A Clinical Guide for Treatment of Dental Cervical Lesions Through a Restorative, Surgical, or Combination Approach: A Proposed Evidence-Based Algorithm.

The incidence of dental cervical carious and noncarious lesions is common, and often these are treated with a restorative material without due attention paid to the amount of exposed cementum/enamel, level of interproximal bone, and final desired esthetic result. This article is intended to provide clinicians an evidence-based clinical decision tree for treating such lesions through a restorative, surgical, or combination approach such that the optimum functional and cosmetic result is achieved.

Long-term evaluation (7 years) of coronally advanced flap with (CAF) and without (e-CAF) vertical release incisions using a subepithelial connective tissue graft in the treatment of multiple recession-type defects.

OBJECTIVES: The objective of this retrospective study was to compare the 7-year outcomes of coronally advanced flap with vertical incisions (CAF) and the envelope type of flap (e-CAF), using a subepithelial connective tissue graft (SCTG) in the treatment of multiple recession defects. METHOD AND MATERIALS: Twenty-two patients (13 CAF and 9 e-CAF) with at least two adjacent recession defects in the esthetic zone contributed to a total of 50 sites (29 CAF and 21 e-CAF). Complete root coverage (CRC), mean root coverage (MRC), and keratinized tissue (KT) width were recorded over the course of the study. RESULTS: In the short term (8 months), CRC, MRC, and KT outcomes were similar between the groups (P > .05). However, at the 3-year follow-up, the e-CAF group displayed significantly higher KT, MRC (100%), and CRC (100% at both tooth- and patient-levels) than the CAF group (MRC 91.43%; CRC 79.31% at tooth-level and 69.23% at patient-level). Similarly, at the 7-year follow-up, statistically significantly superior KT, MRC (94.24%), and CRC (87.71% at tooth-level and 77.78% at patient-level) values were recorded for the e-CAF group compared to the CAF group (MRC 68.98%; CRC 31.03% at tooth-level and 15.38% at patient-level). CONCLUSIONS: Despite similar treatment outcomes recorded by both surgical procedures in the short term, sites treated with e-CAF showed better stability of the gingival margin and superior KT width in the medium (3 years) and long term (7 years).

The Graft Infusion Technique (GIT) for Treatment of Peri-Implantitis Defects: Case Series.

Peri-implantitis is a site-specific infectious disease that causes an inflammatory process in soft tissues, and bone loss around an osseointegrated implant in function. Several techniques with non-surgical or surgical debridement and decontamination followed by ongoing supportive therapy or regeneration of the peri-implant bone defects have been proposed in the literature. However, the literature is still unclear on an effective protocol for implant surface decontamination or the appropriate choice of regenerative materials. This case series describes a surgical technique to treat peri-implantitis osseous defects using a mixture of deproteinized bovine bone mineral with 10% porcine collagen (DBBM-C) in a block form, soaked in an appropriate antibiotic. The use of this combination provides advantages such as good graft adaptability along with localized antibiotic release without the use of systemic antibiotics. Thus, this technique might be an effective method to treat amenable peri-implantitis defects. Additionally, the proposed algorithm also allows for customized culture based antibiotic loading. To the best of the authors' knowledge, this is the first case series documenting this technique for peri-implantitis defects. Long-term studies with controlled samples would be necessary for further evaluation.

Role of thin gingival phenotype and inadequate keratinized mucosa width (<2 mm) as risk indicators for peri-implantitis and peri-implant mucositis.

BACKGROUND: There is growing evidence on the impact of thin gingival phenotype (TnP) and inadequate keratinized mucosa width (KMW <2 mm) around dental implants on peri-implant health. This study investigated the role of TnP and inadequate KMW (<2 mm) as risk indicators for peri-implantitis and mucositis and on dental patient-reported outcomes. METHODS: Sixty-three patients with 193 implants (mean follow-up of 6.9 ± 3.7 years) were given a clinical and radiographic examination and a questionnaire to assess patient awareness of food impaction and pain/discomfort. Chi-squared tests and regression analysis for clustered data were used to compare outcomes. RESULTS: Implants with TnP had a statistically higher prevalence of peri-implantitis (27.1% versus 11.3%; PR, 3.32; 95% confidence interval (CI), 1.64-6.72; P = 0.001) peri-implant mucositis (42.7% versus 33%; PR, 1.8; 95% CI, 1.12-2.9; P = 0.016) and pain/discomfort during oral hygiene (25% versus 5%; PR, 3.7; 95% CI, 1.06-12.96; P = 0.044) than thick phenotype. Implants with inadequate KMW had a statistically higher prevalence of peri-implantitis (24.1% versus 17%; PR, 1.87; 95% CI, 1.07-3.25; P = 0.027) and peri-implant mucositis (46.6% versus 34.1%; PR, 1.53; 95% CI, 1-2.33; P = 0.05) and pain/discomfort during oral hygiene (28% versus 10%; PR, 2.37; 95% CI, 1.1-5.1; P = 0.027) than the adequate KMW. TnP was strongly associated with inadequate KMW (PR = 3.18; 95% CI, 1.69-6.04; P <0.001). CONCLUSION: TnP and inadequate KMW (<2 mm) may be significant risk indicators for peri-implant disease and pain/discomfort during brushing.

Interproximal open contacts between implant restorations and adjacent natural teeth as a risk-indicator for peri-implant disease-A cross-sectional study.

OBJECTIVES: The primary aim of this study was to investigate the relationship between interproximal open contacts and peri-implant disease. The secondary aim was to assess patient-reported outcome measures in relation to contact status. MATERIALS AND METHODS: A cross-sectional study was performed on 61 patients with 142 implants adjacent to at least one natural tooth. Patients underwent a clinical examination to assess contact status and width, plaque index (PI), gingival index (GI), periodontal probing depths (PPD), and bleeding on probing (BoP). Radiographic marginal bone level was measured in vertical bitewings taken within one year. A diagnosis was given to each implant. Last, subjects completed a brief questionnaire. Rao-scott chi-squared tests and generalized estimating equations (GEE) models were used to compare outcomes between groups. RESULTS: Seventy-seven (54.2%) implants were found to have ≥1 interproximal open contact. Sixty-five (45.8%) implants had closed contacts only. Implants with interproximal open contacts were significantly associated with peri-implant mucositis and peri-implantitis (p = .003) and increased prevalence of peri-implant disease (adjusted PR = 1.57; 95% CI: 1.09-2.27, p = .015). Open contact status was also associated with higher PPD (p = .045), PI scores (p = .036), and GI scores (p = .021). Open contact prevalence was 75.4% on the patient-level and 54.2% on the implant-level, involving the mesial surface of the implant restorations 68.5% of the time (p < .001). CONCLUSION: Interproximal open contacts between implant restorations and adjacent natural teeth are a risk indicator for peri-implant disease. Adequate contact between implant restorations and natural teeth may contribute to the health of peri-implant tissues.

COVID-19 Awareness Among Healthcare Students and Professionals in Mumbai Metropolitan Region: A Questionnaire-Based Survey.

Background and objectives The rapid and extensive spread of the COVID-19 pandemic has become a major cause of concern for the healthcare profession. The aim of this study is to assess the awareness of COVID-19 disease and related infection control practices among healthcare professionals and students in the Mumbai Metropolitan Region. Materials and methods A total of 1562 responders from the Mumbai Metropolitan Region completed a questionnaire-based survey on the awareness, knowledge, and infection control practices related to COVID-19 infection in the healthcare setting. The questionnaire was adapted from the current interim guidance and information for healthcare workers published by the US Centers for Disease Control and Prevention (CDC). Convenient sampling method was used for data collection and the distribution of responses was presented as frequencies and percentages. Descriptive statistics were performed for all groups and subgroups based on the percentage of correct responses. Individual pairwise comparisons were done using the median test for the percentage of correct responses. Results The overall awareness for all subgroups was adequate with 71.2% reporting correct answers. The highest percentage of correct responses were from undergraduate medical students and the lowest was from non-clinical/administrative staff. Less than half of the total respondents could correctly define "close contact." More than three-fourths of the responders were aware of the various infection control measures like rapid triage, respiratory hygiene, and cough etiquette and having a separate, well ventilated waiting area for suspected COVID-19 patients. However, only 45.4% of the responders were aware of the correct sequence for the application of a mask/respirator, and only 52.5% of the responders were aware of the preferred hand hygiene method for visibly soiled hands. Conclusion There is a need for regular educational interventions and training programs on infection control practices for COVID-19 across all healthcare professions. Occupational health and safety are of paramount importance to minimize the risk of transmission to healthcare students and professionals and provide optimal care for patients.

In Vitro Surface Testing Methods for Dental Implants-Interpretation and Clinical Relevance: A Review.

More than 2,000 dental implant options are estimated to be available for any given clinical situation. Because many implants have claims that are substantiated mainly on the basis of in vitro studies, it is prudent for clinicians to understand the interpretation of such studies and possible clinical relevance. In vitro tests can be segregated as surface analysis tests and mechanical assessment tests. With a wide variation of methodologies used and results achieved by different implant manufacturers, practitioners may find it difficult to judge the clinical significance of in vitro tests. This article provides an overview, including limitations, of the in vitro implant analysis tests implant companies routinely perform, ranging from older methods involving mechanical testing and surface microscopy to more recent tests such as atomic force microscopy (AFM) studies and gene expression tests, to assist clinicians when choosing an implant system. Having identified the limitations of in vitro testing methods, the current evidence indicates that scanning electron microscopy may be useful in providing insight on the role of implant surface topography. AFM, single cell tests, 3D imaging, and gene expression tests could be useful for assessment of cellular and physio-biochemical properties. 3D finite element analysis may help in the evaluation of mechanical properties of dental implants. Clinicians are encouraged to correlate the findings of in vitro tests with robust animal histologic studies and well-designed, high-quality clinical research to ascertain optimum clinical results.

Long-Term Outcomes of Coronally Advanced Tunnel Flap (CATF) and the Envelope Flap (mCAF) Plus Subepithelial Connective Tissue Graft (SCTG) in the Treatment of Multiple Recession-Type Defects: A 6-Year Retrospective Analysis.

This study evaluated the 6-year results of the subepithelial connective tissue graft (SCTG) plus envelope-type flap (modified coronally advanced flap; mCAF) or coronally advanced tunnel flap (CATF) in the treatment of multiple recessions. Thirty-six patients with at least two adjacent recessions were included. Complete root coverage (CRC), mean root coverage (MRC), and keratinized tissue (KT) width were recorded over the course of the study. Both groups presented similar CRC, MRC, and KT outcomes between the 1-year and 6-year follow-ups. MRC decreased from 96.90% to 94.16% for mCAF, and from 89.56% to 83.10% for CATF. Both surgical techniques were similarly efficient in treating multiple recessions in the short term, and in maintaining the stability of therapy in the medium and long term.

Controlled Palatal Harvest Technique for Harvesting a Palatal Subepithelial Connective Tissue Graft.

Subepithelial connective tissue grafts (SCTGs) have been extensively used to augment soft-tissue volume on dental implants and natural teeth. The authors present a technique called the controlled palatal harvest (CPH) to obtain SCTGs. CPH provides an alternative to the trap-door and single-incision techniques currently utilized. The objective of this article is to describe this harvesting technique for SCTGs. A case report is presented in which the CPH technique was successfully used to obtain a SCTG. Contrary to current techniques where the SCTG is usually taken from the palatal (bone) side, this technique involves the dissection of a thick split-thickness flap in which the graft is harvested from the raised flap. Further, an L-shaped incision (with an anterior release) improves visibility and dexterity during dissection of the connective tissue graft. This technique enables the operator to maintain a certain minimum overlying flap thickness, and excellent control is ensured over the thickness of the harvested SCTG. The thickness of theremaining connective tissue overlying the palatal can also be controlled by the operator. Thus, the chances of leaving behind a thin tissue covering the palatal bone are reduced, minimizing necrosis and flap sloughing, which further improves grafting success. While the CPH can be used as an alternative to currently employed conventional harvest techniques, it may require greater operator skill. To the best of the authors' knowledge, this is the first report that documents such a technique.

Clinical Efficacy of Tooth-Bone Graft: A Systematic Review and Risk of Bias Analysis of Randomized Control Trials and Observational Studies.

PURPOSE: The objective of this systematic review was to assess the clinical efficacy of the tooth-bone graft as a bone substitute in the oral and maxillofacial region in humans as compared to ungrafted sites and other bone substitutes. MATERIALS AND METHODS: Databases were electronically and manually searched up to January 2017 to identify animal and human studies and a risk of bias analysis and descriptive statistics was performed. RESULTS: Eighteen animal controlled trials (401 animals), 4 human randomized controlled trials, 1 cohort study, and 3 controlled trials (184 patients) were included. Graft processing was highly heterogeneous. 71.42% clinical and 55.56% animal studies reported no significant difference between tooth-bone graft and controls. Histologically, a dentin-bone complex was reported. A low risk of bias was noted in only 50% of the randomized controlled trials and 63.33% animal study entries. An independent analysis of 6 high-quality case reports (350 patients) revealed complications in 18.86% cases. CONCLUSION: Tooth-bone graft demonstrated no added benefits over conventional graft materials. Absence of standardized processing and heterogeneous study results limit its use in clinical practice. Until long-term studies determine its success, clinicians are recommended to use it with caution because of high variability in resorption time (2-24 weeks) and a risk of graft dehiscence (12.96%-34.38%).

Current Evidence on the Socket-Shield Technique: A Systematic Review.

The recently popularized socket-shield technique involves intentional retention of a section of the remnant root at the time of immediate implant placement, thereby preserving the buccal/proximal bone from resorption. The objective of this systematic review was to assess the literature available on the socket-shield technique and weigh its biological plausibility and long-term clinical prognosis. A systematic search was performed on PubMed-Medline, Embase, Web of Knowledge, Google Scholar, and Cochrane Central for clinical/animal studies from January 1970 to April 2017. Twenty-three studies were assessed: 1 clinical case-control study, 4 animal histological reports, 1 clinical abstract, and 17+2* case reports. Eighteen out of the 23 studies had a duration of ≤12 months. A quality assessment of 5 studies (4 animal histologic and 1 clinical case-control) performed using the modified Animal Research: Reporting of In Vivo Experiments guidelines revealed that 4/5 studies had low scores. Fifty-eight out of 70 (82.86%) implants from 4 animal histological studies had complications; buccal/crestal bone loss (54.55%) and failure of osseointegration (27.27%) were the most common. Thirty-three out of 136 (24.26%) implants from 19+2 (2 studies had both histologic and clinical components, which are assessed separately) clinical studies had complications; buccal/crestal bone loss (78.78%) and shield exposure/failure (12.12%) were the most common. Other complications recorded were periodontal ligament and cementum formation on implant surfaces, pocket formation, inflammation, mucositis, and peri-implantitis. However, some clinical reports indicated stable results at 12 months. It would be difficult to predict the long-term success of this technique until high-quality evidence becomes available. A video abstract is available for viewing at https://youtu.be/lNMeUxj2XPA?list=PLvRxNhB9EJqbqjcYMbwKbwi8Xpbb0YuHI .

Petroleum Carcinogenicity and Aerodigestive Tract: In Context of Developing Nations.

Head and neck cancers from a diverse group of neoplasms, the occurrence of which can be attributed to habitual tobacco use, race, alcohol consumption, ultraviolet (UV) exposure, occupational exposure, viruses, and diet. The surging incidence rates reflect the prevalence of risk factors such as tobacco use (smoked and smokeless), betel nut chewing, urbanization and issues relating to urban air quality. Urbanization and development have catalyzed a multifold rise in levels of pollution in metropolitan cities. Ever-increasing consumption of fuels to meet demands of the growing population coupled with industrial activity has adversely affected the air quality, especially in developing countries. The cause most neglected in risk assessment of aerodigestive tract cancer research is that from petroleum exposure. The global issue of petroleum carcinogenicity has assumed high proportions. Polycyclic aromatic hydrocarbons and heavy metals are essential constituents of total petroleum hydrocarbons which infiltrate into the environment and are recognized worldwide as priority pollutants because of their toxicity and carcinogenicity. High levels of sulfur dioxide, nitrogen dioxide, ozone, carbon monoxide, ammonia and particulate matter PM10  has skyrocketed aerodigestive tract diseases especially carcinomas. The identification of specific biomarkers and role of metal ions in aerodigestive tract cancers will indicate the molecular basis of disease to provide quality care for patients confronting new threats from climate-sensitive pathologies. There is an urgent need to evaluate existing public health infrastructure so as to take ameliorative and adaptive measures.

Burnout Syndrome Among Medical Practitioners Across India: A Questionnaire-Based Survey.

BACKGROUND AND OBJECTIVES: Excessive and prolonged work-related stress has always been a cause for burnout among healthcare professionals. This has led to emotional, mental, and physical exhaustion. This survey was conducted to assess the burnout among medical practitioners using the abbreviated Maslach Burnout Inventory (aMBI) and Burnout Clinical Subtype Questionnaire (BCSQ-12) scales. MATERIALS AND METHODS: A cross-sectional survey was conducted among 482 registered medical practitioners across India. A questionnaire consisting of 25 socio-demographic and occupational questions related to aMBI and BCSQ-12 scales was used to assess the burnout. The distribution of responses for each variable was examined using frequencies and percentages among the subgroups to find out the burnout levels of various components of the scales. RESULTS: High burnout levels were uniformly recorded for the entire population. For the aMBI, 45.02% (n = 217) and 65.98% (n = 318) of the participants scored high on the emotional exhaustion and depersonalization scales, respectively, whereas 87.14% (n = 420) scored low on the personal accomplishment scale and 62.86% (n = 303) and 11.41% (n = 55) had medium and low scores on the satisfaction with the medical practice scale. The BCSQ-12 scale showed the mean values of 15.89, 11.56, and 10.28 on a scale of 28 for overload, lack of development, and neglect subtypes, respectively, whereas, satisfaction with the financial compensation item showed a mean value of 3.79 on a scale of seven. All these values indicate high levels of burnout. CONCLUSION: The results suggest high levels of burnout in all domains of aMBI and BCSQ-12 scales in all the occupational and socio-demographic groups of medical practitioners and warrant immediate actions to address this issue.