Protostylid: Contributing and Aggravating Factor for Periodontitis.

Clinicians should be well-versed in the anatomy, variations, and teeth anomalies. Developmental disturbances of the teeth can lead to alterations in size, shape, number, structure, and eruption of the teeth. Developmental disturbances can lead to germination, fusion, concrescence, dilaceration, talons, cusps, dens in dente, etc. Protostylid, an additional cusp on the buccal aspect of the maxillary molar, which is a rare clinical finding, can lead to plaque accumulation, making oral hygiene maintenance difficult. This leads to clinical attachment loss and bone loss. This condition may often go undiagnosed. It should be diagnosed to prevent further complications. This case has been reported to make clinicians aware of the importance of diagnosing the case at the earliest possible time so that complications can be prevented and management is easier. From the perspective of forensic dentistry, this morphological feature, though uncommon, may be useful for the classification and identification of victims in mass causalities and bite marks on bodies or inanimate objects. This is one of the rarest cases of protostylids reported to date. This may not only pose a significant problem in endodontic therapy due to morphological alterations in root canals and periodontal therapy due to grove formation leading to an inability to maintain a plaque-free area (bone loss) but also be of very significant interest from the perspective of forensic dentistry.

Randomized controlled clinical trial on the efficacy of a novel antimicrobial chewing gum in reducing plaque and gingivitis in adolescent orthodontic patients.

OBJECTIVES: Chewing gums containing antiseptics or other antimicrobial substances may be effective in reducing plaque and gingivitis. Therefore, the aim of this randomized placebo-controlled clinical trial was to investigate the efficacy of a novel antimicrobial chewing gum containing essential oils (cinnamon, lemon, peppermint) and extracts on reduction of dental plaque and gingivitis as well as on oral health-related quality of life (OHRQoL) in adolescent orthodontic patients. MATERIALS: 52 patients (11-22 years of age) were randomly assigned to use a test chewing gum (COVIDGUM, Clevergum) or a commercially available control chewing gum over a period of 10 days. Approximal plaque index (API), papillary bleeding index (PBI) and an OHRQoL questionnaire for children (COHIP-G19) were assessed at baseline (BL), after 10 days (10d) and 30 days (30d). In addition, oral health and oral hygiene related questions of the COHIP-G19 questionnaire were evaluated separately in subscales at each timepoint. Data were analyzed using non-parametrical statistical procedures (α = 0.05). RESULTS: API and PBI decreased significantly over time from BL to 10d and from BL to 30d in both groups, without significant differences between the groups. In both groups, the COHIP-G19 score, oral health subscale and oral hygiene subscale decreased significantly over time. Regarding the oral hygiene subscale, the test group showed significantly better scores at 30d (p = 0.011). CONCLUSION: Both chewing gums performed similarly effective in terms of reducing plaque accumulation and gingival inflammation and improving OHRQoL. CLINICAL RELEVANCE: Chewing gums without antimicrobial ingredients may be sufficient to decrease plaque accumulation and gingival inflammation.

Evaluation of the efficacy of inter-dental brush and dental floss for peri-implant mucositis: A crossover randomized clinical trial.

OBJECTIVES: To evaluate the most effective method for mechanical inter-dental plaque removal between inter-dental brushes (IDB) and dental floss (DF), in addition to toothbrushing in patients affected by peri-implant mucositis (PIM); to identify possible factors related to the patient or to the single implant-supported element that could influence plaque accumulation and inflammation of peri-implant tissues. METHODS: Forty patients with PIM were recruited. They were randomly assigned to two different groups depending on inter-dental device used (IDB or DF). At baseline (T0), interproximal area (IA), interproximal emergence angle of the implant crown (A°) and manual dexterity (evaluated with Purdue Pegboard) have been recorded. At 14 days (T1), the inter-dental cleaning devices have been inverted between groups. After 14 days (T2), the Plaque Index (PI) and Gingival Index (GI) have been recorded. A questionnaire has been submitted to a patient for the analysis of preferences at T0, T1 and T2. RESULTS: Both inter-dental cleaning devices were effective in reducing PI and GI in the inter-dental area after 14 days of use. GI reduction was influenced by manual dexterity of the dominant hand. No significant differences were found for PI and GI at the variation of IA and A°. CONCLUSION: IDB was the most effective method for inter-dental plaque removal in all subjects regardless of their manual dexterity. DF seems to be more effective than IDB only in subjects with good dexterity.

The Orthodontics-Periodontics Challenges in Integrated Treatment: A Comprehensive Review.

Orthodontics and periodontics are intricately linked since adult orthodontics often implicate the periodontium. Periodontal intervention is needed throughout all phases of orthodontic treatment, from orthodontic diagnosis to mid-treatment periodontal assessment and postoperative evaluation. Invariably, periodontal health affects orthodontic success. Conversely, orthodontic tooth movements may serve as adjunctive therapy in patients with periodontal disease. This review aimed to provide a comprehensive understanding of the orthodontic-periodontic relationship for optimizing therapeutic strategies and achieving the best treatment outcomes in patients.

Comparison of two resilient attachment systems for implant-/mucosa-supported overdentures with a PEKK framework: a clinical pilot study.

OBJECTIVES: The aim of the study was to determine differences between Locator and CM LOC attachment systems regarding patient satisfaction and wear of the abutments and their inserts. Plaque accumulation onto the polyetherketoneketone (PEKK) framework and polymethylmethacrylate (PMMA) was investigated for the implant-supported overdentures. METHODS: Seventeen edentulous patients were randomised to receive either Locator or CM LOC system for the first year. The total number of implants was 53. After the randomisation, 25 implants received Locator system, and 28 implants received CM LOC system in the first year. After a period of 12 months, the attachment system was exchanged from either Locator to CM LOC or vice versa. Oral Health Impact Profile (OHIP-14) questionnaires were used to evaluate patient satisfaction, chewing comfort, and pressure lesions. Prosthesis hygiene on the PMMA and PEKK surfaces was evaluated by using Stark plaque index. After the exchange of the abutments, they were stored until the end of the 24 months, and the surface wear of the abutments was analysed using a scanning electron microscope. RESULTS: Three patients (10 implants) died shortly before the end of the first year. Two patients (7 implants) received only Locator system since CM LOC was not indictable for their implant system. Patient's satisfaction was increased when the attachment system was changed from Locator to CM LOC after 12 months of wearing time. Chewing ability and comfort were increased when the attachment system was changed from CM LOC to Locator after 12-month wearing time. There was no influence of the change of the attachment system on pressure lesions. The observed plaque accumulation was higher on the PMMA than on the PEKK surface. For the 8 investigated Locator abutments, the wear was within low and middle level. For the 28 investigated CM LOC abutments, the wear was within middle and high level for the terminal implants and between low and middle for the central implants (for patients who received 4 implants). CONCLUSIONS: Patient's satisfaction and wearing comfort can be improved with implant-supported overdentures with CM LOC abutments in comparison to Locator. There was no clear difference between both attachment systems concerning the chewing ability of the patients. Plaque accumulation was observed on both attachment systems in different areas. Plaque accumulation on PEKK surface was less than on PMMA surface. CLINICAL RELEVANCE: The CM LOC attachment system offers stable and comfortable wearing conditions for implant-supported overdentures. The use of PEKK as a framework material could reduce the incidence of pressure lesions.

Cerebralcare Granule® enhances memantine hydrochloride efficacy in APP/PS1 mice by ameliorating amyloid pathology and cognitive functions.

BACKGROUND: Alzheimer's disease (AD) is a progressive neurodegenerative disease characterized by memory deficits and cognitive decline. Current drugs can only relieve symptoms, but cannot really cure AD. Cerebralcare Granule® (CG) is a Traditional Chinese medicine (TCM) containing a variety of biologically active compounds. In our previous studies, CG has shown a beneficial effect against memory impairment in mice caused by D-galactose. However, whether CG can be used as a complementary medicine for the treatment of AD remains unexplored. Here, we use a combination of CG and memantine hydrochloride (Mm) to treat Alzheimer-like pathology and investigate the effects and mechanisms in vivo. METHODS: The histology of brain was examined with Hematoxylin-eosin (HE) staining, Golgi staining and Thioflavin S staining. ELISA was applied to assess the expression levels or activities of CAT, SOD, GSH-Px, MDA, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), total bilirubin (TBIL) in serum, as well as the levels of IL-6, IL-1ß, and TNF-α in the mice brain. Western blotting was used to assess the expression of ß-secretase (BACE1), amyloid precursor protein (APP), APPß, APPα, synaptophysin (SYN), growth-associated protein 43 (GAP43), and postsynaptic density 95 (PSD95). RESULTS: In the present study, the combination group (CG + Mm) significantly attenuated Alzheimer-like behavior without adverse effects in APP/PS1 mice, indicating its high degree of safety and efficacy after long-term treatment. CG + Mm reduced AD pathological biomarker Aß plaque accumulation by inhibiting BACE1 and APP expression (P < 0.05 or P < 0.001). Besides, the combination group markedly inhibited the levels of IL-1ß, IL-6, and TNF-α in hippocampus (P < 0.001), as well as activities of SOD, CAT, and GSH-Px in serum (P < 0.001). By contrast, the combination group improved synaptic plasticity by enhancing SYN, PSD95, and GAP43 expression. CONCLUSIONS: Taken together, these data supported the notion that CG combined with Mm might ameliorate the cognitive impairment through multiple pathways, suggesting that CG could play a role as complementary medicine to increase anti-AD effect of chemical drugs by reducing Aß deposition, neuroinflammation, oxidative damage, and improving synaptic plasticity.

Experimental peri-implant mucositis around titanium and zirconia implants in comparison to a natural tooth: part 2-clinical and microbiological parameters.

The aim of this study was to assess the clinical and microbiological parameters around dental zirconia and titanium implants compared with natural teeth during experimental plaque accumulation. Clinical parameters were evaluated (gingival index, plaque index, bleeding on probing, and probing pocket depth). Microbiological samples were analyzed for total bacterial cell counts, as well as Tannerella forsythia and Prevotella intermedia counts. A statistically significant difference over time was observed in the groups in terms of the gingival index (P<0.001), plaque index (P<0.001), and bleeding on probing (P=0.039). The lowest mean total number of bacterial cells was measured around the teeth, followed by the zirconia implants; the highest values were found around the titanium implants. T. forsythia and P. intermedia values showed significant changes over time and sessions around the titanium implants. Compared to the soft tissues around zirconia implants and the teeth, those around titanium implants developed a stronger inflammatory response to experimental plaque accumulation in terms of the total number of bacterial cells and T. forsythia and P. intermedia values.

Experimental peri-implant mucositis around titanium and zirconia implants in comparison to a natural tooth: part 1-host-derived immunological parameters.

The purpose of this study was to assess host-derived parameters around dental zirconia and titanium implants and natural teeth during the occurrence of mucositis. After 4 weeks of perfect oral hygiene, 16 clinically profiled patients were asked to refrain from oral hygiene for 2 weeks, resulting in experimental plaque accumulation. This was followed by 4 weeks of perfect oral hygiene to reverse the inflammation. Immunological samples were analyzed for interleukin 6 (IL-6), tumour necrosis factor alpha (TNF-α), and interleukin 1ß (IL-1ß). Immunological parameters were measured each week, starting at week 4 (session 2) and ending at week 10 (session 8). There were significant differences in IL-6 between the groups (zirconia vs. tooth and titanium vs. tooth), with unfavourable values for the tooth unit (P<0.05). After reinstitution of oral hygiene, there was a significant increase in TNF-α values for the tooth but not for the zirconia and titanium implants. There were significant differences in IL-1ß between the groups (zirconia vs. titanium and titanium vs. tooth), with higher IL-1ß levels around titanium implants (P<0.05). The soft tissue around titanium implants developed a stronger inflammatory response to experimental plaque accumulation in terms of IL-1ß values, whereas the teeth presented an increase in IL-6 and TNF-α values.

A comparative study on 7-year results of "All-on-Four™" immediate-function concept for completely edentulous mandibles: metal-ceramic vs. bar-retained superstructures.

The study aims to document the clinical outcomes over a 7-year period of two techniques used for the rehabilitation of edentulous mandibles according to the "All-on-Four™" concept: (1) fixed complete-arch prostheses fabricated with metal-ceramic implant-supported fixed prosthesis with a titanium framework and all-ceramic crowns and (2) bar-retained implant-supported removable prosthesis with acrylic resin prosthetic teeth. The study was performed on 32 patients who received immediately loaded "All-on-Four™" fixed mandibular prostheses. (Fixed prostheses with ceramic superstructures, n:16; bar-retained removable acrylic prostheses, n:16). The patients were evaluated for up to 7 years after prosthesis completion. The endpoints included the evaluation of prosthodontic complications, bone resorption, plaque accumulation, bleeding on probing, periodontal probing depth and an oral health impact profile (OHIP). Bone loss remained under 1.2 mm in all of the implants, and no difference was observed between two groups. Plaque accumulation increased gradually in both groups, and the bar-retained acrylic-bearing implants showed significantly higher values during the first 5 years. Immediate improvement was assessed by the OHIP score in both groups. The observed bone loss and the subjective outcomes showed equivalent levels of clinical success for bar-retained and ceramic superstructures over a 7-year period. The higher level of plaque accumulation observed around implants with bar-retained superstructures requires that patients with acrylic superstructures be highly motivated to maintain their personal oral hygiene. Further studies are needed to clarify the occurrence of prosthodontic complications and assess their economic aspects.

Plaque accumulation on titanium disks with different surface treatments: an in vivo investigation.

Implants with rough surfaces are today widely used. It has been speculated that rough surfaces (Ra > 0.2 µm) provide a better "substrate" for retention and accumulation of plaque in terms of area, thickness and colony-forming unit that can eventually lead to peri mucositis and/or peri-implantitis. The aim of this investigation was to evaluate in vivo the plaque accumulation after 48 h on three implant surfaces with different treatments. For this investigation, we used 21 sterilized titanium disks, with a diameter of 8mm and a thickness of 3 mm, provided by the manufacturer: 7 with machined surface, as smooth control, 7 with HA grit sandblasted RBM surface and 7 with Ca++ incorporated in titanium Xpeed surface. One disk for each surface treatment was characterized at time 0 by SEM and AFM to study, respectively, the surface morphology and roughness. The other 18 disks were mounted randomly on three upper acrylic bites in a buccal lateral position, worn for 48 h by three volunteer students for plaque accumulation. After 48 h each disk was removed and analyzed qualitatively and quantitatively by an independent operator, not involved into the study, in order to avoid bias. Data collected were statistically analyzed by one-way ANOVA. The qualitative analysis showed no differences in terms of total plaque accumulation between the surfaces. Data from quantitative analysis using Anova Test showed no significance between all groups. In this in vivo investigation all the surfaces studied promoted plaque formation. The degree of surface roughness seems not to be a critical factor for plaque accumulation.

Plaque accumulation beneath maxillary full-arch implant-supported fixed prostheses / 口腔疾病防治

Objective@#To evaluate the plaque distribution on the fitting surface of fixed implant prostheses which were supported by multi-unit abutment. @*Methods @# 21 patients with maxillary full-arch implant-supported fixed prostheses were collected. Plaque accumulation at the fitting surfaces were evaluated 3 months after restoration, by analyzing the digital photographs recorded by Imag e J 2.1.4.7.@*Results@#The average percentage of area covered with plaque was (46.13 ± 7.23)%. Plaque accumulation on the buccal and palatal area were (41.53 ± 3.08) and (53.76 ± 3.07)% respec⁃ tively, with a significant difference (t = 16.750, P < 0.001). The free area (71.86 ± 2.00) % was significantly higher than the anterior area (48.85 ± 2.09)% (t = 40.445, P < 0.001), andalso the middle area (49.33 ± 0.98)% (t = 47.124 , P < 0.001). The plaque percentage was higher when the distance between the implants was shorter.@*Conclusion@#To Minimize the palatal extension and free area of the prostheses, and to maximize the distances between the implants, were helpful to improve the oral hygiene control. It might be the key to keep a good outcome of the maxillary full-arch implant-supported fixed prostheses.

Plaque Accumulation Beneath Maxillary All-on-4™ Implant-Supported Prostheses.

BACKGROUND: Maxillary prostheses supported by four implants, following the All-on-4(™) principles, have become an accepted effective treatment for totally edentulous patients. Maintaining the hygiene of such fixed implant-supported prostheses is challenging. PURPOSE: The purpose of this clinical study was to evaluate the distribution of plaque on the fitting surface of All-on-4 fixed prostheses in order to find new strategies for maintaining their hygiene. MATERIALS AND METHODS: Twenty All-on-4 maxillary fixed prostheses collected from 20 patients, 6 months after delivery, were stained with methylene blue to disclose plaque accumulation at the fitting surfaces of the prostheses. Digital photographs of the fitting surfaces of the prostheses were recorded and processed. The distribution of accumulated plaque was evaluated statistically. RESULTS: The average percentage of area covered with plaque was 28 ± 8% of the total area of the fitting surface of the prostheses. The fitting surfaces of the prostheses had three times more plaque on the palatal area (52.5 ± 7.33%) than on the buccal area (17.3 ± 7.33%, p < .05). The interimplant proximal areas of the fitting surface covered with plaque were high when the distance between implants was short (r = -0.326, p = .014). CONCLUSION: These findings suggest that the hygiene of the All-on-4 prostheses could be improved by maximizing the distances between the inserted implants in the jaw, minimizing the prostheses' palatal extension and guiding patients to optimize their oral hygiene practices targeting the palatal area of their prostheses.

Evaluation of efficiency of manual polishing over autoglazed and overglazed porcelain and its effect on plaque accumulation.

PURPOSE: The aim of this study was to evaluate the efficiency of manual polishing over autoglazed and overglazed porcelain and their effect on plaque accumulation. MATERIALS AND METHODS: Thirty-six porcelain discs were fabricated out of which 18 each was subjected for autoglazing and overglazing. Half surface of the discs was left intact; the remaining half was roughened with medium grit diamond bur. Roughened surfaces were repolished by porcelain polishing kits (Shofu, DFS, Eve). All the surfaces were evaluated by the perthometer and SEM. Six discs from each sample were placed in human volunteer's mouth for 72 hours to evaluate the plaque accumulation. Acquired data was subjected to ANOVA comparative evaluation. RESULTS: Roughened surfaces had average roughness value of 2.88±0.1935 µm. The repolished surfaces by porcelain correction kits Shofu, DFS and Eve, average roughness value reduced to 0.6250±0.1036, 0.9192±0.0953, 0.9017±0.1305 respectively. Autoglazed and overglazed surfaces showed the mean roughness value (Ra) of 0.4217±0.0685, 0.3450±0.0729. SEM study showed the improved surfaces when subjected for polishing. Plaque accumulation percentage was the highest on roughened surface (93.83±6.2552%), followed by porcelain discs polished by commercial kits. Autoglazed surfaces found to be the best surfaces with the least plaque accumulation (0.5237±0.4209%). CONCLUSION: All the polishing kits used in the study reduced the average roughness by approximately 77%. Corrected porcelain surfaces should ideally be reglazed, alternatively, polish the surfaces before final cementation.

Evaluation of efficiency of manual polishing over autoglazed and overglazed porcelain and its effect on plaque accumulation

PURPOSE: The aim of this study was to evaluate the efficiency of manual polishing over autoglazed and overglazed porcelain and their effect on plaque accumulation. MATERIALS AND METHODS: Thirty-six porcelain discs were fabricated out of which 18 each was subjected for autoglazing and overglazing. Half surface of the discs was left intact; the remaining half was roughened with medium grit diamond bur. Roughened surfaces were repolished by porcelain polishing kits (Shofu, DFS, Eve). All the surfaces were evaluated by the perthometer and SEM. Six discs from each sample were placed in human volunteer's mouth for 72 hours to evaluate the plaque accumulation. Acquired data was subjected to ANOVA comparative evaluation. RESULTS: Roughened surfaces had average roughness value of 2.88+/-0.1935 microm. The repolished surfaces by porcelain correction kits Shofu, DFS and Eve, average roughness value reduced to 0.6250+/-0.1036, 0.9192+/-0.0953, 0.9017+/-0.1305 respectively. Autoglazed and overglazed surfaces showed the mean roughness value (Ra) of 0.4217+/-0.0685, 0.3450+/-0.0729. SEM study showed the improved surfaces when subjected for polishing. Plaque accumulation percentage was the highest on roughened surface (93.83+/-6.2552%), followed by porcelain discs polished by commercial kits. Autoglazed surfaces found to be the best surfaces with the least plaque accumulation (0.5237+/-0.4209%). CONCLUSION: All the polishing kits used in the study reduced the average roughness by approximately 77%. Corrected porcelain surfaces should ideally be reglazed, alternatively, polish the surfaces before final cementation.

The effects of plaque control instruction in orthodontic patients / 대한치과교정학회지

The purpose of this study w-s to predict the respose to the chincap therapy from the initial cephalometric measurements and to obtain the indication of chincap therapy. 40 patients selected for this study were classified into two groups by the occlusal stability after completion of permanent dentition and the iiu4n ovement of facial profile, after chincap therapy. One was g response group which consisted of 25 children and the other was poor response group with 15 patients. Various measurements of the craniofacial structure in the initial lateral cephalogram were calculated and analyzed by t-test and discriminant analysis. The results were, as follows 1. Good response group had more horizontal growth pattern in initial stage of treatment, and the contributing measurements were Bjork sum, anterior-posterior facial height ratio, gonial angle, lower gonial angle and occlusal plane to AB plane angle. 2. The critical points and predictive values of the influential skeletal measurements were calculated. 3. The discriminant function was obtained from three. major influential measurements; Bjork sum, gonial angle and occliml plane to AB plane angle, and this function could discreminate correctly in 85% of this samples.