Perceptions regarding the use of a three-dimensionally-printed manufactured educational simulator for periodontal treatment of intraosseous and interradicular lesions.

PURPOSE/OBJECTIVES: Treating intraosseous lesions (IOLs) and interradicular bone lesions (IRLs) is an extremely technical dental procedure in periodontics. Instrumentation of these lesions is often perceived as difficult by students and inexperienced dentists before they perform a certain number of procedures on patients in the clinic. The aim of this article is to evaluate a cost-effective three-dimensional (3D)-printed educational simulator for the periodontal treatment of IOLs/IRLs (including scaling, incisions and sutures). METHODS: The simulators were first developed digitally, and then manufactured using printable resins and specific materials; finally, they were assembled using different bonding systems. To evaluate the simulators, assessments were gathered from two target populations: undergraduate students and periodontics experts. These individuals tested the simulator and completed a cross-sectional questionnaire based on a Likert scale with comparative and pedagogical items scored from one to five. The purpose of the questionnaire was to compare our simulator to clinical reality (i.e., operation on human jaws) and to an animal simulator (i.e., simulation of porcine jaws). The results are expressed as the mean and standard deviation and were statistically analyzed with the Wilcoxon signed-rank test. RESULTS: Overall, the results were satisfactory for both groups of testers (4.70 and 4.61 out of five for students and experts, respectively, for global satisfaction). CONCLUSIONS: The overall educational relevance of the simulator designed herein highlights the fact that 3D-printed educational simulators could enable efficient cognitive-functional learning for clinical IOL/IRL treatment.

A Comparative Analysis of Deep Learning-Based Approaches for Classifying Dental Implants Decision Support System.

This study aims to provide an effective solution for the autonomous identification of dental implant brands through a deep learning-based computer diagnostic system. It also seeks to ascertain the system's potential in clinical practices and to offer a strategic framework for improving diagnosis and treatment processes in implantology. This study employed a total of 28 different deep learning models, including 18 convolutional neural network (CNN) models (VGG, ResNet, DenseNet, EfficientNet, RegNet, ConvNeXt) and 10 vision transformer models (Swin and Vision Transformer). The dataset comprises 1258 panoramic radiographs from patients who received implant treatments at Erciyes University Faculty of Dentistry between 2012 and 2023. It is utilized for the training and evaluation process of deep learning models and consists of prototypes from six different implant systems provided by six manufacturers. The deep learning-based dental implant system provided high classification accuracy for different dental implant brands using deep learning models. Furthermore, among all the architectures evaluated, the small model of the ConvNeXt architecture achieved an impressive accuracy rate of 94.2%, demonstrating a high level of classification success.This study emphasizes the effectiveness of deep learning-based systems in achieving high classification accuracy in dental implant types. These findings pave the way for integrating advanced deep learning tools into clinical practice, promising significant improvements in patient care and treatment outcomes.

Digitally planned surgical crown lengthening: a novel bone reduction strategy to correct a gummy smile.

This report describes the bone reduction guide which was digitally obtained to improve diagnosis, treatment outcome and follow-up. Treatment of gingival smiles due to altered passive eruption should include interdisciplinary planning and smile design to facilitate the prediction of treatment outcome. Crown lengthening surgery can be supported by digital tools to improve surgical planning and follow-up. A 30-year-old female patient was referred to a private dental clinic seeking solutions for her gingival smile. Based on the anatomical crown length, a smile design was created, and the patient was presented with a simulated smile before treatment. In the surgical phase, a full-thickness flap was raised in the upper jaw to achieve the desired outcome. Using cone-beam computed tomography to determine cementoenamel junction for smile design and treatment planning brings many benefits. Patients and clinicians can foresee treatment results. From there, appropriate changes can be made. The bone reduction guide is designed to rest on the bone to help the clinician cut the bone accurately and thoroughly follow the established plan.

A Minimally Invasive Technique for the Management of Physiologic Gingival Melanin Hyperpigmentation: A Case Series.

An attractive smile enhances an individual's self-confidence. The overall harmony of a smile can be attributed to the interplay of the teeth's shape, color, and position along with the gingival tissue. Gingival pigmentation is observed across all human races, exhibiting variations from one race to another. Typically, gingival hyperpigmentation results from the abnormal buildup of melanin in the gingival tissue, imparting a dark appearance on the gums. Various procedures, collectively known as gingival depigmentation, are employed to address gingival hyperpigmentation. While the initial outcomes of depigmentation procedures are often promising, one common issue associated with them is the potential for re-pigmentation. This article aims to evaluate the clinical effectiveness and patient-reported outcomes of intraepidermal (oral mesotherapy) vitamin C injection for nonsurgical management of physiologic gingival melanin hyperpigmentation.

Periodontal Health Status in Adults Exposed to Tobacco Heating System Aerosol and Cigarette Smoke vs. Non-Smokers: A Cross-Sectional Study.

Tobacco heating systems (THS) are new products on the market, advertised as a less harmful alternative for smokers, in which tobacco is heated and not burned like in conventional cigarettes. This research explored the effect on periodontal tissues in contact with heating and burning tobacco residual products (smoke and tobacco). METHODS: The sample included 66 subjects, patients of the Clinic of Dentistry in Rijeka, Croatia, aged 26-56 (median 38), 64% females. Three age- and gender-matched groups were formed (each N = 22): non-smokers, classic cigarettes smokers and THS smokers. Probing depth (PD) and clinical attachment loss (CAL) were primary research parameters. RESULTS: Three groups differed in average PD and CAL (p ≤ 0.002), with cigarette smokers having the highest and non-smokers the lowest values (p ≤ 0.002). THS consumers generally had lower values of periodontal indices than smokers, but only CAL differed significantly (p = 0.011). Periodontal indices CAL and PD were worse in THS consumers than non-smokers, but they did not reach a level of statistical significance. Cigarette smoking was the only predictor of periodontitis (average CAL ≥ 4 mm) in logistic regression models, with an odds ratio of 4.7 (95% confidence interval 1.2-18.3; p = 0.027). CONCLUSIONS: Exposure to nicotine-containing aerosol of THS in adults has a less harmful effect on periodontal tissues, measurable through periodontal indices (PD and CAL), compared to burning tobacco of conventional cigarettes. THS, presented as an alternative product to classic cigarettes, also has a detrimental effect on the periodontium.

Contesting the conventional wisdom of periodontal risk assessment.

Over the years, several reviews of periodontal risk assessment tools have been published. However, major misunderstandings still prevail in repeated attempts to use these tools for prognostic risk prediction. Here we review the principles of risk prediction and discuss the value and the challenges of using prediction models in periodontology. Most periodontal risk prediction models have not been properly developed according to guidance given for the risk prediction model development. This shortcoming has led to several problems, including the creation of arbitrary risk scores. These scores are often labelled as 'high risk' without explicit boundaries or thresholds for the underlying continuous risk estimates of patient-important outcomes. Moreover, it is apparent that prediction models are often misinterpreted as causal models by clinicians and researchers although they cannot be used as such. Additional challenges like the critical assessment of transportability and applicability of these prediction models, as well as their impact on clinical practice and patient outcomes, are not considered in the literature. Nevertheless, these instruments are promoted with claims regarding their ability to deliver more individualized and precise periodontitis treatment and prevention, purportedly resulting in improved patient outcomes. However, people with or without periodontitis deserve proper information about their risk of developing patient-important outcomes such as tooth loss or pain. The primary objective of disseminating such information should not be to emphasize assumed treatment efficacy, hype individualization of care, or promote business interests. Instead, the focus should be on providing individuals with locally validated and regularly updated predictions of specific risks based on readily accessible and valid key predictors (e.g. age and smoking).

Importance of periodontal phenotype in periodontics and restorative dentistry: a systematic review.

BACKGROUND: Periodontal phenotype is regarded to be one of the key factors influencing the efficacy of restorative therapies in dental practice. The objective of the systematic review was to explore the importance of thin and thick periodontal phenotypes and how they affect the outcome of periodontal and restorative therapies by looking at a number of academic publications from various online databases. METHODS: Following the PRISMA guidelines (Preferred Reporting Items for Systematic Review standards), relevant data will be searched and retrieved from three significant scientific databases, including PubMed, EBSCO, and Scopus. The articles with full texts that matched the keywords and published in English between 2018 and 2023 were taken into consideration. RESULTS: The majorities of these articles were based on the type of periodontal phenotype and their impact on periodontal and restorative treatment outcomes were selected. The initial search yielded a total of 530 articles. Only 273 were relevant to the review's objectives, and these were considered for determining eligibility. Only 20 publications were eligible for analysis. CONCLUSION: Understanding these anatomical aspects of periodontal phenotype is crucial to both periodontology and restorative dentistry. The clinical outcome of restorative, prosthetic, orthodontic, surgical, and periodontal therapies is determined in large part by the periodontal phenotype, which also plays a significant role in clinical failure or success in dental treatments. TRIAL REGISTRATION: This study protocol registered with the International Prospective Register of Systematic Reviews (PROSPERO) dated 16th June 2023 with the registration ID CRD42023432568.

To intrude or not to intrude? A systematic review of the controversy surrounding orthodontic intrusion on reduced periodontium.

OBJECTIVE: The main objective of this review was to evaluate the effects of orthodontic intrusion on patients with reduced periodontium. Additionally, this review aims to explore the potential for attachment gain and tissue regeneration in these patients and identify optimal therapeutic conditions to mitigate any negative effects of intrusion. METHODS: A systematic review was conducted according to the PRISMA 2020 statement. Duplicate electronic searches of the PubMed, Cochrane, EMC Premium, and Science Direct databases were performed by two independent reviewers. Data extraction and quality assessments, including risk of bias evaluation using the Cochrane and ROBINS-I tools were conducted. RESULTS: From an initial pool of 418 articles, 29 were selected after title and abstract screening for full-text review. Following thorough full-text reading, 15 studies were ultimately included in the analysis. The total number of patients included in the studies is 528, who underwent orthodontic intrusion on reduced periodontium. Studies indicated a decrease in periodontal pocket depth and an increase in clinical attachment with ortho-periodontal treatment. Alveolar bone level outcomes varied, showing both increases and losses. Authors generally observed improved papillary regeneration and reduced gingival recessions. CONCLUSION: Clinical studies involving combined ortho-periodontal treatment showed that orthodontic intrusion on a reduced but healthy periodontium can be considered a beneficial treatment for the periodontium, provided that potential adverse effects are carefully monitored.

Artificial intelligence in dental education: ChatGPT's performance on the periodontic in-service examination.

BACKGROUND: ChatGPT's (Chat Generative Pre-Trained Transformer) remarkable capacity to generate human-like output makes it an appealing learning tool for healthcare students worldwide. Nevertheless, the chatbot's responses may be subject to inaccuracies, putting forth an intense risk of misinformation. ChatGPT's capabilities should be examined in every corner of healthcare education, including dentistry and its specialties, to understand the potential of misinformation associated with the chatbot's use as a learning tool. Our investigation aims to explore ChatGPT's foundation of knowledge in the field of periodontology by evaluating the chatbot's performance on questions obtained from an in-service examination administered by the American Academy of Periodontology (AAP). METHODS: ChatGPT3.5 and ChatGPT4 were evaluated on 311 multiple-choice questions obtained from the 2023 in-service examination administered by the AAP. The dataset of in-service examination questions was accessed through Nova Southeastern University's Department of Periodontology. Our study excluded questions containing an image as ChatGPT does not accept image inputs. RESULTS: ChatGPT3.5 and ChatGPT4 answered 57.9% and 73.6% of in-service questions correctly on the 2023 Periodontics In-Service Written Examination, respectively. A two-tailed t test was incorporated to compare independent sample means, and sample proportions were compared using a two-tailed χ2 test. A p value below the threshold of 0.05 was deemed statistically significant. CONCLUSION: While ChatGPT4 showed a higher proficiency compared to ChatGPT3.5, both chatbot models leave considerable room for misinformation with their responses relating to periodontology. The findings of the study encourage residents to scrutinize the periodontic information generated by ChatGPT to account for the chatbot's current limitations.

Overview of systematic reviews on periodontal-orthodontic interactions: A comprehensive literature analysis.

The aims of this research were to investigate the methodological quality of systematic reviews on periodontal-orthodontic interactions (i.e. reviews of primary research broadly defined as any including both periodontic and orthodontic components) and to provide a mapping of the researched topics. We searched four major databases (PubMed, Lilacs, Web of Science, and Embase) for systematic reviews of periodontal-orthodontic interactions. We used the AMSTAR-2 tool (the acronym is derived from 'a measurement tool to assess systematic reviews') to assess the methodological quality of the included systematic reviews. Individual AMSTAR-2 ratings were tabulated, and the percentage per item was calculated. To assess the association between the AMSTAR-2 percentage score and the overall confidence in the systematic review results, an ordinal regression model was used. We initially retrieved 973 documents, and 43 systematic reviews were included. Systematic reviews of interventions were the most prevalent (n = 26, 60.5%). Most of the systematic reviews did not report a meta-analysis (n = 25, 58.1%). In addition, most of the studies included in the systematic reviews had an unclear or high risk of bias. Most of the systematic reviews were rated as having critically low or low overall confidence (n = 34, 79.1%). A significant correlation was found between the AMSTAR-2 percentage score and overall confidence in the results. The methodological quality of systematic reviews on periodontal-orthodontic interactions can be improved. The limitations of our study include potential language bias and an arbitrary classification of the topics researched.

A critical look at outcome measures: Comparison between four dental research journals by use of a hierarchical model.

AIM: To assess the status quo of outcome measures used in treatment studies in Endodontics, and potentially identify strategies for improvement, by (i) systematically assessing the outcome measures using a conceptual model and (ii) comparing these with measures used in corresponding studies in the adjacent fields. METHODOLOGY: The International Endodontic Journal, Caries Research, The Journal of Clinical Periodontology and The Journal of Oral & Facial Pain and Headache were selected to cover four adjacent dental disciplines. In each journal, the 50 most recent consecutive publications fulfilling inclusion criteria were included. A hierarchical model for diagnostic imaging studies was modified to assess studies related to treatment. The model comprised six levels, with technical as the lowest level and societal as the highest. Extracted data included study origin, study type, and identified outcome measures. Fisher's Exact Tests with Bonferroni corrections compared studies. p < .05 was considered statistically significant. RESULTS: Amongst 756 publications, the 200 most recent studies matching the inclusion criteria were identified. Less than half (36.5%) assessed the clinical, patient, or societal aspects of treatment; 10.0% in International Endodontic Journal, 28.0% in Caries Research, 38.0% in Journal of Clinical Periodontology, and 70.0% in Journal of Oral & Facial Pain and Headache (p < .001). CONCLUSIONS: According to included publications, research on treatment within the endodontic field is mainly focusing on technical and biological outcomes. The benefits of patients and society were less frequently examined than in corresponding journals in adjacent disciplines. When designing studies, including higher-level outcomes should be considered.

Ibero-Panamerican Federation of Periodontology Delphi study on the trends of periodontology and periodontics by the year 2030. A Latin American consensus.

BACKGROUND AND OBJECTIVE: As elsewhere in the world, the prevalence of periodontitis in stages I-II is high in the Latin American population, this scenario emphasizes the need for identification of urgent needs for allocating adequate resources to provide diagnosis, prevention, and treatment of these diseases. The aim of this Delphi study was to predict the trends in periodontology/periodontics in the Latin American region by the year 2030. METHODS: A steering committee and an advisory group of experts in periodontology/periodontics were selected from 16 countries. An open questionnaire of 60 questions was validated and used following the Delphi methodology. RESULTS: Two hundred and twenty-five experts from Latin America answered the two rounds of the questionnaire. Moderate to strong consensus was reached on 45 questions (75%). The prediction was that the prevalence of gingivitis and periodontitis in stages I and II will be maintained, the importance of the link with systemic diseases will increase, and the impact of prevention and periodontal treatment will also increase, mainly in the private sector. There was a strong consensus that plastic and regenerative surgical procedures will increase, as well as the demand for training in the specialty of periodontology. CONCLUSIONS: The present study has provided relevant and useful information on predictions in periodontology/periodontics in Latin America, with important level of consensus among experts. It has been predicted that periodontitis will still be a highly prevalent disease, and its links with other medical conditions should demand more attention by health authorities to develop adequate prevention and management policies and strategies.

Evaluation of characteristics of periodontal probes

Aim: This study aimed to evaluate the millimeter distances and active tip diameters of different periodontal probes. Methods: Two types of periodontal probes were analyzed (North Carolina (15-UNC) and PCP-12). Two manufacturers were selected for each probe type. Digital images of the probes were obtained and the distances were measured using a software program. The diameter of the active tip was measured using a digital caliper. Both variables were measured by two trained and calibrated examiners. The data were analyzed using the Bland-Altman method and two-way ANOVA with Tukey's post-hoc test. Statistical significance was set at p<0.05. Results: A comparison of measurements between the 15UNC and PCP-12 probes showed a significant difference in all millimeter markings. The 15-UNC probe showed differences between the 3 and 12 mm markings. The PCP-12 probe only showed differences between the marks at the 12 mm mark. The 15-UNC probe had a similar active tip diameter between the two manufacturers. The PCP-12 probe showed a significant difference between the two manufacturers. Both types of probes had similar active tip diameters when compared by the two manufacturers. Conclusion: There was no standardization in relation to millimeter marks and tip diameters of the two types of periodontal probes produced by the two different manufacturers. The probe types exhibited little variability

Clinical Implications of Nanosciences in Dentistry and Periodontics: A Narrative Review.

The nanosciences have recently emerged as a transformative force in dentistry and periodontics, offering fresh strategies to further the development of dental care. This paper provides a concise summary of the effect of nanoparticles, their categorisation, several methods of action, and various dental uses. This review discusses the properties of nanoparticles that lend to their use in dentistry and traces the history of the growth and advancement of nanotechnology in this area, nanomaterials' role in improving dental restorations' durability, aesthetics, and overall dental health by drawing on particular examples from restorative dentistry, prosthodontics, cosmetic dentistry, and general dentistry. In addition, the advancement of nanosciences has made periodontal regeneration easier, which has resulted in more accurate forecasting of its effects. Issues relating to safety, finances, and regulations imposed by the government have been fixed. It is encouraged that research be conducted into the full potential of nanosciences in dentistry and periodontics as a method of realising the field's bright future. Applications of nanotechnology in dentistry and periodontics can be broadly discussed under the prevention, detection, and treatment modalities.

Implications of Gene Therapy in Dentistry and Periodontics: A Narrative Review.

The relentless march of technological progress entails constant evolution and adaptation. A concerted effort is underway in medical research to unravel various diseases' cellular and molecular underpinnings. The traditional approaches to disease treatment often fall short of delivering entirely satisfactory outcomes, which has prompted a shifting spotlight on gene therapy as a versatile solution for many inherited and acquired disorders. Genes, intricate sequences of genetic code, are the complicated blueprints dictating the production of essential proteins within the human body. Remarkably, each individual's genetic makeup is uniquely distinct, with variations in these genetic sequences serving as the bedrock of our diversity. Gene therapy represents an innovative medical strategy that harnesses the power of genes themselves to function as therapeutic agents. It serves as a conduit through which defective genes are either substituted or mended with the introduction of remedial genetic material. This groundbreaking method can tackle various illnesses, from conditions originating from single-gene abnormalities to intricate disorders influenced by multiple genes. In dentistry and periodontics, gene therapy finds a promising array of applications. It contributes significantly to managing salivary gland disorders, autoimmune diseases, and the regeneration of damaged bone tissue, as well as addressing cancerous and precancerous conditions. Moreover, the possibilities extend into DNA vaccination and broader areas of oral health. The advent of gene therapy in dentistry represents a new era of significant progress, offering substantial advancements in the management of periodontal disease and the reconstruction of the dental alveolar apparatus. The aim of this narrative review is to provide a comprehensive overview of the landscape of gene therapy investigations in these disciplines, shedding light on its potential implications for oral health and treatment. With its potential to rectify the genetic underpinnings of various conditions, gene therapy offers a novel frontier in healthcare that continually shapes the landscape of medicine and holds the promise of more effective and personalised treatments.

Immunomodulators and Their Applications in Dentistry and Periodontics: A Comprehensive Review.

The intricate interplay between the immune system and oral health has revealed opportunities for novel therapeutic interventions in dentistry and periodontics. This review article delves into the pivotal role of immunomodulators in orchestrating immune responses within the oral cavity and their applications in managing various oral and periodontal conditions. The oral environment faces many challenges, from microbial infections to tissue injuries, necessitating a precise immune response for optimal oral health maintenance. Characterized by their ability to modulate immune reactions, immunomodulators emerge as versatile tools for maintaining immune equilibrium. This is a comprehensive overview of the mechanisms through which immunomodulators exert their effects, shedding light on their dual role as regulators of both pro-inflammatory and anti-inflammatory pathways. The diverse applications of immunomodulators within dentistry are explored in depth. Immunomodulators exhibit promising outcomes from managing common oral conditions like gingivitis, periodontitis, and oral ulcers to enhancing the integration of dental implants and promoting wound healing post-surgery. This article highlights the various types of immunomodulatory agents utilized in dental practice, elucidating their mechanisms of action, routes of administration, dosages, and potential side effects.

Enhancing the Oral Rehabilitation and Quality of Life of Bisphosphonate-Treated Patients: The Role of Dental Implants.

The purpose of this review is to examine the literature on the topic of bisphosphonate-related osteonecrosis of the jaw (BRONJ) and dental implant failure in patients undergoing bisphosphonate (BP) therapy who also received dental implants before, during, or after BP treatment, as compared to healthy patients. This research followed the guidelines in the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement. The "PICO" or population, intervention, comparison, and outcome clinical question was as follows: does the insertion of dental implants in patients receiving bisphosphonate therapy increase the failure and loss of implants or the incidence of bisphosphonate-related osteonecrosis of the jaw compared to healthy patients? The articles published in PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE) up to July 1, 2023, were retrieved using a mix of Medical Subject Heading (MeSH) words and their entry terms. The absence of randomized clinical trials examining this issue underscores the need for additional studies with extended follow-ups to answer outstanding questions. Because of the potential for BRONJ and implant failure, patients receiving bisphosphonate medication should exercise caution when planning dental implant surgery. In addition, when such procedures are carried out, the patient's entire systemic condition must be considered.

Assessment of suturing and scaling skills of periodontology and oral medicine residents by OSATS method: a pilot study.

INTRODUCTION: Updating the method for evaluating suturing and scaling skills in dental education has attracted relatively little attention and there is no consensus to what should be assessed and how. The purpose of this study was to investigate the applicability of the Objective Structured Assessment of Technical Skill (OSATS) method for these two basic skills, the possible association between the scores and demographic factors, and the level of satisfaction of residents with this method. METHODS: All six periodontics and three oral medicine residents were recruited by census method and video-recorded while performing a simple interrupted suture, a figure eight suture and scaling on a model. Then, the videos were evaluated independently via a checklist and a global rating scale (GRS) by two expert raters. Agreement between raters and residents' satisfaction were evaluated. Correlation between demographic factors of participants and scores was also assessed. T-test and linear regression analysis were used. RESULTS: There was no significant difference between the scores based on the views of the two raters for each of the checklist (ICC = 0.99, CI = 0.96-0.99, P < 0.001) and GRS (ICC = 0.97, CI = 0.86-0.99, P < 0.001). Linear regression showed no correlation between gender and scores but periodontics major and higher year of education showed correlation with higher scores. CONCLUSION: Considering the excellent agreement between raters in using both the checklist and GRS components of OSATS, and satisfaction of 88% the residents with this method, it seems to be able to provide a reliable assessment.