Pink Esthetic Score Around Single-Tooth Implant Crowns After Socket-Shield Technique: A Prospective Cohort Study.

Esthetics is important for any dental implant but crucial for implants in the anterior region. Restorations in this region are demanding, and the goal of re-establishing an attractive smile without revealing differences from the natural teeth is difficult to achieve. The aim of this study was to examine the clinical success of the socket-shield technique regarding soft tissue stability and overall esthetic outcome. Pink esthetic scores (PESs) were collected at two time points (T1: 6 months; T2: 6 years) by three different specialists. This prospective cohort clinical study involved 30 patients (7 women and 23 men) with a mean age of 42.3 years. There were no significant differences in PES values assessed by the oral surgeon and prosthodontist (P > .05) at either of the assigned time points. The periodontist found differences in PES values between T1 and T2 (P < .05), but they were modest in value. Analyses of each individual variable at given time intervals revealed significant differences in the shape of the distal papillae (χ2 = 6.182; P < .05) and soft tissue margin level (χ2 = 6.507; P < .05). The final results suggest that the socket-shield technique is promising for implant placement in the esthetic zone.

Patients' Assessments of Tooth Sensitivity Increase One Day Following Different Whitening Treatments.

OBJECTIVES: The aim of this clinical study was to compare tooth sensitivity scores and color change values before and 1 day following whitening treatments using different concentrations of whitening agents for in-office and at-home procedures. MATERIALS AND METHODS: A total of 60 participants divided into 3 groups were included in this study. A whitening procedure was carried out in groups using 40% hydrogen peroxide (HP) in in-office treatment, 16% and 10% carbamide peroxide (CP), respectively. Participants rated their tooth sensitivity at the baseline and 1 day following the treatment. The CIElab values were recorded and color differences were calculated. RESULTS: Within each of the whitening treatments, the tooth sensitivity scores significantly increased following the procedure (p<0.05). The largest significant increase in scores was noted in 40% HP in-office whitening treatment, while the lowest increase was noted in 10% CP at-home whitening treatments (p<0.05). The highest color change 1 day following the procedure was found in the 40% HP in-office whitening treatment group (3.3) and it significantly differed from both 16% CP and 10% CP at-home whitening treatments whose color difference was both 2.0, respectively (p<0.05). CONCLUSION: 1 day following the procedure, a low concentrate CP agent for at-home whitening causes the least tooth sensitivity compared to higher concentrate CP for at-home and HP for in-office agents, with the same color change efficacy as higher concentrate CP agent. In case with slight tooth sensitivity reported at the baseline, a 10% CP whitening treatment should be recommended.

P2Y2 Receptors Mediate Masseter Muscle Mechanical Hypersensitivity in Rats.

PURPOSE: P2Y2 receptors (P2Y2Rs) are among the various receptors that play an important role in nociception. The goal of this research was to investigate possible P2Y2R expression changes in the trigeminal ganglion (TRG) in bilateral masseter muscle (MM) hypersensitivity following unilateral MM inflammation. The impact of unilateral intramasseteric administration of P2Y2R antagonist on bilateral MM hypersensitivity was also explored. MATERIALS AND METHODS: Bilateral MM hypersensitivity was provoked by unilateral intramasseteric injection of complete Freund's adjuvant (CFA). The head withdrawal threshold (HWT) was assessed bilaterally 4 days later. Bilateral TRG and MM isolation were followed, and quantitative real-time polymerase chain reaction (qRT-PCR) and histopathological analysis were carried out on these tissues, respectively. The involvement of P2Y2Rs in nocifensive behavior was evaluated by administering two doses of P2Y2R antagonist AR-C118925 (0.2 or 1 mg/100 µL) in inflamed MM 4 days post-CFA administration. Bilateral HWT was assessed at different time points following antagonist injection. RESULTS: qRT-PCR analysis demonstrated P2Y2R up-regulation in TRG ipsilateral to the site of CFA administration. Compared to the controls, both doses of AR-C118925 injected ipsilateral to the TRG increased the bilateral HWT at 30, 60, 90, and 120 minutes after antagonist administration. CONCLUSION: The findings suggest that P2Y2Rs may affect MM inflammatory hypersensitivity owing to its up-regulation in the TRG in MM inflammatory pain states.

A clinical study assessing the short-term efficacy of combined in-office/at-home whitening treatment.

OBJECTIVE: The purpose of this randomized clinical trial was to assess the efficacy of color change in combined in-office/at-home whitening. MATERIALS AND METHODS: Thirty participants were randomly divided into two groups: 15 received combined treatment in-office whitening (6% hydrogen peroxide + 2 weeks at-home whitening with 16% carbamide peroxide [CP]); 15 were assigned to control group. Instrumental color measurements were obtained before whitening (t0 ), immediately after in-office whitening (tin-office ), after 1 week of active treatments (t1 ), and at the completion of the whitening treatment (t2 ). CIE L*a*b* values were recorded and CIE L*a*b* and CIEDE2000 color differences were calculated. RESULTS: The color change at tin-office was ΔEab = 4.7 and ΔE00 = 3.2 and overall color change of combined method at t2 was ΔEab = 8.2 and ΔE00 = 5.3 (P < 0.05). A statistically significant effect for the mean CIE L*a*b* and CIEDE2000 values was detected within time with the mean a*, b* and C' values decreasing and mean h' values increasing significantly (P < 0.05). CONCLUSIONS: Combined in-office/at-home whitening was effective. Whitening efficacy increased upon application of 16% CP in combined in-office/at-home treatment (P < 0.05). CLINICAL SIGNIFICANCE: The statistically significant increase in color change recommends clinical application of combined in-office/at-home whitening treatment.

Salivary Oxidant/Antioxidant Status in Chronic Temporomandibular Disorders Is Dependent on Source and Intensity of Pain - A Pilot Study.

Temporomandibular disorders (TMD) have been associated with altered salivary oxidative status, but the relation with pain source and pain severity isn't clarified. With the aim to assess their interaction with TMD, we compared levels of selected salivary oxidative stress (OS) markers (glutathione peroxidase, superoxide dismutase, total antioxidant capacity (TAC), uric acid, 8-hydroxydeoxyguanosine, malondialdehyde) and salivary cortisol (SC) as a stress indicator, between 20 TMD patients and 15 healthy control subjects. In order to record differences relating to pain source and severity, patients were respectively classified according to specific diagnoses (myofascial pain or disc displacement (DD)), and pain intensity (high or low). TAC was significantly higher in TMD patients than in controls (morning p = 0.015; afternoon p = 0.005). Significant differences were also observed when TAC levels between high-intensity pain patients and controls were compared, as well as between DD patients and controls. In logistic regression analysis, higher levels of TAC were related to DD (morning OR: 1.66, 95%CI: 1.05-2.64, p = 0.029; afternoon OR: 2.10, 95%CI: 1.11-3.98, p = 0.021) and to high-intensity pain (morning OR: 1.81, 95%CI: 1.04-3.15, p = 0.037; afternoon OR: 1.79, 95%CI: 1.02-3.14, p = 0.043). We also found that morning SC was positively correlated with antioxidant parameters in TMD patients. Our data suggest compensatory mechanism as response to higher level of stress. This stress could be extrinsic and lead toward TMD, or intrinsic, emerging from established TMD, or could be both. The intensity and the source of pain should be considered important factors in future investigations evaluating salivary OS markers in TMD patients.

Effect of Clinical Experience on the Shade Matching Accuracy in Different Dental Occupational Groups.

OBJECTIVES: The aim of this study was to evaluate the effect of clinical experience level on the shade matching accuracy in different dental occupational groups. MATERIALS AND METHODS: A total of 80 participants, assigned to one of four groups depending on the level of their clinical experience in shade matching: dental technicians (DTs), residents in prosthodontics (RPs), specialists in prosthodontics (SPs) and dental students (DSs) took part in the study. They were asked to use Tooth guide Training Box (TTB) and determine 15 standardized shade tabs using VITA 3D-Master shade guide. The number of mistakes in final test for each participant was recorded and accuracy was calculated. Color difference (ΔE) values for each shade were calculated from L*, a* and b* values. Differences in accuracy, mean ΔE values and mean error ΔE values between four different groups were examined. RESULTS: No statistically significant differences were found between the groups regarding accuracy and mean ΔE values (p>0.05). The accuracy rate in four groups was 0.51±0.20 (DTs), 0,54±0.18 (RPs), 0.49±0.16 (SPs) and 0.55±0.14 (DSs), respectively. Mean ΔE values were 2.10±0.98 (DTs), 2.18±0.97 (RPs), 2.51±0.97 (SPs) and 2.08±0.86 (DSs), respectively. Regarding mean error ΔE values, DTs made errors with significantly less deviations compared to other groups (p<0.05). CONCLUSIONS: This study has shown that clinical experience is not found to be a significant factor to the shade matching accuracy. With regard to the mean error ΔE values, DTs were more successful in shade matching than other participants.

Self Assessment of Dental students' Perception of Learning Environment in Croatia, India and Nepal.

AIM: The aim of this study was to assess dental students' perception of different learning environment in India, Nepal and Croatia. METHODS: The study was conducted during a period of academic year 2016/17. A total of 849 dental students participated in the study. There were 188 respondents from Croatia, 373 from India, and 288 from Nepal. Non-responders were not followed up. The Dental Student Learning Environment Survey (DSLES) was used which consisted of 55 items subdivided into seven scales. The scales measured the following perceptions: Flexibility, 'Student-to-Student Interactions, Emotional Climate, Supportiveness, Meaningful Experience, Organization and Breadth of Interest. Statistical analysis of the data utilised the Kolmogorov Smirnov test. The Kruskal-Wallis "non-parametric ANOVA" was also used to test the differences between the countries. A post hoc analysis was performed using Ranks tables and the Median test. RESULTS: The response rate was 26.9%. Significant differences between the countries were found for all DSLES variables (Kruskal-Wallis, p<0.01). The Median test also showed significant differences between the countries for all DSLES variables (p<0.01). The scales with the highest mean values were 'Student-to-student interactions' in India and Nepal, and the 'Emotional Climate' in Croatia. CONCLUSIONS: Students in Croatia rated their school only with grades excellent and good, while their colleagues in India and Nepal were more critical. Despite the different settings in three countries, 'Flexibility' was identified as the area of weakness in all three educational systems.

Within-Subject Reliability and between-Subject Variability of Oxidative Stress Markers in Saliva of Healthy Subjects: A Longitudinal Pilot Study.

The present study evaluated diurnal variations and day-to-day fluctuations of salivary oxidative stress (OS) markers in healthy adult individuals. Whole unstimulated saliva was collected at 2 time intervals over 3 consecutive days. Glutathione peroxidase (GPX), superoxide dismutase (SOD), total antioxidant capacity (TAC), and uric acid (UA) were analyzed using spectrophotometric methods, while 8-hydroxydeoxyguanosine (8-OHdG) and malondialdehyde (MDA) were determined using immunoassays. No significant differences for salivary OS markers between men and women were observed. For all examined OS markers, no significant day-to-day variations were demonstrated. Significant diurnal variations were found in salivary GPX, TAC and MDA levels. For SOD, TAC, GPX, and UA, good-to-moderate intraindividual coefficients of variations (CVs) were observed in more than 75% of the subjects. For MDA and 8-OHdG, intraindividual CVs > 35% were observed in 60% and 40% of the subjects, respectively. Between-subject variance was wide for all examined OS markers (CV% 30.08%-85.70%). Due to high intraindividual variability in the salivary concentrations of MDA and 8-OHdG, those markers cannot be reliably verified based on single measurements and multiple measurements over several days would provide more reliable information. Salivary SOD, TAC, GPX, and UA proved stable across three days of measurement. Trial Registration. ClinicalTrials.gov NCT03029494. Registered on 2017-01-19.

Marginal leakage of class V cavities restored with silorane-based and methacrylate-based resin systems.

UNLABELLED: The aim of this study was to compare the microleakage of class V cavities restored by silorane resin with those restored by the methacrylate resin system. Sixty standardized class V cavities were prepared on premolars. The teeth were restored with Filtek(TM) Silorane and Silorane(TM) System Adhesive, Filtek(TM) Silorane and Adper(TM) Easy One and Filtek(TM) Supreme XT and Adper(TM) Easy One. The area and the depth of dye leakage were measured. Considering dye leakage area, the best results were achieved in group I (mean-M=0.114±0.083 mm(2)), then in group III (M=0.384±0.480 mm(2)) and finally in group II (M=5.389±6.587 mm(2)). Considering the depth of dye leakage, there was a significant difference between group I (mean rank-m.r.=1.23±0.44 mm) and II (1.98±0.83 mm), group II and III (1.23±0.40 mm). In this study silorane composite and its adhesive showed less microleakage than the methacrylate composite, and it showed compatibility only with its assigned adhesive. CLINICAL SIGNIFICANCE: Less microleakage of silorane restorations could provide better and long lasting composite fillings.

Dental archforms in dentoalveolar Class I, II and III.

OBJECTIVE: To test the hypothesis that no differences exist in dental arch dimensions between dentoalveolar Classes I, II, and III, and between male and female subjects, as measured on virtual three-dimensional (3D) models. MATERIALS AND METHODS: Samples included randomly selected plaster dental casts of 137 white patients (43 Class I, 50 Class II, and 44 Class III) from the Department of Orthodontics, School of Dental Medicine, University of Zagreb, Croatia. Dental models were scanned and digitized using ATOS II SO ("Small Objects") scanning technology (GOM mbH, Braunschweig, Germany). Eight linear and two proportional measurements were calculated for both upper and lower dental arches. RESULTS: In men, a significant difference in the upper dental arch was present in the incisor region, and in the lower dental arch, differences were found in intercanine and intermolar widths (P < .05). Significant differences were noted between male groups in the upper molar depth dimension (P = .022) and in the lower molar and canine depth dimensions (P < .05). Class III males had the greatest lower molar and canine width/depth ratios and the smallest lower canine depth/molar depth ratio. Class III women had wider and shorter mandibular arches when compared with Class I and Class II females. CONCLUSION: The hypothesis was rejected. The dimensions of the dental arches are related to gender and to dentoalveolar class. Class I and II subjects have similar dimensions of maxillary dental arch, but Class II subjects have a transverse deficit in the mandible. In Class III subjects, the maxillary dental arch is insufficient in transverse and sagittal dimensions, and the mandibular arch dominates in the transverse but not in the sagittal dimension.

[Temporomandibular disorders and headaches]. / Temporomandibularni poremecaji i glavobolje.

Temporomandibular disorder (TMD) is a common name for a series of pathologic conditions with similar signs and symptoms, which can lead to a disturbed and altered function of the stomatognathic system. Most of these conditions are of a multifactorial etiology, which can pose difficulties in obtaining a precise and accurate diagnosis. However, TMD is an ever more common and serious problem in contemporary dental practice and at general medical offices, so a more systematic approach in its diagnosis including data collection and interpretation is necessary. Accordingly, accurate diagnosis of TMD requires proper identification and classification of the dysfunction, as well as recognition of the mechanism and origin of pain occurrence.

The influence of dental status on masticatory muscle activity in elderly patients.

PURPOSE: The objective of this study was to determine whether elevator and depressor muscle activity during 5 minutes of mastication is affected by the presence of a prosthetic appliance in elderly patients. MATERIALS AND METHODS: Thirty edentulous subjects (EG) and 30 age-matched dentate subjects (DG) were studied. Surface electromyographic (EMG) recordings were obtained from the anterior temporal muscle, masseter muscle, and the submandibular group in the region of the anterior belly of the digastric muscle on the left and right sides. Muscle activity was recorded during maximal voluntary contraction (MVC) in the intercuspal position, maximal opening (Omax), and during 5 minutes of mastication. Elevator muscle activity during mastication was expressed as a percentage of maximal muscle activity in the intercuspal position (%MVC), and depressor muscle activity was expressed as a percentage of maximal opening (%Omax). The effect of 3 factors was investigated using a mixed analysis of variance design: the factor of muscle, with 6 muscles involved; the factor of time (5 minutes of mastication); and the factor of dental status, where some participants had their own natural dentition and others had complete dentures. RESULTS: The results revealed significant effects for the factors "muscle" and e" (P < .001 for the factor "muscle"; P < .001 for the factor "time"). The time by group interaction was significant (P = .046). In the EG, muscle activity gradually decreased during the 5-minute interval of mastication, while in the DG it decreased more rapidly from the first to the third minute and then increased until the fifth minute. There was also a significant effect regarding the presence of natural teeth or complete dentures (P < .034). Complete denture wearers had higher muscle activity relative to %MVC or %Omax than dentate subjects. CONCLUSIONS: Muscle activity during 5 minutes of mastication depended greatly on the presence of the prosthetic appliance, since edentulous subjects had to use higher potentials of muscle activity (%MVC or %Omax) than age-matched dentate subjects, and were unable to increase activity at the end of mastication. The difference in chewing patterns and activity between complete denture wearers and dentate subjects should be explained to patients prior to prosthetic treatment to help them adjust their expectations.

Influence of occlusal stabilization splint on the asymmetric activity of masticatory muscles in patients with temporomandibular dysfunction.

The aim of present study was to evaluate the symmetry of masticatory muscles' activity at various clenching levels in the intercuspal position in patients with functional disorders and in healthy subjects. The purpose was also to determine the effect of full-arch maxillary stabilization splint on the asymmetry of masticatory muscle activity in patients with temporomandibular dysfunction. In this study 6 TMD patients and 12 healthy subjects were investigated. Surface EMG recordings were obtained from left and right anterior temporal, left and right masseter and from the sub-mandibular group in the region of the anterior belly of the digastric muscle on the left and right side during clenching with the maximum 100% voluntary contraction (MVC) as well as during clenching at 50% and 25% of the maximum activity in the position of maximal intercuspation of teeth. In order to quantify asymmetrical masticatory muscle activity, the asymmetry index (AI) was calculated for each subject and for each muscle from the average anterior temporal, masseter and digastric potentials recorded during each test (100% MVC, 50% MVC and 25% MVC). In the group of patients EMG recordings were repeated during and after the splint therapy. The asymmetries of masticatory muscle activity was present in both groups, but in the group of TMD patients the asymmetry indices for anterior temporal muscle at 100% MVC (p = 0.049) and 50% MVC (p = 0.031) were significantly higher. Results have shown that the use of splint suppressed the asymmetry of all muscles, as during the splint therapy the asymmetry indices were lowered. After the therapy, the level of temporal muscle symmetry during submaximal clenching in the intercuspal position increased significantly (p = 0.046). This investigation points out that electromyography may be a valuable method of documenting that asymmetric activity of masticatory muscles improves after occlusal splint therapy in patients with TMD.