Relationship between soft tissue dimensions and tomographic radial root position classification system for immediate implant installation.

The aim of this study was to evaluate the relationship between soft tissue dimensions and radial root position (RRP) classification for immediate implant placement on maxillary anterior teeth. Maxillary anterior teeth (n = 420) were analyzed in the radial plane of cone beam computed tomography (CBCT) scans. Each tooth was classified according to its RRP: class I, (IA, IB); class II (IIA, IIB) class III; class IV, and class V. Soft tissue thickness at different landmarks, supracrestal soft tissue height, and crestal bone thickness were measured in CBCT. Keratinized tissue width was clinically measured. Gingival phenotype (thick or thin) was evaluated by transparency of the periodontal probe and at the landmark 2 mm from the gingival margin in CBCT. Class I tooth position accounted for 31.7%, class II for 45%, class III for 13.3%, class IV for 0.5%, and class V for 9.5%. The gingival phenotype was associated with RRP (χ2 test, p < 0.05). Soft tissue dimensions were significantly different over RRP classes (ANOVA and Tukey tests, p < 0.05). Types IA and IIA presented both thick soft and hard tissues. When planning immediate implants in the anterior maxilla, soft tissue dimensions evaluation should be incorporated into RRP classification to increase the accuracy and predictability of treatment outcomes.

Radial plane tooth position and bone wall dimensions in the anterior maxilla: A CBCT classification for immediate implant placement.

STATEMENT OF PROBLEM: The biological and esthetic challenge of the post-extraction ridge is relevant to restorative implant dentistry, most significantly in the anterior esthetic zone. Previous authors have discussed facial bone wall dimensions and classified their variations. A reclassification may be pertinent. PURPOSE: The purpose of this observational, clinical study was to introduce a new classification system for anterior maxilla tooth position with guidelines for immediate implant placement. Data for facial and palatal bone wall height and thickness are also presented. MATERIAL AND METHODS: Maxillary anterior teeth (n=591) were analyzed as viewed in the radial plane of cone beam computed tomography (CBCT) scans from 150 patients. Each tooth was classified according to its position and inclination within its alveolus (class I, middle of the alveolus; IA, thick facial bone; IB, thin facial bone; class II, retroclined; IIA, thick crestal bone; IIB, thin crestal bone; class III, proclined; class IV, facially outside bone envelope; class V, both thin facial and palatal bone with apical isthmus). Bone thickness was measured for both facial and palatal walls at the following points: crestal (A), mid-root (B), apex (C), and 4 mm beyond the apex. Bone wall height was also evaluated. RESULTS: A thin facial bone wall predominated (≤1 mm) at the crest (83%) and the mid-root point (92%). Most palatal walls were thin (<1 mm) at the crest (63%) and thick (≥2 mm) at the mid-root point (98%) and apex (99%). Class I tooth position accounted for 6.1%, class II for 76.5%, class III for 9.5%, class IV for 7.3%, and class V for 0.7%. CONCLUSIONS: Maxillary anterior teeth have predominantly thin facial bones, making palatal bone thickness a crucial variable. The new classification system for radial plane tooth position is a pragmatic clinical analysis for immediate implant treatment planning.

Understanding the Dental Profession's Stress Burden: Prevalence and Implications.

Stress among dental practitioners is highly prevalent and is an issue that demands attention. Dental practice has been linked to mental, physical, chemical, and biological hazards that often foster high stress levels, anxiety, depression, burnout, and potential suicidal ideation. This can lead to unhealthy coping mechanisms and low quality of life, increasing the risk of chronic disease, mental issues, and lower patient care quality. This article summarizes data on stress in dentistry, highlighting its high prevalence and deleterious consequences. Five primary stress dimensions in general dental practice contribute to stress and burnout: productivity, patient-derived issues, regulations, fear of litigation, and work-related aspects. Reducing stress can decrease the risk of chronic conditions and mental health issues and potentially increase dental professionals' health span and career longevity.

Immediate Tooth Replacement in the Esthetic Zone with the Socket Shield Technique and a Novel Body-Shift Implant: A Pilot Study with Up to 3 Years of Follow-up.

Successful rehabilitation of the anterior maxilla remains a challenge, primarily due to postextraction ridge collapse, which can lead to gingival recession and a nonesthetic appearance. The socket shield technique presents a viable alternative for immediate dental implant placement in the esthetic zone. This pilot study aimed to evaluate the survival, complication rates, and marginal bone loss around body-shift implants placed in fresh extraction sockets with the socket shield technique to replace maxillary incisors. After socket shield preparation, 14 hopeless incisors were extracted and immediately replaced by a body-shift implant (Inverta, Southern Implants) at baseline. Patients were followed up for 12 to 39 months (mean: 18.1 ± 8.2 months). The average age was 52.3 ± 16.9 years, and the survival rate was 100%. One socket shield presented minimal internal exposure that was successfully treated with a connective tissue graft. The mean PES score was 12.9 ± 1.2. Mean interproximal marginal bone loss was -0.4 ± 0.5 mm. Body-shift implants can be a promising alternative for immediate tooth replacement combined with the socket shield technique. The superior esthetic outcomes remained stable, suggesting that the extra space created by the narrow cervical portion of the implant is beneficial for preserving the alveolar bone and limiting internal shield exposure.

Impacts of Tooth Loss on OHRQoL in an Adult Population in Cape Town, South Africa.

(1) Background: Tooth loss is an important component of the global burden of oral disease, greatly reducing the quality of life of those affected. Tooth loss can also affect diet and subsequent incidences of lifestyle diseases, such as hypertension and metabolic syndromes. This study aimed to evaluate the oral health-related quality of life (OHRQoL) score using the oral impacts on daily performance (OIDP) index in relation to tooth loss patterns among adults. (2) Methods: From 2014 to 2016, a cross-sectional study was conducted on adults living in Bellville South, Cape Town, South Africa. The OHRQoL measure was used to evaluate the impact of tooth loss. (3) Results: A total of 1615 participants were included, and 143 (8.85%) had at least one impact (OIDP > 0). Males were less likely to experience at least one impact compared to the females, OR=0.6, 95% C.I.: 0.385 to 0.942, p = 0.026. Those participants who did not seek dental help due to financial constraints were 6.54 (4.49 to 9.54) times more likely to experience at least one impact, p < 0.001. (4) Conclusions: Tooth loss did not impact the OHRQoL of these subjects. There was no difference in the reported odds for participants experiencing at least one oral impact with the loss of their four anterior teeth, the loss of their posterior occlusal pairs, or the loss of their other teeth.

Dental caries in a South African adult population: findings from the Cape Town Vascular and Metabolic Health Study.

OBJECTIVES: Caries is a ubiquitous non-communicable disease worldwide. There is a paucity of literature on adult caries in Africa, with the last epidemiological caries study in South Africa conducted in 1988/1989. This article reports on the decayed, missing and filled teeth (DMFT) scores in relation to demographic characteristics for a mixed-ancestry South African population. METHODS: This cross-sectional epidemiological study was part of the ongoing Cape Town Bellville South Vascular and Metabolic Health Study. Each participant signed an informed consent form prior to enrolling in the study. During a clinical examination, DMFT score and components were recorded for each participant. Data analysis was performed with the statistical Package STATA 15. RESULTS: A sample of 1,885 participants was included in the study. Sixty-eight percent of the population experienced high DMFT scores. Mean DMFT score increased with age from 5 (≤ 24-year-old group) to 32 (≥ 75-year-old group, P < 0.001). It was higher in women than in men (28.5 vs. 18, respectively, P < 0.001). The missing component contributed 83% to DMFT score, followed by decayed (14%) and filled (3%) scores. Males had a higher average number of teeth present than females (18 vs. 6.5, P < 0.001). CONCLUSIONS: Dental caries experience was very high, with high levels of tooth loss in this community. These findings highlight limited access to preventive oral healthcare and a high rate of tooth extraction. Females presented higher levels of oral disease than males, indicating the need for preventive oral healthcare programmes in Cape Town, South Africa.

Prevalence of Oral Mucosal Lesions and Relation to Serum Cotinine Levels-Findings from a Cross-Sectional Study in South Africa.

Oral mucosal lesions (OML) can decrease oral health-related quality of life and some have the potential to become malignant. The aim of the present study was to report the prevalence of OML in relation to age, sex, and serum cotinine levels in a population with mixed ancestry from South Africa. This study is part of the Cape Town Vascular and Metabolic Health (VHM) study, conducted between 2014-2016. Trained dental examiners assessed the oral mucosa for the presence of OML according to WHO criteria. In total, 1976 individuals were included in the study, being 1496 females (75.7%) and 480 males (24.3%) with average age of 49.5 years (SD = 15.3). In total, 262 lesions were detected in 252 participants (overall prevalence of 13%). Males had higher prevalence than females (14% vs. 9%, p = 0.008). Participants aged 25-34 had the highest prevalence rates (21%). Participants who had cotinine ≥15 ng/mL had higher prevalence of OML as compared to those with <15 ng/mL (15% vs. 5%, p < 0.001). Most common lesions were nicotine stomatitis (33%) and leukoplakia (19%). Age, male sex, and higher cotinine levels were associated with increased prevalence of OML.

Hyperplastic Response Following Soft Tissue Augmentation in the Esthetic Zone.

INTRODUCTION: The indications for augmentation of gingival tissue by connective tissue graft (CTG) are numerous. The techniques are widely adopted with extensive literature reporting high success. Harvest techniques include the mid to anterior palate, versus the posterior palate and tuberosity. The latter comprises denser collagen, identified as a more suitable graft. Alas, rarely have hyperplastic responses been reported. CASE PRESENTATION: Two adult, Caucasian patients presented with clinical need for soft tissue augmentation. Autogenous tissue was opted for, harvesting from the tuberosity gingiva. De-epithelialized outside the mouth and inserted into envelope flaps, late healing resulted in hyperplastic gingival lesions. Neither lesion could be successfully removed, and biopsy for histopathological investigation was carried out. CONCLUSION: Hyperplastic response resulting from soft tissue augmentation with tuberosity CTG is rare but may occur. Laser or scalpel might not ensure complete removal. Informing the patient of this rare adverse effect may be important.

Periodontal Disease Status among Adults from South Africa-Prevalence and Effect of Smoking.

Periodontal diseases are among the six most prevalent non-communicable diseases (NCDs) worldwide, constituting a burden for oral and general health. There is a shortage of epidemiological data on periodontal diseases in Africa. The aim of the present cross-sectional study was to present the periodontal status and cotinine levels of a South African population of adults. This study included individuals living in the Belville South area. Bleeding on probing (BOP) and pocket depth were recorded for each tooth, and clinical attachment loss (CAL) was recorded as the highest score per sextant. Cotinine levels were measured in ng/mL. A total of 951 individuals were included. More than one third of all subjects had BOP. Regarding pocket depth, over 50% of the subjects had shallow pockets (4-5 mm), and almost 6% had deep pockets. CAL ≥ 4 mm was present in 40.1% of the subjects. Males presented worse periodontal conditions than females. In total, 52.7% of the participants had serum cotinine levels of ≥15 ng/mL. Cotinine levels had no effect on periodontal variables. Periodontal diseases were highly prevalent, and periodontal conditions were worse in males. Preventive and restorative public health programs are required to improve oral health in this population.

'Interleukin-4 gene polymorphism and its relation to periodontal disease in a Brazilian population of African heritage'.

OBJECTIVES: Host modifying factors, such as genetic predisposition, may increase severity of periodontitis. Genetic polymorphisms in interleukin-4 (IL-4) genes seem to influence host response to microbial challenge. Two IL-4 polymorphisms were found in association with asthma and atopy, and later with aggressive periodontitis in Caucasians. There seems to be a trend for racial differences regarding polymorphisms. Therefore, this study aimed to evaluate if these IL-4 polymorphisms were associated with periodontal disease in a Brazilian population of African heritage. METHODS: Sixty patients were divided into two groups: periodontitis group (n = 30) and control group (n = 30) Blood samples were taken and genomic DNA was amplified by polymerase chain reaction (PCR). Identification of 70 bp repeat polymorphism in intron 2 and in the -590 position of the promoter region was performed through PCR-RFLP and electrophoresis in agarose gel. RESULTS: No significant differences were found in the genotype frequency of the polymorphisms between control and periodontitis group. Chi square test and Mann-Whitney test were used for statistical analysis. CONCLUSIONS: We concluded that the studied IL-4 polymorphisms were not related to periodontal disease susceptibility in this African-American Brazilian population.

Uso de matriz dérmica acelular para eliminação de manchas melânicas gengivais / Use of dermal matrix allograft to eliminate gingival melanin pigmentations

A matriz dérmica acelular (MDA) é usada como substituta de enxertos gengivais. Então, o objetivo deste estudo foi avaliar a eficiência da MDA na eliminação de pigmentações melânicas gengivais. Seis áreas bilaterais foram selecionadas e designadas aleatoriamente a receber MDA ou a ter o epitélio removido por abraão. Após nove meses, a área média de recorrência no grupo experimental foi de 0,65±1,59 por cento, enquanto no grupo de controle foi de 22,65±18,81 por cento. Pôde-se concluir que a MDA pode ser empregada na eliminação das manchas melânicas gengivais, sendo mais eficiente que a abrasão do epitélio (p<0,01), cuja pigmentação recorreu em menos de seis meses