Quintessence international最新文献

Objectives: The primary reason for replacement of adhesive tooth restorations is failure due to secondary caries. The decision may vary depending on the diagnostic criteria used. This cross-sectional observational study aimed to compare clinical treatment decisions for adhesive restorations in high-caries-risk children using three diagnostic systems: International Dental Federation (FDI), Caries Associated with Restorations and Sealants (CARS), and modified United States Public Health Service (USPHS) Ryge.

Method and materials: A total of 267 teeth (475 restored surfaces) in 80 children aged 5 to 10 years, classified as high caries risk, were examined. Each restoration was independently evaluated using FDI, CARS, and modified USPHS criteria. Treatment recommendations were categorized into no intervention, repair, or replacement. Analyses explored associations between treatment decisions and variables like restorative material, tooth type, number of surfaces involved, and age of restoration. Evaluations were performed at both surface and tooth levels.

Results: The findings affirm strong correlations within the three diagnostic criteria observed at lower scores (rho = 0.9, P .001). However, within higher scores, there was less overlap for aggressive treatment. The modified USPHS criteria resulted in the highest rate of interventions (59.8%), followed by the FDI (35.2%) and CARS (24.8%) systems. Presence of secondary caries was the strongest predictor of replacement (P .001). Restorations using glass-ionomer cement were significantly more likely to require intervention than those using composite resin (P .001). The number of surfaces did not significantly influence treatment decisions, whereas restoration age and tooth type had variable impacts.

Conclusions: The results of the present study demonstrated an increased shift of treatment decisions towards aggressive interventions (repair/replacement) for restored tooth surfaces/restored primary/permanent teeth as per modified USPHS criteria, with fewer interventions indicated using FDI, followed by the CARS criteria. Future pediatric restorative protocols should incorporate standardized training modules for practitioners and researchers to interpret criteria uniformly.

Aims to critically analyze the effects of photobiomodulation on recovery of the donor area after free gingival graft (FGG) surgery. A comprehensive literature search was conducted in PubMed, Scopus and Web of Science between May 7th and April 7th, 2025, structured according to the PICO strategy: patients ≥18 years undergoing removal of free gingival grafts from the palatal region (P), intervention with photobiomodulation at the donor site (I), compared with natural healing (C), evaluating wound healing as the primary and pain as the secondary outcome (O). A total of 668 records were identified and 8 randomized clinical trials, in which 284 participants were included. In outcomes, clinical healing parameters and patient-reported pain were analyzed, in which the majority of most studies demonstrated that photobiomodulation positively influenced epithelialization, reduction in wound area, and tissue color during the first two postoperative weeks. However, the effect on pain control was inconsistent among studies, with only two showing statistically significant reductions. The studies included demonstrated clinical and methodological heterogeneity due to different laser parameters, and their designs made statistical pooling of data unfeasible for a meta-analysis. In conclusion, photobiomodulation appears to be a promising adjunctive therapy to accelerate palatal wound healing after FGG, particularly in the early postoperative period. Nevertheless, the clinical benefit in pain management remains uncertain. Future well-designed studies with standardized protocols are needed to strengthen contemporary evidence.

Background: Since emerging studies have reported a positive association on oral cancer and periodontal disease, this study aims to evaluate the odds ratio of having concurrent oral cancer in patients with periodontal disease.

Methods: A systematic review following the PRISMA guidelines was conducted with three electronic databases. The inclusion criteria were structured according to the PECOS framework: (P) Human subjects aged over 18; (E) Patients with periodontal disease; (C) Individuals without periodontal disease; (O) The odds of patients developing oral and/or head and neck cancers; (S) Case-control studies. After screening, 18 clinical studies from 13 different regions, comprising a total of 31,504 participants, were included.

Results: A meta-analysis was performed and revealed that the odds ratio (OR) for developing oral cancer in patients with periodontal disease, compared to those without, was 3.35 (95% CI: 2.63-4.26; P < .001). After adjusting for potential confounding factors, the adjusted OR was found to be 2.32 (95% CI: 1.71-3.15; P < .001). Case definition also has an impact, with OR of 2.02 if using missing teeth compared to OR of 2.68 by using AAP clinical periodontal parameters.

Conclusion: Clinical considerations for this specific group of patients should draw new attention for a strategic interdisciplinary care.

Mixed connective tissue disease (MCTD) combines features of systemic lupus erythematosus, scleroderma, and polymyositis. Neurological involvement, including trigeminal neuropathy, is rare. This report describes isolated trigeminal sensory neuropathy as the initial manifestation of MCTD. Quantitative sensory testing revealed progressive bilateral trigeminal sensory deficits. Laboratory evaluation showed elevated anti-U1-RNP antibodies, and clinical examination revealed lymphadenopathy and hand swelling, confirming the diagnosis. No other systemic manifestations were present at onset. This case highlights considering MCTD in patients with orofacial sensory disturbances and performing comprehensive serological and clinical evaluation for early diagnosis and management to monitor potential life-threatening complications such as pulmonary hypertension.

Objective: Orthodontic treatment can influence patients' dietary habits and oral health-related quality of life (OHRQoL) due to appliance-related discomfort. We prospectively evaluated short-term changes in dietary habits among orthodontic patients with clear aligners versus fixed appliances.

Methods: Thirty-seven patients (73.0% females, 34.7±17.0 years old) starting non-extraction comprehensive treatment with clear aligners (n=26) or fixed appliances (n=11) were enrolled. OHRQoL (Oral Health Impact Profile), anxiety/depression (Patient Health Questionnaire), dental anxiety (Modified Dental Anxiety Scale), and pain catastrophizing (Pain Catastrophizing Scale) were assessed at baseline and at 2 months. Dietary changes and pain intensity were recorded in daily diaries over 5 consecutive days after bonding, 1-month, and 2-month adjustments. OHRQoL changes were evaluated with paired t-tests; dietary limitations were compared between- and within-group with chi-square and Cochran's Q tests across timepoints.

Results: OHRQoL significantly improved from baseline to 2 months (2.8 ± 2.8 vs. 1.6 ± 1.8, p <0.001), regardless of appliance type (p = 0.15). Psychological functioning did not differ between groups. Fixed-appliance patients reported dietary limitations significantly more frequently than aligner patients at day 2 (100.0% vs. 42.1%, p = 0.020, relative risk [RR] = 2.38, 95% confidence interval [CI] 1.40, 4.02), day 3 (100.0% vs. 30.0%, p = 0.020, RR=3.33, 95%CI 1.71, 6.49), day 4 (100% vs. 36.8%, p = 0.015, RR = 2.72, 95%CI 1.51, 4.90) after bonding, despite no significant differences in pain intensity (p>0.05). Between-group differences in dietary limitations were not sustained at 1- and 2-month adjustments.

Conclusion: Although OHRQoL similarly improved, patients with fixed appliances reported more dietary limitations in the post-bonding week compared to aligner patients, independent of pain or psychological functioning. Differences were not maintained at 1- and 2-month follow-ups.

Dental prescribing is a crucial component of general dental practices, enabling the management of pain, control of infection, and promotion of postoperative recovery. Analgesics, antibiotics, and antiseptic mouthwashes are frequently prescribed as short-term adjuncts to definitive dental treatments, such as extractions, endodontic, and periodontal therapies. These medications can significantly affect cardiovascular, renal, hepatic, metabolic, and the microbiome beyond the oral cavity. In this review, we aim to summarize the systemic health effects of three medication classes frequently prescribed by general dentists and discusses their mechanisms, clinical implications, and stewardship opportunities. Nonsteroidal anti-inflammatory drugs (NSAIDs) are the first-line treatment for dental pain, but even a brief course can affect renal function, blood pressure, and gastrointestinal integrity in susceptible patients. Acetaminophen is an important analgesic for mild to moderate dental pain though its cumulative dosing may increase the risk of hepatotoxicity. Opioids are historically prescribed after tooth extractions, endodontic and periodontal surgeries, but they offer no advantage over non-opioid analgesics and contribute to opioid misuse in the community. Gabapentinoids are emerging as lower-risk opioid alternatives in patients who cannot use NSAIDs or acetaminophen, but their use also requires caution. Antibiotics continue to be prescribed for conditions that are not clinically indicated but may increase the risks of antimicrobial resistance, gut microbiome dysbiosis, and Clostridioides difficile infection. Mislabeling of penicillin allergies is widespread and may promote the use of higher-risk alternatives such as clindamycin. Antiseptic mouth rinses, particularly chlorhexidine, can effectively reduce oral microbial load but may disrupt nitrate-reducing oral bacteria and alter nitric oxide-mediated vascular function. General dental practitioners should integrate systemic health awareness when prescribing these medications to ensure safety and advance antimicrobial and pharmacologic stewardship in daily practices.

We present a female patient with chronic orofacial pain, followed up for 12 years. She described her pain as throbbing with intermittent pain attacks, and frequently accompanied by symptoms such as photophobia, phonophobia, and nausea. This was associated with myofascial pain of masticatory muscles, which were very painful on palpation. The patient was diagnosed with a complex pain profile that included chronic facial migraine, chronic masticatory myofascial pain, nonspecific neuropathic components, and generalized facial hypersensitivity. Despite the diversity of pharmacological treatments, clinical benefit was limited and transient, with many medications discontinued due to adverse effects or lack of efficacy. We present the successful use of botulinum toxin type A (BoNT-A; Dysport®) in treating this patient. Planned administration of BoTN-A into anatomically and symptomatically defined trigger zones, produced significant and sustained relief of migraine symptoms, followed up for two years. However, mild residual myofascial discomfort persisted. BoTN-A administration has the advantage of providing periodic rather than daily prophylactic treatment, the latter utilized by the present conventional method.

Objective: This in-vitro study examined the bond between denture teeth (milled, printed, prefabricated) and milled, printed, and autopolymerized denture bases.

Method and materials: 88 Specimens (11 groups, n=eight per group) of denture teeth and denture base resins were fabricated using systems of three different manufacturers (Vita-Zahnfabrik, Ivoclar-Vivadent, Formlabs). The groups consisted of combinations of six different teeth, five different denture base materials, and four different adhesive bonding options. Teeth were either printed, milled, or prefabricated, while denture bases were either conventionally polymerized, milled, or printed. In addition, two dentures were milled from industrially prepolymerized blocks. After 24 h of storage in distilled water, all specimens were loaded to failure to determine fracture forces. The fracture pattern was classified according to adhesive, cohesive, and mixed failures. Statistical analysis was performed using one-way analysis of variance and the Bonferroni-test for post-hoc analysis. The level of significance (α) was set to 0.05.

Results: Mean fracture forces ranged between 34.6 N and 649.3 N. The monobloc dentures Formlabs (459.0 ± 82.5 N) and Ivoclar (649.3 ± 32.3 N) featured the significantly highest fracture forces (p<0.001). For adhesively luted teeth, the conventional base-conventional tooth group showed the highest bond strength (289.5 ± 44.3 N), while the printed base-printed tooth group had the lowest (34.6 ± 12.7). Milled base group showed intermediate values (236.5 ± 56.4).

Conclusion: Bond strength between denture teeth and denture base depends on the fabrication process. Monolithic systems demonstrated optimal bond strength. Among all other combinations, the conventionally polymerized denture base combined with prefabricated teeth showed the best results. Prefabricated teeth and milled teeth in combination with milled denture bases showed similarly good results. Printed denture bases in combination with prefabricated, milled and printed teeth showed reduced and variable bond strength. A precise bonding protocol is recommended to ensure optimal bonding of different systems.

Objectives: To describe the main clinical challenges in managing molar-incisor hypomineralization (MIH), evaluate dentists' knowledge and clinical decision-making, and illustrate a timed extraction approach through a clinical case.

Methods and materials: A narrative review was combined with a cross-sectional digital questionnaire assessing dentists' knowledge, diagnostic ability, and treatment preferences, stratified by experience (≤10 years vs. >10 years) and training (GPs vs. Spec/Res). Scores were calculated on a 0-100 scale. Additionally, a case report of an 8.5-year-old girl with bilateral post-eruptive breakdown (PEB) of maxillary first permanent molars was presented to demonstrate the management of severe MIH.

Results: A total of 145 dentists participated: 61.4% general practitioners (GPs) and 38.6% specialists/residents (Spec/Res). Spec/Res scored significantly higher than GPs (p < 0.05), particularly in diagnostic and management domains. Glass ionomer restorations were the most frequently chosen treatment (43%), followed by stainless steel crowns (SSC) (26%). Younger practitioners more often selected inlays/onlays. The case demonstrated favorable eruption of second molars following timed extraction.

Conclusion: MIH management requires early diagnosis and severity-based treatment planning. Persistent knowledge gaps, especially among GPs, emphasize the need for enhanced continuing education. Timed extraction, when appropriately planned, may provide a predictable outcome in severe MIH cases.

Objective: The aim was to evaluate the impact of cross-linked hyaluronic acid (HA) gel on the clinical outcomes of gingival depigmentation using scalpel or diode laser techniques.

Method and materials: In this single-blinded, prospective, randomized clinical trial, 44 patients who had maxillary gingival pigmentation were allocated into a test group (HA+) that had HA gel applied, and a control group (HA-). Depigmentation was performed using a scalpel or a 940-nm diode laser (0.8 W) in a split-mouth design. The follow-up visits were at 3, 7, 14, and 30 days. Clinical measurements included the Wound Healing Index (WHI), digital measurement of the non-healed remaining area (NRA), pigmentation, pain, and Bleeding Index.

Results: At 30 days, WHI and NRA showed similar results in both HA- and HA+ groups (P > .05). In contrast, the diode laser had significantly improved mean WHI by day 7 and 14, and mean NRA by day 3 and 7 (WHI = 1.55 and 1.02; NRA = 28.7% and 2.1%, respectively) in comparison to the scalpel (WHI = 1.70 and 1.14; NRA = 52.6% and 5.0%, respectively). The decrease in pigmentation intensity and distribution was highly significant (P .001) and similar between the HA-, HA+, scalpel, and laser groups at 1 month (P > .05). The pain did not differ significantly between HA- and HA+ groups (P > .05). However, pain was significantly less with the diode laser than the scalpel (P .05). Significantly less bleeding occurred with the diode laser than the scalpel (P .001).

Conclusion: HA did not confer additional benefits to promote wound healing and reduce pain in depigmentation. Diode laser is a convenient method of depigmentation that improves initial healing and decreases initial pain, with reduced bleeding. Gingival hyperpigmentation is a major esthetic issue for many individuals. Laser and scalpel treatments produce equivalent esthetic outcomes.