Interdental Space Research Articles

Express Diagnostics of Proteolytic Activity of Periodontopathogens-Methodological Approach.

The species spectrum of the oral microbiome is considered to be the key factor in the development and progression of periodontal inflammatory disorders. The "red complex" including Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola has the highest pathogenic potential. These bacteria have several biochemical mechanisms that allow them to colonize and destroy periodontal tissues. Proteolytic enzymes play a crucial role in this process. Early diagnosis of pathological conditions induced by microbial contamination allows for the timely treatment of periodontitis. Otherwise, the development of the disease may lead to tooth loss. A total of 48 patients aged 18 to 65 years old who required professional oral hygiene were recruited for this clinical study. Microbial content analysis of dental plaque from the interdental space and the back of the tongue was performed using real-time PCR. To determine the proteolytic activity of oral bacteria, the new express diagnostic method was applied (diagnostic sensitivity, 0.875; specificity, 0.928). The results demonstrate a strong and significant correlation between the new method and the PCR analysis (r = 0.785, p < 0.001). These results show that the new express method can be valuable as an early diagnostic method for periodontal inflammatory disorders caused by the "red complex" bacteria.

Oral Health Related Habits, Knowledge, and Frequency of Dental Floss use among Undergraduate Medical and Dental Students in a Public Health Sector University in Pakistan: A Comparative Study

Objective: The current study aimed to evaluate oral health related habits, knowledge, and frequency of dental floss use among undergraduate medical and dental students. Methods: A cross-sectional study was undertaken at two institutes, Sindh Institute of Oral Health Sciences (SIOHS) and Sindh Medical College (SMC) of Jinnah Sindh Medical University (JSMU), Karachi, Pakistan, between March to May 2022. All undergraduate medical and dental students irrespective of gender, cast, creed, or socioeconomic status were eligible to partake in the study. The data on demographics including the age, gender, primary way of cleaning teeth, frequency of dental flossing, general oral health habits, assessment of knowledge of interdental cleaning aids etc. were recorded in a structured questionnaire. Results: The majority of the students acknowledged the importance of the role of students in promoting dental floss use among the community. Years of study in Bachelor of Dental Surgery (BDS) students was significantly associated with cleaning frequency (p < 0.0001) and primary cleaning method (p = 0.001). Interdental cleaning aid awareness, frequency of interdental cleaning, issues from not cleaning the interdental spaces, the role and use of dental floss were all significantly correlated with year of study among BDS students. Use of secondary methods was significantly associated with years of study among Bachelor of Medicine, Bachelor of Surgery (MBBS) students (p < 0.001). Conclusion: The present study concluded that years of study significantly correlated with the knowledge, awareness, and habits of dental students with respect to dental flossing. Keywords: dental hygiene, dental floss, interdental cleaning, oral health, dentist, medicine

Quantifications of Mandibular Trabecular Bone Microstructure Using Cone Beam Computed Tomography for Age Estimation: A Preliminary Study.

Simple SummaryStudies pertaining to age-related changes in the human jaw are very limited. Age-related changes for forensic assessments were merely based on the qualitative architecture and external geometry. With advancements in imaging technology, the paradigm has shifted and more emphasis is laid on the internal trabecular architecture, as this imparts more complexity and strength when compared to other determinants. The desired objective of this study was to draw useful associations between trabecular microarchitecture and chronological age. In this study, we characterize trabecular bone microstructure in the human mandible in 20 subjects ranging from 22 to 43 years using retrospective cone beam computed tomography image datasets. The images were post-processed via a semi- automated threshold guided approach and reconstructed using AnalyzeDirect 14.0 software to correlate trabecular number (Tb. N), trabecular thickness (Tb. Th), trabecular separation (Tb. Sp), trabecular surface density (Tb- BS/TV) and trabecular bone volume (Tb- BV/TV) with the individual’s chronological age and sex. Statistically significant negative correlations were observed in trabecular number (r =−0.489) and trabecular surface density (r = −0.527) in relation to chronological age. The characterization and quantification of the trabecular bone microarchitecture can immensely serve as a digital imprint in chronological age estimation.The aim of this study is two-fold: first, to correlate the values for each of the trabecular bone microstructure (TBM) parameters to the individual’s chronological age and sex, thereby facilitating the assessment of potential age and sex-related changes in trabecular bone microstructure parameters in the mandible; and second, to quantify the trabecular microstructural parameters in relation to chronological age. Twenty cone-beam computed tomographic (CBCT) scans were retrieved retrospectively from a database of adult patients with ages ranging in age from 22 to 43 years. In the mandible, the volume of interest included the inter-dental space between the second mandibular premolar and the first mandibular molar, as well as the trabecular space beneath and between the apices. Using the AnalyzeDirect 14.0 software, the DICOM images of CBCT scans were pre-processed, transformed, segmented using a novel semi-automatic threshold-guided method, and quantified. In addition, TBM parameters were derived, and statistical analysis was conducted using a Pearson correlation test with two tails. All parameters exhibited no statistically significant differences (p > 0.05) between chronological age and sex. Statistically significant negative correlations were found between Tb. N (r = −0.489), BS/TV (r = −0.527), and chronological age (p = 0.029 and p = 0.017, respectively). Only Tb. N and BS/TV exhibited an inverse relationship with chronological age. Numerous studies have quantified the trabecular architecture of the jaw bones, but none have found a correlation between the quantified trabecular parameters and chronological age. The digital imprints produced by radiographic imaging can serve as biological profiles for data collection.

Frequency and impact of musculoskeletal symptoms on quality of life in MEN2B.

To investigate the impact of musculoskeletal (MSK)-related symptoms on the quality of life of patients with multiple endocrine neoplasia Type 2b (MEN2B). An online survey was distributed by the Association for Multiple Endocrine Neoplasia Disorders (AMEND) to their members and worldwide via a social media group for MEN2B patients. The survey consisted of a detailed questionnaire analysing the MSK-related symptoms and structural deformities of MEN2B patients and their impact on patient's lives. Forty-eight participants completed the survey. Participants reported several musculoskeletal complaints; the most prevalent being musculoskeletal weakness at 73% (n = 35) and pain 58% (n = 28). The median pain score was 7 (interquartile range [IQR]: 5-8) and the frequency of pain was daily in 44% (n = 15) and constant in 21% (n = 7). Structural complaints were common with 63% (n = 30) stating their physique was 'different' and 40% (n = 19) describing marfanoid body features. Spinal curvature and foot deformities were the commonest structural abnormalities with scoliosis 70% (n = 16) and pes cavus 63% (n = 22) prevailing. Dental problems were mentioned by 69% (n = 33) with interdental spacing being the most common complaint at 61% (n = 20). The musculoskeletal symptoms of MEN2B had a median impact of 6 (IQR: 3-9) on quality of life (QOL) with structural deformities 53% (n = 18) and pain 26% (n = 9) listed as having the highest impact. Poor MSK health affected exercise, work and mobility. We report a high prevalence of musculoskeletal-related complaints in MEN2B which significantly affects QOL. This suggests a need to provide better holistic care including a multidisciplinary team with physiotherapist, orthopaedic and dental specialist input.

Assessment of Knowledge, Attitude, and Practices of Adjunctive Oral Hygiene Aids Brushing Among Medical and Dental Students in UCMS, Nepal

INTRODUCTIONPeriodontal disease is a bacterial infection that affects tissues that support the teeth and bacterialplaque is the primary cause of this disease. In the interdental spaces, periodontal disorders are more common as a result, removing plaque from these regions is critical. This can be managed by using various interdental cleaning aids such as dental floss, interdental brushes, and chemical agents such as mouth washes. Thus, the aim of our study is to assess the knowledge of other oral hygiene aids except brushing among medical and dental students in a Teaching hospital. This is a knowledge, attitude, and practices model of analyzing the knowledge of adjunctive oral hygiene aids performance and measures other than tooth brushing among medical and dental students. MATERIAL AND METHODSA Knowledge, Attitude and Practices (KAP) survey was designed for the present cross-sectional study which was conducted for a period of three months from July 2021 to September 2021 among a sample of 275 medical and dental undergraduates in a Teaching hospital. Pre-tested structured 22-item closed-ended questionnaire was given to each on survey tool and the link was passed to the participants. Statistical analysis was done using SPSS (version 21.0) software. RESULTSThe response rate for the present survey was 98.9% (272 participants). It was seen that, 29.78% participants reported that poor oral hygiene is the main cause of bleeding and 59.19 % believed that poor oral hygiene is responsible for bad breath. A total of 65.81% reported that most widely recommended interdental aid to be used is dental floss. On gender wise comparison, significant positive response (p< 0.05) was seen among females for items (2,6,11) as compared to males. On stream wise comparison, significant positive response (p< 0.05) was seen among dentists for items (16,17,20) as compared to medical students. CONCLUSIONThe study concluded that dental and medical students must be encouraged to be good role models in practicing as well as promoting oral health for their patients, families, friends and ultimately the society.

Clinical efficiency of the technique for restoring the contact surfaces of the posterior teeth considering the age features

BACKGROUND: Esthetic restoration methods of the posterior teeth using composite materials currently used in dentistry can only be used to create contact in a shape of a point, which does not correspond to the age characteristics of the teeth of adult patients.
 AIM: This study aimed to develop and introduce into the dental practice methods for creating and precise positioning of contact pads with size and location that correlated with the patients age.
 MATERIAL AND METHODS: The quality of restorations of the contact surfaces of the teeth and contact points were assessed considering age characteristics. A total of 289 direct composite restorations of class II (Black) defects that were performed during the treatment of dental caries in 178 patients aged 2059 years were conducted. The characteristics of 162 Black class II composite restorations performed with modeling contact pads/surfaces using contact formers were compared with the characteristics of 127 Black class II composite restorations performed using the traditional restoration technique.
 RESULTS: In the study groups (restorations created using contact formers) 7 days after treatment, restorations were completely in line with the clinical requirements (4 of 4 points) according to the criteria for assessing the quality of the contact surfaces of the teeth and contact pads: 98.3%1.02% of restorations; after 12 months, 92.5%2.07%; after 24 months, 74.8%3.41% of the investigated composite dental restorations. In the comparison groups, the values were as follows: 16.3%3.28% of restorations (p 0.005); after 12 months, 11.3%2.81% (p 0.005); and after 24 months, 9.8%2.64% (p 0.005).
 CONCLUSION: The clinical application of the developed technique of contact area modeling during posterior teeth caries treatment, taking into account the age characteristics and using the contact adapter of the original design, makes it possible to improve the quality of the restoration of the contact surfaces of the teeth, contact areas, interdental embrasures, and anatomy of the interdental spaces in general.

Multidisciplinary approach for aesthetic rehabilitation in gummy smile and fluorosis: a case report

Background: Teeth, gingiva and lips are the three interrelated primary components in aesthetic dentistry. These combinations warrant a multidisciplinary approach for planning and predictable treatment outcome. Objective: The aim of this article is to describe the multidisciplinary approach for aesthetic rehabilitation involving gingivectomy and minimally invasive tooth preparation with porcelain laminate veneer (PLV) restorations and resin bonded bridge. Case: A 25-year-old female patient attended with existing space between maxillary anterior teeth post orthodontic treatment and missing mandibular anterior teeth. Intraorally, patient had uneven interdental spacing in between 13 to 23, missing 31 and 32, with merging and irregular opacities suggestive of enamel fluorosis appearance. The zenith lines were asymmetrical with short clinical crowns and disharmonious teeth axes. To optimize the aesthetic outcome and overall smile appearance, gingivectomy was performed after confirmation of biologic width. Eight weeks after healing, PLV restorations were delivered from 13 to 23, and zirconia resin bonded bridge were used to restore missing mandibular lateral incisors. Conclusion: The present case illustrates the sequential and predictable approach for management of gummy smile and fluorosis. An alternative treatment modality such as electrocautery may enhanced the smile and obtain positive outcome.

Evaluation of fibre-reinforced composite splinting mobile the lower front teeth of patients who suffer from periodontitis

Aim: to evaluate the effectiveness of fibre-reinforced composite splints for lower front teeth immobilization in the scheme of complex therapy of severe periodontitis (III and IV stages) in short-term and long-term after treatment in persons with and without risk factors. Materials and methods. To reach the goal, a total of 58 patients with stage III and IV periodontitis were examined with identification of risk factors for the periodontal disease progression (smoking and diabetes). After a detailed periodontal examination, all patients were non-surgically treated for periodontitis, and mobile teeth were immobilized by fibre-reinforced composite splints. After splinting, mandatory supportive periodontal care was prescribed (every 3 months) with the dynamic monitoring of oral hygiene (PI), probing depth (PD), clinical attachment loss (CAL), bleeding on probing (BOP) and the splint structure condition (cracks and fractures of the splint, violation of the marginal fit, a single tooth separation from the overall structure, chipping of the material and defects in the interdental spaces). The patients were dynamically examined before treatment, immediately after treatment (1 month) and at the long-term periods (12, 24, 36 months). Results. The splinting structure integrity was preserved in 67.24 % of patients for 3 years, and splinting defects were detected in 32.76 % of patients at different stages of the follow-up. Depending on the presence or absence of risk factors for periodontal disease, the splint structure integrity was preserved for 3 years in 18 patients (56.25 %) with associated risk factors and in 21 patients (80.77 %) without risk factors (P = 0.06). Conclusions. The use of fibre-reinforced composite splints for immobilization of lower front teeth in the scheme of complex therapy for periodontitis (III and IV stages) allowed to preserve mobile teeth and reduce values of the studied periodontal indices both immediately and in the long term after treatment in individuals with and without risk factors.

Multicenter Randomized Controlled Trial Comparing the Contribution of Proxabrushes with Regular Toothbrushes and Only Regular Toothbrushes to the Oral Health of Thai Elderly.

Objective The aim of this two-group experimental study was to explore the effects of proxabrush on Thai elderly oral health. Design and Setting. Multicenter randomized controlled trial, parallel grouped, open label, blocked randomization was used at each province to allocate treatment. The study was conducted at public hospitals in 16 provinces in Thailand between November 2019 and January 2020. Methods Participants in the test group used proxabrushes and regular toothbrushes, and participants in the control group used only regular toothbrushes for 6 weeks. Plaque accumulation, gingival status, and oral healthcare data were collected at baseline and at 6-week follow-up. Clinical oral health examiner was blinded to group assignment. Randomization was computer-generated, with allocation concealment by opaque sequentially number sealed envelopes. Data analysis compared plaque and gingival indices between the test and control groups. Results A total of 510 elderly with at least 20 natural teeth and interdental spaces were randomized (test n = 255; control n = 255), and 35 were excluded from analysis because of early drop out leaving 239 in the test group and 236 in the control group. A sample of 475 aged between 60 and 91 years participated in the study; 158 (33.3%) were males and 317 (66.7%) were females. The results revealed that, compared to baseline knowledge, attitude and practice were improved at follow-up for both the test and control groups (p < 0.05). At follow-up, the independent-samples t-test compares the test group plaque index mean of 0.49 (SD 0.44) to the control group mean of 0.60 (SD 0.56); a mean difference of 0.11 (95% CI 0.02 to 0.20) obtained demonstrated statistical significance (p = 0.014), and comparing the test group gingival index mean of 0.52 (SD 0.50) to the control group mean of 0.65 (SD 0.60), a mean difference of 0.13 (95% CI 0.03 to 0.23) obtained demonstrated statistical significance (p = 012). At follow-up, the test group had lower plaque accumulation and better gingival status than the control group. Gender, medical problems, educational level, occupation, and age were not different between the test and control groups. A combination of daily proxabrush and regular toothbrush use yielded significant benefits over regular tooth-brushing alone. Conclusions In conclusion, proxabrush has been found to be an effective interdental cleaning aid among Thai elderly. This trial is registered with TCTR20220127004.

Reference map of localization of contact points and contact areas of posterior teeth

The aim of the study: to find correlations in age-related characteristics of the localization and shape of the contact points in permanent posterior teeth and to develop a reference card for dentists, reflecting the age-related characteristics of the localization, shape and size of the contact areas of the posterior teeth in adults.Materials and research methods. The linear dimensions, area, shape, vertical and horizontal position in the interdental space of 1224 contact points of the posterior teeth in 236 patients aged 20 to 59 years was assessed based on a comprehensive analysis of intraoral radiographs performed using the bitewing technique, the results of the study of contact points using floss, displaying contact points on dental impressions made using a special technique.Research results. It was found that the interdental spaces of the posterior teeth in adult patients are characterized by the following features: the contact areas of the teeth are displaced in the vestibular direction, the buccal and lingual (palatal) interdental embrasures are asymmetric; dynamics of the depth of occlusal interdental embrasures, linear dimensions and area of contact areas is expressed as average digital values for different age groups: 20-40 years: contact areas – 1×2 mm, S = 2 mm2, depth of occlusal interdental embrasure - 1.5 mm ; over 40 years old: contact pads – 1.5×3 mm, S = 4.5 mm2, the depth of the occlusal interdental embrasure – 1.0 mm.Conclusion. On the basis of the data obtained, a «Reference map of the localization of contact points and contact areas of posterior teeth in adult patients» was proposed, which allows a dentist to obtain data on the features of the topography of the contact areas of the posterior teeth, taking into account the patient’s age during planning and performing interproximal caries treatment.

ВОЗРАСТНЫЕ ОСОБЕННОСТИ КОНТАКТНЫХ ПУНКТОВ БОКОВЫХ ЗУБОВ С ТОЧКИ ЗРЕНИЯ РЕСТАВРАЦИОННОЙ СТОМАТОЛОГИИ

Reconstruction of the age-related anatomical and physiological features of the contact surfaces and contact points inherent in natural teeth in the treatment of caries of posterior teeth with a direct restoration with light-cured composite is one of the unsolved problems of practical dentistry. The study is devoted to the determination of age-related characteristics of the localization and shape of contact points of posterior teeth in permanent dentition. The assessment of localization and shape of 1224 contact points of posterior teeth in 236 patients aged 20 to 59 years was carried out. Comparison of data about the surface area, shape, vertical and horizontal positions of contact points related to teeth anatomic structures in the interdental space was performed. The analysis of interproximal intraoral radiography data, examination and measurement of the parameters of interdental contacts using dental floss, analysis of the display of contact points on dental impressions made according to a special technique were carried out. The localization of the contact areas of the posterior teeth with a displacement in the vestibular direction, the associated asymmetry of the buccal and lingual (palatal) interdental embrasures, as well as a gradual increase in the surface area of contact areas and a decrease in the depth of the occlusal interdental embrasures, correlated with the age of the patients, were recorded. The average numerical values of the listed parameters are derived, taking into account the age of the patients. Anatomical and topographic features of the interdental spaces of the posterior teeth in adult patients are characterized by the following features: the contact areas of the posterior teeth are displaced in the vestibular direction, the buccal and lingual (palatal) interdental embrasures are asymmetric; dynamics of the depth of occlusal interdental embrasures, linear dimensions and area of contact areas is expressed as average digital values for different age groups: 20-40 years: contact areas – 1×2 mm, S = 2 mm2, depth of occlusal interdental embrasure – 1.5 mm; over 40 years old: contact pads – 1.5 × 3 mm, S = 4.5 mm2, the depth of the occlusal interdental embrasure – 1.0 mm.

Cone-Beam Computed Tomographic Assessment of Bone Thickness in the Mandibular Anterior Region for Application of Orthodontic Mini-Screws.

To determine the proper zones for placement of orthodontic mini-screws, based on cone-beam computed tomography (CBCT) measurements in the anterior mandibular region. The current cross-sectional study was performed on CBCT images of 77 individuals in the age range of 18-60 years. Axial slices at the levels of 2, 5, and 8 mm from the cementoenamel junction (CEJ) of the mandibular anterior teeth were selected. Interdental distances were measured in the mesiodistal direction, parallel to the midline of the mandibular arch. Areas with more suitable width were investigated for measuring the minimum interdental space. On the reconstructed cross-sectional images, labiolingual thickness of the bone was measured at the levels of 2, 5, 8, and 11 mm from the CEJ. The Kruskal-Wallis test, Mann-Whitney test with Bonferroni correction, Welch test, and Tukey's multiple analogy test were used to analyze the data. Mesiodistal and labiolingual distances between the roots in every measured region had the highest values at the levels of 8 and 11 mm from the CEJ. The highest measured values were related to the interdental region between the lateral incisor and canine teeth on both sides of the arch. There were no statistically significant differences between these values (P < .001). The lateral incisor-canine areas at the level of 8 mm from the CEJ are introduced as the optimal sites for placement of orthodontic mini-screws. In addition, the results recommend the application of mini-screws with 1.3-1.7 mm diameter and 5-7 mm length.

Experience in the use of high-molecular-weight hyaluronic acid in the treatment of chronic generalized periodontitis

As a rule, periodontal diseases are accompanied by marginal recession of the gums, loss of attachment and exposure of the roots of the teeth. Traditional drugs for injection treatment are being replaced by modern drugs based on high molecular weight hyaluronic acid, which are successfully and highly efficiently used for local therapy of inflammatory and destructive periodontal diseases. In order to restore the volume of soft tissues in the interdental spaces, eliminate recessions and bleeding of the gingival margin, a preparation of high molecular weight hyaluronic acid “Revident +” was used, which was injected into the base of the gingival papilla at a distance of 2—3 mm from its top with the bevel of the needle upwards. To assess gingival bleeding, the PBI (papilla bleeding index) index was used, which is a sensitive indicator of the severity of gingival inflammation. The magnitude of gingival recession before and after treatment was assessed according to its severity: mild — up to 3 mm, moderate — 3—5 mm, and severe — 6 and more mm. Examination of periodontal patients before and 1.5 months after the application of high molecular weight hyaluronic acid in the composition of the Revident + preparation showed that the degree of gingival bleeding according to PBI decreased significantly after the third visit from 4 to 2 and from 3 to 1, respectively. The degree of gingival recession in the area of the anterior group of teeth decreased by an average of 2.1 mm, in the area of premolars — by 2.5 mm, and in the area of molars — by 2.8 mm.

Trueness evaluation of digital impression: The impact of the selection of reference and test object

ObjectivesThis study evaluated the importance of defining the reference and the test object during 3D surface comparisons to assess the trueness of an intraoral scanner. Materials and methodsA maxillary complete-arch cast with interdental spaces was digitized with a high-resolution scanner to obtain the ground truth dataset [GT]. Fifteen intraoral scanning datasets [IOS] were obtained with an intraoral scanner. The trueness of the [IOS] datasets were evaluated by two different comparison procedures using a 3D analysis software: In the first comparison [REF-GT], the [GT] dataset was set as reference object and the [IOS] dataset was defined as test object. In the second comparison [REF-IOS], the [IOS] dataset were set as reference object and the [GT] dataset was defined as test object. The mean trueness of both comparisons was calculated with absolute mean deviation, (90–10)/2 percentile, and root-mean-squared (RMS) error method. Statistical significance was analyzed using the t-test (α=0.05). ResultsThe mean trueness values of [REF-GT] were 31.4(±6.1) µm for (90–10)/2 percentile, 77.0(±5.3) µm for absolute mean deviation, and 203.1(±4.8) µm for RMS error method. [REF-IOS] revealed 23.9(±4.8) µm, 28.3(±6.3) µm, and 39.6(±9.5) µm, respectively. The results differed significantly. ConclusionThe datasets obtained from the intraoral scanner captured more adequately interproximal spaces in comparison to the [GT] dataset. Therefore, the [GT] dataset defined as reference object in the analysis software for 3D comparisons revealed misleading results. Clinical significanceThe selection of the reference object and of the areas to be compared have to be defined carefully regarding complete arch scanning accuracy analysis.

Current Global Status and the Epidemiology of Entamoeba gingivalis in Humans: A Systematic Review and Meta-analysis

Entamoeba gingivalis (E. gingivalis) is one of the members of the wide range of oral resident pathogens in humans, particularly found in dental plaques, surfaces of gingiva or teeth, interdental spaces and carious lesions. The purpose of the current review and meta-analysis was to determine the global prevalence of E. gingivalis infection and its association with oral diseases based on published literatures. Multiple English databases (PubMed, Scopus, Science Direct, Web of Science and Google Scholar) were explored for papers published until August 2020. A total of 52 studies (including 7596 participants) met the inclusion criteria. The overall prevalence of E. gingivalis was estimated to be 37% (95% CI 29-46%). With regard to different countries, the highest and lowest pooled prevalence of E. gingivalis infection were related to Jordan with 87% (95% CI 81-92%) and Portugal with 3% (95% CI 0-10%), respectively. Based on WHO regions, the highest prevalence was related to the region of the Americas with 56% (95% CI 31-79%). The infection was most prevalent in 46-55 mean age groups [61% (95% CI 21-94%)]. Among different diagnostic methods, the highest rate of the pooled prevalence was related to the molecular [53% (95% CI 24-81%)] and the direct methods [36% (95% CI 25-47%)], respectively. Our analyses revealed that E. gingivalis infection was associated with 4.34-fold increased risk of oral diseases (P < 0.05). Our findings revealed a high prevalence rate of the infection among periodontal disease patients with 37% (95% CI 20-57%). To conclude, it must be considered that E. gingivalis can be a risk factor associated with oral diseases and a wide range of research is needed to specify its role in the pathogenesis of these disorders.

Approximal plaque pH lowering after sugar intake in a periodontally infected dentition

Objectives The aim of this study was to evaluate the effect of periodontal inflammation on the approximal plaque pH after a sucrose rinse. Materials and methods Thirty-two periodontitis patients (aged 38–72 years; 9M/23F) were included. All patients were in need of periodontal surgery. Two non-adjacent interdental spaces, one healthy (no bleeding on probing [BoP] and probing pocket depth [PPD] < 4 mm) and one periodontally diseased (BoP and PPD ≥5 mm) were selected. Before and after surgery, the approximal plaque pH was measured before and after 2, 5 and 10 min after a 1-min rinse with sucrose solution. Results In periodontally diseased interdental spaces, a significant pH drop was seen 5 min after rinsing. In healthy spaces and after surgery, a significant pH drop was seen after 2 min. A multilevel regression analysis showed that greater probing pocket depths were significantly associated with pH change measured 5 min after rinsing (p < .05). Further on, the approximal pH drop after a sucrose rinse tended to be delayed in dentitions with ≥10% of PPD ≥5 mm (p = .052). Conclusions The results suggest that an ongoing periodontal inflammation could temporarily neutralize acidic metabolic products after a sugar challenge. This may further suggest that plaque pH measured after a sugar rinse might be used to identify an ongoing periodontal disease.

Transformação estética do sorriso com acréscimos estratégicos em resina composta: Caso clínico

Diastemas são espaços interdentais maiores que 0,5mm com etiologia multifatorial que podem comprometer a estética do sorriso. Várias formas de tratamento têm sido relatadas na literatura para sua correção, como: ortodontia, cirurgia, uso de laminados cerâmicos ou resinas compostas. Entretanto, a escolha terapêutica está na dependência da identificação de sua etiologia. O objetivo deste estudo é relatar um caso clínico de fechamento de diastemas com resina composta direta, utilizando guia palatina em silicone, pós-tratamento ortodôntico. Inicialmente foi realizado: seleção de cor da resina composta com a superfície dental hidratada; isolamento absoluto do campo operatório; profilaxia com pasta de pedra pomes e água; condicionamento com ácido fosfórico 37% (30 segundos em esmalte); remoção com spray de água/ar pelo dobro do tempo de condicionamento; secagem; aplicação do adesivo universal (duas camadas); fotopolimerização (20 segundos); confecção da concha palatina, modelação do contornos e superfícies em resina composta; remoção do isolamento do campo operatório; ajuste oclusal e polimento. Conclui-se que: 1) A utilização de resinas compostas para o fechamento de diastemas e remodelação dental com aumento incisal representa. uma escolha de custo acessível e pode ser uma alternativa para finalizações ortodônticas, no fechamento de diastemas. 2) O emprego da guia de silicone proporciona maior facilidade para definição de altura; contornos e confecção da parede palatina, minimizando a necessidade de ajustes. 3) A terapêutica empregada é eficaz para o aprimoramento estético do sorriso, sendo uma técnica conservadora, reversível, previsível e que acarretou a satisfação do paciente.

Impact of Image Context on Deep Learning for Classification of Teeth on Radiographs.

Objectives: We aimed to assess the impact of image context information on the accuracy of deep learning models for tooth classification on panoramic dental radiographs. Methods: Our dataset contained 5008 panoramic radiographs with a mean number of 25.2 teeth per image. Teeth were segmented bounding-box-wise and classified by one expert; this was validated by another expert. Tooth segments were cropped allowing for different context; the baseline size was 100% of each box and was scaled up to capture 150%, 200%, 250% and 300% to increase context. On each of the five generated datasets, ResNet-34 classification models were trained using the Adam optimizer with a learning rate of 0.001 over 25 epochs with a batch size of 16. A total of 20% of the data was used for testing; in subgroup analyses, models were tested only on specific tooth types. Feature visualization using gradient-weighted class activation mapping (Grad-CAM) was employed to visualize salient areas. Results: F1-scores increased monotonically from 0.77 in the base-case (100%) to 0.93 on the largest segments (300%; p = 0.0083; Mann–Kendall-test). Gains in accuracy were limited between 200% and 300%. This behavior was found for all tooth types except canines, where accuracy was much higher even for smaller segments and increasing context yielded only minimal gains. With increasing context salient areas were more widely distributed over each segment; at maximum segment size, the models assessed minimum 3–4 teeth as well as the interdental or inter-arch space to come to a classification. Conclusions: Context matters; classification accuracy increased significantly with increasing context.

Clinical features of all-ceramic restorations in the oral cavity

BACKGROUND: Porcelain veneers make up the particular section of prosthetic dentistry. Veneers are necessary for frontal teeth restorations.&#x0D; AIM: To study the principles of dental preparation and the features of the formation of a natural anatomical contour on all-ceramic restorations.&#x0D; MATERIAL AND METHODS: To achieve a high-quality result of prosthetics with all-ceramic fixed prostheses, it is necessary to take into account many important aesthetic criteria: the shape of the tooth, the inclination of the axes of the teeth, the interdental space and the level of interdental contacts, the gum biotype, its color, the position of the gingival margin, the zenith of the gingival contour; tooth color (shades); the level of the cutting edge of the incisors; the relief of the teeth surface; the smile line and the position of the lower lip.&#x0D; To determine the color-optical characteristics of future prostheses, it is convenient to use the Vitapan 3-D Master Shade Guide color scale.&#x0D; For the manufacture of facings, it is necessary to take into account that the preparation is carried out within the enamel layer, the facings are made only for vital teeth, as clinically possible, while preserving the natural boundaries of the tooth.&#x0D; Prosthetics with ceramic prostheses is not recommended for dental dystopia (lingual, palatal position); significant loss of hard tooth tissues, their increased erasability, incomplete orthopedic treatment, deep bite, parafunctions of the masticatory muscles. Before manufacturing the facings, it is necessary to perform an X-ray examination of the teeth to be restored; assess the state of oral hygiene, determine the color of the future structure, replace all failed fillings, assess the condition of the interdental gap and the contact point.&#x0D; RESULTS: It is necessary to preserve the vestibular relief of the tooth surface, the uniformity of the lining, Contact with the surface (cutting edge) of the antagonist tooth should not be placed on the surface or on the border of the lining, but only on the tooth tissues.&#x0D; The advantage should be given to dissection by partial or complete palatal (lingual) overlap. The facings are fixed with the help of light polymerization composite materials, removing the excess with polishing boron.&#x0D; CONCLUSION: If there are significant risks and the patient refuses orthodontic treatment, the creation of contact points on veneers is a complex clinical task. In addition, with the destruction of the crown part of more than 1/3, the use of veneers is risky due to the increase in the layer of ceramic cladding, there is a possibility of chipping of the lining and the risk of manifestation of pulpitis after preparation. Under such conditions, it is desirable to carry out depulpation of teeth, restoration with zirconium stump pin tabs and prosthetics with zirconium crowns with ceramic lining.

Use of a Novel Implant with an Inverted Body-Shift and Prosthetic Angle Correction Design for Immediate Tooth Replacement in the Esthetic Zone: A Clinical Case Series.

A clinical case series of three patients is presented using a novel implant design to not only address primary stability but also to prevent damage to the labial bone plate and improve the interdental space for papillae preservation with immediate tooth replacement therapy. This unique implant design features an apicocoronal inverted body-shift in diameter (wide to narrow), shape (tapered to cylindrical), thread depth (deep to shallow), and thread pattern (V-shaped to square) to achieve uncompromised primary stability and esthetics, particularly in extraction sockets, in a singular body form. In addition, the implant possesses a prosthetic angle correction within the implant body to facilitate screw-retention of the restoration and avoid the risk of apical socket perforation.