edentulous alveolar bone and jaw contouring in CFD cases.

Objective: While a bidirectional relationship between sleep health and musculoskeletal (MSK)-pain have been established among chronic pain patients, few studies explored it among dental students. This cross-sectional study assessed the relationship of self-report MSK-pain with sleep health and psychological outcomes among dental students, and whether differences existed as a function of number and location of painful body-sites.

Method and materials: Validated questionnaires were sent through REDCap to dental students at a predoctoral dental school, assessing presence, location (head, shoulder/neck, jaw, back, body), and intensity of MSK-pain, sleep health (risk of sleep apnea, insomnia severity symptoms, sleep quality, daytime sleepiness, and chronotype), and psychological outcomes (anxiety/depression). Differences between those with and without MSK-pain, and across participants with different number and location of painful sites were tested with t-tests and ANOVA, adjusting for age/gender.

Results: Out of 80 participants (82.5% females), 76.3% reported MSK-pain (68.9% in neck/shoulders). Those with MSK-pain scored significantly worse in sleep quality (7.7±3.7 vs. 4.8±2.1, p<.001), daytime sleepiness (6.1±4.2 vs. 3.3±2.7, p<.001). Those with >3 painful body-sites reported worse sleep quality (p=.006) and daytime sleepiness (p=.003) than pain-free controls. There were no differences on sleep and psychological outcomes as a function of number of painful body-sites. Those reporting back pain scored worse in insomnia (p=.037), daytime sleepiness (p=.002), and sleep quality (p=.006) than those without back pain.

Conclusion: MSK-pain is prevalent among dental students and associated with worse sleep health. While number of painful sites may not influence sleep/psychological health, specific locations (e.g., back pain) were associated with worse sleep functioning.

Objective: This clinical trial aimed to evaluate and compare the effectiveness of diode laser gingivectomy, conventional gingivectomy, and nonsurgical periodontal treatment (NSPT) in the management of gingival enlargement (GE) during orthodontic treatment.

Materials and methods: forty-five healthy, orthodontic patients with labial gingival enlargement on the 6 anterior teeth were selected and randomly assigned to one of the groups (Conventional, Laser, and NSPT). Clinical parameters including clinical crown length (CCL) , periodontal pocket depth (PPD), and vertical gingival overgrowth index (vGOi) were recorded at baseline, 1 month, 3 months, and 6 months. Postoperative pain was evaluated at 1,3, and 7 days. Esthetic satisfaction and acceptance of the procedure were recorded on day 10 and repeated after 6 months.

Results: Statistically significant results were obtained for mean reduction in PPD for conventional, laser, and NSPT groups (-1.43, -.1.75, and -0.9 mm, respectively; P < 0.001), CCL gain (1.45, 1.7, and 0.38 mm, respectively; P<0.001) and mean vGOi score (-1.14, -1.29 and -0.76, respectively; P<0.001) over 6 months. Both test groups showed greater statistically significant changes in clinical parameters over 6 months compared to NSPT (P<0.001). There was a gradual decrease in postoperative pain for all three groups over 7 days, with conventional group showing statistical difference in mean pain score on days 1 and 3 compared to other groups.

Conclusion: Both conventional and laser gingivectomies were more effective in controlling enlargement over non-surgical periodontal treatment alone at 1, 3, and 6 months.

Clinical significance: laser and conventional gingivectomies as adjunctive treatments achieved superior results when compared to NSPT alone in the treatment of GE and gingival inflammation during orthodontic treatment, with no significant clinical differences between the two treatments.

Objectives: This study aims to investigate the impact of photobiomodulation (PBM) and/or azithromycin (AZM) therapy in combination with full-mouth subgingival instrumentation (FSI) on receptor activator of nuclear factor κB ligand (RANKL) and osteoprotegerin (OPG) levels and RANKL/OPG ratios in gingival crevicular fluid (GCF) on patients with stage III-IV grade C periodontitis.

Materials and methods: The study was conducted on 77 stage III-IV grade C periodontitis patients and 20 periodontally healthy controls. Patients with stage III-IV grade C periodontitis were categorized into four treatment groups: 1) only FSI (FSI) group; 2) FSI+AZM (AZM) group; 3)FSI+PBM (PBM) group and 4) FSI+PBM+AZM (AZM+PBM) group. Clinical periodontalparameters and RANKL and OPG levels and RANKL/OPG ratios in GCF were measured at thebaseline and month 3rd of the therapy.

Results: Compared with the periodontally healthy controls,all the baseline clinical parameters were higher in the Stage III-IV grade C periodontitis groups (P< 0.05); however, there were no statistically significant differences between the Stage III-IV gradeC periodontitis groups (P>0.05). In month 3rd, the lowest values in all clinical parameters weregenerally observed in the antibiotics groups whereas the highest values were observed in the FSIgroup. Furthermore, the highest RANKL and OPG values in antibiotic groups and the highestRANKL/OPG ratio in PBM group were observed in the third months. RANKL/OPG ratios did notchange in the FSI and antibiotics groups after the treatment, but it increased significantly in thePBM group.

Conclusion: While PBM treatment combined with FSI increases the RANKL levels,AZM increases OPG levels. Also, PBM+AZM treatment shows additional clinical andimmunological beneficial efficacy.

Objective: The study aims to evaluate the stress distribution on tooth and restoration of zirconia endocrowns with pulp chamber or intracanal extension and zirconia post performed maxillary first molar using finite element analysis.

Method and materials: Three three-dimensional endodontically treated maxillary molars were modeled. Cortical bone and cementum were modeled 2 mm and 200 μm in thickness. Periodontal ligament at 250 μm thickness was constructed. Zirconia endocrown with pulp chamber extension of 2 mm (Model E+PCE), zirconia endocrown with intracanal extension of 4 mm (Model E+ICE), and zirconia post of 4 mm and crown (ZP) were modeled using software. All restoration models were placed on the maxillary molars. Models were subjected to 400 N loading from the three occlusal contact points. Von Mises stress was recorded.

Results: Expectingly, points where the stress was applied showed high stress compared to other regions of the models. The stress did not occur at the trifurcation in any of the models. For the stresses occurring in the restoration material, there were 14.67 MPa, 57.79 MPa, and 155.56 MPa, in Models E+PCE, E+ICE, and ZP, respectively. At the remaining dentin, these values were 47.04 MPa, 32.85 MPa, and 33.42 MPa in Models E+PCE, E+ICE, and ZP, respectively.

Conclusions: Within the limitation of the study, zirconia endocrowns with intracanal extension exhibit more favorable stress distribution in both restoration material and dentin compared to zirconia posts and pulpal extension endocrowns. These findings suggest that endocrown with intracanal extension may be a better restorative option for reducing stress.

Objectives: To evaluate clasp-retained removable partial dentures (C-RPDs) with a metal framework for survival, maintenance requirements, and biologic implications.

Method and materials: C-RPDs were retrospectively analyzed based on patient records. Treatment failure was defined as fracture of a framework component (metal base or connector) or loss of an abutment tooth. Other outcome variables included factors that might conceivably impact C-RPD survival (maxilla vs mandible, Kennedy classes, opposing dentitions, treatment by students vs certified dental practitioners), mobility and caries of abutment teeth (in relation to clasp designs), and maintenance requirements (relining, clasp or resin fractures). Differences were evaluated by appropriate statistical tests at the P ≤ .05 level.

Results: A total of 612 patients (339 men, 273 women) 60.0 ± 11.5 years old at delivery were included, covering 842 C-RPDs and a mean observation period of 42.1 ± 33.2 months. Kaplan-Meier C-RPD survival was 76.2% after 5 years and 49.5% after 10 years. Biologic complications (ie, loss of abutment teeth) accounted for the vast majority (95.6%) of C-RPD failures, and Kaplan-Meier C-RPD survival was significantly better in the mandible (P = .015). Some clasp designs contributed significantly to caries and removal of abutment teeth (both P .05). No other significant differences were noted.

Conclusion: Tooth loss both emerges as the main cause of C-RPD failure and might be amenable to careful selection of clasp designs. Overall, better C-RPD survival should be expected in the mandible. A noncontributory role of Kennedy classes and opposing dentitions is tentatively suggested based on numerically heterogenous subgroups.

Objectives: The study examines the impact of changes on dental education and practice in Europe, including the development of new practice models such as investor-owned dental centers and practice chains.

Method and materials: This study aimed to collect and critically examine data regarding the care environment, education, and organizational structures of the dental profession across European Regional Organization of the FDI World Dental Federation (ERO) member states and other countries in the World Health Organization European region. A questionnaire from the ERO was used.

Results: National dental associations across 45 countries participated. An average of 1,459.79 (SD ± 800.80) inhabitants per dental practitioner was found, with independent practices being the most prevalent form of dental practice (48.65% ± 28.28%) followed by employment in private practice (24.32% ± 20.33%), and joint practices (15.27% ± 20.39%). There are statistically significantly more state universities than private universities (P .01); the percentage of females attending dental schools was statistically significantly higher than males (P .01). Two-thirds of the participating countries (n = 30, 66.67%) have legal frameworks allowing various stakeholders, including investors, and local communities, to establish dental health care centers.

Conclusions: The findings highlight the evolving landscape of the dental profession in Europe and its regulatory context. There is a clear need for ongoing evaluations and adjustments in educational and practice frameworks to ensure and maintain high-quality oral health care. Future research should delve into the various professional dental practice forms and incorporate qualitative, care-related, and patient-centered considerations for a more thorough understanding of Europe's oral health care dynamics. (Quintessence Int 2024;55:744-755; doi: 10.3290/j.qi.b5714883).

Two cases of pain evoked by cold food ingestion, following root canal therapy, are presented. The source of pain was detected when cold application to the vestibular, periapical area corresponding to the teeth involved evoked strong pain of about 30-second durations. In the first case, the patient suffered from strong pain in the mandibular right area over the last 4 months. After successive root canal therapy of three mandibular right teeth, the spontaneous pain eased significantly, but strong pain evoked by cold food ingestion persisted. Cold application to the vestibular periapical area of teeth involved identified the source of pain, which was abolished by 80 mg/day of slow-release propranolol. In the second case, cold allodynia developed after root canal therapy. The root canal therapy was performed for prosthetic reasons with no prior pain. Pain could be duplicated by cold application to the vestibular area of the treated tooth. The patient preferred no treatment when the source of pain was explained. In both cases cold application did not produce any pain in other intraoral locations, including the contralateral vestibular area or the mid soft or hard palate. Pain mechanisms, neurovascular and neuropathic, which differ for each case are discussed.

Objective: The aim of this study was to identify the relationship between preventative dental practices and cardiometabolic health in adolescents.

Method and materials: Analysis included children aged 13 to 17 years enrolled in the National Health and Nutrition Examination Survey (NHANES) from 2011 to 2018 who completed an Oral Health Examination and Questionnaire. Deferred dental care was defined as not having a dental visit in the past year. Financial barriers to seeking dental care (vs no financial barriers) were assessed among those with deferred dental care in the past year. Primary cardiometabolic outcomes included obesity, elevated blood pressure, and hypertensive blood pressure. Secondary outcomes included dyslipidemia, glucose intolerance, uric acid, glomerular hyperfiltration, and albuminuria. Regression models adjusted for age, sex, race/ethnicity, household income, food insecurity, health insurance status, household education, and body mass index z-score examined associations using complex survey design procedures.

Results: Of 2,861 adolescents, 17.6% (SE 0.9%) did not receive dental care in the past year and 20.2% (SE 1.9%) had a financial barrier to accessing dental care. In adjusted regression models, adolescents with deferred dental care had higher odds of dyslipidemia (odds ratio [OR]= 1.51, 95% CI 1.07 to 2.11, P = .020). Having a financial barrier was associated with lower odds of dyslipidemia (OR = 0.35, 95% CI 0.14 to 0.89, P = .03). Financial barriers were associated with lower non-high-density lipoprotein cholesterol (b = -7.95, 95% CI -14.87 to -1.05, P = .03) and higher high-density lipoprotein cholesterol (b = 3.06, 95% CI 0.37 to 5.75, P = .03) in adjusted models. Deferred dental care and financial barriers were not associated with any other cardiometabolic parameters.

Conclusion: In this nationally representative cohort of adolescents, there was an association between lack of preventative dental care and the cardiometabolic health marker of dyslipidemia. However, financial barriers to dental care were surprisingly associated with higher high-density lipoprotein cholesterol levels and lower odds of dyslipidemia.