Final Posttreatment Occlusion in Patients With Unilateral Cleft Lip and Palate.

OBJECTIVE: To evaluate final posttreatment occlusion in patients with complete unilateral cleft lip and palate (cUCLP) by comparing (1) 3 treatment centers, (2) males and females, (3) cleft and noncleft sides, (4) right- and left-sided clefts, and (5) orthodontic treatment with/without orthognathic surgery (OS). DESIGN: Retrospective cohort study. PATIENTS: Blinded posttreatment dental casts of 56 patients (19.4 ± 1.4 years) with cUCLP from 3 centers in Switzerland. MAIN OUTCOME MEASURE: Occlusal assessment using the modified Huddart/Bodenham (MHB) index. RESULTS: Our sample comprised 35 males and 21 females, 46 with left- and 10 with right-sided clefts, of which 32 had undergone OS. The final posttreatment occlusion showed a median MHB score of 0 (interquartile range: -1.0 to 2.0) in the total sample and did not seem to depend on treatment center, sex, or OS. The MHB scores for the anterior buccal and the buccal segments were more negative on the cleft than on the noncleft side (P = .002 and P = .006, respectively). When the cleft was on the left side, the MHB score tended to be more positive in the labial (P = .046) and anterior buccal segments (P = .034). CONCLUSIONS: This study shows a very satisfactory final posttreatment occlusion in patients with cUCLP. The more constricted buccal occlusion on the cleft side emphasizes the attention that should be given in correcting the more medially positioned lesser maxillary segment. The influence of cleft-sidedness should be analyzed further on a sample including more patients with right-sided clefts.

The effect of clinical education on optimizing self-care by dental students in Switzerland.

Students, who may begin their dental education with sub-optimal oral self-care practices, are taught they should motivate patients to clean interdentally and reduce/stop smoking. To better understand their internalization of these concepts, students were surveyed at two distinct time points. Student cohorts from four Swiss universities were asked to complete an interdental cleaning/smoking habit questionnaire at the beginning of their pre-clinical education (n = 110) and again a year later, when beginning treatment of patients (n = 115). A local cohort (n = 28) was observed for comparison. All subjects participated voluntarily and anonymously. Interdental cleaning ≥ 3 times per week was performed by 48% first-year and 43% secondyear students in Basel, 60% and 76% in Bern, 60% and 70% in Geneva, 41% and 49% in Zurich, and 29% in the local cohort. Logistic regression using gender, class year and school as explanatory variables showed gender (p < 0.001) and school (p = 0.018) influenced cleaning frequency, with the odds being 3.16 [95% CI: 1.76, 5.67] times higher for females to perform interdental cleaning ≥ 3 times per week. Smoking was reported both years in numbers too low to analyze. Approximately 29% of the local cohort and 52% of the first-year students displayed an interdental cleaning frequency congruent with oral health recommendations. Adequate cleaning frequency increased for second-year students to 58%, which was not significant. Further study is needed to determine why more dental students do not themselves clean interdentally.

Diagnostic Accuracy of Cystic Lesions Using a Pre-Programmed Low-Dose and Standard-Dose Dental Cone-Beam Computed Tomography Protocol: An Ex Vivo Comparison Study.

BACKGROUND: This study aimed to analyze the diagnostic reliability of radiographic assessment of cystic lesions using a pre-set, manufacturer-specific, low-dose mode compared to a standard-dose dental cone-beam computed tomography (CBCT) imaging protocol. METHODS: Forty pig mandible models were prepared with cystic lesions and underwent both CBCT protocols on an Orthophos SL Unit (Dentsply-Sirona, Bensheim, Germany). Qualitative and quantitative analysis of CBCT data was performed by twelve investigators independently in SIDEXIS 4 (Dentsply-Sirona) using a trial-specific digital examination software tool. Thereby, the effect of the two dose types on overall detectability rate, the visibility on a scale of 1 (very low) to 10 (very high) and the difference between measured radiographic and actual lesion size was assessed. RESULTS: Low-dose CBCT imaging showed no significant differences considering detectability (78.8% vs. 81.6%) and visibility (9.16 vs. 9.19) of cystic lesions compared to the standard protocol. Both imaging protocols performed very similarly in lesion size assessment, with an apparent underestimation of the actual size. CONCLUSION: Low-dose protocols providing confidential diagnostic evaluation with an improved benefit-risk ratio according to the ALADA principle could become a promising alternative as a primary diagnostic tool as well as for radiological follow-up in the treatment of cystic lesions.

Potential of different fluoride gels to prevent erosive tooth wear caused by gastroesophageal reflux.

BACKGROUND: This in-vitro-study aimed to evaluate the potential of different fluoride gels to prevent gastroesophageal reflux induced erosive tooth wear. METHODS: Surface baseline profiles of a total of 50 bovine enamel specimens [randomly assigned to five groups (G1-5)] were recorded. All specimens were positioned in a custom made artificial oral cavity and perfused with artificial saliva (0.5 ml/min). Reflux was simulated 11 times a day during 12 h by adding HCl (pH 3.0) for 30 s (flow rate 2 ml/min). During the remaining 12 h (overnight), specimens were stored in artificial saliva and brushed twice a day (morning and evening) with a toothbrush and toothpaste slurry (15 brushing strokes). While specimens in the control group (G1) did not receive any further treatment, specimens in G2-5 were coated with different fluoride gels [Elmex Gelée (G2); Paro Amin Fluor Gelée (G3); Paro Fluor Gelée Natriumfluorid (G4); Sensodyne ProSchmelz Fluorid Gelée (G5)] in the evening for 30 s. After 20 days, surface profiles were recorded again and enamel loss was determined by comparing them with the baseline profiles. The results were statistically analysed using one-way analysis of variance (ANOVA) followed by Tukey`s HSD post-hoc test. RESULTS: The overall highest mean wear of enamel (9.88 ± 1.73 µm) was observed in the control group (G1), where no fluoride gel was applied. It was significantly higher (p < 0.001) compared to all other groups. G2 (5.03 ± 1.43 µm), G3 (5.47 ± 0.63 µm, p = 0.918) and G4 (5.14 ± 0.82 µm, p > 0.999) showed the overall best protection from hydrochloric acid induced erosion. Enamel wear in G5 (6.64 ± 0.86 µm) was significantly higher compared to G2 (p = 0.028) and G4 (p = 0.047). CONCLUSIONS: After 20 days of daily application, all investigated fluoride gels are able to significantly reduce gastroesophageal reflux induced loss of enamel.

Gingival recession after scaling and root planing with or without systemic metronidazole and amoxicillin: a re-review.

BACKGROUND: Gingival recessions inevitably occur during healing after scaling and root planing, but synoptic data on this topic is still lacking. This review compared the recession formation with and without the administration of systemic antibiotics. OBJECTIVES: To evaluate the formation of recession with and without the administration of antibiotics during the healing after scaling and root planing. MATERIALS AND METHODS: This study re-analyzed publications that reported clinical attachment levels (CAL) and probing pocket depths (PD) up to January 2019, including the pivotal review by Zandbergen and co-workers (2013). Whereas these studies traditionally focused on PD and CAL, the present analysis compared recession formation (ΔREC) after adjunctive systemic administration of amoxicillin (amx) and metronidazole (met) during scaling and root planing (SRP) and SRP alone. The mean increase in ΔREC, if not reported, was calculated from CAL and PD values and statistically analyzed. Recession formation was compared after 3 and 6 months after therapy. Results were separately reported for chronic periodontitis (CP) as well as aggressive periodontitis (AP) cases. RESULTS: Recessions increased consistently between baseline and follow-up. In the AP group, median ΔREC was 0.20 mm after 3 months, irrespective of whether antibiotics were administered or not. After 6 months, median ΔREC increased to 0.35 mm after AB and remained stable at 0.20 mm with SRP alone. In the CP group, after 3 months with and without antibiotics, median ΔREC accounted for 0.30 mm and 0.14 mm, respectively. After 6 months, median ΔREC accounted for 0.28 mm (with AB) and 0.20 mm (without AB). The quantitative assessment by meta-analyses also yielded small values (≤ 0.25 mm) for the estimated differences in recession formation between AB and noAB; however, none of them reached statistical significance. CONCLUSIONS: Although a slight tendency towards higher recession formation after SRP in combination with AB could be observed in many studies, quantitative meta-analyses showed no clinically relevant difference in recession formation due to the administration of AB. In general, the description and discussion of recessions in the literature seems not to be a major focus so far. CLINICAL RELEVANCE: Since the preservation of gingival tissues is important by preventive and therapeutic means, e.g., when avoiding postoperative root sensitivity or performing regenerative surgery, these aspects should not be neglected. We thus suggest to report REC measurements along with PD and CAL values for more direct recession formation (ΔREC) assessments in the future.

Treatment of Peri-Implant Mucositis with Repeated Application of Chlorhexidine Chips or Gel during Supportive Therapy - A Randomized Clinical Trial.

Background: To assess the effect of chlorhexidine (CHX) chip application in patients with peri-implant mucositis as compared to CHX gel application. Methods: In peri-implant sites with mucositis, CHX gel was applied in the control group (GC) and CHX chips in the test group (CC) at baseline and after three months. At baseline and after six months, peri-implant pocket depths (PPD), bleeding-on-probing (BOP) and activated matrix metalloproteinase-8 (aMMP8) were assessed. Longitudinal changes were tested for inter-group differences. Results: Thirty-two patients were treated. BOP was more reduced (p = 0.006) in CC than in GC, with means and standard deviations of 46 ± 28% and 17 ± 27%, respectively. PPD was more reduced (p = 0.002) in CC than in GC with 0.65 ± 0.40 mm and 0.18 ± 0.32 mm, respectively. Regarding BOP, the percentages of improved, unchanged and worsened sites accounted for 32%, 61% and 7% in GC and 46%, 53% and 1% in CC, respectively. For probing pocket depth, the according values were 26%, 66% and 8% (GC) versus 57%, 38% and 5% (CC). Conclusions: During supportive therapy, repeated CHX chip application might resolve marginal peri-implant inflammation in terms of bleeding better than CHX gel.

Change of saliva composition with radiotherapy.

OBJECTIVE: The aim of this study was to analyze the physiological and microbiological changes of saliva from patients with head and neck cancer during and after intensity-modulated radiotherapy (IMRT). DESIGN: In this prospective clinical trial saliva samples and oral candida swabs were collected from patients receiving IMRT due to head and neck cancer (examination group). The first measurement was scheduled before radiotherapy, the other measurements during and after radiotherapy up to a one year follow-up. Additionally samples from healthy controls were collected over six weeks. Salivary flow rate and pH were measured. Microbiological analysis of cariogenic and periodontopathogenic taxa was performed by fluorescence in situ hybridization and oral Candida spp occurrence was evaluated by swab tests. RESULTS: 11 patients and 19 controls were included. The salivary flow rate and the unstimulated pH of the examination group were significantly reduced during radiotherapy compared with the measurement before radiotherapy and to the control group. Total bacteria, streptococci and lactobacilli numbers slightly increased after radiotherapy, resuming baseline levels after one year. Mutans streptococci, Porphyromonas gingivalis and Treponema denticola were barely detectable, whereas Tannerella forsythia slightly increased following radiotherapy. No differences in Candida levels were observed in the study. CONCLUSIONS: Salivary changes in quantitative, qualitative and microbial composition occur during and after radiotherapy, with resumption of the measurements towards baseline levels after one year. While low levels of cariogenic and periodontopathogenic species were detected, the lower pH and salivary flow combined with increased numbers of aciduric and acidogenic lactobacilli corroborates a higher risk for caries, necessitating prevention.

The amount of keratinized mucosa may not influence peri-implant health in compliant patients: A retrospective 5-year analysis.

AIM: (a) To investigate the influence of the keratinized mucosa (KM) on peri-implant health or disease and (b) to identify a threshold value for the width of KM for peri-implant health. MATERIALS AND METHODS: The total dataset was subsampled, that is one implant was randomly chosen per patient. In 87 patients, data were extracted at baseline (prosthesis insertion) and 5 years including the width of mid-buccal KM, bleeding on probing, probing depth, plaque index and marginal bone level (MB). Spearman correlations with Holm adjustment for multiple testing were used for potential associations. RESULTS: Depending on the definition of peri-implant diseases, the prevalence of peri-implantitis ranged from 9.2% (bleeding on probing threshold: <50% or ≥50%) to 24.1% (threshold: absence or the presence). The prevalence of peri-implant mucositis was similar, irrespective of the definition (54%-55.2%). The width of KM and parameters for peri-implant diseases demonstrated negligible (Spearman correlation coefficients: -0.2 < ρ < 0.2). No threshold value was detected for the width of mid-buccal KM in relation to peri-implant health. CONCLUSION: The width of KM around dental implants correlated to a negligible extent with parameters for peri-implant diseases. No threshold value for the width of KM to maintain peri-implant health could be identified.

Intraoperative 3-dimensional cone beam computed tomographic imaging during reconstruction of the zygoma and orbit.

OBJECTIVE: Fractures of the zygoma and orbit are common facial skeleton injuries. Inadequate reduction and internal fixation may result in functional and aesthetic impairment. The aim of this study was to assess the use of intraoperative 3-dimensional (3-D) cone beam computed tomography (CBCT) for determining the intraoperative revision rate and the need for additional reconstruction of the orbit. STUDY DESIGN: We conducted a retrospective analysis of 48 consecutive patients (15 females, 33 males) suffering from simple or complex zygomatic fractures, seen between June 2015 and October 2016. Intraoperative 3-D CBCT (Xoran Technologies, Ann Arbor, MI) was performed, and the intraoperative image was overlaid on the preoperative image by using iPlan software (Brainlab, Feldkirchen, Germany) for quality control. Categorical variables were cross-tabulated and compared using Fisher's exact test. P values and 95% confidence intervals were assessed. RESULTS: In 6 of 48 patients, intraoperative revision was deemed necessary on the basis of the superimposition on the preoperative images. Five of these 6 patients had comminuted fractures (P = .001). In 7 patients, the indication for orbital reconstruction was revised after intraoperative 3-D CBCT. CONCLUSIONS: Intraoperative 3-D CBCT allows for immediate revision and prevents unnecessary orbital reconstruction.

Comparison of preseptal and retroseptal transconjunctival approaches in patients with isolated fractures of the orbital floor.

Transconjunctival approach has become a standard procedure to access fractures of orbit and the infraorbital rim. The transconjunctival incision can be performed pre- or retroseptally. Both approaches have been described combined with modifications such as transcaruncular or detachment of the lateral canthus for wider exposure of the orbital walls and rim. Particularly concerning aesthetics, the transconjunctival approach shows advantages compared to the transcutaneous incisions, such as the transciliary and infraorbital access. Moreover, transconjunctival approach is preferred in the literature regarding lid retraction. In this study the preseptal approach is compared with the retroseptal approach concerning en- or ectropion, foreign body sensation and formation of symblepharon. In our collective complication rates were lower in the retroseptal transconjunctival group, although this was not statistically significant. Whether the preseptal or the retroseptal transconjunctival approach is selected, is rather based on the surgeon's preferences. Nevertheless, the retroseptal approach must be considered as advantageous alternative to the preseptal approach because of simpler surgical technique and the safer distance to the vulnerable lid apparatus.

Anti-erosive effect of a self-assembling peptide gel

This study analyzed the anti-erosive effect of a self-assembling peptide fibre gel. One hundred and twelve bovine enamel samples were ground flat and subjected to a three times de- and re-mineralization cycle: erosion (5 min, HCl, pH 2.6) alternated with storage in artificial saliva under agitation. Then, samples were covered with different anti-erosive compounds (2 min): Duraphat toothpaste (DT), Elmex Erosion Protection Toothpaste (EET) or Elmex Gelée (EG) ­ all mixed with saliva (1:3) ­, Elmex Erosion Protection Mouthwash (EEM), Curodont Protect (CP; self-assembling peptide gel) or MI Paste Plus (MIP). Untreated, water stored samples served as control. In experiment 1, half of the samples of each group were continuously superfused with HCl (pH 2.6, 60 µl/min, 8 min). In experiment 2, the second half of samples were subjected to eight cycles, each consisting of application of the respective anti-erosive compound followed by an erosion (60 s, HCl, pH 2.6), followed by remineralization in artificial saliva (45 min). Enamel loss was profilometrically determined. In experiment 1, EEM and EET performed significantly better compared to all other compounds. Substance loss of all other compounds did not differ significantly from control. In experiment 2, significantly better performance was achieved by EEM and EET. EG showed significantly lower protection than the control. All other applied compounds yielded no significant difference compared to control. Under the chosen conditions, the self-assembling peptide-containing compound showed no anti-erosive effect.

Use of a monopolar microneedle device in a transconjunctival, retroseptal approach.

Transconjunctival approach is a standard procedure to address fractures of orbit and the infraorbital rim. Modifications such as transcaruncular or lateral canthal widening allow for extended orbital wall exposure. Especially concerning aesthetics, the transconjunctival approach shows benefits compared to the transcutaneous incisions, such as the transciliary and infraorbital access. Moreover, transconjunctival approach is favored in the literature concerning lid retraction. Monopolar devices have become popular in surgery in the past decades because of good depth control and simultaneous hemostasis with consequently improved overview. Also numerous surgeons use monopolar device in orbital surgery, their safety have never been proved. In this study monopolar microneedle device is compared with conventional access by scalpel concerning lid retraction, foreign body sensation and formation of symblepharon. In our collective complication rates were comparable between the scalpel and the microneedle group. The monopolar microneedle device shows favorable results compared with the scalpel and is easy to handle. Weather the conventional access by scalpel or the access by monopolar device is selected, is rather driven by the surgeon's preferences than by statistical relevance. Nevertheless, monopolar microneedle device shows better depth control and simplifies readaptation of the conjunctival wound's margin.

Characterization, Quantification and Compound-specific Isotopic Analysis of Pyrogenic Carbon Using Benzene Polycarboxylic Acids (BPCA).

Fire-derived, pyrogenic carbon (PyC), sometimes called black carbon (BC), is the carbonaceous solid residue of biomass and fossil fuel combustion, such as char and soot. PyC is ubiquitous in the environment due to its long persistence, and its abundance might even increase with the projected increase in global wildfire activity and the continued burning of fossil fuel. PyC is also increasingly produced from the industrial pyrolysis of organic wastes, which yields charred soil amendments (biochar). Moreover, the emergence of nanotechnology may also result in the release of PyC-like compounds to the environment. It is thus a high priority to reliably detect, characterize and quantify these charred materials in order to investigate their environmental properties and to understand their role in the carbon cycle. Here, we present the benzene polycarboxylic acid (BPCA) method, which allows the simultaneous assessment of PyC's characteristics, quantity and isotopic composition ((13)C and (14)C) on a molecular level. The method is applicable to a very wide range of environmental sample materials and detects PyC over a broad range of the combustion continuum, i.e., it is sensitive to slightly charred biomass as well as high temperature chars and soot. The BPCA protocol presented here is simple to employ, highly reproducible, as well as easily extendable and modifiable to specific requirements. It thus provides a versatile tool for the investigation of PyC in various disciplines, ranging from archeology and environmental forensics to biochar and carbon cycling research.