Search Results (175)

Background/Objectives: The main purpose of the present scoping review was to map and explore the efficacy of computer-controlled intraosseous anesthesia (CCIA) in comparison with conventional dental anesthesia in pediatric dental patients. Secondarily, this study aimed to compare the acceptance and preference factors between CCIA and conventional dental anesthesia in children. Given the limited and heterogeneous nature of the available literature, this review aimed to identify gaps and scope the extent of research conducted in this area, providing a foundation for future, more targeted studies. Methods: The search was conducted in 19 electronic databases, and the appropriate studies were identified according to PRISMA-ScR guidelines. Only split-mouth randomized controlled clinical trials that reported on the clinical outcomes of CCIA in children were included. Two reviewers worked independently on the screening and selection of the studies. The same two reviewers carried out the data extraction and the risk of bias assessment, using the Cochrane risk of bias tool. Due to the exploratory nature, this review focused on mapping the characteristics, outcomes, and research trends rather than synthesizing effect sizes. Results: Out of 841 papers, 2 randomized clinical trials were ultimately included in the scoping review. The outcomes were categorized as primary (including results that answered the focus question) and secondary (relating to additional quality characteristics). Regarding the primary outcomes, in both studies, intraosseous anesthesia was efficacious in achieving the adequate level of anesthesia. One of the secondary outcomes was the acceptance and preference of CCIA in comparison with conventional dental anesthesia in children. The limited number and the high risk of bias in existing studies highlight the necessity for more comprehensive and high-quality research. Conclusions: The selected studies support the assertion that CCIA is a promising technique since it results in less pain perception and is preferred by patients compared to conventional local anesthesia. However, the existing literature is limited and at high risk of bias. Thus, further targeted investigations are needed to evaluate and yield more definitive results regarding the superiority of CCIA. Full article

Background: Periodontitis is linked to sleep-disordered breathing (SDB), including snoring, with 50–75% of cases involving mouth breathing (MB). Standard treatment includes scaling and root planing (SRP). Oral appliance therapy (OAT) is used to treat snoring and SDB. OAT plus a mouth shield (OAT+) worn during sleep may reduce MB to enhance periodontal health. This study evaluated whether OAT+, as an adjunct to SRP, improves periodontal health by reducing periodontal pathogens and facilitating upper airway patency. Methods: Fourteen participants with mild–moderate periodontitis were randomized to receive SRP on one side of the mouth at baseline (T0). Pocket depth (PD), bleeding on probing (BOP), and plaque index (PI) were recorded, and bacterial DNA from periodontal pockets were analyzed via PCR at baseline (T0) and 12 weeks (T3). At 4 weeks (T1), all participants received a self-titrated myTAP^® OA, followed by a mouth shield at 8 weeks (T2). Sleep metrics, including respiratory disturbance index (RDI), were recorded using the NOX T3 at T0–T3. Results: BOP and deep PD levels exhibited slight improvements from the baseline for both SRP and non-SRP (OAT+ only) treated sites but did not achieve significance. BOP decreased significantly more from the baseline in the SRP than in the non-SRP group at T3 (p = 0.028); P. gingivalis’ presence declined on both sides (p = 0.0135). Other periodontal and bacterial parameters showed no significant differences between or within groups. Snoring (p = 0.011), MB (p = 0.025), and RDI (p = 0.019) significantly decreased with OAT+ at T3. Conclusions: In mild–moderate periodontitis patients who snore, OAT+ reduces snoring, MB, and obstructive events, serving as an adjunct to SRP with no negative clinical effects over the short term. The combined therapy yielded similar results to OAT+ alone, likely due to minimization of MB. Its capacity to improve the oral environment is worthy of further investigation. Full article

Background: The aim of this study was to evaluate the effect of Photobiomodulation Therapy (PBMT) on the eruption rate of impacted maxillary canines after surgery, using a split-mouth design. Methods: A 16-year-old patient was referred to the Department of Oral and Maxillo-Facial Sciences of “Sapienza” University of Rome. Clinical examination revealed the persistence of maxillary primary canines and the absence of a palpable canine bump. CBCT scans confirmed that both upper permanent canines were impacted in the palatal osteomucosal region and showed a mesial inclination. Conventional surgery with cold blade was performed for both impacted canines, and PBMT was applied on element 2.3 for three sessions after surgery. Since this is a case report, no statistical analysis was performed. Results: The eruption movement of the two impacted canines was evaluated 16 weeks after surgery. The extent of the spontaneous eruption movement of element 1.3 was 0.21 mm, while element 2.3, which underwent three sessions of PBMT following surgery, moved 3.16 mm. Conclusions: The element that underwent PBMT appears to respond positively in terms of spontaneous eruption following disinclusion surgery compared to the contralateral element that was not stimulated with the laser. These findings suggest that photobiomodulation therapy could be effective in accelerating the eruption of palatally impacted canines following surgery, avoiding the need to use orthodontic traction. Future randomized controlled clinical trials are needed to demonstrate these preliminary results. Full article

Background: Alveolar ridge preservation (ARP) following tooth extraction plays a vital role in maintaining ridge dimensions and supporting subsequent implant therapy. Objectives: This study histologically and radiographically evaluates the efficacy of techBiomat bone^®—a deproteinized bovine bone mineral (DBBM)—for alveolar ridge preservation (ARP), comparing the results of bone formation, residual graft particles, and nonmineralized tissue to those of spontaneous healing in human tooth sockets. Methods: A split-mouth study was conducted to evaluate the radiographic and histologic outcomes in human sockets with and without ARP. Results: A significant improvement in bone fill was observed compared to untreated sockets. Radiographically, 87% of the treated sockets demonstrated more than 75% bone fill, whereas only 7% of the untreated sockets did. Histologically, the percentage of new bone formation was greater in treated sockets (42%) than in untreated sockets (25%). The findings also highlighted a lower proportion of nonmineralized tissue in grafted sites, suggesting improved healing over spontaneous healing. The residual graft material in the treated sockets had a moderate resorption rate, with almost complete replacement by the host bone after six months. The use of techBiomat bone^® demonstrated promising results, with a resorption rate conducive to optimal bone regeneration, with less than 9% residual graft material remaining after six months. Conclusions: This study supports the efficacy of techBiomat bone^® graft material for ARP, highlighting its potential in maintaining ridge volume. Further studies with larger sample sizes are needed to confirm these findings. Full article

Purpose: The objective of this research was to compare the pain-reducing effects of two topical anesthetic agents, 10% atomized lidocaine spray and an EMLA, cream before needle injection applied at different time intervals using parameters of visual analog scale (VAS) score and heart rate (HR). Methods: The randomized split-mouth study included 30 patients (17 boys, 13 girls) aged 8.22 ± 1.8 years. The application of atomized lidocaine spray or cream was randomly used in the maxillary second premolar region. The parameters were measured prior to and following each needle insertion after being applied for 10, 30, 60, and 120 sec. Paired t-test and independent t-test were used for statistic analyses. Results: Compared with the first applications (10 s), atomized lidocaine and EMLA cream applications significantly decreased scores of VAS at the 30 and 120 s applications, respectively. Despite atomized lidocaine showing an early effect compared with EMLA, there were no significant differences in VAS scores between the atomized lidocaine and EMLA cream at the 60 and 120 s measurements. Although HR significantly increased at first anesthetic administration with the atomized lidocaine spray, HR significantly decreased at 30 and 120 s administrations. Conclusions: Atomized 10% lidocaine-based topical anesthetics significantly reduced pain more rapidly and better than EMLA from needle pricks in the buccal mucosa. Therefore, atomized lidocaine topical anesthesia could be used as a substitute for EMLA cream prior to buccal anesthetic administration. On the other hand, further comprehensive studies are required to explore the effects of several doses of atomized lidocaine in various areas of the oral cavity. Full article

Background: During the initiation of routine orthodontic treatment with fixed appliances, placing elastic separators (ESs) may lead to the patient experiencing considerable pain. Earlier studies evaluating the effects of low-level laser therapy (LLLT) on reducing pain caused by orthodontic ESs have reported contradictory results. The aim of our study was to evaluate the effect of a single application of LLLT on the experience of pain following ES placement. Methods: A double-blind, placebo-controlled randomized controlled trial was performed—with implementation of the split-mouth technique—where n = 33 volunteers (12 male and 21 female; aged between 19 and 36 years) were enrolled. ESs were placed at the mesial and distal surfaces of the first permanent molars in the upper or lower jaws. Jaws were divided into two quadrants; the treatment group received LLLT (using a GaAlAs diode laser, at a 980 nm wavelength, with 100 mW producing 6 J of energy; continuous wave), while the other quadrant served as the placebo side receiving a similar treatment, but without laser irradiation, immediately after separation. A questionnaire with a visual analogue scale (VAS; 0–100) was used for the assessment of pain (spontaneous pain and pain on mastication) scored for each first permanent molar directly after separation and after 6, 24, 48 and 72 h of both laser and placebo treatment application. Results: Mean VAS values were lower, but not significantly different, between the treatment vs. placebo groups for spontaneous pain at either measurement point (p > 0.05). Mean VAS values were significantly lower in the treatment groups for pain on mastication at the 6 (9.29 ± 12.65 vs. 19.07 ± 20.99; p = 0.025), 24 (21.96 ± 21.11 vs. 37.19 ± 26.35; p = 0.012) and 48 h (28.01 ± 21.40 vs. 42.60 ± 26.29; p = 0.016) measurement points. The analgetic effect of LLLT was most effective after 6 h, both in the resting position (−49% decrease) and during mastication (−51% decrease). Conclusions: A single application of LLLT with 6 J of energy may have beneficial effects on reducing the pain caused by orthodontic ESs used at the initiation of treatment with fixed appliances, especially during mastication, after 6–48 h following the separation procedure. Trial registration: clinicaltrials.gov ID NCT06816537 (date of registration: 7 February 2025, retrospectively registered). Full article

The objective of the study was to determine the relationship between burning, xerostomia, dysgeusia and other subjective symptoms in patients with burning mouth syndrome (BMS). This cross-sectional study was conducted at the Dental Polyclinic Split, Split, Croatia. A total of 71 patients with BMS, i.e., 60 women and 11 men, were included in the study. The patients were divided into four subgroups: burning (B), burning and xerostomia (BX), burning and dysgeusia (BD), burning, xerostomia and dysgeusia (BXD). The following data were collected from all patients: sociodemographic status, comorbidities, medications, characteristics of the burning, presence of other subjective symptoms, topography of the burning. The majority of patients with BMS were women (86.0%) with an average age of about 65 years. Gastrointestinal diseases were the most common comorbidity (48.35%), and the most commonly used medications were proton pump inhibitors (PPIs) (29.8%). In the largest number of patients (N = 34), the burning symptom worsened in the evening hours (p = 0.059). The majority of BMS patients suffered from burning symptoms that occurred continuously (N = 54, 75.13%) and from an improvement (reduction/cessation) of symptoms during meals (N = 54, 76.65%). Of the other subjective symptoms, changes in the morphology of the tongue (10.6%) and a feeling of swelling (9.1%) were the most common. The tongue was the most common localization (67.35%). The multivariable logistic regression analysis showed a statistically significant effect of female gender (p = 0.049) as a potential positive predictor in subgroup B. The sociodemographic and medical data collected cannot explain the different occurrence of symptoms in the four subgroups of patients with BMS. Full article

Introduction: non-surgical periodontal treatment, primarily comprising scaling and root planing, is crucial for the maintenance and enhancement of oral health. However, the invasive nature of this procedure often leads to patient discomfort and pain, which may deter individuals from seeking necessary dental care, ultimately compromising their oral health outcomes. Methods: This prospective randomized crossover split-mouth study involved the application of Ultra-Low Frequency (ULF) Transcutaneous Electrical Nerve Stimulation (TENS) in 20 adult patients undergoing non-surgical periodontal treatment. Pain and discomfort levels were quantitatively assessed during procedures conducted with and without the ULF-TENS intervention. Results: The assessment of maximum voluntary opening, pain intensity, and overall comfort levels indicated a statistically significant reduction in pain (p < 0.0001) and discomfort (p < 0.0001) when ULF-TENS was employed during the treatment, and an increase in the maximum mouth opening after TENS (p = 0.00062). Conclusions: The findings of this pilot study suggest that ULF-TENS may serve as a valuable adjunctive therapy in non-surgical periodontal treatment by reducing pain and discomfort, potentially enhancing patient comfort and compliance. Further research with larger sample sizes is warranted to confirm these findings. Full article

Background/Objectives: This double-blinded study aimed to evaluate the clinical performance of a giomer restorative material in comparison to a nanotechnology-based restorative system for the restoration of non-carious cervical lesions over a period of 48 months. Methods: A 48-month randomized, controlled, split-mouth trial was conducted with 49 subjects at its baseline, which was reduced to 34 subjects at follow-up, yielding a statistical power of 69.55%. Cervical lesions were restored using either BEAUTIFIL II LS (BL) or 3M/ESPE Filtek Supreme Universal Restorative (FS). Clinical assessments were performed by blinded examiners, excluding the one who placed the restorations. Evaluations were based on the Hickel criteria, covering esthetic, functional, and biological properties, with comparisons made using the Wilcoxon signed-rank test. Results: Hickel scores were analyzed with the Mann–Whitney U test to compare BL and FS groups within subjects. Changes in median Hickel scores, sensitivity, and the gingival index were assessed via Friedman’s test, followed by Wilcoxon signed-rank tests with a Bonferroni correction for post-hoc comparisons. The p-values under 0.05 were considered significant, except with the Bonferroni correction. Statistical analysis showed no significant differences between materials across most Hickel parameters (p > 0.05), though BL exhibited a trend of better surface staining (76.5% excellent with BL vs. 76.5% excellent with FS) and adjacent mucosa, while FS showed slight advantages in surface luster and color match. Conclusions: The clinical evaluation of restorations for non-carious cervical lesions using giomer and nanotechnology-based restorative systems revealed no statistically significant differences according to the Hickel criteria, indicating a similar clinical performance for both restorative materials. Full article

There is continuing interest in using biologics in root coverage procedures. The aim of the present study was to explore the 2-year outcomes following multiple gingival recessions (GRs) coverage using the application of cross-linked hyaluronic acid (HA) in combination with modified coronally advanced tunnel (MCAT) together with subepithelial connective tissue graft (SCTG). Adopting a split-mouth design, 266 GRs were randomly allocated to either a test (MCAT + SCTG + HA) or control group (MCAT + SCTG). The main outcome variable was the stability of the obtained mean root coverage from 6 months to 24 months. Twenty-four patients were evaluated at the 2-year follow-up. Comparisons between test and control sides at the same time points were evaluated using the t-test for independent variables. The changes in time were compared by one-way analysis of variance with the Tukey post hoc test separately for the test and control groups. The study protocol was registered at ClinicalTrials.gov (NCT05045586). At 2 years, around ninety percent of recessions showed complete root coverage (87.02% of the test group and 91.90% of the control group). Mean root coverage did not differ between the two sides, with 81.37 ± 37.17% (test) and 84.63 ± 35.33% (control), respectively. Significant improvements in the reduction of gingival recession height, clinical attachment level gain, gingival thickness increase, and the root esthetic score were found in both groups after 2 years, but no statistically significant difference was observed between the groups. The adjunctive application of HA significantly improved soft tissue texture (STT, 0.94 ± 0.23 for the test group vs. 0.71 ± 0.46 for the control group). Treatment of multiple gingival recessions with MCAT + SCTG with or without HA yielded marked and comparable 2-year clinical outcomes, which could be maintained over a period of 24 months. The clinical relevance of the demonstrated significant difference in STT between groups may be minimal. Full article

Background: Effective pain management during dental procedures is essential to ensure positive treatment outcomes, particularly for pediatric patients. Intraosseous anesthesia, administered via the QuickSleeper system, has shown promise as an alternative to traditional local anesthesia techniques. Methods: A single-blinded split-mouth randomized controlled clinical trial took place at the dental hospital at King Saud University with 33 healthy patients (aged 4–9 years), who required pulpotomies and stainless steel crown procedures on two mandibular primary molars, to evaluate the effectiveness of two local anesthetic techniques. Each tooth was randomly assigned to receive 4% articaine either delivered via the intraosseous route using QuickSleeper 5 or buccal infiltration. The effectiveness of the anesthesia was evaluated by the number of injections needed and at various stages using the Sounds, Eyes, and Motor (SEM) scale. Postoperative complications, including pain, swelling, and lip numbness, were assessed through follow-up phone calls with the patients’ legal guardians. Results: The techniques demonstrated comparable effectiveness; there were no statistically significant differences in the number of injections and in the SEM scale scores. Minimal postoperative complications were reported: lip biting (two cases) and prolonged numbness (nine cases) were reported only when buccal infiltration was used, and swelling and pain were reported when both techniques were used. Conclusions: Intraosseous anesthesia via the QuickSleeper 5 system is comparable to traditional buccal infiltration anesthesia for pulpotomies and stainless steel crown procedures in pediatric mandibular molars. Intraosseous anesthesia offers the added benefit of reduced soft tissue numbness and associated complications. Full article

Background: Mandibular reconstruction poses challenges in achieving functional and aesthetic outcomes. Effective oral rehabilitation is crucial for restoring function and improving quality of life; however, the altered neomandibular anatomy complicates oral hygiene, increasing the risk of peri-implant complications and making successful rehabilitation more difficult. This study introduces a novel approach combining vestibuloplasty with patient-specific implant-retained splints to enhance oral health and improve rehabilitation outcomes. Methods: Three patients underwent mandibular reconstruction with a free vascularized fibula flap (FFF). After 6 months of osseointegration, vestibuloplasty and soft tissue refinement were performed, with a split-thickness skin graft placed on the FFF periosteum. An implant-retained splint was secured to the abutments for two weeks to support soft tissue healing. Implant survival, bone loss, and peri-implant health were evaluated over a 2-year follow-up. Results: A total of 12 implants were placed, primarily in the neomandible (83.3%), with a 100% survival rate. Implant survival was assessed. Implant survival was assessed based on established criteria for clinical success, including stability, presence of pain, bleeding on probing (BOP), pocketdepth, bone loss and lack of peri-implant radiolucency. Functional outcomes included normal mouth opening, laterotrusion, and protrusion. Pocket depths ranged from 3 to 4 mm, except for one implant in cases 1 and 2. The mean BOP was 51.7%. Conclusions: This case series introduces a surgical technique that combines CAD/CAM and vestibuloplasty to optimize dental rehabilitation in mandibular FFF reconstructions, demonstrating safe thinning of soft tissues for improved oral hygiene and survival. Full article

Background: This study evaluated the postoperative effects of hyaluronic acid (HA) on pain, swelling, and trismus following mandibular third molar surgery. Material and Methods: Thirty healthy patients with bilateral impacted mandibular third molars underwent two surgeries at 21-day intervals. In a split-mouth design, one extraction socket was treated with 0.2 mL of high-molecular-weight hyaluronic acid gel (Monovisc^® [molecular weight ≈ 1.5–2.2 million Da]), while the contralateral socket received no additional treatment. Perioperative medications, including NSAIDs, were standardized for all patients. Data collection included postoperative pain, swelling (using Gabka and Matsumura’s method), analgesic consumption, and trismus (mouth opening) on designated days. Data were analyzed using the Mann–Whitney U and Wilcoxon signed-rank tests with Bonferroni correction (adjusted significance level: p > 0.0083). Results: The mean VAS pain scores on day 1 were 63.5 ± 22.3 in the HA group and 61.9 ± 12.5 in the control group, decreasing to 3.9 ± 7.6 and 3.3 ± 7.2, respectively, by day 7 (p > 0.0083). The maximum interincisal distance on day 7 was 45.9 ± 7.4 mm in the HA group and 43.5 ± 7.3 mm in the control group, showing a slight improvement (p = 0.002). Swelling, measured using the tragus–pogonion distance, was 164.6 ± 20.7 mm in the HA group and 166.3 ± 18.9 mm in the control group on day 7 (p > 0.0083). Analgesic consumption remained comparable across all postoperative days (p > 0.0083). No statistically significant differences were observed between the HA and the control groups at any evaluated time point. Conclusions: Hyaluronic acid application after mandibular third molar surgery demonstrated a slight improvement in trismus on day 7, but no significant long-term advantages in pain or swelling. While early postoperative improvements in trismus were observed, these findings require further validation. Additional studies are needed to explore HA’s potential clinical applications in oral surgery. Full article

The present study describes the case of a severe surgical complication in a 42-year-old female patient undergoing bimaxillary orthognathic surgery for the correction of skeletal class III, where a detachment of the surgical plates and fibrous healing of the palatal suture occurred. The aim of this study was to enlighten two important concepts: (I) how occlusal and mandible position changes can be well tolerated by the temporomandibular joint even in the case of a failed orthognathic surgery; (II) how a prosthodontic approach based on the search for occlusal stabilization made it possible to manage a complicated clinical case. Clinical Presentation: Clinically, the patient presented an occlusal instability and a split and mobile maxillary bone with respect to the cranial base. The case was resolved using full-mouth prosthodontic rehabilitation to fix the occlusal instability and guide maxillofacial surgeons, establishing the new occlusal position during an orthognathic reintervention. Clinical Relevance: The function was reestablished independently on any treatment planning centered on the temporomandibular joint repositioning concepts. However, although neuromuscular plasticity and the patient’s adaptation skills can explain the clinical success in such complex rehabilitations, these findings must be interpreted with caution due to the limited generalizability inherent to the study’s design. Full article

Background: In order to reduce the prolonged duration of orthodontic treatment, several surgical techniques have been proposed over the years. Corticotomy and piezocision are the two most widely used techniques, and, given the lack of consensus in the literature, along with the renewed interest in these approaches in recent years, the primary objective of this study is to evaluate their effectiveness in accelerating canine retraction in patients requiring extraction of the upper first premolar and, as a secondary objective, to assess if there is a worsening of periodontal health and how the surgical approach is perceived by the patient. Methods: An electronic search was performed on PubMed, Scopus, Web of Science, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) up to 30 November 2024. The PRISMA statement was adopted for the realization of the review, and the Cochrane Collaboration’s risk of bias assessment tool (RoB 2) was used to assess the studies’ quality. Results: After full text assessment, fifteen randomized clinical trials (14 split mouth design, 1 single-blind, single-center design) covering 326 patients (mean age 20, 19 years) were included. The data collected reveal that corticotomy accelerates canine retraction by 1.5 to 4 times, while piezocision achieves retraction 1.5 to 2 times faster, making corticotomy the most effective technique. No statistically significant adverse effects on periodontal ligament, molar anchorage loss, or root resorption were observed following the two surgical techniques. In addition, patients reported experiencing mild to moderate pain. Conclusions: Corticotomy and piezocision are effective techniques for accelerating upper canine retraction in extraction cases, significantly reducing the overall duration of orthodontic treatment. Full article