Psychological impact and perceptions of orthodontic treatment of adult patients with different motivations.

INTRODUCTION: Motivations, perceptions, and psychosocial states of adult patients with orthodontic disorders in China have not been widely studied. The study assessed the psychosocial states and perceptions of adult patients undergoing orthodontic treatments with different motivations. METHODS: Two hundred forty-three adult patients (mean age, 30.2 ± 7.4 years; women, 79.0%) undergoing orthodontic treatment were recruited from a tertiary stomatology hospital. The patients answered a patient-centered questionnaire regarding motivations and perceptions of orthodontic treatment and the Psychosocial Impact of Dental Aesthetics Questionnaire. Data were analyzed using the chi-square test on the basis of multiple responses. Multiple linear regression analyses were performed to determine the association between motivation factors and the Psychosocial Impact of Dental Aesthetics Questionnaire subscale scores (P <0.05). RESULTS: Patients with various motivations were as follows: occlusal function reason (70.4%), dental esthetic reason (54.7%), facial esthetic reason (24.3%), and following others' suggestions (18.5%). Patients with esthetic or occlusal motivations exhibited significantly greater need and interest for orthodontic treatment (P <0.001). Multiple linear regression analyses revealed that the scores of social impact, psychological impact, and esthetic concern subscales were significantly associated with both dental and facial esthetic motivations (P <0.001). CONCLUSIONS: The primary motivations of Chinese patients were observed to be improved esthetics and occlusal function. Patients with esthetic or occlusal motivations exhibited significantly greater need and interest in treatment. Patients with facial or dental esthetic motivations experienced greater impacts of psychosocial states. Therefore, the patient motivations and impacts of esthetic-related psychosocial states on them should be considered during treatment.

Effect of glycine powder air-polishing as an adjunct in the treatment of peri-implant mucositis: a pilot clinical trial.

BACKGROUND: Glycine powder air-polishing (GPAP) has the potential to effectively erase biofilms and may improve the treatment efficacy of peri-implant mucositis. This pilot clinical trial evaluated the effect of GPAP as an adjunct in treating peri-implant mucositis. MATERIALS AND METHODS: Twenty-four subjects having at least one implant with peri-implant mucositis were randomly assigned to test (12 subjects with 17 implants) and control (12 subjects with 16 implants) groups. Following baseline assessment, all subjects received oral hygiene instruction and non-surgical debridement. In the test group, the sites with probing depth (PD) ≥4 mm were additionally treated by GPAP for 5 sec. Clinical parameters were measured at 1-week, 1-month, and 3-month recall visits. RESULTS: At the 3-month visit, the mean reductions in PD at site level were 0.93 ± 0.93 mm and 0.91 ± 0.98 mm in the test and control groups, respectively (P < 0.05), and no significant difference existed between two groups. Mean bleeding score was also significantly reduced in both groups after the intervention. No complications or discomfort were reported during the study. CONCLUSIONS: This pilot clinical trial suggests that non-surgical mechanical debridement may effectively control peri-implant mucositis, and adjunctive GPAP treatment seems to have a limited beneficial effect as compared with mechanical debridement alone. However, further clinical trials with a large sample size are needed to confirm this preliminary observation.

Application of Botulinum Toxin at the Yonsei Point for the Treatment of Gummy Smile: A Randomized Controlled Trial.

BACKGROUND: Demand for less-invasive procedures for treating gummy smile, such as botulinum toxin A injections, has increased substantially over the years. Meanwhile, the optimal injection site for botulinum toxin A injection is debated. The authors aimed to investigate the efficacy of botulinum toxin A injection at the Yonsei point for treating gummy smile. METHODS: In this double-blind, single-site, randomized clinical trial, healthy participants with a gummy smile (anterior gingival exposure of ≥3.0 mm) were enrolled and randomized (1:1 ratio) into two groups. The experimental group was administered 6 U of botulinum toxin A at the Yonsei point (a single-site injection of 3 U to the right Yonsei point and 3 U to the left Yonsei point), and the control group received the same dose in the bilateral levator labii superioris alaeque nasi muscle sites. The patients were assessed at baseline and 4, 12, 24, and 48 weeks after the first injection using a digital vernier caliper. RESULTS: A total of 49 participants were enrolled. Anterior and bilateral posterior gingival exposure were reduced at 4, 12, and 24 weeks ( P ≤ 0.05) and returned to baseline at 48 weeks in both groups; there was no difference between the groups at these time points. The increase in satisfaction among patients was significant, and few adverse events were observed. CONCLUSION: Both the Yonsei point and the levator labii superioris alaeque nasi muscle site can be used as botulinum toxin A injection sites for treating gummy smile. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Adiponectin inhibits lipoplysaccharide-induced inflammation and promotes osteogenesis in hPDLCs.

Periodontal diseases are infections of the structures that surround and support the teeth; they are characterized by local inflammation and alveolar bone loss. Most treatments focus on only one aspect, inhibiting inflammation, or promoting osteoblasts. We set out to develop a new method that would intervene in the two aspects simultaneously. Adiponectin (APN), secreted by adipocytes, inhibits the inflammatory response and promotes osteogenesis. However, its role in human periodontal ligament cells (hPDLCs) is unclear. Therefore, we aim to investigate whether APN could suppress lipopolysaccharide (LPS)-induced inflammation and promote osteogenesis in hPDLCs. In the present study, we stimulated hPDLCs with LPS in the presence or absence of APN. Real-time PCR and Western blotting results demonstrated that APN partially inhibited the activation of the classical nuclear factor κ-B (NF-κB) pathway. These results were confirmed by a change of expressions of NF-κB downstream inflammatory genes, such as decreased cyclooxygenase (COX)-2 and tumor necrosis factor α (TNF-α), along with increased interleukin (IL)-10. As for the role of APN in osteogenesis, Alizarin Red S staining showed that APN treatment induced more calcium deposition nodules than controls. We also found that APN enhanced the expression of osteoblast-related genes (osteopontin (OPN), collagen 1, osteocalcin, alkaline phosphatase, runt-related transcription factor 2 (RUNX2), and bone morphogenetic protein 2) in hPDLCs via the APPL1 (the adaptor protein containing PH domain, PTB domain, and leucine zipper motif 1)/p38 signal transduction pathway. Therefore, APN inhibits LPS-induced inflammation and promotes osteogenesis in hPDLCs and may have potential therapeutic value in treating periodontitis by inhibiting the inflammatory lesions and contributing to bone tissue regeneration.

[Clinical effects of ridge augmentation with the half-columnar shaped mandibular bone block for the placement of dental implants].

OBJECTIVE: To evaluate the treatment effects of the half-columnar shaped mandibular block bone onlay grafting technique for augmentation of the resorbed maxillary anterior alveolar ridge after single tooth missing. METHODS: A total of 15 sites of 14 patients received ridge augmentation surgeries. The recipient sites were prepared with trephines, the half-columnar shaped bone blocks were harvested from the ramus and external oblique ridges with trephines according to diameters of the recipient sites. The bone blocks were placed as lateral onlay grafts on recipient beds and secured by means of titanium screws. Particulate bone was added and absorbable membranes were used to stabilize and protect the grafts. After a mean interval of 4.5 months of healing the flaps were re-opened, the screws were removed and non-submerged implants were placed. The width and height of the alveolar ridges were recorded. After 3 months, implant-supported crowns were provided to the patients. One year later, the peri-impant condition and the marginal bone resorption on the proximal sites were observed. RESULTS: Mean lateral augmentation obtained at the time of bone grafting was (3.8 + or - 0.8) mm, 5 out of 15 sites exhibited a mean of 3 mm of vertical augmentation. The mean healing time was 4.5 months, the mean percentage of horizontal and vertical bone resorption in the mean time were 8% and 7% respectively. No major complications were recorded at donor sites. No implant was lost during the study period. Clinical parameters and probing depth (< or = 4 mm) demonstrated the presence of a healthy peri-implant mucosa after 1 year of prosthetic reconstruction. The clinical and radiographic bone observations showed no more than 1.2 mm of resorption after bone graft and implant placement. CONCLUSION: The half-columnar shaped mandibular bone graft (from the ramus and external oblique ridge) is a promising technique for bone augmentation in localized alveolar ridge defects after single tooth missing. This procedure offers easy access, good bone quantity for localized repair, low morbidity, decreased complaints of postoperative sensory disturbances or discomfort, minimal graft resorption, and a shorter healing time as compared with other methods for bone repair.

Subepithelial Connective Tissue Grafts to Improve Tissue Biotype Control in Peri-implant Disease: A Case Series.

Three patients diagnosed with peri-implant disease after osseointegration exhibited soft tissue oedema and fistulae. Treatment options for controlling the fistulae were investigated. Free subepithelial connective tissue grafts (SCTGs) and microinvasive surgery were used to improve the soft tissue biotype of the patients with fistulae. After SCTG surgery, the fistulae disappeared. The clinical outcomes were stable and aesthetic outcomes were satisfactory after 3-5 years of follow-up. Based on this study, utilising SCTG to improve the tissue biotype may be an effective clinical approach for controlling fistulae occurring during peri-implant disease.

Occurrence of Maxillary Central Diastema between Tooth-supported and Implant-supported Prostheses: a 5-year Clinical Follow-up.

A 27-year-old patient with a history of maxillary anterior tooth trauma presented with a maxillary central diastema between tooth- and implant-supported prostheses that had been in use for 5 years. The all-ceramic crowns were placed in 2012 after rigorous occlusal adjustment. Evaluations were carried out at 0, 2, 3, 4 and 5 years post restoration. The central diastema between the natural teeth and the implant-supported prosthesis on teeth 11 and 12 was first observed 2 years after implantation. After 5 years, the distance was found to have increased, with anterior occlusion and esthetic changes having taken place. The following possible causes were discussed: occlusal problems, anterior traumatic effects, the possible impact of guided bone regeneration (GBR) on the adjacent natural teeth and natural movement. More predictive information should be given to patients with implant-supported prostheses and natural teeth so that they are fully informed of the impact of any necessary clinical compromise and are aware of the modifications that may occur to their natural dentition.

Changes of Microbial Community in Treated Peri-implantitis Sites: An Experimental Study in Beagle Dogs.

OBJECTIVE: To investigate the changes of the bacterial community in the oral environment of beagle dogs to gain insights on the possible causes of failed therapy in peri-implantitis. METHODS: Beagles were used as models for experimental peri-implantitis. Samples from peri-implant soft tissue (supramargin and submargin), ligature and contaminated surface of peri-implantitis sites were collected and analysed by sequencing the bacterial 16S rRNA gene. RESULTS: The residual microbial community from the curettes-treated implant surface contained a variety of microorganisms, including periodontal pathogens, which showed no changes in their composition and structure. CONCLUSION: It is possible that the residual bacterial community remained unchanged and this was the cause of recurrent episodes of inflammation.

Accuracy Assessment of Three-dimensional Surface Reconstructions of In vivo Teeth from Cone-beam Computed Tomography.

BACKGROUND: The accuracy of three-dimensional (3D) reconstructions from cone-beam computed tomography (CBCT) has been particularly important in dentistry, which will affect the effectiveness of diagnosis, treatment plan, and outcome in clinical practice. The aims of this study were to assess the linear, volumetric, and geometric accuracy of 3D reconstructions from CBCT and to investigate the influence of voxel size and CBCT system on the reconstructions results. METHODS: Fifty teeth from 18 orthodontic patients were assigned to three groups as NewTom VG 0.15 mm group (NewTom VG; voxel size: 0.15 mm; n = 17), NewTom VG 0.30 mm group (NewTom VG; voxel size: 0.30 mm; n = 16), and VATECH DCTPRO 0.30 mm group (VATECH DCTPRO; voxel size: 0.30 mm; n = 17). The 3D reconstruction models of the teeth were segmented from CBCT data manually using Mimics 18.0 (Materialise Dental, Leuven, Belgium), and the extracted teeth were scanned by 3Shape optical scanner (3Shape A/S, Denmark). Linear and volumetric deviations were separately assessed by comparing the length and volume of the 3D reconstruction model with physical measurement by paired t- test. Geometric deviations were assessed by the root mean square value of the imposed 3D reconstruction and optical models by one-sample t-test. To assess the influence of voxel size and CBCT system on 3D reconstruction, analysis of variance (ANOVA) was used (µ = 0.05). RESULTS: The linear, volumetric, and geometric deviations were -0.03 ± 0.48 mm, -5.4 ± 2.8%, and 0.117 ± 0.018 mm for NewTom VG 0.15 mm group; -0.45 ± 0.42 mm, -4.5 ± 3.4%, and 0.116 ± 0.014 mm for NewTom VG 0.30 mm group; and -0.93 ± 0.40 mm, -4.8 ± 5.1%, and 0.194 ± 0.117 mm for VATECH DCTPRO 0.30 mm group, respectively. There were statistically significant differences between groups in terms of linear measurement (P < 0.001), but no significant difference in terms of volumetric measurement (P = 0.774). No statistically significant difference were found on geometric measurement between NewTom VG 0.15 mm and NewTom VG 0.30 mm groups (P = 0.999) while a significant difference was found between VATECH DCTPRO 0.30 mm and NewTom VG 0.30 mm groups (P = 0.006). CONCLUSIONS: The 3D reconstruction from CBCT data can achieve a high linear, volumetric, and geometric accuracy. Increasing voxel resolution from 0.30 to 0.15 mm does not result in increased accuracy of 3D tooth reconstruction while different systems can affect the accuracy.

Accuracy of computer-guided implant surgery by a CAD/CAM and laser scanning technique.

OBJECTIVES: To explore the method of manufacturing an implant surgery template with a computer-aided design/computer-aided manufacturing (CAD/CAM) technique and evaluate its precision in clinical cases. METHODS: Patients referred to the 2nd Dental Center of Peking University who were partially edentulous, were enrolled and scanned with cone beam computed tomography (CBCT). Diagnostic casts were laser scanned to record the configuration of the patients' dentition and mucosae. CBCT and laser scanning data were subsequently loaded into Simplant software. Implant positions were planned in the software with a computer-aided design technique, and surgical templates were fabricated with a rapid prototyping technique. These templates were used to guide implant placement surgery. RESULTS: The mean value of linear deviation was 1.00 mm (range 0 to 2.16 mm) for implant shoulder and 1.26 mm (range 0.51 to 2.86 mm) for the implant apex. The mean angular deviation was 4.74 degress (0.37 to 10.28 degrees). Deviations were higher in the posterior region than anterior. The tooth-supported template provided higher precision than did the tooth/ mucosa-supported template, but no statistically significant difference was found. CONCLUSION: Computer-guided implant surgery with the CAD/CAM technique provides dentists with a good platform for preoperative planning, precise implant insertion, and ideal rehabilitation. The protocol of this three-dimensional laser scanning technique can provide precision comparable to that of double-scanning.