The wingspan suspension approach: A modified semilunar technique for multiple areas of recession.

BACKGROUND: Gingival recession can be considered an undesirable condition that results in the exposure of the root surface. There are many techniques that can be employed to address gingival recession; however, they frequently involve a second surgical site. Other approaches have been introduced in the past to address this concern, and this case study discusses the use of a modified technique to achieve root coverage. METHODS: A patient presented to the periodontics clinic with concerns regarding gingival recession. A modification to the semilunar technique was employed to address the recession, whereas double sling sutures were utilized to maintain the coronal repositioning of the flap. RESULTS: Maxillary central incisors initially presented with 2-3 mm of facial recession and root coverage was achieved by use of a modified surgical semilunar approach. No rebound noted over a 6-month period, newly established gingival margin deemed clinically stable. CONCLUSIONS: This case study provides an alternative to addressing gingival recession in the maxillary anterior region, when <3 mm of recession is noted. Avoidance of a second surgical procedure and/or donor site is of particular benefit, as well as maintenance of the blood supply. KEY POINTS: Why is this case new information? There is insufficient evidence on the use of a modified wingspan incision design Phenotype modification with elimination of a second surgical site is most ideal for the patient. What are the keys to successful management of this case? Comprehensive diagnosis and proper case selection Meticulous flap management and adequate release to allow for repositioning without tension Appropriate use ofsuture and suturing technique. What are the primary limitations to success in this case? Thin periodontal phenotype Poor oral hygiene and plaque accumulation postoperatively Loss to follow-up.

A randomized, double-blind pilot study of analgesic and anti-inflammatory effects of naproxen sodium and acetaminophen following dental implant placement surgery.

Introduction: Post-surgical pain following dental implant placement surgery is typically managed with non-opioid analgesics, including non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. However, the comparative analgesic efficacy of over-the-counter doses of non-steroidal anti-inflammatory drugs and acetaminophen in implant patients is unknown. Therefore, we compared the analgesic and anti-inflammatory effects of naproxen sodium and acetaminophen after surgical placement of one or two dental implants. Methods: Adult patients were treated with naproxen sodium (440 mg loading dose +220 mg q8h, n = 15) or acetaminophen (1,000 mg q6h-max daily dose 3,000 mg, n = 15) for 3 days after implant placement in a randomized, double-blind design. Pain was assessed on a 0-10 scale every 20 min for 6 h after study medication treatment. Tramadol (50 mg) was available as a rescue medication. Plasma and gingival crevicular fluid (GCF) were collected prior to the surgery and 0, 1, 2, 4, 6, 24, and 72 h after surgery for quantification of interleukin (IL)-6, IL-8, and IL-1ß levels. Results: Pain scores were significantly lower in patients treated with naproxen sodium compared to those treated with acetaminophen. Inflammatory mediator levels in plasma and gingival crevicular fluid increased after surgery and returned to near baseline levels by 72 h. Plasma IL-6 levels were significantly lower 6 h after surgery in patients treated with naproxen sodium compared to acetaminophen. No differences in inflammatory mediator concentrations in gingival crevicular fluid were observed between the treatment groups. The number of implants placed and body mass index (BMI) influenced inflammatory mediator concentrations in plasma and gingival crevicular fluid, respectively. Discussion: Naproxen sodium was more effective than acetaminophen in reducing post-operative pain and systemic inflammation following surgical placement of one or two dental implants. Further studies are needed to determine whether these findings are applicable to more complex implant cases and how they affect clinical outcomes following implant placement. Clinical Trial Registration: ClinicalTrials.gov, identifier NCT04694300.

Patient aggression toward dentists.

BACKGROUND: Workplace violence toward health care professionals is both widespread and widely overlooked. Only 4 studies of aggression toward dentists have been published-none in the United States-with the prevalence of aggression ranging from 29% through 80%. The purpose of this study was to provide an initial estimate of rates of patient aggression in dental practices in the United States. METHODS: The authors surveyed 98 dentists recruited from the faculty and alumni network of a college of dentistry. Participants completed a confidential online survey assessing whether they had experienced any of 21 specific types of aggressive behaviors from their patients. RESULTS: Past-year aggression prevalence was 22.2%, 55.0%, and 44.4% for physical, verbal, and reputational aggression, respectively. Career prevalence was 45.5%, 74.0%, and 68.7% for physical, verbal, and reputational aggression, respectively. Rates did not differ by sex, race, ethnicity, specialty, age, years practicing, or average number of patients treated per day. CONCLUSIONS: Participants reported levels of physical, verbal, and reputational aggression at rates comparable with those of other health care professionals in the United States and abroad. Additional research with larger representative samples of dentists in the United States is necessary to confirm these prevalence estimates. Future research should also investigate predictors and outcomes of patient aggression and prevention and intervention strategies. PRACTICAL IMPLICATIONS: Substantial rates of patient aggression highlight the need to address this problem in dental practices. The authors discuss implications for the dental profession, including proactive steps that could be taken to reduce patient aggression in dental offices.

Patient aggression toward dental students.

Aggression from patients is one of the risks faced by healthcare workers during a typical work week. This risk begins during training. Although rates of patient aggression have been estimated for nursing students and medical residents, studies of aggression toward dental students have not been conducted. To begin to address this knowledge gap, we surveyed 160 D.D.S. student dentists in their third- or fourth years who were attending a large urban college of dentistry during the 2018-2019 academic year. Each class had approximately 375 students, leading to a response rate of 21%. Approximately 28% of students reported experiencing at least 1 instance of physical aggression, 86% reported experiencing at least 1 instance of verbal aggression, and 36% reported experiencing at least 1 instance of reputational aggression. There were no differences in rates of experienced aggression by age or gender, but Hispanic or Latinx students were more likely to experience physical and reputational aggression than non-Hispanic White or Asian students. We discuss implications for dental education, including modifications to training clinic procedures and curriculum additions or modifications that may help prepare students to prevent and address patient aggression within the dental clinic environment.