A comparative retrospective study on the prevalence and therapeutic treatment of dental agenesis between healthy children and children with systemic disease or congenital malformation.

BACKGROUND: Dental agenesis (DA) in the permanent dentition is one of the most common dental anomalies, with a prevalence up to 2-10%. Therefore, the aim of this retrospective study was to investigate the prevalence and therapeutic treatment of DA in healthy children (HC) compared to children with systemic disease or congenital malformation (SD/CM). METHODS: Out of 3407 patients treated at the Department of Paediatric Dentistry of the Justus Liebig University Giessen (Germany) between January 2015 and December 2020, a total of 1067 patients (594 female, 473 male) aged between 4.5 and 18 years were included in this study due to DA. Besides the patients' general medical history and therapeutic treatments, panoramic radiographs were analysed. RESULTS: In contrast to the HC group with 9.7% DA, the SD/CM group showed a significantly higher prevalence of DA (19.8%; p < 0.05). The latter group was further classified into children with ectodermal dysplasia (4.4%), down syndrome (8.2%), cleft lip and palate (4.4%), intellectual disability/developmental delay (16.4%), and other genetic/organic diseases without intellectual disability (45.9%). Regarding therapeutic treatments, the HC group (59.5%) was significantly more often treated with an orthodontic gap opening compared to the SD/CM group (42.6%; p < 0.05), followed by orthodontic gap closing 36.5% in the HC group and 22.9% in the SD/CM group (p < 0.05), whereas no treatment was predominantly performed in the SD/CM group (37.7%) compared to the HC group (4%; p < 0.05). Furthermore, 50% in the SD/CM group required general anaesthesia for therapeutic treatment (vs. 8.1% in the HC group; p < 0.05). CONCLUSIONS: Children with SD/CM suffered more often from DA compared to HC that underlines multi- and interdisciplinary treatment of utmost importance. Furthermore, due to intellectual disability, common treatment methods can be complicated by insufficient compliance. This fact underlines the importance of an early attempt to establish the necessary cooperation enabling children with SD/CM to receive therapy.

Impact of molar incisor hypomineralization on oral health-related quality of life in 8-10-year-old children.

OBJECTIVES: The aim of this study was to compare oral health-related quality of life (OHRQoL) in children with and without molar incisor hypomineralization (MIH) and to assess the impact of severity of MIH on OHRQoL in children between 8-10 years using the German version of the Child Perceptions Questionnaire (CPQ-G8-10). MATERIALS AND METHODS: Children aged 8-10 years were recruited at a pediatric dental clinic in Hannover, Germany. Half of them were affected by MIH. Participants were evaluated for presence and severity of MIH (MIH-TNI), plaque and dental caries status. Children were asked to answer the CPQ-G8-10. Statistical analysis was performed using GraphPad Prism-software version 8. RESULTS: One hundred eighty-eight children (mean age 8.80 [± 0.84]; 43.10% female) were included in the study with 94 children having MIH. CPQ-G8-10 mean scores in MIH-affected children were significantly higher than in children showing no MIH (13.87 [± 8.91] vs. 4.20 [± 3.74]; p < 0.0001) showing that MIH has negative impact OHRQoL. Similar trends were seen in all four subdomains. Regarding severity, CPQ-G8-10 mean scores increased from mild to severe forms of MIH. CONCLUSION: Children affected by MIH show an impaired OHRQoL compared to children without MIH; with increasing severity, OHRQoL gets more impaired. Clinical relevance To understand the patient's perception and the individual oral health needs will help to prioritize MIH and recognize its impact.

Management of Amelogenesis Imperfecta in Childhood: Two Case Reports.

Amelogenesis imperfecta (AI) is defined as an interruption of enamel formation due to genetic inheritance. To prevent malfunction of the masticatory system and an unaesthetic appearance, various treatment options are described. While restoration with a compomer in the anterior region and stainless steel crowns in the posterior region is recommended for deciduous dentition, the challenges when treating such structural defects in mixed or permanent dentition are changing teeth and growing jaw, allowing only temporary restoration. The purpose of this case report is to demonstrate oral rehabilitation from mixed to permanent dentition. The dentition of a 7-year-old patient with AI type I and a 12-year-old patient with AI type II was restored under general anesthesia to improve their poor aesthetics and increase vertical dimension, which are related to problems with self-confidence and reduced oral health quality of life. These two cases show the complexity of dental care for structural anomalies of genetic origin and the challenges in rehabilitating the different phases of dentition.

Application of the inverted classroom model in the teaching module "new classification of periodontal and peri-implant diseases and conditions" during the COVID-19 pandemic.

Background: Due to the need for patient-free dental education during the COVID-19 pandemic, Hannover Medical School (MHH) implemented a new periodontology module. Its didactic structure was based on the "inverted classroom model" (ICM) in combination with elements of case-based learning. The educational objective was to increase the diagnostic confidence of dental students in the classification of periodontal patients (staging & grading), based on 33 digitized patient cases. To assess the suitability of the module for future dental curricula, this study aimed to evaluate student satisfaction and skills acquisition. Methods: The periodontology module, which was attended by final year dental students of MHH (n=55, mean age: 26.5±3.9 years, male/female ratio: 24.1%/75.9%) was evaluated in a two-tiered way. Student satisfaction was recorded using a questionnaire. Learning success was assessed by comparing error rates in patient case classifications before (T0) and after (T1) participation in the periodontology module. Results: The study found a high level of student satisfaction with the ICM format and a significant reduction in error rates (T0 error rate=28.3%; MV±SD=3.12±1.67 vs. T1 error rate=18.7%; MV±SD=2.06±1.81; Δ=9.6%). However, of the 11 diagnostic decisions required, only four parameters (extent, grading, percentage of bone loss per age, phenotype) showed significant improvements, with effect sizes ranging from small to medium. Conclusions: The ICM-based teaching concept is definitely not an alternative to patient-based learning. However, in regard to student satisfaction and learning success, it might be superior to conventional classroom-based lectures, especially when complex topics are covered. In summary, the newly developed periodontology module may be a useful addition to traditional dental education in future curricula, even for the time after the COVID-19 pandemic.

Features of Marfan syndrome not listed in the Ghent nosology - the dark side of the disease.

Introduction: The revised Ghent nosology presents the classical features of Marfan syndrome. However, behind its familiar face, Marfan syndrome hides less well-known features.Areas covered: The German Marfan Organization listed unusual symptoms and clinical experts reviewed the literature on clinical features of Marfan syndrome not listed in the Ghent nosology. Thereby we identified the following features: (1) bicuspid aortic valve, mitral valve prolapse, pulmonary valve prolapse, tricuspid valve prolapse, (2) heart failure and cardiomyopathy, (3) supraventricular arrhythmia, ventricular arrhythmia, and abnormal repolarization, (4) spontaneous coronary artery dissection, anomalous coronary arteries, and atherosclerotic coronary artery disease, tortuosity-, aneurysm-, and dissection of large and medium-sized arteries, (5) restrictive lung disease, parenchymal lung disease, and airway disorders, (6) obstructive- and central sleep apnea, (7) liver and kidney cysts, biliary tract disease, diaphragmatic hernia, and adiposity, (8) premature labor, and urinary incontinence, (9) myopathy, reduced bone mineral density, and craniofacial manifestations, (10) atrophic scars, (11) caries, and craniomandibular dysfunction, (12) headache from migraine and spontaneous cerebrospinal fluid leakage, (13) cognitive dysfunction, schizophrenia, depression, fatigue, and pain, (14) and activated fibrinolysis, thrombin, platelets, acquired von Willebrand disease, and platelet dysfunction.Expert commentary: Future research, nosologies, and guidelines may consider less well-known features of Marfan syndrome.

Periodontal conditions in patients with Marfan syndrome - a multicenter case control study.

BACKGROUND: Marfan syndrome (MFS) is a disorder of the connective tissues. Alterations of the elastic fibers may manifest in different tissues especially in the skeletal, cardiovascular and ocular system. Oral manifestations like orthodontic or skeletal anomalies and fragility of the temporomandibular joint have been well described by various authors. However, no data are available regarding a possible periodontal involvement of MFS. Hence, the aim of the present study was to investigate for the first time if MFS may increase the susceptibility to periodontitis. METHODS: A comprehensive periodontal examination including documentation of probing pocket depth, gingival recession, clinical attachment level, and bleeding on probing was conducted in all patients. In addition, dental conditions were assessed by determining the Index for Decayed, Missing and Filled Teeth (DMFT) and a self-administered questionnaire was filled out by patients. For statistical analysis, the unpaired t-Test was applied (level of significance: p < 0.05). Both groups were matched concerning well known periodontal risk factors like age, gender and smoking habits. RESULTS: 82 participants, 51 patients with MFS (30 female and 21 male, mean age: 40.20 ± 15.35 years) and 31 sound controls (17 female and 14 male, mean age: 40.29 ± 13.94 years), were examined. All assessed periodontal and dental parameters were not significantly different between groups. CONCLUSIONS: Based on our data, patients with MFS did not reveal a higher prevalence of periodontitis compared to the control group. However, Marfan patients showed a tendency to more inflammation signs, which can be explained by the crowded teeth. Therefore, a regular professional cleaning of the teeth is recommendable (i.e., 6 months intervals) in order to reduce the bacterial biofilm in the oral cavity and thus resulting in a decreased risk of systemic diseases, specifically endocarditis.

Use of elaborate feedback and an audience-response-system in dental education.

INTRODUCTION: The aim of the study was to examine the effect of an elaborate feedback and an audience response system (ARS) on learning success. METHODS: Students of the 1st clinical semester were randomly assigned to a study and a control group. The randomization was carried out considering the factors of age, gender and power spectrum during preliminary dental examination. Within 10 lectures 5 multiple-choice questions were asked about the learning objectives and answered by the students using an ARS. Only the study group received an immediate comprehensive feedback on the results. A final exam at the end was carried out in order to evaluate whether the elaborate feedback leads to a successful learning. Furthermore the effect of the ARS on the lecture atmosphere was investigated. RESULT: The results of the final exams showed no significant difference between the study and the control group regarding the learning success. CONCLUSION: Although no significant effect on learning success was found, the ARS creates a more interactive, positive learning environment.

Periodontal status of HIV-infected patients undergoing antiretroviral therapy compared to HIV-therapy naive patients: a case control study.

BACKGROUND: Although severe oral opportunistic infections decreased with the implementation of highly active antiretroviral therapy, periodontitis is still a commonly described problem in patients infected with human immunodeficiency virus (HIV). The objective of the present investigation was to determine possible differences in periodontal parameters between antiretroviral treated and untreated patients. METHODS: The study population comprised 80 patients infected with HIV divided into two groups. The first group was receiving antiretroviral therapy while the second group was therapy naive. The following parameters were examined: probing pocket depth, gingival recession, clinical attachment level, papilla bleeding score, periodontal screening index and the index for decayed, missed and filled teeth. A questionnaire concerning oral hygiene, dental care and smoking habits was filled out by the patients. RESULTS: There were no significant differences regarding the periodontal parameters between the groups except in the clinical marker for inflammation, the papilla bleeding score, which was twice as high (P < 0.0001) in the antiretroviral untreated group (0.58 ± 0.40 versus 1.02 ± 0.59). The participants of this investigation generally showed a prevalence of periodontitis comparable to that in healthy subjects. The results of the questionnaire were comparable between the two groups. CONCLUSION: There is no indication for advanced periodontal damage in HIV-infected versus non-infected patients in comparable age groups. Due to their immunodeficiency, HIV-infected patients should be monitored closely to prevent irreversible periodontal damage. Periodontal monitoring and early therapy is recommended independent of an indication for highly active antiretroviral therapy.

Prevalence of pulp calcifications in patients with Marfan syndrome.

OBJECTIVE: The purpose of this study was to examine the prevalence of pulp calcifications in patients with Marfan syndrome. STUDY DESIGN: The prevalence of pulp stones and pulp obliteration was evaluated on bitewing radiographs in 21 subjects with Marfan syndrome and in 100 healthy controls. RESULTS: Subjects with Marfan syndrome older than 30 years of age showed a significantly higher prevalence of pulp stones (P = .027) or pulp obliteration (P < .001). Pulp stones were present in 20.7% and pulp obliteration was found in 7.9% of the examined teeth in this group. Subjects with Marfan syndrome also revealed a significant correlation between age and number of teeth with pulp stones or pulp obliteration. CONCLUSION: The results of the present study indicate that pulp calcifications are frequent findings in subjects with Marfan syndrome. This should be taken into consideration in endodontic or orthodontic treatment.

Root development of immature third molars transplanted to surgically created sockets.

PURPOSE: The aim of this study was to compare root development after transplantation of teeth into surgically created sockets or into fresh extraction sites. PATIENTS AND METHODS: The sample consisted of 62 patients with a total of 64 transplanted immature third molars. All transplants were at root development stages 3 to 4. In 22 cases, a new socket was created by means of burs. Forty-two teeth transplanted into a fresh extraction site served as controls. Postoperative root development was determined on intraoral radiographs taken immediately after transplantation and at the final follow-up. For all transplants, extraoral storage time and number of trials were recorded during transplantation. RESULTS: No significant intergroup differences were observed at root development stage 3. In contrast, at root development stage 4 transplantations to surgically created sockets showed a significantly lower final root length (P = .025) and root length increment (P = .038) than transplants in the control group. In addition, a significant correlation was determined in the prepared socket group at developmental stage 4 between root length increment and extraoral storage time (r = -0.910, r(2) = 0.828, P < .001) or number of trials in the recipient socket (r = -0.775, r(2) = 0.601, P < .001). CONCLUSIONS: Teeth at advanced developmental stages transplanted to surgically created sockets show an impaired postoperative root development. A possible explanation might be damage of Hertwig's epithelial root sheath during the transplantation procedure.

The effect of pulp obliteration on pulpal vitality of orthodontically intruded traumatized teeth.

Limited information exists on the impact of pulp obliteration on pulpal vitality of orthodontically treated traumatized teeth. Pulpal condition was examined in 269 traumatized maxillary incisors after orthodontic intrusion (OT group) and in 193 traumatized maxillary incisors without subsequent orthodontic treatment (C group). According to the degree of initial pulp obliteration, the teeth were divided into three categories: teeth without, teeth with partial, and teeth with total pulp obliteration. Teeth in the OT group revealed a significantly higher rate of pulp necrosis than teeth in the C group (p < 0.001). In addition, teeth in the OT group with total pulp obliteration showed a significantly higher rate of pulp necrosis than teeth without (p < 0.001) or only partial pulp obliteration (p = 0.025). The results indicate that traumatized teeth with total pulp obliteration have a higher susceptibility to pulpal complications during orthodontic intrusion than traumatized teeth without or only partial pulp obliteration.

Influence of overjet and lip coverage on the prevalence and severity of incisor trauma.

OBJECTIVE: The aim of this study was to assess the influence of overjet size and lip coverage on the prevalence and severity of incisor trauma. PATIENTS AND METHODS: Dental records made on presentation of 1,367 patients were examined for data concerning the prevalence, type and severity of incisor trauma. Original overjet was measured on the pre-treatment study models and divided into two categories: normal overjet (0-3.0 mm) and increased overjet (> 3.0 mm). Lip coverage of the upper incisors was estimated with reference to photographs showing the patient's face and was then rated as adequate or inadequate. The patients were then divided into three groups: normal original overjet and adequate lip coverage (Group 1), increased original overjet and adequate lip coverage (Group 2), and increased original overjet and inadequate lip coverage (Group 3). RESULTS: Group 1 patients revealed a significantly lower prevalence of traumatic injuries than those in Group 2 (p = 0.028) or Group 3 (p = 0.003), and the odds ratios compared to Group 1 were 1.6634 for Group 2 and 2.0336 for Group 3. Regarding the type of trauma, Group 3 patients showed a significantly higher frequency of periodontal injuries than those in Group 1 (p = 0.018) or Group 2 (p = 0.015). Furthermore, Group 3 patients had significantly more in juries to two or more teeth per person than patients in Group 1 (p < 0.001) or Group 2 (p < 0.001). CONCLUSIONS: Increased overjet and inadequate lip coverage increase the risk and severity of incisor trauma. Early orthodontic treatment might prevent dental trauma in these patients.