Buccal Sites Research Articles

Factors associated with furcation involvement and fixed prostheses: A cross-sectional study.

The study aims to explore the relationship between horizontal and vertical furcation involvement (FI) in teeth with or without a single unit fixed prosthesis (FP). Adult subjects presenting to the periodontics department requiring cone beam computed tomography (CBCT) analysis were recruited for this study. 79 patients, with a total of 200 teeth, were split into two groups based on the presence or absence of FP within the same patient. Our analysis considered patient-level factors like smoking, diabetes, and periodontal severity and tooth-level factors including root trunk length (RTL), probing depth (PD), periodontal supracrestal tissue height (STH), supracrestal tissue attachment (STH-PD), interproximal bone distance (IPBD) to the cementoenamel junction (CEJ) (control) or crown margin (Test), and the distance from the furcation to the CEJ (control) or crown margin (Test). Subsequently, we developed a predictive model for FI. The presence of a prosthesis had a significant association with FI, with an odds ratio (OR) of 12.8 (p < 0.001). Other factors significantly correlated with FI were periodontitis (OR = 10.9; p = 0.006), buccal furcation site (OR = 5.70; p < 0.001), and PD (OR = 1.90; p = 0.027). FP placement increased IPBD by 1.08mm (p < 0.001). The predictive model built for FI demonstrated a sensitivity of 92.9% and a specificity of 66.7%. Fixed prosthesis significantly influenced FI only in periodontitis patients. Factors such as periodontitis Stage, probing depth, and buccal site contribute to FI. The high sensitivity of the predictive model highlights the importance of considering these correlations during treatment planning. Comprehending FI factors is vital for devising customised treatment plans to halt disease progression and enhance outcomes of periodontal regenerative therapies.

Oral squamous cell carcinoma: Effect of tobacco and alcohol on cancer location.

The underlying factors of oral squamous cell cancers (OSCC) have been elucidated, but studies have focused little on etiological differences in affected oral cavity sites. The aim of this retrospective study was to clarify the role of carcinogen exposure in OSCC of different oral cavity areas. A cross-sectional study of patients with primary OSCC was conducted retrospectively, based on patient records from Helsinki University Hospital, Finland, between January 2016 and December 2020. The patients' self-reported history of tobacco smoking and alcohol use was explained by tumor site, age, sex, tumor size, and lymph node status in a logistic regression model. The information on smoking and alcohol use was compiled from a patient background form. In 519 patients, tumors occurred most often in the tongue (51%), gingiva (21%), or floor of the mouth (FOM; 15%). FOM had 26-fold greater odds for a history of smoking and alcohol use than other tumor sites (OR=25.78; 95% CI: 8.02-82.95; p<0.001). Gingival and buccal sites were associated significantly less with smoking and alcohol use (OR=0.43, 95% CI: 0.28-0.67; p<0.001 and OR=0.47; 95% CI: 0.25-0.92; p<0.026, respectively). Patients of older age were less likely to have a history of smoking and alcohol use (AOR=0.95; 95% CI: 0.94-0.97; p<0.001) than younger patients. Tumor size (T3-4) and FOM increased the odds for history of smoking and alcohol use (AOR=1.73; 95% CI: 1.15-2.60; p=0.009 and AOR=26.15; 95% CI: 8.01-84.84; p<0.001, respectively). OSCC of oral cavity sites has notable differences in etiology. FOM seems to be related almost exclusively to conventional smoking and heavy alcohol use.

Morphological study of distal furcation in mandibular first molars based on cone beam computed tomography images in Beijing population.

This retrospective study explored the incidence of independent distal-lingual root (DLR) in mandibular first molars and the morphologic features of distal furcations through cone beam computed tomography (CBCT) in Beijing population. A total of 401 CBCT images of both mandibular first molars existed were included. The sex of the patients, the incidence of DLR, the distal root trunk length (DRT), the locations of distal furcation entrance (DFE), and the separation angle of distal furcation (ADF) were recorded. The incidence rates of DLR were 33.2% on the subject level and 26.8% on the tooth level. The incidence of DLR was not different between genders but was higher on the right sides. The DRT values were 4.15 mm±1.02 mm. The ADF was 65.56°±11.56°. The DFE was located lingually, and 97.2% DFE was located more apically than buccal/lingual furcations. A high incidence of DLR was found in the Beijing population. The DRT was longer than buccal and lingual sites. The DFE was located lingually with a wide separation. Understanding the morphological features of distal furcation can help clinicians to make proper treatment plans.

Erosion protective properties of the enamel pellicle in-situ

Objectives: Previous studies on short- and long-term pellicles showed that the enamel pellicle provides partial protection against erosion. The aim of the present study was to investigate the protective properties of clinically relevant pellicles formed within 2 to 24 h. The hypothesis was that factors such as pellicle formation time, intraoral location, and acidic challenge severity would not influence the erosion-protective properties of the pellicle.Methods: Six subjects participated in the study. Bovine enamel specimens were prepared and intraorally exposed at buccal or palatal sites for 2, 6, 12, and 24 h to allow pellicle formation, followed by erosion using 0.1 % or 1 % citric acid. Calcium release and surface microhardness were measured, and specimens were analysed using scanning and transmission electron microscopy. Quantitative data were statistically analysed with three-way ANOVA and Tuckey's multiple comparison test (p = 0.05).Results: Pellicle formation time and intraoral location did not significantly influence the erosion-protective properties of the pellicle, while citric acid concentration significantly affected enamel erosion. The pellicle thickness increased with longer formation times and on buccal sites, but decreased or was entirely removed following treatment with 0.1 % or 1 % citric acid, respectively. The enamel surface exhibited a characteristic erosion pattern.Conclusions: This study underscores the importance of investigating pellicle properties within the critical 2- to 24-h timeframe and highlights the significance of pellicle thickness in acid resistance.Clinical significance: These findings provide valuable insights into the factors influencing the protective properties of enamel pellicles and could guide preventive measures in dental practice.

Anatomical Bone Characteristics of the Buccal Step Insertion Site for Mini-Screw Placement in Orthodontic Treatment: A CBCT Study

Background: To analyze the anatomical characteristics of a posterior area in the mandible localized distally to the second molars and extending in the vestibular direction toward the bony step, which we define as “buccal step”, in a patient with different skeletal patterns for mini-screw insertion. Methods: The sample included 85 CBCT (cone beam computed tomography) records selected from the digital archive. Analysis focused on the buccal step area. Sections were obtained in axial view using reference lines, and measurements of cortical and total bone were taken at specific points M0 (starting point, 6 mm apical from CEJc—cementoenamel junction crest), M2 (located 2 mm posterior to M0 in the apical direction), and M4 (positioned 4 mm posterior to M0 in the apical direction) in both directions. Six measurements were recorded for each scan root plane, assessing cortical and total bone depth. Results: The thickness of the bone increases toward the inside of the mouth at all tested sites (M0, M2, M4), which is good for placing mini-screws. Cortical bone thickness decreases toward the inside of the mouth, with no significant differences among the sites except for M0 vs. M4. People with a particular jaw shape (hypo-divergent) have a thicker cortical bone, indicating that facial structure affects bone thickness. Conclusions: The posterior buccal step insertion site has biomechanical advantages and reduces the risk of damaging roots during mini-screw insertions.

Free Gingival Graft: A Viable Surgical Option for Treating Mandibular Anterior Thin Gingival Phenotype and Gingival Recession

Thin gingival phenotype and thin labial plate bone morphotype predispose lower anterior teeth to gingival recession. Free gingival graft has become one of the periodontal plastic surgeries of choice in dealing with aesthetic demand, impaired hygiene care, and dentin hypersensitivity secondary to the gingival recession. The prognosis of free gingival graft as a single augmentation procedure for root coverage is usually good and predictable with proper post-surgery care and maintenance. In this case report, a 28-year-old female patient having gingival recession that was associated with interproximal attachment loss less than to the buccal site, limited keratinised tissues, and thin gingival phenotype in relation to teeth 31 and 41 that was treated using autogenous graft which harvested from hard palate mucosa with satisfactory postoperative results.

Assessment of the correlation between supracrestal gingival tissue dimensions and other periodontal phenotypes components via the digital registration method: a cross‑sectional study in a Chinese population

BackgroundSupracrestal gingival tissue dimensions (SGTDs) has been considered to be an essential element of periodontal phenotype (PP) components. This study aimed to explore the relationship between SGTDs and other PP components by digital superposition method that integrated cone beam computed tomography (CBCT) with intraoral scanning.MethodsThis cross-sectional study was conducted at the Stomatology Hospital of Fujian Medical University. Participants were recruited based on the inclusion and exclusion criteria. The data obtained from the digital scanner (TRIOS 3, 3Shape, Denmark) and CBCT images were imported into the TRIOS software (Implant Studio, 3Shape, Denmark) for computing relevant parameters. The significant level was set at 0.05.ResultsA total of 83 participants with 498 maxillary anterior teeth were finally included. The mean values of supracrestal gingival height (SGH) and the distance from the cementoenamel junction (CEJ) to the crest of the alveolar ridge (CEJ-ABC) on the buccal site were significantly higher than palatal SGH (SGH-p) and palatal CEJ-ABC (CEJ-ABC-p). Men exhibited taller CEJ-ABC and SGH-p than women. Additionally, tooth type was significantly associated with the SGH, SGH-p and CEJ-ABC-p. Taller SGH was associated with wider crown, smaller papilla height (PH), flatter gingival margin, thicker bone thickness (BT) and gingival thickness (GT) at CEJ, the alveolar bone crest (ABC), and 2 mm apical to the ABC. Smaller SGH-p displayed thicker BT and GT at CEJ, the ABC, and 2 and 4 mm apical to the ABC. Higher CEJ-ABC showed lower interproximal bone height, smaller PH, flatter gingival margin, thinner GT and BT at CEJ, and 2 mm apical to the ABC. Smaller CEJ-ABC-p displayed thicker BT at CEJ and 2 and 4 mm apical to the ABC. On the buccal, thicker GT was correlated with thicker BT at 2 and 4 mm below the ABC.ConclusionSGTDs exhibited a correlation with other PP components, especially crown shape, gingival margin and interdental PH. The relationship between SGTDs and gingival and bone phenotypes depended on the apico-coronal level evaluated.Trial registrationThis study was approved by the Biomedical Research Ethics Committee of Stomatology Hospital of Fujian Medical University (approval no. 2023-24).

Impact of keratinized mucosa on implant-health related parameters: A 10-year prospective re-analysis study.

To investigate whether the lack of keratinized mucosa (KM) affects peri-implant health after 10 years of loading. Data from 74 patients with 148 implants from two randomized controlled studies comparing different implant systems were included and analyzed. Clinical parameters including bleeding on probing (BOP), probing depth (PD), plaque index,marginal bone loss (MBL), and KM width (KMW) at buccal sites were collected at baseline (time of the final prosthesis insertion), 5-year and 10 years postloading. Multivariable logistic and linear regression models by means of a generalized estimated equation (GEE) were used to evaluate the influence of buccal KM on peri-implant clinical parameters; BOP, MBL, PD, and adjusted for implant type (one-piece or two-piece) and compliance. A total of 35 (24.8%) implants were healthy, 67 (47.5%) had mucositis and 39 (27.6%) were affected by peri-implantitis. In absence of buccal KM (KM = 0 mm), 75% of the implants exhibited mucositis, while in the presence of KM (KMW >0 mm) 41.2% exhibited mucositis. Regarding peri-implantitis, the corresponding percentages were 20% (KM = 0 mm) and 26.7% (KM >0 mm). Unadjusted logistic regression showed that the presence of buccal KM tended to reduce the odds of showing BOP at buccal sites (OR: 0.28 [95% CI, 0.07 to 1.09], p = 0.06). The adjusted logistic regression model revealed that having buccal KM (OR: 0.21 [95% CI, 0.05 to 0.85], p = 0.02) and using two-piece implants (OR: 0.34 [95% CI, 0.15 to 0.75], p = 0.008) significantly reduced the odds of showing BOP. Adjusted linear regression by means of GEE showed that KM and two-piece implants were associated with reduced MBL and MBL changes (p < 0.05). The lack of buccal KM appears to be linked with peri-implant parameters such as BOP and MBL, but the association is weak. The design of one-piece implants may account for their increased odds of exhibiting BOP.

Evaluation of peri-implant bone defects on cone-beam computed tomography and the diagnostic accuracy of detecting these defects on panoramic images.

This study was conducted to identify the typical sites and patterns of peri-implant bone defects on cone-beam computed tomography (CBCT) images, as well as to evaluate the detectability of the identified bone defects on panoramic images. The study population included 114 patients with a total of 367 implant fixtures. CBCT images were used to assess the presence or absence of bone defects around each implant fixture at the mesial, distal, buccal, and lingual sites. Based on the number of defect sites, the presentations of the peri-implant bone defects were categorized into 3 patterns: 1 site, 2 or 3 sites, and circumferential bone defects. Two observers independently evaluated the presence or absence of bone defects on panoramic images. The bone defect detection rate on these images was evaluated using receiver operating characteristic analysis. Of the 367 implants studied, 167 (45.5%) had at least 1 site with a confirmed bone defect. The most common type of defect was circumferential, affecting 107 of the 167 implants (64.1%). Implants were most frequently placed in the mandibular molar region. The prevalence of bone defects was greatest in the maxillary premolar and mandibular molar regions. The highest kappa value was associated with the mandibular premolar region. The typical bone defect pattern observed was a circumferential defect surrounding the implant. The detection rate was generally higher in the molar region than in the anterior region. However, the capacity to detect partial bone defects using panoramic imaging was determined to be poor.

Evaluation of gingival crevicular fluid volume with periopapers in patients who have recovered from COVID-19 infections

Aim: Coronavirus disease 2019 (COVID-19) reportedly affects many body tissues and organs and is detectable in body fluids, such as saliva and gingival crevicular fluid (GCF). Additionally, COVID-19 can cause an increased GCF volume (GCFV). This study investigated GCFV in patients with a history of COVID-19 infection using periopapers. Methodology: This study included 50 patients (25 males and 25 females) aged 21–69 years who were considered periodontally healthy and had a history of COVID-19 infection. GCF was collected from the central incisors’ buccal sites using paper strips, and GCFV was calculated using a Periotron 8000. Results: In patients with a history of COVID-19, the mean GCFV for all patients was 0.5226 ± 0.11 µl. The mean was 0.5208 ± 0.1011 µl in men and 0.5244 ± 0.1261 µl in women. No significant difference was found between the two genders regarding GCFV. Conclusion: Regarding GCFV, no significant difference was found between individuals with a history of COVID-19 infection and those with no history of COVID-19 infection. How to cite this article: Üner DD, İzol BS. Evaluation of gingival crevicular fluid volume with periopapers in patients who have recovered from COVID-19 infections. Int Dent Res 2023;13(3):119-24. https://doi.org/10.5577/intdentres.492 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Insertion of orthodontic temporary anchorage devices with free gingival grafting for phenotype modification of the peri-implant mucosa

BackgroundMini Implants are widely used in contemporary orthodontics, they provide skeletal anchorage even in non-compliant patients, facilitate orthodontic tooth movement, are easy to place and are relatively inexpensive. Their failure is multifactorial, and the quality of the soft tissue can present a risk limitation for the insertion of TADS. Orthodontic Mini Implants inserted in keratinized gingiva present fewer tissue-related complications and higher survival rate, than those inserted in non-keratinized mucosa. The purpose of this report is to present and describe this novel technique to modify and enhance the peri-implant mucosa of Orthodontic Mini Implants inserted in nonkeratinized gingiva. MethodsA free gingival graft was harvested from the palate in combination with a buccal recipient site preparation in the alveolar mucosa and a TAD insertion procedure. ResultsAfter twenty-one days of healing, graft integration was observed. One hundred and eighty days after insertion and twelve weeks of loading, none to mild signs of clinical inflammation were documented, and the patient reported no pain or discomfort. ConclusionWithin the limitations of this report, free gingival grafting for phenotype modification of the peri-implant mucosa, can benefit patients who need insertion of orthodontic mini-implants in non-keratinized mucosa for orthodontic tooth movement.

A comparison of alveolar ridge mucosa thickness in completely edentulous patients.

The purpose of this cross-sectional clinical study was to determine and compare alveolar ridge mucosa thickness at crestal, buccal, and lingual locations of the maxillary and mandibular arches in completely edentulous patients using a dedicated, ultrasonic gingival scanner. Thirty-eight completely edentulous subjects were included in the study. In each subject, soft tissue thickness was measured at 28 sites of the edentulous ridge by a single calibrated examiner. Intra-observer reliability was calculated with Intraclass Correlation Coefficients by measuring 10 subjects twice, after 1 week. Measurements (mm) were taken at the buccal, lingual, and crestal aspects of the ridge with a dedicated ultrasonic scanner. Repeated measures ANOVA and paired t-tests were used to compare the mean buccal, lingual, and crestal soft tissue thicknesses at each site. The GeneralizedEstimating Equations model was used to study the effects of age, sex, and race. Confidence level was set to 95%. Mean tissue thickness ranged from 0.96 to 1.98mm with a mean of 1.63 ± 0.25mm. Intraclass Correlation Coefficients were > 0.97. No significant differences between buccal, crestal, and lingual sites were noted for the mandibular arch as well as at 4 sites on the maxillary arch (maxillary right second molar, maxillary right canine, maxillary left first premolar, maxillary left second molar). However, significant differences in soft tissue thickness were noted for all remaining maxillary sites. Race was found to be positively correlated with tissue thickness, with Black individuals showing a significantly greater thickness than Whiteindividuals at 4 sites (maxillary right first molar, maxillary left canine, mandibular right second premolar, mandibular right first molar). Age was found to be positively correlated with tissue thickness at 4 sites (maxillary left central incisor, maxillary left first molar, maxillary left second molar, mandibular left second premolar) and negatively correlated at 2 sites (mandibular right canine, mandibular right second molar). Female sex was positively (maxillary left second premolar, maxillary left second molar) and negatively (mandibular right canine) correlated, respectively, with tissue thickness at 3 sites. When data for anterior and posterior sites were respectively pooled, tissue thickness was significantly less at anterior sextant lingual and crestal sites, while no difference was seen for buccal sites. Statistically significant differences for alveolar ridge mucosa thickness were found at several sites in the maxilla and between anterior and posterior sextants for lingual and crestal sites in the maxillary and mandibular arches. Tissue thickness differences were also noted for race with Black individuals showing greater tissue thickness at some sites. Age and sex did not show a clear effect on tissue thickness. Recorded differences in tissue thickness were however small and appear of uncertain clinical significance.

Randomized controlled pilot study comparing small buccal defects around dental implants treated with a subepithelial connective tissue graft or with guided bone regeneration.

To compare subepithelial connective tissue grafts (SCTG) versus guided bone regeneration (GBR) for the treatment of small peri-implant dehiscence defects in terms of profilometric (primary outcome), clinical, and patient-reported outcome measures (PROMs). Sixteen patients who presented with small buccal bone dehiscences (≤3 mm) following single implant placement were recruited. Following implant placement, buccal bone defect sites were randomly treated either with a SCTG or GBR. Six patients who lacked bone dehiscences after implant placement were assigned to a negative control. Transmucosal healing was applied in all patients. Patients were examined prior (T1) and after (T2) implant placement, at suture removal (T3), at implant impression (T5), at crown delivery (T6), and 12 (T7) months after crown delivery. Measurements included profilometric outcomes, marginal bone levels, buccal bone and soft tissue thickness, PROMs, and clinical parameters. All data were analyzed descriptively. The median changes in buccal contour as assessed by profilometric measures between T1 and T5 showed a decrease of 1.84 mm for the SCTG group and 1.06 mm for the GBR group. Between T2 and T7, the median change in the buccal contour amounted to 0.45 mm for SCTG and -0.94 mm (=loss) for GBR. Patients' pain perception tended to be higher in SCTG than in GBR. All peri-implant soft tissue parameters showed healthy oral tissues and no clinically relevant differences between groups. Within the limitations of this pilot study, treating small peri-implant dehiscence defects with a SCTG might be a viable alternative to GBR. The use of a SCTG tended to result in more stable profilometric outcomes and comparable clinical outcomes to GBR. However, patient-reported outcome measures tended to favor GBR.

The 3D emergence profile on implant-supported restorations: A method for evaluating restorative angles.

Emerging evidence indicates that the emergence profile and subsequent restorative angle play a crucial role in clinical outcomes and can potentially affect the development and progression of peri-implant diseases. However, the traditional evaluation of the emergence profile and angle has been limited to mesial and distal sites using periapical x-rays, without considering the buccal sites. To describe a novel 3D method to estimate the emergence profile and restorative angles around single implant-supported crowns including buccal sites. A total of 30 implant-supported crowns (11 molars, 8 premolars, 8 central incisors and 1 canine) were extra-orally scanned using an intraoral scanner and the STL files produced were imported into a 3D software. The crown/abutment interface of each crown was delineated, and apico-coronal lines were automatically drawn following the shape of the crown. Three reference points were defined on the apico-coronal lines at the transition edge of the biological (BC) and the esthetic zone (EC) and the resulting angles were then calculated. The reliability of the measurements (2D and 3D) were assessed using the intraclass correlation coefficient (ICC). In anterior restorations, the mean angle of the esthetic zone amounted to 162 ± 14° at mesial sites, to 140 ± 10° at buccal sites and to 163 ± 11° at distal sites. The corresponding angles at the biological zones, amounted to 155 ± 13° at mesial sites, 139 ± 15° at buccal sites and 157 ± 5° at distal sites. In posterior restorations, the mean angle of the esthetic zone amounted to 162 ± 12° at mesial sites, to 157 ± 13 at buccal sites and to 162 ± 11 at distal sites. The corresponding angles at the biological zone, amounted to 158 ± 8 at mesial sites, 150 ± 15° at buccal sites and 156 ± 10 at distal sites. The ICC for all measurements ranged between 0.77 and 0.99 indicating a good intra-examiner reliability. Within the limitations of the present study, the 3D analysis seems to be a reliable and applicable method for the quantitative evaluation of the emergence profile in daily practice. Future randomized clinical trials are needed to assess whether a 3D analysis with the ensuing the emergence profile serves as a predictor for clinical outcomes. The development and implementation of a 3D workflow will provide technicians and dentists with the ability to assess the restorative angle of implant-supported restorations during the provisional phase and the final restoration. This approach may help achieve an aesthetically pleasing restoration while minimizing potential clinical complications.

Optimal Buccal Site for Mini-Implant Placement on Attached Gingiva of Posterior Maxilla: A CBCT Study

This research aims to investigate the optimal buccal site on the attached gingiva of the posterior maxilla for mini-implant placement for anchorage purposes in orthodontics. In 23 female patients, mini-implants were implemented between the roots of the first molar and second premolar, in the maxilla, for anchorage purposes. A CBCT was acquired for diagnostic purposes, and intraoral scanning was performed. Using the digital model that was the result of combining the DICOM and STL files, the cortical bone thickness and density, as well as the trabecular bone density, were measured on three axial bone slices corresponding to the three defined height levels (lower, middle, upper) on the attached gingiva, in the interradicular area. Pearson and eta correlation tests were performed in order to investigate possible correlations between height in the attached gingiva, and the corresponding cortical bone thickness and density, as well as the corresponding trabecular bone density. The correlations regarding the height level in the attached gingiva were medium for the cortical bone thickness, and weak for the cortical bone density, while a strong correlation was found between the cortical bone thickness and density. The upper level of the attached gingiva, between the second premolar and the first molar in the maxilla, is the optimal site for mini-implant placement, as the cortical bone thickness and density are probably greater than in the lower and middle level.

Comparison of Closure versus Non-closure of Buccal Mucosal Graft Harvesting Site in Urethroplasty.

Background: Buccal mucosal graft is commonly used in substitution urethroplasty for the treatment of anterior urethral strictures. However, the optimal management of the donor site remains a topic of debate. This prospective study aimed to compare the outcomes and morbidity associated with closure versus non-closure of the buccal mucosal graft harvesting site in urethroplasty.&#x0D; Methodology: A total of 60 patients with anterior urethral strictures underwent buccal mucosal urethroplasty. The patients were divided into two groups: group A (non-closure, n=30) and group B (closure, n=30). Post-operative pain, perioral numbness, early return to diet, and swelling of the cheek were assessed and compared between the two groups. Pain was measured using the Visual Analog Scale (VAS), and statistical analysis was performed using appropriate tests.&#x0D; Results: The mean age of the patients was 35.73 ± 13.42 years, and the mean length of the stricture was 58.45 ± 26.87 mm. Post-operative pain scores measured through VAS were comparable between the closure and non-closure groups at different time points. Perioral numbness was observed in 43.33% of the non-closure group and 30.0% of the closure group (p=0.284). Early return to diet was reported in 40.0% of the non-closure group and 70.0% of the closure group (p=0.019). Swelling of the cheek was noted in 53.33% of the non-closure group and 33.33% of the closure group (p=0.118).&#x0D; Conclusion: This study suggests that non-closure of the buccal mucosal graft harvesting site in urethroplasty results in less post-operative pain, early return to diet, and lower perioral numbness. However, it is associated with increased swelling of the cheek. These findings support the use of non-closure as a viable alternative to closure of the buccal mucosal graft harvesting site. Further research with larger sample sizes and longer-term follow-up is warranted to validate these findings and assess additional outcomes such as stricture recurrence and cosmetic outcomes.

(089) Regional Vestibulectomy and Buccal Mucosal Graft Reconstruction for Refractory Neuroproliferative Vestibulodynia

Abstract Introduction Buccal mucosal grafts (BGM) are widely used in male urethral reconstruction and have more recently been reported for female urethral reconstruction. We report the first case of using a buccal mucosa graft (BMG) to cover the excised 12:00 vestibule in a 19 year old woman with lifelong persistent genital arousal disorder (PGAD) presumed secondary to congenital neuro-proliferative vestibulodynia. She presented to our clinic at 17 and underwent lysis of clitoral adhesions, excision of the core 12:00 region with primary closure, and complete vestibulectomy with vaginal advancement flap. Her vestibular specimen positively stained for CD117 and PGP9.5 consistent with excess mast cells and nerves, respectively. Post-operatively, there was marked reduction of vestibular pain in the 1:00 to 11:00 region posteriorly, however she had persistent PGAD and significant residual tenderness to cotton-tipped swab testing at the 12:00 region. Her PGAD was medically managed successfully with tramadol, clonazepam and low dose zolpidem. Desiring to eliminate the need for systemic medications, the patient returned to the clinic at age 19. Again, local anesthesia applied to the clitoris and 12:00 vestibule region resulted in clinically significant PGAD symptom reduction and 12:00 vestibulodynia. We discussed repeat clitoral lysis and re-excision of the 12:00 region with BMG reconstruction. Objective To report on a novel technique using BMG for 12:00 region vestibular reconstruction in one woman with distressing vestibulodynia and PGAD. Methods Pre-operative counseling included discussion of routine surgical risks, benefits, alternatives, with additional possible complications including failure of the procedure to relieve PGAD or vestibulodynia, graft contracture, buccal harvest site contracture, sexual dysfunction, and genital disfigurement. The patient gave consent for the procedure and underwent a repeat lysis of clitoral adhesions and 12:00 regional subepithelial vestibulectomy. The defect measured 2.5 cm x 2.5 cm. A non-tubularized onlay patch of buccal mucosa was harvested and used for vestibular reconstruction. The procedures were performed by a single surgeon. The patient was discharged the same day. Results The patient’s post-operative course was notable for acute urinary retention in the recovery room. She was discharged with a foley catheter and passed a voiding trial on post-op day 1. Her pain was well-controlled with non-opioid medications and she was able to resume a soft food diet immediately after surgery. At post-op week 5, the clitoral area, buccal harvest site, and graft site were healed without complication. The patient reports that her 12:00 pain to touch has resolved. Her PGAD has decreased slightly, although she has not yet attempted to discontinue oral medications. Conclusions For this patient, regional vestibulectomy with BMG to the 12:00 region of the vestibule appears to have been a safe and feasible technique for refractory neuroproliferative vestibulodynia. Given that the vestibule is of endodermal origin derived from the urogenital sinus, and neuroproliferation may represent a congenital anomaly, there is a rationale to replace urogenital sinus endoderm with a non-urogenital sinus endoderm such as buccal mucosa. Pre-operative counseling should include surgery specific adverse events like mouth opening restriction and genital disfigurement. Longer follow up and larger studies are needed. Disclosure No

Comparative Evaluation Of Clinical Probing Versus Cbct For Furcation Involvement In Patients With Periodontitis - A Step Ahead In Comprehensive Implant Planning

Aim: The study aims to compare the use of clinical probing and Cone Beam Computed Tomography (CBCT) in the diagnosis of furcation involvement (FI) in patients with periodontitis. Methods and materials: Twenty-two patients, aged 30 to 65 years with periodontitis were included in the study. The patients who visited from April 2021 to May 2022 were assessed based on selection criteria. A total of 135 teeth were checked for furcation involvement. Buccal, mesiopalatal, and distopalatal sites of maxillary molars and buccal and lingual sites of mandibular molars were examined clinically using a Nabers probe and radiographically by CBCT. Results: There was a significant difference between clinical and radiographic evaluations with the percentage of grade (III) cases detected with radiographic evaluation being significantly higher than that of clinical evaluation. The maxillary 1st molar 21 (60%) and maxillary 2nd molar had no furcation involvement on clinical evaluation. In Radiographic evaluation Grade I FI was more in maxillary first molars least in mandibular 2nd molar. Furcation involvement was detected clinically more on the buccal side, maxillary 1st molar and least detected at maxillary 2nd molar at MP and DP sides (0.00%) Radiographically the FI was detected more on the buccal side, maxillary 1st molar 14 (40.00%) and least detected at maxillary 1st molar at DP and MP side of maxillary 2nd molar (4.00%). Conclusion: CBCT was more reliable in the detection of grade III FI compared to clinical probing. It can be a useful tool in detecting maxillary furcations. This makes CBCT reliable in the diagnosis of furcation involvement compared to conventional methods. Dental implant planning made easy with CBCT scans as it is evaluated for its efficiency. Bangladesh Journal of Medical Science Vol.22 (Special Issue) 2023 p.87-92

Accurate gingival segmentation from 3D images with artificial intelligence: an animal pilot study

BackgroundGingival phenotype plays an important role in dental diagnosis and treatment planning. Traditionally, determining the gingival phenotype is done by manual probing of the gingival soft tissues, an invasive and time-consuming procedure. This study aims to evaluate the feasibility and accuracy of an alternatively novel, non-invasive technology based on the precise 3-dimension (3D) soft tissue reconstruction from intraoral scanning and cone beam computed tomography (CBCT) to predict the gingival biotype.MethodsAs a proof-of-concept, Yorkshire pig mandibles were scanned, and the CBCT data were fed into a deep-learning model to reconstruct the teeth and surrounding bone structure in 3D. By overlaying the CBCT scan with the intraoral scans, an accurate superposition was created and used for virtual measurements of the soft tissue thickness. Meanwhile, gingival thicknesses were also measured by a periodontal probe and digital caliper on the buccal and lingual sides at 3 mm apical to the gingival margin of the posterior teeth and compared with the virtual assessment at the same location. The data obtained from virtual and clinical measurements were compared by Wilcoxon matched-pairs signed-rank analysis, while their correlation was determined by Pearson’s r value. The Mann–Whitney U test was used for intergroup comparisons of the amount of difference.ResultsAmong 108 investigated locations, the clinical and virtual measurements are strongly positively correlated (r = 0.9656, P < 0.0001), and only clinically insignificant differences (0.066 ± 0.223 mm) were observed between the two assessments. There is no difference in the agreement between the virtual and clinical measurements on sexually matured samples (0.087 ± 0.240 mm) and pre-pubertal samples (0.033 ± 0.195 mm). Noticeably, there is a greater agreement between the virtual and clinical measurements at the buccal sites (0.019 ± 0.233 mm) than at the lingual sites (0.116 ± 0.215 mm).ConclusionIn summary, the artificial intelligence-based virtual measurement proposed in this work provides an innovative technique potentially for accurately measuring soft tissue thickness using clinical routine 3D imaging systems, which will aid clinicians in generating a more comprehensive diagnosis with less invasive procedures and, in turn, optimize the treatment plans with more predictable outcomes.

Spontaneous regeneration of keratinized tissue at implants and teeth.

To investigate the spontaneous regeneration of the implanto-mucosal and dento-gingival unit after complete removal of keratinized tissue (KT). One hemi-mandible per dog (n = 4) was allocated to receive three dental implants (test sites, premolar region), whereas three premolars on the contralateral side were controls. After osseointegration, the entire KT (buccal + lingual) was surgically excised on all test and control sites, leaving the bone exposed. Clinical measurements were performed before excision (T0 ) and after 12 weeks (T1 ). Following healing, the animals were euthanized, and the specimens were histologically processed. Descriptive statistical analyses were performed. Clinical measurements revealed that at T1 , on all teeth, a band of KT was spontaneously regenerated (mean width: 2.60 ± 0.66 mm), whereas on implants, KT was detected only occasionally at mesial or distal but not at buccal sites (mean total: 0.35 ± 0.53 mm; p < .0001). Histologically, spontaneous regeneration of the dento-gingival unit was evident, displaying masticatory mucosa. At the implant sites, on the other hand, the implanto-mucosal unit was characterized by a non-keratinized epithelium and elastic fibres, indicating the characteristics encountered in alveolar mucosa. After excision of KT at implant sites, the spontaneous regeneration of the soft tissue is characterized by a non-keratinized epithelium typical for alveolar mucosa, while at tooth sites the spontaneous regeneration was characterized by soft tissue resembling gingiva.