Editor’s Choice Articles

Objectives: The objective of this study was to see how the bacterial composition changes on clear orthodontic retainer over a 14-day period. Methods: Saliva and plaque samples collected from a clear retainer surface were obtained from five healthy volunteers receiving retainer treatment. Prior to clear retainer delivery, patients had not been wearing any other appliances. Patients were instructed to wear their clear retainer for the 14-day period, taking them off to eat and to clean them with a soft-bristle toothbrush. The bacterial composition was determined via Illumina MiSeq sequencing of the bacterial 16S rRNA. After bioinformatics processing using the QIIME pipeline, the intra- and intergroup biodiversity of the sample was analyzed. Results: The bacterial composition changed over a 14-day period in the saliva and on the clear retainer. When comparing the different phylum levels between saliva and clear retainer’ microbiota, the Firmicutes were significantly increased 1.26-fold (p = 0.0194) and 1.34-fold (p = 0.0123) after 7 and 14 days of retainer treatment when compared to saliva, respectively. The Campylobacteriota were significantly decreased 1.80-fold (p = 0.05) in the clear retainer when compared to saliva at 7 days. At the genus level, several microbiota were significantly increased in relative abundance in the clear retainer after the 14-day period. Conclusion: These findings reveal that the presence of a clear retainer in the mouth might lead to enamel changes or periodontal tissue destruction, especially after 14 days of use. Full article

This cross-sectional study was to evaluate the association between the oral health-related quality of life (OHRQoL) of older Thai people with obesity and oral health indicators. General and oral conditions were assessed. Oral dryness was determined using the Xerostomia Inventory-11 (XI-11) and clinical oral dryness score (CODS). OHRQoL was evaluated by the oral health impact profile (OHIP-14). Participants were aged 60–86 years; 73 (59.3%) were overweight or obese, and 50 (40.7%) were normal weight. Older patients with obesity had almost four times the rate of hypertension (OR = 3.59; 95%CI:1.34–9.60; p = 0.002), more missing teeth (p = 0.025), and higher CODS (p = 0.014) than those without obesity. The total XI-11 scores were positively associated with the total CODS, after adjusting for BMI (r = 0.267, p = 0.003). Those with obesity had almost three times the tendency for a negative OHRQoL compared with the non-obese (OR = 2.73; 95%CI:1.12–6.71; p = 0.04). After adjusting for all related factors, the chances of predicting an OHIP-14 score of four based on obesity and total XI-11 score were 4.42 (95%CI:1.57–12.47; p = 0.005) and 1.11 (95%CI:1.02–1.20; p = 0.013), respectively. Obesity had an increasingly undesirable negative impact on the OHRQoL of older Thai people and was influenced by BMI and oral dryness. Full article

Here, we explored the role of S. mutans’s whole cell and discrete fractions in the degradation of type I collagen and dentinal collagen. Type I collagen gels and human demineralized dentin slabs (DS) were incubated in media alone or with one of the following: overnight (O/N) or newly inoculated (NEW) cultures of S. mutans UA159; intracellular proteins, supernatant or bacterial membranes of O/N cultures. Media from all groups were analyzed for protease-mediated release of the collagen-specific imino acid hydroxyproline. Images of type I collagen and DS were analyzed, respectively. Type I collagen degradation was highest for the supernatant (p < 0.05) fractions, followed by intracellular components and O/N cultures. Collagen degradation for DS samples was highest for O/N samples, followed by supernatant, and intracellular components (p < 0.05). There was lower detectable degradation for both type I collagen and DS from NEW culture samples (p < 0.05), and there was no type I collagen or DS degradation detected for bacterial membrane samples. Structural changes to type I collagen gel and dentinal collagen were observed, respectively, following incubation with S. mutans cultures (O/N and NEW), intracellular components, and supernatant. This study demonstrates that intracellular and extracellular proteolytic activities from S. mutans enable this cariogenic bacterium to degrade type I and dentinal collagen in a growth-phase dependent manner, potentially contributing to the progression of dental caries. Full article

Introduction. Oral lichen planus is a chronic autoimmune inflammatory disease of unknown origin, characterized by various clinical forms of which the atrophic–erosive causes patients the greatest symptomatology. For this reason, there are different treatments that improve the associated signs and symptoms. One of these therapies is photobiomodulation (PBM), which, although new, has a high level of acceptance in dentistry based on evidence. However, there are inconsistent results in its application against lichen planus. The aim of this review was to evaluate the effect of photobiomodulation and its effectiveness as a therapeutic alternative for atrophic–erosive lesions. Material and methods. The databases PubMed, Google Scholar and Cochrane Library were searched to identify studies investigating the photobiomodulation treatment in atrophic–erosive lesions of oral lichen planus. A total of 294 articles were identified, published between 2017 and 2022, and then evaluated; 7 articles that met all the inclusion criteria were included in this study. Results. The type of laser light source used in PBM was the diode laser (four cases), the Nd–YAG laser at the same wavelength of 1064 nm (two cases) and the He–Ne laser (one case). The minimum and maximum wavelengths used were 630 nm and 1064 nm, respectively. Most studies used lesions treated with topical corticosteroids as a control group. The follow-up times of the studies were highly variable. Conclusions. Photobiomodulation is a treatment that competently combats oral lichen planus lesions by improving signs and symptoms, with no known adverse reactions so far, which makes it more beneficial compared to more conventional therapies, such as corticosteroids, for which side effects have been found. Full article

The aim of this clinical study was to investigate the change in occlusal vertical dimension (OVD) with dental casts mounted on a mechanical articulator using an average axis facebow and on a virtual articulator mounted using the Bonwill triangle and the Balkwill angle and compare these groups with OVD change observed clinically in patients. Casts were obtained from each patient (n = 14) and mounted on a semi-adjustable articulator in the facebow preservation group (FPG) and on a virtual articulator using average anatomic values in the average mounting group (AMG). Customized mandibular anterior splints were virtually designed at an OVD increased by 3, 6, and 9 mm. Digital buccal scans were performed with the anterior devices in the participants’ mouths in the intraoral group (IOG), AMG, and FPG at the different OVD increases accordingly. While no statistically significant differences (p > 0.05) were observed in the posterior interocclusal measurements with the incisal guide pin raised by 3 mm and 6 mm among all groups, a 9 mm increase resulted in a significant difference between AMG and IOG. The interocclusal posterior-to-anterior opening ratio observed clinically was 1:1.575. Increases in OVD up to 6 mm on dental casts mounted using average anatomic values performed similarly to the actual intraoral changes. Full article

Background: The purpose of this study is to investigate the relationship between children’s and parents’ dental anxiety. Methods: 731 children of different ages and their parents from six European countries participated in this study. Dental anxiety was investigated through an online questionnaire, which consisted of general questions and the Corah Dental Anxiety Scale (CDAS), which is a questionnaire that measures respondents’ reactions on a 5-point scale for four different situations. Results: CDAS results were calculated for all children and their parents. A total of 12.5% of children from Croatia, 26.67% from Macedonia, 10.94% from Bosnia and Herzegovina, 20.31% from Montenegro, 23.08% from Slovenia and 16.10% from Serbia showed a high level of anxiety. The correlation between dental anxiety of parents and children was 0.4 (p < 0.01). Conclusions: Parents with negative experience from a dental office can have a bad effect on their child’s behaviour, which results in the creation of a non-active patient. Due to the clear and existing cause-and-effect relationship of dental anxiety in children and parents, it is extremely important to educate parents about the proper psychological approach to children in order to promote positive experiences from dental offices, as well as to emphasize the importance of regular visits to the dentist. Full article

Aims: This case demonstrates the adverse sequelae that can follow a traumatic dental injury at a young age. It also highlights the importance of taking a full history and undertaking a thorough exam, independent of the information in the referral. Case presentation: A 9-year-old boy was referred for treatment of “an extra tooth” and “hypoplastic and non-vital” maxillary left permanent incisors. Examination revealed a sinus tract labial to these incisors (21,22) with increased probing depth. However, the teeth were otherwise normal. The child sustained a fall as a baby and lost one of his primary teeth that was never recovered. Information collected suggested the most likely diagnosis was an undiagnosed complete intrusion of a primary incisor, with subsequent hypoplasia and malalignment in the developing teeth. Management included the removal of the intruded primary tooth and monitoring of the hypoplastic permanent incisors until complete eruption and root maturation. Aesthetic restorations were then provided. The patient was referred for orthodontic correction of the malalignment. Conclusion: Misdiagnosis and inappropriate management of dental trauma can cause additional damage. In this case, endodontic therapy in the permanent incisors was avoided by correct diagnosis. Clinicians have to correctly assess and justify their decisions on each individual case. Full article

Background: Bone grafting in post-extractive site improves tissue regeneration. Soft tissue sealing of the grafted post-extractive alveolus is supposed to limit microbiological contamination from the oral cavity and to stabilize the coagulum. Several techniques are presented in the literature to reach this goal using different heterologous matrices or autogenous grafts. In addition, recently, a technique based on the use of granulation tissue in the post-extractive alveolus has been proposed. Aim: To compare the effect of different graft sealing approaches in post-extractive sites by qualitatively evaluating their healing process. Materials and Methods: This retrospective investigation included 30 patients requiring post-extractive site regeneration in the aesthetic area. Post-extractive sites were regenerated using a bovine bone matrix and patients were divided into three groups (10 patients in each group) according to the material used to seal the alveolar socket. In the UD group, the granulation tissue was used to seal the defect; in the PC group, epithelial-connective soft tissue graft was used, and in the COLL group, a collagen-based membrane was employed. Images of the post-extractive sites at different follow-up periods (2 and 12 weeks) were taken and the healing process was blindly evaluated by two independent practitioners. The Healing Index (HI) by Landry, Turnbull and Howley was used to assess the quality of the healing process. The combination of presence/absence of five clinical criteria defines an HI ranging from 1 (very poor) to 5 (excellent). Patients’ clinical-pathological variables were recorded. One-way ANOVA was used to explore the dependence of HI on the different socket preservation protocols. Results: Based on clinical-pathological characteristics of the included patients, there were no statistically significant differences among the different sealing techniques. At the 2-week follow-up appointment, HI did not differ among the socket preservation protocols evaluated. Moreover, smoking status and reason for extraction did not influence the HI among the three groups (two-way ANOVA p-value = 0.686, p-value = 0.248 respectively). At the 2-week follow-up appointment, HI was significantly different among the socket preservation protocols investigated. Specifically, the group undergoing collagen-based socket preservation procedure reported the highest HI, compared to the other two techniques (COLL mean 4.60 ± 0.5; PC mean 3.5 ± 1.2; UD mean 3.4 ± 0.5, one-way ANOVA p-value 0.006). Conclusions: The use of collagen porcine membranes may represent a suitable option to improve the patient healing process in grafted post-extractive sites together with reducing the surgical intervention time compared to alternative sealing techniques. Full article

The aim of the current study was to evaluate the learning curve and accuracy of implant placement by young professionals using a dynamic computer-assisted surgical system for dental implant placement. Ten students tried to place eight implants with a dynamic surgical system in predefined positions on two consecutive weekends, resulting in 160 implant placements in total. Postoperatively, the positions of the implants were scanned with an intraoral scanner and compared for deviations at the entry point, the apex, as well as angular deviations to the master model. The mean values of all measurements improved; statistical significance was found for the changes in the angle as well as for the position of the implants to the apex (p < 0.001). Furthermore, the young professionals indicated subjective improvement in handling the dynamic surgery system. Navigated surgical dental implant placement can be learned quickly and can support young professionals in everyday clinical practice, especially in difficult anatomic situations. Full article

The use of traditional intra-oral devices in maxillary molar distalization is not without undesirable consequences. The aim of the present study was to compare the miniscrew-supported distal-jet appliance to a traditional distal-jet appliance by evaluating the amount of upper first molar distalization and the dentoalveolar side effects. Data of 600 subjects visited at the orthodontic unit of Sapienza University of Rom were analyzed. Only 46 patients met the inclusion criteria and were selected and treated. Subjects were assigned randomly to receive treatment either with miniscrew-supported distal-jet appliance (Group A) or with a traditional distal-jet appliance (Group B). In Group A, miniscrews were inserted using a computer-guided surgical guide. The amount of upper first molar distalization and the dentoalveolar side effects were assessed both on the digital casts and on the lateral cephalometric radiograph at the end of the distalization phase. A descriptive statistical analysis that included the mean values and the standard deviation was conducted to evaluate the molar distalization and the dentoalveolar effects in two groups. Intergroup differences were determined using the Student’s t-test. The significance was set at p ≤ 0.05. In Group A, greater maxillary first molar distalization and a spontaneous distalization of the first premolars and a palatal inclination of central incisors were observed. By contrast, in Group B, the first premolars tipped mesially and a proclination of the maxillary central incisors was observed. In both groups, the transverse widths of the dental arch increased while a greater tendency of first premolar extrusion and of maxillary first molar rotation was observed in Group B. The skeletal anchorage device achieved greater first molar distalization and did not cause dento-alveolar side effects. Full article

Althouh cone beam computed tomography (CBCT) is popular for dental implant planning, the horizontal mesiodistal space of the edentulous ridge is still conventionally measured with a handheld sliding caliper in the oral cavity or on a plaster cast. For clinical application in implant planning, our aim was to evaluate the accuracy of CBCT horizontal mesiodistal linear measurements in comparison with conventionally obtained direct measurements on plaster casts. Postoperative CBCT acquisitions and plaster casts of 27 patients with adjacent posterior mandibular implants were analyzed in a prospective clinical study. On CBCT images, two observers assessed the inter-implant distances on axial and sagittal views. On plaster casts, the inter-implant distances were measured with a digital caliper. CBCT measurements on axial and sagittal views were, on average, 0.2 mm larger than measurements on plaster casts. Correlation was perfect between measurements of the same inter-implant distance performed by the observers on CBCT images and on plaster casts. When compared with conventionally obtained direct measurements on plaster casts, CBCT views slightly overestimated (mean 0.2 mm) the horizontal mesiodistal measurements between two implants as reference points. CBCT imaging is sufficiently accurate to evaluate mesiodistal distances on axial and sagittal views for dental implant planning in clinical practice. Full article

Lymphoepithelial carcinoma (LEC) of the oral mucosa is a rare histopathologic subtype of squamous cell carcinoma (SCC), which shares morphologic similarities with nasopharyngeal carcinoma (NPC), non-keratinizing undifferentiated subtype. The admixture of neoplastic epithelial tumor cells and a dense lymphoplasmacytic infiltrate makes microscopic diagnosis challenging. LEC etiopathogenesis has been variably associated with Epstein–Barr virus (EBV) infection, depending on the specific anatomic location and racial predilection, with a higher incidence in endemic populations. Although described in several subsites of the head and neck region, including the major salivary glands, the oral mucosa is considered an infrequent location for LEC development, deriving either from minor salivary glands (MSGs) or the surface epithelium. Herein, we report a rare case of an EBV-negative LEC arising from the oral surface epithelium, presenting as gingival swelling, and review the pertinent English-language literature, which revealed only 26 previously reported oral LECs. Our case is only the fourth oral LEC originating from the surface epithelium and the first one to affect the gingiva. Full article

Corticotomy is a surgical procedure that induces injury to the cortical bone to accelerate tooth movement. This study aimed to increase the depth of corticotomy to the trabecular bone and to evaluate the amount and rate of tooth movement and alveolar bone changes in response to various degrees of cortical and trabecular bone injury. Seventy-eight male Wistar rats were randomly divided into four groups based on procedure used: (1) baseline control group of orthodontic tooth movement (OTM) only; (2) OTM + 4 corticotomies (CO); (3) OTM + 4 osteotomies (OS); and (4) OTM + 16 CO. A closed-coil nickel–titanium spring was placed to move the maxillary first molar mesially with a 10 g force. On days 0, 7, 14, and 21, alveolar bone alteration and tooth movement were measured using microcomputed tomography. Significant tooth movement was related to the number and the depth of the perforations. The OTM + 16 CO group showed a greater amount and rate of tooth movement than the OTM + 4 CO group. When osteotomy and corticotomy were compared with the same volume of bone removed, the OTM + 4 OS group had a faster rate of tooth movement than the OTM + 16 CO group during the first week, with significantly reduced bone volume. However, no significant difference was observed in the amount of tooth movement between the OTM + 4 OS and OTM + 16 CO groups at the end of the study. Extending the depth of corticotomy to trabecular bone increased the amount of tooth movement by accelerating the induction and completion of bone remodeling, which accelerated the rate of tooth movement during the initial stage. Full article

Peri-implantitis is a common biological complication in dentistry. The aim of the present study was to retrospectively analyze risk characteristics in a group of patients referred to a university-based consultation for peri-implantitis. In all, 190 initial cases from 2010 to 2019 were evaluated and descriptively summarized. The evaluation included various parameters such as periodontitis, smoking and oral hygiene status, implant position, type of prosthetic restoration and retention, mucosal quality, and further anamnestic and clinical findings related to the potential risk of developing peri-implantitis. Peri-implantitis was diagnosed in 83% of the cases, with peri-implant mucositis alone in 16% of cases; furthermore, 38% of the patients were diagnosed with active/instable periodontitis, while 14% had stable periodontitis. Residual cement was considered as a potential co-factor of peri-implant inflammation in 43% of cases. Suboptimal implant positioning was found in 19% of patients. Peri-implantitis or peri-implant mucositis was present in about one-third of patients in the absence of smoking and periodontitis factors. Of note, 6% showed no identifiable risk factors. Factors related to an increased risk of peri-implantitis should be taken into consideration when planning implant treatment. Adequate prosthetic implant position, restoration, and cleanability remain important for long-term success. Full article

In society, tobacco products, such as e-cigarettes, and smokeless tobacco products, such as snus and nicotine pouches, are becoming more attractive. There is still a lack of information regarding the effects of these products on the oral mucosa and oral saliva biomarkers. The aim of this study is to evaluate oral mucosa and the presence of inflammatory biomarkers IL-6, IL-1, IL-8, TNF alpha and LRG-1 in saliva. Respondents were divided in four groups based on their tobacco product usage. Oral examination was carried out, saliva samples were taken, and the detection of IL-6, IL-8, IL-1, TNF alpha and LRG-1 levels in saliva was carried out. Out of the tobacco users, 30.8% were snus users, 48.7% were cigarette users and 20.5% were e-cigarette users. The control group was composed of respondents who did not use any tobacco products. E-cigarettes were used more by women, but snus was used more by men. Mucosal changes were seen in the group of snus users, and mucosal changes were only seen in men who had used 5–10 tobacco units per day for 5–10 years. Increased IL-6 levels in saliva were detected in respondents who also experienced mucosal changes. Mucosal changes were white, leathery and localized at the site where snus sachets were placed. Saliva, as an easily available biofluid, could be used as a first tool to detect potentially precancerous signs, but the LRG1 marker cannot be used as a prognostic marker. Full article

The SIBLING proteins are a family of non-collagenous proteins (NCPs) previously thought to be expressed only in dentin but have been demonstrated in other mineralized and non-mineralized tissues. They are believed to play vital roles in both osteogenesis and dentinogenesis. Since they are tightly regulated lifelong processes and involve a peak of mineralization, three different age groups were investigated. Fifteen wild-type (WT) mice were euthanized at ages 1, 3, and 6 months. Hematoxylin and eosin staining (H&E) was performed to localize various microscopic structures in the mice mandibles and tibias. The immunostaining pattern was compared using antibodies for dentin sialoprotein (DSP), dentin matrix protein 1 (DMP1), bone sialoprotein (BSP), and osteopontin (OPN). Immunostaining of DSP in tibia showed its most noticeable staining in the 3-month age group. DSP was expressed in alveolar bone, cellular cementum, and PDL. A similar expression of DMP1 was seen in the tibia and dentin. BSP was most noticeably detected in the tibia and acellular cementum. OPN was mainly expressed in the bone. A lower level of OPN was observed at all age groups in the teeth. The immunostaining intensity was the least detected for all proteins in the 6-month tibia sample. The expression patterns of the four SIBLING proteins showed variations in their staining intensity and temporospatial patterning concordant with skeletal and dental maturity. These findings suggest some role in this tightly regulated mineralization process. Full article

This review aims to discuss and illustrate various uses of cantilevers to solve multiple clinical issues and prove their versatility. Cantilevers are commonly used in the segmented arch technique, and they can be designed to solve various clinical problems with highly predictable results. Its design and shape can modify the various combinations of vertical and horizontal forces. The novel trend is to combine cantilevers with skeletal anchorage. Cantilevers offer a very simple and statically determined force system. The advantage is the control over side effects, which normally occur on the anchor teeth and the occlusion. The disadvantages include possible side effects on the anchorage unit, when the anchorage is poorly controlled. The review highlights the clear benefits of cantilever use in complex corrections of single teeth, segments, and entire arch with a diminished effect on the dentition, also with the use of skeletal anchorage. With their simple and easily tailored design, these springs can be called an orthodontic multi-tool. Full article

Aim: This study sets out to explore the relationship between craniofacial morphology and obstructive sleep apnea (OSA) severity, assessing the relative contribution of obesity, calculated using BMI. Methods: A sample of 30 adult patients (20 males; 10 females), mean age = 54(±76) years, with a polysomnography-confirmed diagnosis of OSA, i.e., with an apnea-hypopnea index (AHI) of over 5 events/h, was recruited and underwent cephalometric evaluation. Sleep parameters, namely AHI, AHI supine, oxygen desaturation index (ODI), and mean oxygen saturation [Mean SaO2%], were assessed. Correlation analysis between 13 cephalometric features and AHI was performed using a Pearson test. The sample was split into three groups based on AHI score (mild = 10 < AHI < 15; moderate = 15 < AHI < 30; severe = AHI > 30), and ANOVA was performed to compare the means of cephalometric features. In addition, the sample was split into two groups according to BMI (normal weight = BMI < 25; overweight = BMI > 25). Correlation analysis between cephalometric features and AHI was performed for each group using a Pearson test. Results: The average polysomnographic values were AHI = 29.08(±16); AHI supine = 43.45(±21); ODI = 23.98(±21); mean SaO2(%) = 93.12(±2). Posterior facial height (PFH) was significantly lower in the severe OSA group than in patients with moderate OSA (p = 0.05). In the normal-weight group, negative correlations of the PFH and SNA angle with AHI (r = −0.36; r = −0.25, respectively), and positive correlations of the FMA angle and MP-H distance with AHI (r = 0.29; r = 0.20, respectively), were found. In the overweight group, negative correlations of AO-BO distance, SPAS (upper posterior airway space) and PAS (posterior airway space) with AHI (r = −0.30; r = −0.28; r = −0.24, respectively), and positive correlations of AFH (anterior facial height) and the FMA angle with AHI (r = 0.32; r = 0.25, respectively), emerged. Conclusions: PFH seems to be related to the aggravation of OSA. In normal-weight subjects, hard tissue-related factors have a greater impact on OSA severity, whereas in overweight subjects, the impact of fat tissue is greater. Full article

There is empirical evidence of an association between periodontitis and coronary heart disease (CHD). However, it is uncertain whether periodontal treatment in CHD patients might lead to reduced healthcare costs. This study aims to assess the association between periodontal treatment and healthcare costs in newly diagnosed CHD patients. Data from 21,263 adults who were continuously insured between 2011 and 2016 and who were newly diagnosed with CHD in 2013 were selected from a German claims database. The study population was differentiated by the utilization of periodontal treatment. The average treatment effect (ATE) of periodontal treatment on healthcare costs (total, inpatient, outpatient, drugs) was investigated using weighted Poisson regression models conditional on covariates and is shown as a ratio (of geometric means). Periodontal treatment was documented for 4.7% of the persons in the study population. Newly diagnosed CHD patients showed an ATE of 0.98 for total healthcare cost (95% CI 0.90–1.06), 0.79 for inpatient costs (95% CI 0.61–1.04), and 0.95 for drug costs (95% CI 0.87–1.04). A statistically significant 7% increase in outpatient costs was shown (95% CI 1.01–1.13). Despite a lack of statistical significance in most cases, the study provides evidence of a meaningful decrease in inpatient costs after periodontal treatment. Further studies are needed. Full article

Individuals with orofacial clefting (OFC) have a higher prevalence of tooth agenesis (TA) overall. Neither the precise etiology of TA, nor whether TA occurs in patterns that differ by gender or cleft type is yet known. This meta-analysis aims to identify the spectrum of tooth agenesis patterns in subjects with non-syndromic OFC and controls using the Tooth Agenesis Code (TAC) program. An indexed search of databases (PubMed, EMBASE, and CINAHL) along with cross-referencing and hand searches were completed from May to June 2019 and re-run in February 2022. Additionally, unpublished TAC data from 914 individuals with OFC and 932 controls were included. TAC pattern frequencies per study were analyzed using a random effects meta-analysis model. A thorough review of 45 records retrieved resulted in 4 articles meeting eligibility criteria, comprising 2182 subjects with OFC and 3171 controls. No TA (0.0.0.0) was seen in 51% of OFC cases and 97% of controls. TAC patterns 0.2.0.0, 2.0.0.0, and 2.2.0.0 indicating uni- or bi-lateral missing upper laterals, and 16.0.0.0 indicating missing upper right second premolar, were more common in subjects with OFC. Subjects with OFC have unique TA patterns and defining these patterns will help increase our understanding of the complex etiology underlying TA. Full article

A clear aligner is an esthetic and more comfortable option for patients who need orthodontic treatment. However, some types of tooth movement, such as extrusion, are difficult with this tool. Therefore, composite attachments have been suggested to improve tooth movement. This study aims to evaluate the initial displacement and stress distribution during upper central incisor extrusion using the conventional composite attachments. Maxillary models with the upper teeth, clear aligners, and composite attachments placed on the labial surface of the upper right central incisor were constructed. Four models were created to simulate upper central incisor extrusion: (1) without any composite attachment; (2) rectangular beveled attachment; (3) ellipsoid attachment; and (4) horizontal rectangular attachment. Clear aligners were designed to perform upper central incisor extrusion. The constructed models were analyzed using the finite element method. Initial displacement and stress distribution were analyzed. Output analysis found that the upper right central incisor in the model with a horizontal rectangular attachment had the greatest extrusive movement, followed by the model with ellipsoid attachment and the model with beveled attachment. Maximum compressive stress was seen at the cervical region of the composite attachment. Composite attachments including horizontal rectangular attachment, ellipsoid attachment, and rectangular beveled attachment can be used to perform upper central incisor extrusion. Full article

With continuing technological developments, there have been advances in the field of fixed prosthetics, particularly in impression-taking techniques. These technological advances mean that a wide variety of diagnostic and/or rehabilitation possibilities can be explored without the need for physical models. The aim of this study was to evaluate the accuracy of three intraoral scanners used in oral implant rehabilitation using an extraoral scanner as a reference and varying the scanning area. Three models representing different clinical scenarios were scanned 15 times by each intraoral scanner and three times by the extraoral scanner. The readings were analyzed and overlaid using engineering software (Geomagic^® Control X software (Artec Europe, Luxembourg)). Statistically significant differences in accuracy were found between the three intraoral scanners, iTero^® (Align Technology Inc., San Jose, CA, USA), Medit^® (Medit^®: Seoul, Korea), and Planmeca^® (Planmeca^®: Helsinki, Finland). In all clinical scenarios, the iTero^® scanner had the best trueness (24.4 μm), followed by the Medit^® (26.4 μm) and Planmeca^® (42.1 μm). The Medit^® showed the best precision (18.00 μm) followed by the iTero^® (19.20 μm) and Planmeca^® (34.30 μm). We concluded that the iTero^® scanner had the highest reproducibility and accuracy in the clinical setting. Full article

Background: The purpose of the study was to investigate the accuracy of mini-implant placement with the use of a computer designed surgical guide derived by intraoral scanning alongside Cone-Beam Computed Tomography (CBCT) or the use of a 2D radiograph. Methods: Thirty-five mini-implants (Aarhus^® System: n = 20, Ø: 1.5 mm and AbsoAnchor^®: n = 15, Ø: 1.3–1.4 mm) were placed in the maxilla and mandible of 15 orthodontic patients for anchorage purposes in cases where a CBCT was needed due to impacted teeth or for safety reasons. All were placed with the help of a computer designed surgical guide. One implant became loose and was excluded from the study. For 18 mini-implants (study group), CBCT and intraoral scanning were used for guide design, while for 16 (control group) only intraoral scanning and panoramic imaging information were used. Mini-implant position was recorded by angular and linear measurements on digital models created by combining Digital Imaging and Communications in Medicine (DICOM) and stereolithography (.stl) files. Accuracy in positioning was determined by comparing corresponding measurements for virtual and real positioned mini-implants on digital models before and after operation. The results were statistically analyzed with t-tests and the Mann-Whitney test. Results: No significant statistical differences were found for pre- and post-operational angular measurements in the study group, while significant statistical differences occurred on the same measurements for the control group (coronal angle 13.6° pre-op and 22.7° post-op, p-value = 0.002, axial angle 13.4° pre-op and 15.9° post-op, p-value = 0.034). Linear measurements pre- and post-operational for either group presented no significant statistical differences. Conclusions: A 3D designed and manufactured surgical guide with information concerning CBCT and intraoral scanning ensures accuracy on mini-implant placement while design of the guide without the use of a CBCT is less accurate, especially on inclination of the implant. Full article

The aim of the present systematic review was to evaluate and possibly differentiate the effects of traditional cigarettes, heat-not-burn tobacco, and electronic cigarettes on periodontal and peri-implant health status. Electronic cigarettes and heat-not-burn tobacco have become very popular in recent years and have been proposed to consumers as a safer alternative to conventional tobacco smoke, although their effect on periodontal and peri-implant health remains unclear. The study protocol was developed according to PRISMA guidelines, and the focus question was formulated according to the PICO strategy. A literature search was conducted across PubMed/MEDLINE and the COCHRANE library from 2003 to April 2022. From the 1935 titles initially identified, 18 articles were finally included in the study and extracted data were qualitatively synthesized. It may be carefully concluded that e-cigarettes may cause attenuated clinical inflammatory signs of periodontitis and, hypothetically, of peri-implantitis when compared to conventional tobacco smoke. Both alternative smoking products, containing nicotine, may likewise exert negative effects on periodontal and peri-implant health, as demonstrated by in vitro studies. Further investigations are needed to assess the impact of electronic cigarettes and heat-not-burn tobacco products on periodontal and peri-implant health status. Full article

Denture wearers often complain about jeopardized function and reduced quality of life due to lack of prosthesis’ retention. Implant-retained mandibular overdentures, on two non-connected implants (2IOD) are well-proven solutions to overcome these issues. We prospectively assessed 69 patients and scrutinized clinical records until at least seven years of function. Thirty-six were retained on Locator^® Abutments (LA) and thirty-tree on Ball Abutments (BA). Both systems were compared regarding the type, amount, and total cost of required maintenance. One implant was lost, yielding 98.7% survival after seven years. In total, 438 technical issues occurred: 121 (27.35%) in BA and 317 (72.4%) in LA. Out of these, 343 events (78%) were solved chairside: 191 (43.6%) were replacements of retention caps, 113 (25.8%) were minor acrylic repairs, 26 (5.9%) pressure ulcers had to be relieved, and 13 (3%) were related to abutments. LA required 179 insert replacements compared to 12 in the BA group. The overall initial treatment cost was EUR 3850 (base year of the analysis: 2003). The average total maintenance cost in relation to the initial cost for the LA and BA groups was 19.11 (range 0–82.24%) and 18.91% (range 0–113.26%) respectively (p = 0.540). Conclusions: The seven-year maintenance costs for a 2IOD is acceptable when the patient is regularly checked and professionally maintained. Most events are easily solvable chairside, but a few patients required more expensive interventions, regardless of the type of attachment used. Full article

Recently, a novel magnetic attachment with extremely low cost and high performance was developed. This article aims to introduce a novel magnetic attachment and to evaluate its basic eligibility for denture retention in clinical practice. The novel magnetic attachment system used in this study was the direct-bonding root-keeper-type Magteeth™ MT800 (MagneDesign, Nagoya, Japan). The retentive force without displacement (position 0) and after horizontal displacement to positions 0.5, 1, 1.5, 2, 2.5, and 3 mm were measured. The values relative to the retentive force without displacement were gradually decreased to 82.7 ± 16.3%, 68.8 ± 17.1%, 62.4 ± 15%, 47.2 ± 13.1%, 35.7 ± 9.9%, and 20.7 ± 6.5%, respectively. The retentive force and magnetic field strength did not change significantly after the load test (100 N load, 10,000 times). No new gap between the metal and resin was found in the root keeper- and magnet assembly-embedded blocks after the load test. Some scratches on magnetic assembly and root keeper surface, while no change in the resin texture after the load test were observed. Based on the findings of this preliminary study, this novel low-cost magnetic attachment exhibited favorable retention, strength, and durability for clinical use. Full article

The Stockholm Studies are a series of investigations started in 1985 and still ongoing. Out of 105,798 inhabitants, aged 30 and 40 years and living in the greater Stockholm area in Sweden, 3273 subjects were randomly selected. Of them, 1676 were clinically examined focusing on oral health. The subjects were then followed up using national population and health registers in order to study associations between oral health parameters and systemic health outcomes and finally death. The 35 years of observation provides unique possibilities to analyze, for example, how periodontitis links to a number of systemic health issues. The results have consequently provided numerous new associations and confirmed earlier observations on how poor oral health is associated with heart diseases and cancer. Full article

Background: Numerous studies have been conducted to explicate the scope of emotional intelligence in educational success and coping with stress in different academic sectors, but very few have been conducted with dental students. This scoping review aimed to ascertain the role of emotional intelligence in academic performance and stress factors among dental students. Methods: All publications in the English language between 2001 and 2020 were retrieved employing MeSh keywords. Academic resources such as Pubmed, Pubmed Central, EMBASE, Web of Science, EBSCO-Host, Cochrane, PROSPERO, and ARU E-library were comprehensively searched for empirical research. One thousand, three hundred and fifty-nine papers were screened according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards for inclusion and exclusion criteria. These publications were then evaluated further by deleting duplicates, examining full-text articles, and conducting an abstract assessment. This review included a critical appraisal of 24 articles. Results: The narrative analysis method was applied to evaluate the data retrieved from publications regarding EI, academic performance, and stress factors. The review found that EI had a greater impact on the educational success of dental students throughout their clinical years. Moreover, EI may be a key tool in coping with stress and negative emotions. Higher EI scores were shown to be associated with better performance in organizational and leadership abilities, which are important for career advancement. Conclusion: The review suggested including EI training in the dental curriculum. Furthermore, EI should be used as a selection criterion for admission to dental education. Full article

The objective was to compare marginal defects and evaluate discoloration for adhesively cemented veneers in vitro when using two cement removal techniques. Twenty premolars were prepared with chamfer and borders in enamel. IPS e.max CAD veneers were cemented using Panavia V5 and divided in two groups (n = 10): cement excess removed with a probe after tack-curing for 3–5 s, or cement excess removed with a brush, then completely polymerized. All teeth were stored in alginate gel until micro-CT examination. Scanning was performed twice: directly after cementation and after thermocycling (5000 cycles, between 5 and 55 °C). To analyze discoloration, teeth were colored using 0.5% basic fuchsine and examined under a stereomicroscope. Depth of dye infiltration was scored 0 (no discoloration) to 5 (discoloration along the entire margin). Statistically significant differences of cement defects before thermocycling were reported, where brushing showed more defects than probing (p = 0.0161). After thermocycling, the defects increased for both groups. Extensive discoloration was the most common (55.56%) when removing excess by probing; by brushing, 90% of the specimens exhibited slight discoloration (p = 0.008). Regression analysis showed no relationship between type of defect and degree of discoloration. Removing cement with a brush causes more marginal defects, however less discoloration after thermocycling. Full article

This study assessed the longitudinal impact of early preventive dental visits on the number of dental operative procedures in a prevention-oriented pediatric dental practice. Inclusion criteria consisted of patients zero to four years of age with at least two years of preventive services provided by the practice. Early preventive visits were the intervention and dental operative procedures were the assessed outcome. The goal was to determine if preventive visits at an early age decreased the number of operative procedures needed by the patient. The patients were divided into two groups: those with older siblings in the practice and those without older siblings in the practice. A secondary outcome was to compare these two patient groups to determine if a child who had older siblings previously treated in this preventive practice had better outcomes than those without siblings in the practice. ANCOVA tests were used to compare the average number of operative procedures in two age groups (<2 years and ≥2 years), and for those with and without dental insurance, in addition to children being younger sibling versus children without sibling, adjusting for the effect of covariates. The study sample consisted of 363 pediatric patients. Patients’ age at first visit ranged from 0 to 4 years old (mean = 2.13; SD = 1.15). The average number of operative procedures per year increased as the age at first visit increased (p < 0.05). The average number of operative procedures in two age groups (<2 years and ≥2 years) differed (p < 0.05) with those whose age at first visit ≥2 years experiencing more dental operative procedures than the younger group. The average number of operative procedures was similar between younger siblings (mean = 1.91; SD = 7.44) and children without siblings (mean = 1.54; SD = 2.1) (p > 0.05). The difference in the average number of operative procedures in children with insurance (mean = 1.59; SD = 5.25) and children without insurance (mean = 1.58; SD = 2.38) was non-significant (p > 0.05). More dental cleaning examinations were associated with fewer dental operative procedures (p < 0.05). These findings demonstrate that dental examinations before two years of age and more dental cleaning examinations lead to a decrease in the number of dental operative procedures needed by children. Full article

The aim of this study was to investigate abrasion on human dentin after brushing with activated charcoal toothpastes. A self-designed brushing machine was used to brush five groups (Group A: Water, Group B: Sensodyne Pro Schmelz, Group C: Splat Blackwood, Group D: Curaprox Black is White, and Group E: Prokudent Black Brilliant) with electrically powered toothbrushes for 4 h. The abrasive dentin wear was calculated using profilometry data. Furthermore, thermogravimetric analyses and scanning electron microscopy were used to analyze the composition of the toothpastes. Mean dentin loss by brushing were (71 ± 28) µm (Splat Blackwood), (44 ± 16) µm (Curaprox Black is White), (38 ± 13) µm (Prokudent Black Brilliant), (28 ± 14) µm (Sensodyne Pro Schmelz), and (28 ± 13) µm (Water). Groups A/B/D/E and group C each lie in one subset, which is statistically different from the other subset according to a post hoc Tukey test (p = 0.05). Within the limitations, it can be concluded that the content of activated charcoal in charcoal toothpastes had little influence on the observed abrasive behavior, although one of the charcoal toothpastes showed the highest abrasion on dentin. Full article

Sinus surgery procedures such as sinus lifting with bone grafting or maxillary functional endoscopy surgery (FESS) can present different complications. The aims of this systematic review are to compile the post-operatory complications of sinus elevation with bone grafting and FESS including voice changes, and to elucidate if those changes are either permanent or temporary. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were used, and the literature was exhaustively searched without time restrictions for randomized and non-randomized clinical studies, cohort studies (prospective and retrospective), and clinical case reports with ≥4 cases focused on sinus lift procedures with bone grafts and functional endoscopic maxillary sinus surgery. A total of 435 manuscripts were identified. After reading the abstracts, 101 articles were selected to be read in full. Twenty articles that fulfilled the inclusion criteria were included for analysis. Within the limitations of this systematic review, complications are frequent after sinus lifting with bone grafts and after FEES. Voice parameters are scarcely evaluated after sinus lifting with bone grafts and no voice changes are reported. The voice changes that occur after FESS include a decreased fundamental frequency, increased nasality, and nasalance, all of which are transitory. Full article

(1) Background: The aim of this study is to understand from a microscopic point of view whether bicarbonate air-abrasive powders associated with ultrasonic instruments can decontaminate nine different surfaces used for the abutment/implant junction. Fibroblast growth was carried out on decontaminated surface in order to understand if there are significative differences in terms of biocompatibility. (2) Methods: After taking samples of patient plaque, nine different surfaces were contaminated and analyzed by SEM, then their wettability was evaluated. Fibroblasts were cultured on the decontaminated surfaces to understand their ability to establish a connective tissue seal after decontamination. The results were analyzed from a statistical point of view to hypothesize a mathematical model capable of explaining the properties of the surfaces. (3) Results: A negative correlation between roughness and contamination has been demonstrated, whereas a weak correlation was observed between wettability and decontamination capacity. All surfaces were topographically damaged after the decontamination treatment. Grade 5 titanium surfaces appear tougher, whereas anodized surfaces tend to lose the anodizing layer. (4) Conclusions: further studies will be needed to fully understand how these decontaminated surfaces affect the adhesion, proliferation and differentiation of fibroblasts and osteoblasts. Full article

Background: Clear cell odontogenic carcinoma (CCOC) is a rare malignant odontogenic epithelial neoplasm of the jaws. It is composed of irregular nests of clear to faintly eosinophilic cells resembling clear cell rests of primitive dental lamina and an intermixed hyalinized fibrous stroma. Most cases occur in the 5th and 6th decades of life, with a female predominance. The mandible is affected more than the maxilla. Clinical features vary from asymptomatic to non-specific pain, ill-defined radiolucency, root resorption, and sometimes soft tissue extension. Histology varies from bland to high grade. CCOC demonstrated a significant tendency to recur. Metastasis typically involves regional lymph nodes, which haves been reported in 20–25% of cases. Pulmonary metastasis rarely occurs. Differential diagnoses are broad and include odontogenic, salivary, melanocytic, and metastatic neoplasia. CCOCs are positive for cytokeratins, mainly AE1/AE3 and CK19. Most cases show EWSR1 rearrangement and rarely, the BRAFV600E mutation. Design: Patient charts were reviewed at our institution. A total of three cases were found in electronic medical records, which were diagnosed as clear cell odontogenic carcinoma over a period of six years (2014–2019). Patient charts were reviewed for medical history and radiology data. The pathology slides were reviewed by one or more faculty members. Results: We present three cases of CCOC, ranging in age from 40 to 69 years (two women and one man). Two cases involved the maxilla and one involved the mandible. Two presented with painful swelling and one with mass recurrence. Radiography results show that two had poorly defined radiolucent lesions, and one was heterogeneous with a small nodule projecting into the maxillary sinus. Histological examination revealed an epithelial neoplasm composed of irregular sheets, cords, and nests of polygonal cells with central hyperchromatic, mildly pleomorphic nuclei surrounded by clear to pale eosinophilic cytoplasm, with occasional mitotic figures. The tumor had infiltrated the bone and soft tissues. Two cases were immunopositive for CK5/6 and one case was positive for p63 and CK19. Interestingly, the eosinophilic dentinoid matrix interspersed among tumor cells in one case was consistent with its odontogenic origin. Histochemical staining showed PAS-positive and diastase-labile intracytoplasmic material consistent with glycogen. Conclusion: Our study highlights the potential diagnostic significance of dentinoid (although reportedly seen in only 7% of cases), along with CK5/6 immunopositivity, in supporting the histologic diagnosis of CCOC among a variety of neoplasia in its differential diagnosis. 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

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

Despite their popularity, resin composite restorations fail earlier and at higher rates than comparable amalgam restorations. One of the reasons for these rates of failure are the properties of current dental bonding agents. Modern bonding agents are vulnerable to gradual chemical and mechanical degradation from a number of avenues such as daily use in chewing, catalytic hydrolysis facilitated by salivary or bacterial enzymes, and thermal fluctuations. These stressors have been found to work synergistically, all contributing to the deterioration and eventual failure of the hybrid layer. Due to the expense and difficulty in conducting in vivo experiments, in vitro protocols meant to accurately simulate the oral environment’s stressors are important in the development of bonding agents and materials that are more resistant to these processes of degradation. This narrative review serves to summarize the currently employed methods of aging dental materials and critically appraise them in the context of our knowledge of the oral environment’s parameters. Full article

With the advent of a digital workflow in dentistry, the inter-occlusal articulation of digital models is now possible through various means. The Cadent iTero intraoral scanner uses a buccal scan in maximum intercuspation to record the maxillomandibular relationship. This in-vitro study compares the occlusion derived from conventionally articulated stone casts versus that of digitally articulated quadrant milled models. Thirty sets of stone casts poured from full arch polyvinyl siloxane impressions (Group A) and thirty sets of polyurethane quadrant models milled from digital impressions (Group B) were used for this study. The full arch stone casts were hand-articulated and mounted on semi-adjustable articulators, while the digitally derived models were pre-mounted from the milling center based on the data obtained from the buccal scanning procedure. A T-scan sensor was used to obtain a bite registration from each set of models in both groups. The T-scan data derived from groups A and B were compared to that from the master model to evaluate the reproducibility of the occlusion in the two groups. A statistically significant difference of the contact region surface area was found on #11 of the digitally articulated models compared to the master. An analysis of the force distribution also showed a tendency for a heavier distribution on the more anterior #11 tooth for the digitally articulated models. Within the limitations of this study, the use of a digitally articulated quadrant model system may result in a loss of accuracy, in terms of occlusion, the further anteriorly the tooth to be restored is located. Care must be taken to consider the sources of inaccuracies in the digital workflow to minimize them for a more efficient and effective restorative process. Full article

Saliva consists of organic and inorganic constituents. During exercise, analysis of the saliva can provide valuable information regarding training stress, adaptation and exercise performance. The objective of the present article was to review the effect of physical exercise on saliva composition. The shift in the composition of the saliva, during and after a workout, reflects the benefits of exercise, its potential risks and the capability of the saliva to serve as a health indicator. The type and the frequency of training, the physical condition and the athletes’ general health influence the hormones, immunoglobulins and saliva enzymes. The correlation between saliva and physical exercise has to be further investigated and the available knowledge to be applied for the benefit of the athletes during sports activities. Full article