Dent. J., Volume 9, Issue 9 (September 2021) – 11 articles

A 47-year-old Caucasian man, in good general, oral and periodontal health, presented with a non-bleeding bluish lesion on the back of his tongue, presumably due to an ecchymotic area of traumatic origin which was left untreated. The day after, other ecchymotic-type lesions on the mucous membranes of the cheeks and the upper lip, a bleeding lesion at the apex of the tongue and gingivorrhagia, along with petechiae on the back, scalp, lower limbs and feet, occurred, with rapid clinical deterioration, requiring immediate hospitalization. Oral, dermatological, and hematological evaluations lead to idiopathic thrombocytopenic purpura (ITP) diagnosis and hydrocortisone prescription, with a complete recovery in the next few days.The presented case of ITP, with early intra-oral manifestations, aimed both to emphasize the role of oral healthcare workers in theearly recognition of ITP, which may be especially relevant for those cases with extremely fast platelet depletion, high risk of internal bleeding and consequent potentially fatal complications, and in the differential diagnosis of the diseasethat may be aided by the diagnostic protocol described, and to provide dentists with recommendations on oral care management of cases of ITP, both in dental and multi-disciplinary settings. Full article

Background: Extrusion, lateral luxation, and intrusion are among the most serious types of dental trauma. Only a few studies have specifically focused on extrusion; the present one was aimed at reporting a case of domestic traumatic dental injury to primary tooth and describing the measures taken in managing the trauma in order to avoid future consequences to the underlying permanent tooth germ. Case report: A 3.5-year-old boy reported a dental injury with extrusion and root fracture of deciduous tooth 5.1. After intraoral and radiographic evaluation, the element was repositioned and stabilized by an orthodontic flexible splint attached to the adjacent teeth. Several follow-up checkups were made and showed good healing of the tissues and physiological exfoliation of the tooth, with a healthy and unaffected corresponding central permanent incisor. Conclusion: This case report strengthens the importance of well-timed diagnosis and treatment and of regular follow-up of traumatized teeth as they may affect both dentitions with a negative impact on Oral Health-Related Quality of Life. Conservative treatment should be taken into consideration when possible, being in some cases more appropriate. Full article

Oral and dental diseases are a major global burden, the most common non-communicable diseases (NCDs), and may even affect an individual’s general quality of life and health. The most prevalent dental and oral health conditions are tooth decay (otherwise referred to as dental caries/cavities), oral cancers, gingivitis, periodontitis, periodontal (gum) disease, Noma, oro-dental trauma, oral manifestations of HIV, sensitive teeth, cracked teeth, broken teeth, and congenital anomalies such as cleft lip and palate. Herbs have been utilized for hundreds of years in traditional Chinese, African and Indian medicine and even in some Western countries, for the treatment of oral and dental conditions including but not limited to dental caries, gingivitis and toothaches, dental pulpitis, halitosis (bad breath), mucositis, sore throat, oral wound infections, and periodontal abscesses. Herbs have also been used as plaque removers (chew sticks), antimicrobials, analgesics, anti-inflammatory agents, and antiseptics. Cannabis sativa L. in particular has been utilized in traditional Asian medicine for tooth-pain management, prevention of dental caries and reduction in gum inflammation. The distribution of cannabinoid (CB) receptors in the mouth suggest that the endocannabinoid system may be a target for the treatment of oral and dental diseases. Most recently, interest has been geared toward the use of Cannabidiol (CBD), one of several secondary metabolites produced by C. sativa L. CBD is a known anti-inflammatory, analgesic, anxiolytic, anti-microbial and anti-cancer agent, and as a result, may have therapeutic potential against conditions such burning mouth syndrome, dental anxiety, gingivitis, and possible oral cancer. Other major secondary metabolites of C. sativa L. such as terpenes and flavonoids also share anti-inflammatory, analgesic, anxiolytic and anti-microbial properties and may also have dental and oral applications. This review will investigate the potential of secondary metabolites of C. sativa L. in the treatment of dental and oral diseases. Full article

Background: The treatment of the surface of titanium implants with argon plasma improved its hydrophilicity and cell adhesion, resulting in higher bone apposition on implant and graft surfaces. The spontaneous perforation over time of the sinus mucosa after sinus augmentation has been documented in experimental studies at both implants and graft particles. The aim of the present study was to evaluate the influence of plasma argon treatment of the implant surface on bone apposition and on the rate of sinus mucosa perforations. Methods: A sinus lifting procedure was performed bilaterally in sixteen rabbits, and implants, either treated with argon plasma or left without treatment (control), were placed simultaneously without grafts. After 8 weeks, histological analyses were carried out. Results: A collapse of the sinus mucosa was observed at all implants. Twenty-four out of thirty-two implants presented sinus mucosa perforations at the apex. Several perforations were also found at the threads. Thinned mucosa sites (width < 40 µm) were found around almost all implants. About 2.6–2.9 mm of the apical regions of the implant did not present signs of osseointegration and about 1.3 mm were exposed to the sinus cavity. No statistically significant differences were found between plasma and control sites. Conclusions: In conclusion, the sinus mucosa was damaged and perforated by direct contact with treated and non-treated implant surfaces. The treatment of the implant surface with argon plasma did not affect the outcomes. Full article

Additive manufacturing (AM) has many advantages and became a valid manufacturing technique for polymers and metals in dentistry. However, its application for dental ceramics is still in process. Among dental ceramics, zirconia is becoming popular and widely used in dentistry mainly due to its outstanding properties. Although subtractive technology or milling is the state of art for manufacturing zirconia restorations but still has shortcomings. Utilizing AM in fabricating ceramics restorations is a new topic for many researchers and companies across the globe and a good understanding of AM of zirconia is essential for dental professional. Therefore, the aim of this narrative review is to illustrate different AM technologies available for processing zirconia and discus their advantages and future potential. A comprehensive literature review was completed to summarize different AM technologies that are available to fabricate zirconia and their clinical application is reported. The results show a promising outcome for utilizing AM of zirconia in restorative, implant and regenerative dentistry. However further improvements and validation is necessary to approve its clinical application. Full article

Background: Success of an implant-supported prosthesis is highly dependent on implant diameter and bone quality. The objective of this study is to assess these two variables under axial or 30° angulated loading. Methods: The study was conducted using finite element model simulations of dental implants with an unchanging length of 6.5 mm and varying diameters of Ø3.3; Ø3.5; Ø3.75; Ø4, Ø4.25 and Ø4.75 mm. The implants were placed in an axial position and a 2 mm high straight transepithelial (intermediate abutment) was used to perform a single tooth restoration. Four bone quality scenarios, Type IV, III, II or 0-I bone, were simulated from a simplified model of the mandible. A 200N load was applied both axially and at a 30° angle to the occlusal surface of the prosthesis, which was 11 mm above the implant platform, and the equivalent Von Mises stress in the bone was analyzed. Results: The maximum stress value was obtained for the Ø3.3 implant in Type IV bone (235 MPa), while the lowest value was obtained for the Ø4.75 implant and in Type 0-I bone (41 MPa). Regardless of the implant diameter, an improvement in bone quality produced a reduction in bone stress. The same effect was observed as the implant diameter was increased, being this effect even more pronounced. Conclusions: Implant diameter has an important effect on bone stress, with a reduction in stress as the implant diameter increases. Full article

The identification of human remains relies on the comparison of post-mortem data, collected during the autopsy, with the ante-mortem data gathered from the missing persons’ reports. DNA, fingerprints, and dental data are considered primary identifiers and are usually collected during any human identification process. Post-mortem dental data should be collected and analyzed by forensic odontologists, as a dental autopsy must not be confused with a dental examination. The virdentopsy project was inaugurated in 2020, during the COVID-19 pandemic, to allow the correct process of human remains by collecting dental data from teeth and jaws, which was then transmitted to forensic odontologists remotely for an expert opinion to achieve a generic profile of the unidentified human remains. The post-mortem dental biography is paramount to narrow the search for compatible missing persons but requires knowledge and experience of forensic odontologists. The virdentopsy process uses radiographic imaging (periapical X-rays, CT scans, panoramics), 2D/3D photos and video recording, photogrammetry documentation, 3D scanning, and live streaming where possible. This registered term was created by merging the terms “virtual” and “dental autopsy” but with no commercial benefits. The proposed process combines research topics under the field of the human rights of the dead and humanitarian forensic odontology services. It should enhance and accelerate the human identification process of the deceased, age estimation of the living, analysis of panoramic X-ray images, and be an educational tool for remote live training in forensic odontology and anatomy of skulls. This paper presents an overview of the virdentopsy process in the field of forensic odontology as a remote consultation as well as an educational tool for undergraduates and postgraduates. Full article

Soft gingival tissue deficiency remains a severe problem leading to postoperative recession, peri-implantitis, and bone resorption. The use of collagen matrices does not always lead to complete rebuilding of the gingiva volume. The application of mesenchymal stromal cells (MSCs) simultaneously with collagen materials represents a promising approach for the restoration of soft gingival tissues. However, short-term effects of MSCs-enriched collagen grafts after gingival augmentation have not yet been studied properly. Mucograft and Mucoderm matrices were implanted in rabbits (n = 12) simultaneously with the intraoperative injection of rabbit bone marrow-derived mesenchymal stromal cells (BM-MSCs) or without cells. Collagen matrices were implanted under the flap or by the surface technique without intentional primary closure. The samples were harvested seven days after implantation, histological staining with hematoxylin and eosin, and immunohistochemical staining for VEGF, IGF1, and TGF were performed. The use of Mucoderm led to better augmentation outcomes on day 7 compared with Mucograft (p < 0.0001). Gingival augmentation in combination with the local administration of BM-MSCs led to better regeneration of the soft gingival tissues independently of the type of implanted collagen matrices (p < 0.0001). Furthermore, injection of BM-MSCs significantly enhanced gingival vascularization and epithelization with a clear positive correlation between vascular growth and epithelial response. Administration of BM-MSCs in combination with various collagen materials may potentially improve gingiva regeneration. Full article

Hyperlipidemia is a well-recognized risk factor for cardiovascular disease, which, in turn, acts as a contributory factor in periodontitis development. Periodontitis has been associated with benign tumors and cancers and withseveral disorders, including hyperlipidemia. Correspondingly, periodontal treatment may exert a positive effect on lipid metabolism, although opposite evidence has also been reported. As a counterpart, the therapy for hyperlipidemia, conventionally based on statins, has been proposed to positively affect periodontal conditions, mainly due to statin pleiotropic effects, reducing periodontal inflammation and promoting osseointegration. Therefore, the present systematic review aimed to evaluate, in subjects with untreated periodontitis and peri-implant disease (Population), the effect of routine systemically administered statins (Intervention), compared to non-statin use (Comparison), on periodontal parameters around natural teeth and implants (Outcome). Discordant results were found in periodontal parameters, and the current lack of such data related to peri-implant tissues and to alveolar bone loss highlights the need for further studies on the topic, potentially paving the way for a more comprehensive approach to periodontitis and peri-implantitis management. Indeed, the validation of the beneficial effect provided by systemically delivered statins on periodontal and peri-implant tissues may direct recall scheduling, predict response to therapy and, therefore, guide treatment strategies of periodontal and peri-implant treatments in statin users. Full article

An increase in the number of implants placed has led to a corresponding increase in the number of complications reported. The complications can vary from restorative complications due to poor placement to damage to collateral structures such as nerves and adjacent teeth. A large majority of these complications can be avoided if the implant has been placed accurately in the optimal position. Therefore, the aim of this in vitro pilot study was to investigate the effect of freehand (FH) and fully guided (FG) surgery on the accuracy of implants placed in close proximity to vital structures such as the inferior alveolar nerve (IAN). Cone-beam computed tomography (CBCT) and intraoral scans of six patients who have had previous dental implants in the posterior mandible were used in this study. The ideal implant position was planned. FG surgical guides were manufactured for each case. In this study, the three-dimensional 3D printed resin models of each of the cases were produced and the implants placed using FG and FH methods on the respective models. The outcome variables of the study, angular deviations were calculated and the distance to the IAN was measured. The mean deviations for the planned position observed were 1.10 mm coronally, 1.88 mm apically with up to 6.3 degrees’ angular deviation for FH surgery. For FG surgical technique the mean deviation was found to be at 0.35 mm coronally, 0.43 mm apically with 0.78 degrees angularly respectively. The maximum deviation from the planned position for the apex of the implant to the IAN was 2.55 mm using FH and 0.63 mm FG. This bench study, within its limitations, demonstrated surgically acceptable accuracy for both FH and FG techniques that would allow safe placement of implants to vital structures such as the IAN when a safety zone of 3 mm is allowed. Nevertheless, a better margin of error was observed for FG surgery with respect to the angular deviation and controlling the distance of the implant to the IAN using R2 Gate^® system. Full article

Internal bleaching is a conservative, non-invasive, and simple treatment that is frequently performed in daily clinical practice. The present in vitro study analyzes the oxygen expansion of different bleaching agents resulting from the oxidation reaction when interacting with enamel and dentin. Enamel and dentin were crushed separately until obtaining a fine powder with particles of an approximate size between 0.06 and 0.2 mm. Each enamel and dentin sample were mixed with 37% carbamide peroxide (CP 37%), 30% hydrogen peroxide (HP 30%), sodium perborate (SP) combined with HP 30% (HP 30% + SP) and SP with distilled water (SP). A total of 280 1 mm diameter glass tubes were used with 70 for each bleaching agent (30 for powdered enamel evaluation, 30 for powdered dentin evaluation, and 10 controls). The bleaching agents were placed in the prepared tubes immediately after mixing the components. As expansion occurred, the oil inside the tube was displaced, through which the resulting expansion was evaluated and measured for 10 days. A significant expansion was observed that varied in magnitude according to the bleaching agent and the tooth structure used. Student’s t test and Welch’s ANOVA were used to analyze the data obtained. The highest mean expansion of both enamel and dentin was observed with 30% HP (66.6 mm for enamel, 94.5 mm for dentin) followed by HP 30% + SP (48.6 mm for enamel, 52.7 mm for dentin), CP 37% (38.4 mm for enamel, 52.6 mm for dentin) and finally SP with water (12.7 mm for enamel, 4.4 mm for dentin). It was observed that the expansion in the SP group with enamel was significantly lower than in the rest of the groups, while that registered for HP 30% was significantly higher. (p < 0.001). The results with dentin were similar, with a significantly lower expansion for SP and higher for HP 30% (p < 0.001). The oxygen expansion observed as a result of the interaction between bleaching agents and dental tissues could contribute to improving our understanding of bleaching and its results. These results suggest that bleaching agents react with the organic component of the tooth structure. Full article