Quintessence international最新文献

Objective: This prospective case series aimed to clinically evaluate the bleaching effect, spontaneous tooth sensitivity, and variation in the thermal sensation threshold of different groups of teeth undergoing in-office bleaching.

Method and materials: Ten patients received conventional bleaching treatment: 35% hydrogen peroxide with three bleaching sessions of 45 minutes, evaluating color change (∆E and ∆E00), Whitening Index (WID), and tooth sensitivity (visual analog scale). Thermal stimulus-generating devices were used to simulate sensitivity caused by low temperatures through quantitative sensory tests. Analyses were conducted individually on different teeth groups (n = 20) (mandibular incisors, maxillary incisors, canines, maxillary first premolars).

Results: Regarding color change, mandibular and maxillary incisors did not statistically differ from each other but showed significant difference and greater bleaching potential compared to canines and maxillary first premolars (P = .018). Regarding sensitivity, mandibular and maxillary incisors presented the highest spontaneous sensitivity values (P = .032), while maxillary first premolars did not display painful symptoms, also observed in provoked sensitivity analysis (P = .025).

Conclusions: The general analysis of the results indicates that the tooth type affects the response to the whitening treatment, both in relation to the esthetic benefit and the occurrence of tooth sensitivity. It was observed that mandibular incisors reach the degree of chromatic saturation before canines and premolars, in addition to presenting greater bleaching sensitivity. Personalizing the treatment, based on prior knowledge of the degree of saturation, anatomical factors, and the risk of sensitivity, can provide considerable advantages in the whitening technique.

Objective: To evaluate the ability of near-infrared light transillumination (NIR-LT) to detect interproximal enamel and dentinal caries lesions compared to clinical-visual inspection aided by fiber-optic transillumination (FOTI).

Method and materials: From 170 Finnish adolescents aged 15 to 17 years, 5,294 interproximal surfaces of premolars and molars were examined first clinical-visually aided by FOTI (VI+FOTI) using the International Caries Detection and Assessment System (ICDAS) classification. Subsequently, the surfaces were examined using NIR-LT. The extent of lesions was determined using the modified NIR-LT classification based on the Söchtig criteria. For the analyses, data on maxillary and mandibular premolars and molars were combined. Distributions of lesions were presented as frequencies. Differences between VI+FOTI and NIR-LT at the tooth and tooth surface levels were analyzed by chi-square and Fisher exact tests. Sensitivity and specificity of the NIR-LT method to detect any lesion was performed using VI+FOTI as the gold standard.

Results: By VI+FOTI, 92.4% surfaces were classified as sound and by NIR-LT, 88.2%. Enamel caries lesions were found on 7.0% of the surfaces by VI+FOTI and on 11.6% by NIR-LT. Nearly double the number of enamel lesions were identified by NIR-LT for all examined teeth groups, except for mandibular molars where this was 1.3-fold. In 66% of the surfaces, the differences between NIR-LT and VI+FOTI findings were statistically significant (P .001). The sensitivity for all teeth of NIR-LT was 48.4% and the specificity was 91.1%.

Conclusion: Radiation-free NIR-LT method shows considerable potential as a supplementary method for early detection of caries lesions among low-caries prevalence adolescents.

Objective: To evaluate two methods for assessing the changes in periodontitis grading in patients undergoing supportive periodontal therapy 10 years (T10) after retrospective baseline grading.

Method and materials: The periodontitis grade of 51 supportive periodontal therapy patients was assessed using indirect evidence as the primary criterion for periodontitis progression at baseline and T10 (radiographic bone loss/age index, periodontitis phenotype). Grading at T10 was also performed using the direct evidence for periodontitis progression (clinical attachment loss over the previous 5 years). The use of indirect evidence for periodontal progression at baseline and T10 was defined as method 1 to assess the changes in periodontitis grading. The use of indirect evidence at baseline and direct evidence at T10 was defined as method 2. Changes in periodontitis grading using methods 1 and 2 were evaluated (Wilcoxon signed-rank test). Agreement between methods 1 and 2 was assessed (Cohen kappa).

Results: Indirect baseline grading revealed five grade B and 46 grade C patients. The indirect grading at T10 revealed 17 grade B and 34 grade C patients. The direct T10-grading classified all patients as grade C. Method 1 led to an overall improvement in periodontitis grading after 10 years of supportive periodontal therapy (P = .0030), whereas method 2 led to a deterioration (P = .0369). The comparison between methods 1 and 2 showed that they led to different results in terms of grading (Cohen kappa = 0.116208).

Conclusions: Periodontitis grading may change during supportive periodontal therapy. Using indirect or direct evidence as the primary grading criterion during supportive periodontal therapy may lead to different results.

Objectives: The aim was to investigate the impact of smoking on pocket closure at 6 months after treatment of severe periodontitis, in relation to residual clinical inflammation.

Method and materials: The clinical records of deep pockets (probing depth ≥ 6 mm, n = 984) in 46 individuals with periodontitis were analyzed. Following baseline clinical assessments (Plaque Index, probing depth, clinical attachment level, and bleeding on probing), nonsurgical periodontal treatment was performed. Clinical assessments were repeated at 2 and 24 weeks after periodontal therapy. A logistic regression model using generalized estimation equations adapting the cluster robust standard errors was performed to investigate potential associations between bleeding on probing and pocket closure at posttreatment 24 weeks.

Results: Absence of bleeding at 2 weeks after nonsurgical treatment related to pocket closure after 6 months. Pockets that do not bleed either at baseline or at 2 weeks (OR = 2.7; P .005) and pockets of nonsmokers (OR = 6.32; P .001) and females (OR = 1.79; P = .022) associated with pocket closure at 6 months.

Conclusion: Pocket closure is associated with being a nonsmoker and the absence of inflammation after nonsurgical periodontal treatment, which indicates the importance of smoking cessation and inflammation control in achieving optimal clinical outcomes.

Objective: The aim of this study was to elucidate the nuanced interactions between antihypertensive medications and the risk of periodontitis using the Mendelian randomization analysis method.

Method and materials: The study adopted a drug-target Mendelian randomization method to assess the long-term effects of nine antihypertensive drug categories on the risk of periodontitis in both acute and chronic cases. Genetic variants located in or near genes relevant to the targets of these drugs and associated with systolic blood pressure (SBP) were selected to simulate the influence of antihypertensive treatments. Genetic information on SBP and periodontitis susceptibility was extracted from extensive genome-wide association studies for both acute and chronic conditions. Additionally, a secondary analysis was conducted using expression quantitative trait loci for the genes of interest as alternative proxies. Colocalization analysis was performed to explore shared variants between antihypertensive drugs and periodontitis.

Results: The analysis revealed that the use of angiotensin-converting enzyme inhibitors with an increased risk of acute periodontitis (odds ratio (OR) [95% confidence interval] 1.43 [1.11, 1.85] per 1 mmHg reduction in SBP; P = 5.93 × 10-3) and loop diuretics with a decreased risk of chronic periodontitis (OR 0.94 [0.90, 0.98]; P = 2.94 × 10-3). Moreover, genetically mimicking the use of a suggestive protective effect of thiazides and related diuretics on acute periodontitis was observed in both acute (OR 0.95 [0.90, 0.99]; P = .021) and chronic (OR 0.98 [0.97, 1.00]; P = .045) periodontitis. Colocalization analysis revealed antihypertensive drugs and periodontitis shared causal variants in ACE and SLC12A2 locus.

Conclusion: The research indicates that loop diuretics might decrease the risk of periodontitis, while angiotensin-converting enzyme inhibitors could heighten the risk. Further investigations are required to evaluate the potential of reusing antihypertensive drugs for periodontitis prevention.

Objectives: This study aimed to investigate periodontal stability and treatment needs in patients under antiresorptive therapy (ART) during supportive periodontal care (SPC), with a focus on medication-related osteonecrosis of the jaw (MRONJ) risk and reasons for tooth loss.

Method and materials: In this retrospective case-control study, records of 100 stage III/IV SPC patients (50 ART-exposed, 50 unexposed) were analyzed for probing pocket depth (PPD), clinical attachment level (CAL), bleeding on probing (BOP), history of periodontal surgery, tooth loss and MRONJ risk over a period of up to 15 years after active periodontal therapy.

Results: Baseline patient characteristics were similar between ART-exposed and unexposed patients. Osteoporosis was the underlying condition for ART in 72% of cases, and 74% exhibited an intermediate MRONJ risk profile. Over time, no significant differences between the groups were found in number of teeth, CAL, PPD, or BOP. Periodontal re-treatment needs (teeth with PPD >=4 mm or >=6 mm) were relatively low and comparable between exposed and unexposed patients. However, periodontal surgery was performed more frequently in unexposed patients, also due to the risk of MRONJ in exposed patients. Both groups showed similar numbers of tooth loss, primarily due to periodontal and endodontic causes. Regression analyses identified ART, age, and diabetes mellitus as significant factors associated with higher BOP, while smoking and diabetes mellitus were linked to higher PPDs.

Conclusion: Achieving periodontal stability during SPC in ART-patients, most of whom had an intermediate MRONJ risk profile, appeared comparable to unexposed patients. However, the different MRONJ risk profiles should be taken into consideration and further investigated.

Objectives: Small-scale studies reported increased blood pressure in patients using chlorhexidine mouthwash with the rationale that the rinse mitigates nitric oxide production by oral bacteria. The present study evaluated whether prior use of chlorhexidine mouthwash can be associated with an increased odds ratio for primary hypertension in a large hospital cohort.

Materials and methods: The i2b2 NIH-established platform was used to search for deidentified medical information coded by ICD-10 for subjects with a hypertension diagnosis who have used chlorhexidine rinses before between October 2015 and May 2024. Binary statistics and logistic regression were used to calculate the odds ratio for hypertension in the group that used chlorhexidine mouth rinse before and after adjustments for demographic data, diabetes, and periodontal disease.

Results: The unadjusted odds ratio for primary hypertension in subjects who used chlorhexidine gluconate mouthwash before was significantly elevated (OR 3.09, 95%CI 3.03 - 3.16, p<0.0001). It remained significant after adjusting for male gender (OR,1.44,95%CI 1.42 - 1.47, p<0.0001), age <45 years (OR 1.90 95%CI 1.86 - 1.93, p<0.0001), White race (OR 2.3, 95%CI 2.27 - 2.37, p<0.0001, diabetes (OR 1.99, 95%CI 1.93 -2.05, p< 0.001, and periodontal disease. (OR 3.28, 95%CI 3.21 - 3.34, p< 0.0001). The odds ratio for hypertension for subjects with gingivitis or periodontal disease after adjustment for chlorhexidine mouthwash was elevated. (OR 20.11, 95%CI 20.11 -21.44, p<0.0001) Conclusions: With the cavitate of a retrospective study design, the results indicate an increased odds ratio for primary hypertension for subjects with prior use of chlorhexidine mouthwash.

Aim: There has been found that patients with chronic periodontitis showed higher salivary concentrations of reactive nitrogen species (RNS) than healthy subjects. However, only a study from elderly Koreans has reported that high salivary RNS concentrations are associated independently with periodontitis. Thus, the objective of this study was to determine whether salivary nitrites concentrations are associated with periodontitis controlling risk factors in other populations (such as European population).

Methods: This was a prospective and observational study carried out in a Dental Clinic including European subjects without periodontitis (including subjects with periodontal health or with localized gingivitis in <30% sites) or with periodontitis (thus, with loss of periodontal tissue). The levels of nitrite in saliva were assessed using the Griess method. A multivariate regression analysis was performed to determine that variables were associated independently with periodontitis. To determine the association between salivary malondialdehyde levels and severity of periodontitis was used Spearman's rho correlation coefficient. A receiver operating characteristic analysis with salivary nitrites levels and periodontitis diagnostic was performed.

Results: Subjects with periodontitis (n=54) in comparison to subjects without periodontitis (n=30) had higher salivary nitrites levels (p=0.003), higher rate of arterial hypertension history (p=0.02) and were older age (p<0.001). Nevertheless, differences between subject with and without periodontitis in other variables were not found. A positive correlation was found between salivary nitrites levels and periodontitis severity (rho=0.23; p=0.04). Multiple logistic regression analysis showed that elevated salivary nitrites levels > 209 nmol/mL were associated with periodontitis controlling for arterial hypertension history and age (OR=10.212; 95% CI=2.665-39.128; p=0.001) and controlling for diabetes mellitus and smoker (OR=8.793; 95% CI=3.038-24.450; p<0.001). The area under the curve for periodontitis diagnostic by salivary nitrites levels was of 69% (95% CI=58%-79%; p<0.001). The selected point of salivary nitrites levels > 209 nmol/mL for periodontitis diagnostic had 72% of sensitivity (58%-84%), 77% of specificity (58%-90%), 3.1 of p ositive likelihood ratio (1.6-6.1), 0.4 of negative likelihood ratio (0.2-0.6), 85% of positive predictive value (74%-92%) and 61% of negative predictive value (49%-71%).

Conclusions: Salivary nitrites concentrations could be associated independently with periodontitis, could be associated with periodontitis severity and could help in periodontitis diagnosis in a European population according to the results of this preliminary study.

Objectives: To assess blood flow alterations after horizontal Guided Bone Regeneration (GBR) and to evaluate correlations between blood flow and hard tissue changes.

Method and materials: Twelve mandibular surgical sites were involved in the current case series. GBR was carried out using a split-thickness flap design. Blood circulation was assessed with Laser Speckle Contrast Imaging at baseline as well as 1, 4, 6, 11, 13, 20, 27, and 34 days after the surgery, subsequently on a monthly basis until 6 months. Hard tissue alterations were measured horizontally and vertically using linear measurements. The first measurement point was 2 mm distal to the distal surface of the last tooth; additional measurement points were placed every 3 mm up to the 15th mm. Volumetric hard tissue loss and gain were also assessed.

Results: Baseline blood circulation was statistically significantly higher on the buccal side. On the first postoperative day, all regions presented a statistically significant decrease in blood flow circulation. The buccal-inner region presented significant ischemia on day 6. Mean volumetric hard tissue gain and loss were 712.62 ± 317.08 mm3 and 222.431 ± 103.19 mm3, respectively. Mean baseline alveolar ridge width was 4.82 ± 1.02 mm, 6 months ridge width averaged 7.21 ± 0.99 mm. Vertical resorption measured 1.24 ± 0.5 mm. Correlations between blood flow changes and hard tissue alterations were only found on Day 34 and Day 60.

Conclusion: Laser Speckle Contrast Imaging is an efficient method to measure flap microcirculation. No correlation was found between flap microcirculation changes hard tissue and alterations.