A retrospective study on the effect of the COVID-19 pandemic on dental treatments in adults.

BACKGROUND: The aim was to analyze the prevalence of dental treatments that were not performed in a dental care university referral center in the capital of Spain during the first wave of the COVID-19 pandemic. METHODS: This was a retrospective observational study based on the registry of medical records. Sex, age, nationality, and the type of treatment that was not performed in the service of the Integrated Adult Dental Clinic subject of the Dentistry degree at the Rey Juan Carlos University of Madrid were analyzed. RESULTS: A total of 392 medical records were analyzed. The prevalence of the treatments that were not performed was 58.67% (95% CI 53.74-63.44) of conservative treatments, 47.45% (95% CI 42.55-52.39) of periodontal treatments, 27.30% (95% CI 23.12-31.91) and 13.52% (95% CI 10.49-17.26) of clinical activities. The patients most affected by the absence of dental treatment ranged in age from 35 to 74 years. Age, sex, and nationality were not influential in not performing dental treatments. CONCLUSIONS: The COVID-19 pandemic could have negatively influenced treatments, such as conservative and periodontal treatments, that increasing the risk of tooth loss in adults.

Self-reported prevalence of periodontal disease among the Spanish population and immigrants: 2006, 2011/12 and 2017: a population-based study.

BACKGROUND: Periodontal disease is one of the most common pathologies in the population. Self-reporting has been used as a diagnostic tool in large populations, among other reasons, to detect the needs of potentially vulnerable groups. This study evaluated the prevalence of periodontal disease in people of Spanish nationality and immigrants in Spain. METHODS: This population-based, cross-sectional study was carried out using data obtained from National Health Interview Surveys (NHSs) carried out in 2006, 2011/2012 and 2017 in Spain. Subjects aged 16 years and older were included in the NHS-2006 and aged 15 years and older were included in the other NHSs. The following variables were self-reported by the participants: gum bleeding, tooth mobility, tooth extraction and missing teeth. Chi-square homogeneity tests were performed to assess the main associations between the independent variable (nationality) and the dependent variables (bleeding gums, tooth mobility, tooth extraction and missing teeth). Multinomial logistic regression models were constructed to evaluate the influences of the variables age and sex and their interactions on the main associations. RESULTS: A total of 115,123 participants were included in the NHS-2006 (n = 37,327, 11.38% immigrants), NHS-2011/12 (n = 38,727, 14.39% immigrants) and NHS-2017 (n = 39,069, 13.71% immigrants). The variables directly related to periodontal disease were gum bleeding and tooth mobility. These were significantly associated with nationality in the NHS-2006 and NHS-2017 cohorts. In the NHS-2011/12 cohort, only tooth mobility was associated with nationality. After adjustments for sex, age, and their interactions, immigrant status was associated with increased odds of bleeding in only the NHS-2006 cohort (RR = 1.65, 95% CI 1.38-1.99, p = 0.000). CONCLUSION: Immigrants in Spain have a lower probability of developing signs associated with periodontal disease than the Spanish population. Among the immigrant cohort, females and those in adult age groups had lower prevalence rates than their counterparts.

Safety and Efficacy of a New Synthetic Material Based on Monetite, Silica Gel, PS-Wallastonite, and a Hydroxyapatite Calcium Deficient: A Randomized Comparative Clinic Trial.

Background and Objectives: Maxillary bone defects related to post-extraction alveolar ridge resorption are usual. These defects may lead to failure in further surgical implant phases given the lack of bone volume to perform the dental implant. The objective of this clinical assay was to evaluate the safety and efficacy of an experimental synthetic bone substitute in the preservation of post-extraction maxillary alveoli. Materials and Methods: 33 voluntary patients who had at least one maxillary premolar tooth that was a candidate for exodontia (n = 39) and subsequent implant rehabilitation participated. The regenerated alveoli were monitored by means of periodic clinical examinations (days 9 ± 1, 21 ± 4, 42 ± 6, and 84 ± 6), measuring the height and width of the alveolar crest (days 0 and 180 ± 5), measurement of radiodensity using tomographic techniques (days 0-5 and 175 ± 5), and histological examination of biopsies collected at 180 ± 5 days. Results: No significant differences were observed during the entire follow-up period between the two groups with respect to the safety variables studied. A variation in width of -0.9 ± 1.3 mm and -0.6 ± 1.5 mm, and a variation in height of -0.1 ± 0.9 mm and -0.3 ± 0.7 mm was observed for experimental material Sil-Oss® and Bio-Oss®, respectively. The radiodensity of the alveoli regenerated with the experimental material was significantly lower than that corresponding to Bio-Oss®. However, the histological study showed greater osteoid matrix and replacement of the material with newformed bone in the implanted beds with the experimental material. Conclusions: Both materials can be used safely and proved equally effective in maintaining alveolar flange dimensions, they are also histologically biocompatible, bioactive and osteoconductive. The experimental material showed the advantage of being resorbable and replaced with newformed bone, in addition to promoting bone regeneration.

State anxiety and depression as factors modulating and influencing postoperative pain in dental implant surgery. A prospective clinical survey.

OBJECTIVES: To determine whether preoperative state anxiety and depression modulate or influence objective and subjective postoperative pain following dental implant insertion. STUDY DESIGN: Prospective, clinical study with 7-day follow-up of a sample of 105 subjects who preoperatively completed the state anxiety questionnaire (STAI-E) and Beck Depression Inventory (BDI) and postoperatively, at 2 and 7 days, recorded objective pain with the Semmes-Weinstein mechanical esthesiometer (SW test) and subjective pain with the Visual Analog Scale (VAS). RESULTS: 85.6% and 81.5% of patients, respectively, recorded no signs of state anxiety or depression. The correlation between anxiety and depression for both maxillary bones was the lower (P=0.02). The correlation between subjective and objective pain at 2 and 7 days, and the anatomic regions intervened, was statistically significant in the mandible at day 7 (P<0.01), and highly significant (P<0.001) for the other variables. The correlation between state anxiety and objective pain at day 7 was nearly statistically significant (P=0.07). CONCLUSIONS: The correlation between state anxiety and depression, and objective and subjective pain at day 7 was not statistically significant. A strong correlation was found between objective and subjective pain in the immediate postoperative period.

Indications and contraindications of dental implants in medically compromised patients: update.

The aim of this study was to review the current scientific literature in order to analyse the indications and contraindications of dental implants in medically compromised patients. A reference research was carried out on PubMed using the key words "implant" AND (oral OR dental) AND (systemic disease OR medically compromised), in articles published between 1993 and 2013. The inclusion criteria were the following: clinical studies in which, at least, 10 patients were treated, consensus articles, reviewed articles and meta-analysis performed in humans treated with dental implants, and which included the disease diagnosis. A total of 64 articles were found, from which 16 met the inclusion criteria. Cardiac systemic diseases, diabetic endocrine pathologies or controlled metabolic disorders do not seem to be a total or partial contraindication to the placement of dental implants. Tobacco addiction, and head and neck radiotherapy are correlated to a higher loss of dental implants. Patients suffering from osteoporosis undergoing biphosphonates therapy show an increased risk of developing bone necrosis after an oral surgery, especially if the drugs are administered intravenously or they are associated to certain concomitant medication.

Eating Behaviours, Oral Hygiene, and Caries in a Population of Spanish Children with Divorced Parents: A Cross-Sectional Study.

Dental caries are a public health problem that is influenced by dietary habits. This cross-sectional study aimed to investigate the feeding and hygiene habits that divorced parents exercise over their children compared to non-divorced parents, and how this may influence the rate of caries in their children. The data of participants (n = 174) with an average age of 12.17 ± 2.04 years were examined to assess the mean decayed/missing/filled teeth (DMFT) index, and they were asked questions about their oral hygiene habits. At the same time, their parents answered the parental feeding style questionnaire. A moderation analysis was conducted with family control of oral hygiene habit levels as an independent variable, decayed teeth as a dependent variable, and feeding control as a moderating variable. Results showed that divorced parents were found to have more problems in controlling their children's hygiene and dietary habits, have less control over their children's feeding, and make more use of instrumental feeding, which led to children of divorced parents having more caries. Despite the limitations linked to the cross-sectional design of the study and considering both the convenience sample and the impossibility of controlling for all aetiological factors linked to the development of caries, it can be concluded that children of divorced parents have an increased risk of tooth decay. However, parental controlled feeding interferes with the effect of family controlled oral hygiene habits on the decayed tooth, decreasing the rate of caries.

Third molar autotransplant planning with a tooth replica. A year of follow-up case report.

The advantages of dental autotransplantation and its high level of clinical success mean that it should be considered as a therapeutic option when replacing a lost tooth. In order to achieve optimum results, it is necessary to know the technique of dental autotransplantation, promoting its use whenever the clinical conditions to perform it are present. The objective of this article is to describe the technique in detail by means of a clinical case of a dental autotransplant whose donor tooth was a third unerupted molar. A 39-year-old male patient with no medical history of interest. On clinical examination, tooth 2.6 shows vertical fracture with indication of exodontia. A compatibility study is carried out using a CBCT and after this, a subsequent preparation of a 3D-printed replica of the donor tooth 2.8 is made. A step-by-step description is given of the autotransplantation technique from 2.8 to 2.6. After this, antibiotic coverage, semi-rigid splinting and root canal treatment are carried out in a short time. Results are shown at 12 months. The main factor for the success of this technique is the preservation of periodontal ligament cells. The unerupted teeth are the only ones that fully preserve the periodontal ligament, but they require greater surgical skills. Autotransplantation is a predictable treatment alternative to dental implants, being above all an option indicated to replace teeth with dental fissures or vertical root fractures or poor restorative and/or endodontic prognosis. The third molars are the most used teeth for transplantation, due to their indications for extraction in a high percentage preserving the entire periodontal ligament. The diagnosis by CBCT and the use of 3D- printed replicas of the tooth to be transplanted have meant a highly significant improvement in the prognosis and predictability of the technique. Key words:Dental autotransplant, tooth replica, third molar.

Genetic study in patients operated dentally and anesthetized with articaine-epinephrine.

Aims: In this study we wanted to figure out if there was a correlation between OPRM1 N40D, TRPV1 I316M, TRPV1 I585V, NOS3 -786T>C and IL6 -174C>G polymorphisms and the response to locally applied articaine-epinephrine anesthetic. Methods: In this observational study, 114 oral cell samples of patients anesthetized with articaine-epinephrine (54 from men 60 from women), were collected from dental centers in Madrid (Spain). High molecular weight DNA was obtained from oral mucosa cells. The analysis of OPRM1 N40D (rs1799971), TRPV1 I316M (rs222747), TRPV1 I585V (rs8065080) and IL6 -174C>G polymorphism was performed through real-time PCR allelic discrimination using TaqMan probes. Polymorphism NOS3 -786T> C (rs2070744) was analyzed using RFLP-PCR. Results: The studied polymorphisms are involved neither in the response to the anesthetic, nor in the intensity of perceived dental pain. However, in a subset of female patients we found that TRPV1 I316M was associated with a delayed onset of anesthesia. Conclusions: There is no association among these polymorphisms and the time elapsed between the application of the anesthetic and the onset of its effect.

Gingival hyperplasia as an early manifestation of acute myeloid leukemia. A retrospective review.

BACKGROUND: We study the prevalence of acute myeloid leukemia (AML) among patients with severe gingival enlargement. MATERIAL AND METHODS: We retrospective reviewed the clinical records of patients with severe gingival enlargement, between 2011 and 2018. The Saxer and Mühlemann index were used to measure inflammation and gingival bleeding. The degree of dental mobility was measured by the Nyman and Lindhe technique. RESULTS: A correlation analysis was carried out to test whether there were any associations among the different variables. In the sample of 117 patients the mean gingival bleeding index was ≥3 and the degree of dental mobility ≥2.3. 1.7% of patients, with severe gingival hyperplasia were diagnosed with AML. We found a significant association between gingival bleeding and aging (p<0.001) and a trend (0.54) between bleeding and suffering from AML. CONCLUSIONS: Severe gingival enlargement, abundant gingival bleeding, and dental mobility could be early manifestations of a blood dyscrasia. Key words:Acute myeloblastic leukemia, gingival hyperplasia, bleeding, tooth motility, oral health.

Effect of Strontium-Coated Titanium Implants on Osseointegration in Animal Models: A Literature Systematic Review.

PURPOSE: This study represents a systematic review of the literature to assess the effectiveness of strontium-coated titanium surfaces on osseointegration in experimental assays with healthy, nonosteoporotic and/or nonosteopenic animals. MATERIALS AND METHODS: An electronic search was conducted of the databases MEDLINE/PubMed, Wiley Library, and Web of Science through 2018, with the aim of identifying studies on the osseointegration of titanium implants modified with strontium. RESULTS: A total of 255 papers were found, of which 11 were included in this systematic review. The primary result was the percentage of bone-to-implant contact (BIC) around the titanium implants with or without a strontium-coated surface. The different techniques used to coat titanium surfaces with strontium recorded significant results in terms of the improvement in the implant's quality, as they increased its contact with the bone, bone area, and bone formation, as well as enhanced its biomechanical properties. CONCLUSION: Nine of 11 studies reported that titanium implants coated with strontium showed significantly higher BIC (P < .001 to P < .05). This coating also improved the implants' biomechanical properties.

Complications in the treatment of mandibular condylar fractures: Surgical versus conservative treatment.

OBJECTIVES: In the present article, we aim to review the main intra- and post-operative complications associated with two different therapeutic approaches for treating mandibular condylar fractures: conservative (CTR) and surgical treatment (ORIF, Open Reduction and Internal Fixation). MATERIAL AND METHODS: We have carried out a retrospective, meta-analytic, observational study using literature review, covering the period between 2000- September 2017. The data obtained were processed using statistical software SPSS v.0.18 and R v.2.11.1. The chi-squared test was used for comparison of relative frequencies for independent samples. RESULTS: A total of 2458 patients with 2810 fractures were collected for study. Patients treated with CTR and ORIF were an average of 29 years old, of those treated with CTR, 72.37% and 27.63% were male or female respectively and, of those treated with ORIF, 70.36% and 29.64% were male or female respectively. The main complications suffered by CTR and ORIF patients were: asymmetry (10.2%/6.4%), residual pain (6.5%/5.6%), temporomandibular joint and articular imbalance (15.9%/10.3%) and malocclusion (11.1%/4.0%), respectively. We only found significant differences between CTR and ORIF in the number of cases of temporomandibular joint and articular imbalance and malocclusion. Facial nerve damage was found exclusively among ORIF patients (8.6%) of which 8.3% were temporary and 0.3% permanent. CONCLUSIONS: The complications associated with either technique are minimal and infrequent, resulting in successful outcomes with minimal morbidity. CTR are associated with complications deriving from delayed mobilization leading to functional limitation, whereas the main complication associated with ORIF treatment was facial nerve damage.

Epidemiological survey on third molar agenesis and facial pattern among adolescents requiring orthodontic treatment.

BACKGROUND: The aim of this study was to determine the association between facial pattern according to Ricketts cephalometric analysis, and prevalence of third molar agenesis, taking subject age and gender as control variables. MATERIAL AND METHODS: An epidemiological survey was conducted based on a sample of 224 candidates for orthodontic treatment aged 12 to 24 (n=224). Third molar agenesis was recorded using Ricketts cephalometric analyses of lateral teleradiographs and panoramic radiographs. The risk for agenesis was predicted considering the 5 Vert Index parameters (facial axis, facial depth, mandibular plane angle, lower facial height and mandibular arch), facial type (brachyfacial, mesofacial, dolichofacial) and sociodemographic variables (age and sex), using odds ratio (OR) calculated by logistic regression. RESULTS: Third molar agenesis was observed in 25% of the sample. Risk for agenesis is significantly determined by sociodemographic factors (age, OR: 1.2), cephalic patterns (mesofacial vs dolichofacial, OR:4.3; and brachyfacial vs dolichofacial OR: 3.2) and cephalometric patterns (facial axis, OR: 0.8; lower facial height, OR: 0.8; and mandibular plane angle, OR:0.9). CONCLUSIONS: Facial parameters (facial axis, lower facial height, and mandibular plane angle) proved to be strong predictors of the risk for third molar agenesis, the prevalence of agenesis being significantly lower in dolichofacial individuals. Key words:Facial Pattern, Ricketts Analysis, Third Molar Agenesis.

Soft Tissue Augmentation Techniques in Implants Placed and Provisionalized Immediately: A Systematic Review.

The aim of this study was to evaluate the effectiveness of techniques for soft tissue augmentation in the placement of immediate implants with and without provisionalization and to assess the quality of the reports in the literature. Randomized clinical trials, prospective clinical trials, and case series were included in this review. Clinical questions were formulated and organised according to the PICOS strategy. An electronic search was performed in PubMed, Cochrane Central Register of Controlled Trials, Scopus, and ISI Web up until June 2016. Interexaminer agreement on eligibility (k = 0.842; p = 0.103) and quality (k = 0.933; p < 0.001) was high. Methodological approaches were assessed using criteria based on design related forms designed by the Dutch Cochrane Collaboration. Finally, 14 papers were identified. In two studies, the implant survival was 90%; for the rest of the studies it was 100%. All studies reported favourable aesthetic, biological, and radiographic outcomes. Surgical and biomechanical complications of this technique were not relevant. This technique effectively compensates for the expected loss of volume of the oral soft tissues and maintains high success rates with good aesthetic results over time.

Effect of topical application of melatonin on serum levels of C-reactive protein (CRP), interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) in patients with type 1 or type 2 diabetes and periodontal disease.

BACKGROUND: The present clinical trial study was designed to assess the effect of topical application of melatonin on serum levels of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6) and C-reactive protein (CRP) in patients with diabetes and periodontal disease in comparison with healthy controls. MATERIAL AND METHODS: Serum levels of TNF-α and IL-6 were measured by enzyme-linked immunosorbent assay and CRP by nephelometry by using the proper commercial kits in 30 patients with diabetes and periodontal disease, and also in a control group of 30 healthy subjects. Periodontograms were performed using the Florida Probe®. Patients with diabetes were treated with a topical application of melatonin (1% orabase cream formula) once daily for 20 days. Healthy subjects were treated with a placebo orabase cream. RESULTS: Patients with diabetes and periodontal disease had significantly higher mean levels of serum TNF-α, IL-6 and CRP than healthy subjects (P < 0.001). Following topical melatonin application, there was a statistically significant decrease in the gingival index and pocket depth (P < 0.001) as well as a significant decrease in IL-6 and CRP serum levels (P < 0.001). Local melatonin application in patients with diabetes and periodontal disease resulted in a significant decrease in CRP and IL-6 serum levels as well as an improvement in the gingival index and pocket depth. Patients with periodontal disease had significantly higher serum CRP, IL-6 and TNF-α values by comparison with healthy subjects. CONCLUSIONS: We conclude that melatonin can modulate the inflammatory action of these molecules in periodontal patients. KEY WORDS: Melatonin, periodontal disease, diabetes mellitus, interleukin-6, tumor necrosis factor-alpha, C-reactive protein, inflammatory markers.

Effect of adhesive application prior to bracket bonding with flowable composites.

OBJECTIVE: To evaluate the effect of applying an adhesive, prior to different flowable composite resins, on the shear bond strength (SBS) of orthodontic brackets to acid-etched human enamel. MATERIALS AND METHODS: One hundred metal brackets were bonded to 35% phosphoric acid-etched human premolars using four flowable composites (Admira Flow, Tetric Flow, Filtek Supreme, Transbond Supreme) and a conventional orthodontic composite resin (Transbond XT). For each experimental group, half of the specimens were bonded in combination with Transbond XT adhesive. After 24 hours of storage, an SBS test was performed. Adhesive remnant index scores were determined after the failure of brackets. Two-way analysis of variance and Student-Newman-Keuls multiple comparison tests were performed at P < .05. RESULTS: When using an adhesive system, the five composites performed equally. The application of adhesive had a significant effect on SBS. Without adhesive, SBS decreased in all groups, except for Transbond Supreme LV. All the test groups exhibited similar bracket failure modes. CONCLUSIONS: When using an adhesive system, flowable composite resins exhibited similar SBS. Transbond Supreme was the only resin performing similarly with or without adhesive system application.