Efficacy of a new sonic powered toothbrush versus a manual toothbrush in a young population. A randomized cross-over clinical trial.

OBJECTIVE: To compare the effectiveness of dental plaque removal between a new sonic toothbrush and a manual toothbrush. METHODS: In total, 75 healthy dental students participated in this randomized double-blind crossover clinical trial. Subjects were randomly assigned to one of the two groups (manual or sonic toothbrush) and underwent a single toothbrushing exercise. Seven days after, patients were asked to repeat the same procedure with the other toothbrush. Plaque scores were recorded before and after brushing. RESULTS: A significant mean reduction in the full-mouth plaque index was observed after the use of both type of brushes: 46.2% ± 0.28% (p = 0.000) and 50.5% ± 0.24% (p = 0.000) for the manual and sonic toothbrush, respectively. However, there were no statistically significant differences between the two types of brushes (p = 0.277). Regarding plaque reduction on the distinct tooth surfaces, differences between the groups reached statistical significance in favour of the sonic toothbrush only on the buccal sites (p = 0.003). CONCLUSIONS: Both devices lead to similar plaque score reduction after a single tooth brushing.

Efficacy of professionally administered chemical agents as an adjunctive treatment to sub-marginal instrumentation during the therapy of peri-implant mucositis.

AIM: To evaluate the efficacy of professionally administered chemical agents as an adjunctive treatment to sub-marginal instrumentation (SMI) in the therapy of peri-implant mucositis. MATERIALS AND METHODS: The primary outcome criteria were reduction in bleeding on probing (BOP), whereas resolution of disease, elimination of suppuration, including suppuration on probing, reduction of peri-implant probing pocket depth, reduction of plaque, and patient-reported outcome measures were considered as secondary outcome parameters. A literature search was performed on three electronic databases (01/1980 to 05/2022) focused on clinical studies with at least 3 months of follow-up, and meta-analyses were performed when appropriate. RESULTS: From a total of 139 publications, 40 articles were identified for full-text reading, and 5 randomized controlled clinical trials (RCTs) on antimicrobial photodynamic therapy (aPDT), 1 RCT on chlorhexidine (CHX), and 1 RCT on sodium hypochlorite (NaOCl) were included. Three studies had a low risk of bias and four had a mid-level (some concerns) risk of bias. The application of aPDT, 0.95% NaOCl, or 0.12% CHX as an adjunctive treatment to SMI showed no difference in changes in BOP and PD compared with SMI alone (p > .05). CONCLUSIONS: Within the limitations of this review and based on a low level of evidence from seven RCTs, it is concluded that the professional adjunctive topical application of aPDT, 0.95% NaOCl, and 0.12% CHX may not be effective to improve changes for BOP and PD when compared with SMI alone.

Ridge preservation in molar sites comparing xenograft versus mineralized freeze-dried bone allograft: A randomized clinical trial.

OBJECTIVES: The main objective of the study was to compare the dimensional ridge changes and the histological composition after the use of an allograft or xenograft and a resorbable membrane in ridge preservation in molar sites and to evaluate the influence of bone plate thickness on dimensional changes and the need of lateral sinus augmentation following ridge preservation. MATERIALS AND METHODS: Twenty-four patients in need of maxillary or mandibular first or second molar extraction and subsequent implant placement were included and randomly assigned to a group; allograft or xenograft, plus a collagen membrane. Cone-beam computed tomographies were obtained after molar extraction and after 5 months. A bone sample was harvested at the time of implant placement and analyzed by histomorphometry. RESULTS: Bone ridge was reduced significantly. Major changes in width occurred at 1 mm from the bone crest (-2.93 ± 2.28 mm) (p = .0002), while in height, the greatest reduction occurred at the buccal area (-1.97 ± 2.21 mm) (p = .0006). However, differences between groups were not significant. Thicker buccal bone plates exhibited less bone remodeling, while histologically, both biomaterials resulted in similar tissue composition. The resulting available bone height in the implant site measured 7.30 ± 3.53 mm initially and 6.8 ± 3.61 mm after 5 months which allowed implant placement without the need for lateral sinus augmentation in all cases. Still, 55% of the preserved areas needed transcrestal sinus lift. CONCLUSION: Ridge preservation in molar sites using a mineralized allograft or xenograft provides similar dimensional and histomorphometrical results after 5 months.

Fracture Resistance in Non-Vital Teeth: Absence of Interproximal Ferrule and Influence of Preparation Depth in CAD/CAM Endocrown Overlays-An In Vitro Study.

There is ample evidence to support the use of endocrowns to restore endodontic teeth. However, the influence of the position of the interproximal margins on fracture strength has not yet been studied. The aim was to determine the relationship between the apicocoronal position of the interproximal restorative margins and fracture resistance in nonvital teeth restored with CAD/CAM endocrown overlays. Forty extracted human maxillary premolars were prepared for endocrown overlay restorations without ferrule on the interproximal aspects and classified according to the position of the interproximal restoration margins in relation to the alveolar crest: 2 mm (group A), 1 mm (group B), 0.5 mm (group C), and 0 mm (group D). Fracture strength was measured using a universal testing machine applying a compressive force to the longitudinal tooth axis. Group A had a mean fracture resistance of 859.61 (±267.951) N, group B 1053.9 (±333.985) N, group C 1124.6 (±291.172) N, and group D 780.67 (±183.269) N, with statistical differences between groups. Group C had the highest values for fracture strength compared to the other groups (p < 0.05). The location of the interproximal margins appears to influence the fracture resistance of CAD/CAM endocrown overlays. A distance of 0.5 mm between the interproximal margin and the alveolar crest was associated with increased fracture resistance.

Biologically oriented preparation technique for surgically extruded teeth: A clinical report.

Surgical extrusion allows a ferrule to be obtained without the use of orthodontic extrusion or the need to remove hard and soft tissues. However, after the healing period, the soft tissue of the extruded tooth might become thinner, creating an unesthetic gingival margin. Unlike other preparation techniques, the biologically oriented preparation technique provides increased long-term gingival thickness. This article describes the treatment of 3 patients with teeth with no ferrule that were surgically extruded and restored with the biologically oriented preparation technique .

Keratinized tissue gain after free gingival graft augmentation procedures around teeth and dental implants: A prospective observational study.

AIM: The primary goal was to compare the amount of keratinized tissue width (KTW) gain after free gingival graft (FGG) procedures around implants and teeth after 6 and 12 months of healing. MATERIALS AND METHODS: Patients with mucogingival defects (<2 mm of KT) around teeth and implants underwent a gingival augmentation procedure by means of a FGG. Clinical measurements were performed with an individual stent to determine keratinized tissue width (KTW), length (KTL), graft shrinkage (GS) and gingival margin position (GMP) at 2 weeks, 6 weeks, 3 months, 6 months and 12 months after surgery. RESULTS: Twenty-nine patients (35 sites) participated in this prospective study. After surgery, KTW decreased and GS increased significantly in both treatment groups during the whole follow-up period, but the biggest changes were observed at 6 weeks. When comparing both treatment groups, implant sites showed significantly more reduction in KTW and more GS. Thus, at 12 months, KTW and GS reduced 2.03 ± 2.1 mm and 36.74 ± 38.2% in the teeth group and 2.91 ± 12.03 mm and 61.8 ± 36.25% around implants, respectively. CONCLUSIONS: A significantly greater reduction in KTW and more GS might be expected at implant sites.

Extrusión quirúrgica para la restauración del diente altamente comprometido: seguimiento a 3 años / Surgical extrusion to restore highly compromised tooth: 3-year follow-up

INTRODUCCIÓN: Un ferrule de 2 mm a 3600 asegura la supervivencia a largo plazo del diente restaurado. Sin embargo, existen situaciones clínicas donde el ferrule es insuficiente. Existen básicamente 3 opciones de tratamiento para la obtención de ferrule sin invadir el espacio biológico: el alargamiento de corona quirúrgico, la extrusión ortodóntica rápida y la extrusión quirúrgica. CASO CLÍNICO: EL presente caso clínico describe la restauración de un premolar inferior sin ferrule por medio de la extrusión quirúrgica, el retratamiento de conductos, y la colocación de poste y corona. CONCLUSIÓN: La extrusión quirúrgica permite, de manera altamente predecible restaurar dientes sin ferrule con raíces largas y periodontalmente sanos, sin comprometer los tejidos periodontales ni necesidad de aparatología ortodóntica

INTRODUCTION: A 2-mm ferrule over 3600 ensures a long-term survival of the restored tooth. However, there are clinical situations in which ferrule is insufficient. Thus, there are 3 treatment options to obtain ferrule without invading the biological width: surgical crown lengthening, rapid orthodontic extrusion and surgical extrusion. CLINICAL CASE: The present clinical case describes the restoration of a lower premolar without ferrule by means of surgical extrusion, root canal re-treatment, and post and crown. CONCLUSION: Surgical extrusion allows predictably the restoration of long, periodontally healthy teeth with no ferrule, without compromising the periodontal tissues or the need for orthodontic appliances

Molecular signatures of extracellular vesicles in oral fluids of periodontitis patients.

OBJECTIVE: To characterize extracellular vesicles (EVs) in gingival crevicular fluid (GCF) and saliva samples from healthy/gingivitis and periodontitis patients and correlate them with clinical inflammatory periodontal parameters. MATERIAL AND METHOD: An exploratory study, including 86 subjects, was conducted. Clinical and periodontal data were recorded, and oral fluid samples were obtained. EVs were precipitated by ExoQuick-TC™ and characterized by nanoparticle tracking (NanoSight™), Western blot (WB), transmission electron microscopy (TEM), and ELISA analysis. RESULTS: TEM showed nanoparticles morphologically compatible with EVs, and WB analysis revealed bands of specific EV markers (CD9, TSG101, and Alix) in both oral fluids of periodontitis and healthy/gingivitis subjects. The total concentration of EVs in GCF was increased in periodontitis patients compared to healthy/gingivitis subjects (p = .017). However, we did not observe differences in the EV concentration of saliva samples (p = .190). The size of GCF-EVs was 144.2 nm in periodontitis and 160.35 nm in healthy/gingivitis patients (p = .038). The CD63 exosome marker was increased in GCF of periodontitis patients (p = .00001). The total concentration of EVs in GCF was correlated with bleeding on probing (rho = 0.63, p = .002), periodontal probing depth (rho = 0.56, p = .009), and clinical attachment level (rho = 0.48, p = .030). CONCLUSION: Periodontitis patients have an increased concentration of EVs in GCF, and their role in periodontitis should be clarified.

Stability of the gingival margin after an aesthetic crown lengthening procedure in the anterior region by means of a replaced flap and buccal osseous surgery: a prospective study.

OBJECTIVES: The main objective of this study was to assess changes in the position of the gingival margin (GM) after performing an aesthetic crown lengthening (ACLP) by means of submarginal incisions, buccal osseous surgery, and a replaced flap after a healing period of 6 months. METHODS: Twenty-one patients who needed a surgical crown lengthening in the maxillary anterior teeth were included. An individual stent was fabricated to record changes in the position of the GM. Clinical measurements were recorded pre-surgically; immediately post-surgically (baseline); and at 42, 90, and 180 days. RESULTS: After the ACLP, the GM displacement did not change significantly after 42, 90, and 180 days (4.32 ± 1.17 mm, 4.29 ± 1.14 mm, and 4.26 ± 1.11 mm, respectively). Tissue rebound seems to be related to the distance from the GM to the alveolar bone (AB) at the time of suturing (GM-AB(X)). When GM-AB(X) was ≤ 2 mm, 3 mm, and ≥ 4 mm, the GM rebound at 6 months was 0.94 ± 0.53 mm, 0.10 ± 0.28 mm, and - 0.26 ± 0.40 mm, respectively. These differences were statistically significant (P < 0.001). CONCLUSIONS: An ACLP releasing the flap up to the mucogingival junction, with a ≥ 3-mm distance from the bone crest to the gingival margin can lead to a stable GM position at 42, 90, and 180 days. CLINICAL RELEVANCE: This article focuses on variables affecting the stability of the GM, which is a critical factor that may compromise the biological and aesthetic long-term outcomes.

In vitro evaluation of the root surface microtopography following the use of two polishing systems by Confocal Microscopy (CFM) and Scanning Electron Microscope (SEM).

OBJECTIVES: To compare and evaluate the root surface roughness after using two polishing instruments for root planing. MATERIALS AND METHODS: This comparative study was carried out on a sample of ten extracted human teeth with twenty interproximal root surfaces. Control group 1 and 2: (n=20 root surface): Gracey Curettes, 15 vertical strokes. Test group 1 (n=10): control group 1 + Termination Diamond Curettes (TDC), 15 strokes. Test group 2 (n=10): control group 2 + Termination Diamond Burs -15 µm (TDB), with irrigation for 15 seconds at 3000 rpm. The root surface was planed with the polishing instruments and test measurements were obtained with Confocal Microscopy (CFM) and Scanning Electron Microscope (SEM). The primary outcome variable was surface roughness (Ra). RESULTS: CFM showed that the TDC, mean changes in surface roughness (Ra) were reduced by 0.11 ± 0.14 (p-value = 0.000), and the TDB, Ra: were reduced by 0.27 ± 0.86 (p-value = 0.037). Non-statistically significant differences were observed in Ra (p-value = 0.581) between the two polishing instruments. SEM showed that the Group 2 showed a generally rougher surface with more parallel grooves than Group 1. CONCLUSION: There are no statistically significant differences between these two polishing systems, although TDB seems to reduce the surface roughness more than the TDC after being treated with Gracey Curettes.

Técnicas de cirugía mucogingival para el cubrimiento radicular / Mucogingival surgical procedures to attain root coverage

La recesión radicular puede desencadenar problemas de hipersensibilidad, caries radicular y problemas estéticos. Para corregir estos defectos y cubrir las superficies denudadas de las raíces se han propuesto gran variedad de técnicas de cirugía plástica periodontal. El propósito de este artículo es realizar una descripción detallada de diferentes procedimientos quirúrgicos para el cubrimiento radicular. Las técnicas de injerto gingival libre, injertos conectivos subepiteliales e injertos de matriz dérmica acelular son descritas paso a paso, según se encuentran definidas en la literatura. Para conseguir la máxima predictibilidad en el cubrimiento de las raíces denudadas es imprescindible diagnosticar con exactitud el caso y observar detalladamente todos los pasos de la técnica quirúrgica (AU)

Gingival recessions may be associated with problems such as dental hypersensitivity, root caries and unacceptable aesthetics. Different techniques are proposed in order to achieve root coverage and correction of the mucogingival defects. The purpose of this article is to present a review and the description of the most common procedures for root coverage. Among these techniques, the most popular procedures are the free gingival graft, the connective tissue grafts and acellular dermal grafts. In order to select the most predictable technique for root coverage, a proper diagnosis has to be established (AU)

Halitosis y colutorios orales. Revisión de la literatura / Halitosis and mouthwashes. Revision of medical literature

La halitosis viene siendo descrita en la literatura desde hace muchos años, pero sólo en los últimos años se le ha dado una importancia profesional significativa. Existen numerosos factores localizados y sistémicos causantes del mal olor oral. Sin embargo, según se trate de una u otra causa podemos estar ante condiciones transitorias, como en los casos del hambre, de un bajo nivel de saliva durante el sueño, de restos alimenticios o de prescripción de drogas o tabaco. En caso de halitosis patológicas crónicas, las causas pueden ser de origen oral o no. Algunos estudios han demostrado que la producción de olor es el resultado del metabolismo de bacterias Gram. El tratamiento y control del mal olor bucal debe enfocarse a determinar la causa del problema y a discernir su origen, ya sea médico y/o dental. Desde el punto de vista odontológico, el mejor tratamiento consiste en estimular al paciente a mantener una correcta higiene oral. Procedimientos comunes como la profilaxis y el raspado radicular pueden ser efectivos en los pacientes en los que la causa del mal olor es la periodontitis. Para combatir el mal olor bucal mediante un método químico han sido utilizados varios tipos de enjuagues bucales. El uso de colutorios será recomendado según su grado de eficacia científicamente comprobada (AU)

Halitosis has been described in medical literature for many years, but it has only recently received professional recognition. Several local and systemic factors can cause oral malodour: Some of these factors are transient such as hunger, low salivary flow during sleep, retention of food debris, prescription of some drugs or tobacco consumption. Pathologic chronic situations can have oral and systemic conditions. Clinical and laboratory trials have demonstrated that the odour results from the metabolism of gram-bacteria. Treatment and control of oral malodour must be directed to the medical and/or oral origin of the cause. The treatment must focus on controlling and stimulating the oral hygiene of the patient. Prophylaxis, scaling and root planing therapies, are proven to be effective in cases related to periodontal disease. Different mouthwashes have been used in the chemical therapy of halitosis. The recommendation for mouthwash must be determined by the efficiency of the product (AU)