Individualized digitally designed surgical template for guided soft tissue surgery in cases with severe gingival enlargement: A clinical application in hereditary gingival fibromatosis.

AIM: The purpose of this study was to present the use of computer-assisted periodontal surgery utilizing a novel surgical guide for cases with severe gingival enlargement through a clinical application in a patient with hereditary gingival fibromatosis. MATERIALS AND METHODS: The treatment plan included nonsurgical periodontal therapy, surgical periodontal treatment, and regular periodontal maintenance before the initiation of orthodontic treatment. Due to the increased soft tissue thickness, a surgical guide with a novel design was fabricated to facilitate the periodontal surgery since most of the patient's teeth were malpositioned and underexposed due to fibromatosis. For this purpose, the patient's intraoral scan was merged with a CBCT image in order to plan surgical excisions based on the anatomy of the teeth and the bone contour. RESULTS: The customized surgical guide facilitated the gingivectomy by controlling not only the shape of the initial incisions but also their orientation toward the level of the cementoenamel junction, improving the efficiency of the clinical time compared with freehand surgery and assisting in the verification of the final soft tissue shape, based on the treatment plan. CONCLUSION: Digital technology through the superimposition of multiple data sets can assist in the diagnosis and multidisciplinary management of cases with gingival fibromatosis. The proposed design of the surgical guide can facilitate soft tissue surgery based on the digital treatment plan, leading to more predictable management of the soft tissue, especially in patients with severe gingival enlargement, as in cases with hereditary gingival fibromatosis or drug-induced gingival overgrowth.

The effect of antiretroviral therapyon the periodontal conditions of patients with HIV infection: A systematic review and meta-analysis.

AIM: To assess any differences (1) in the prevalence of periodontitis and necrotizing periodontal diseases, specifically necrotizing gingivitis (NG) and necrotizing periodontitis (NP) between HIV patients receiving antiretroviral therapy (HAART) and those not receiving the therapy and (2) in the severity of periodontitis based on probing depths (PDs) and clinical attachment loss (CAL) between the two groups. MATERIALS AND METHODS: Systematic electronic search on five databases (PubMed, Google Scholar, Scopus, Web of Science and Scielo) was conducted to identify cross-sectional and longitudinal studies reporting on prevalence of NG, NP and periodontitis among HIV patients who either receive or do not receive HAART treatment. The differences in clinical parameters of PDs and CAL among these patients were assessed. RESULTS: Eighteen articles were considered. The meta-analysis for NG showed that the overall assessment for the relative frequency ratio in the two groups was 0.45 (n = 7; 95% confidence interval [CI]: [0.21, 0.97]; p < .042). Regarding NP, the overall assessment for the relative frequency ratio in both groups was 0.60 (n = 5; 95% CI [0.22, 1.64]; p = .321). With regard to periodontitis, the overall assessment for the relative frequency ratio in the two groups was 1.17 (n = 9; 95% CI [0.90, 1.52]; p = .248). No significant differences in PD and CAL were found between the two groups 0.00 (n = 3; 95% CI [-0.52, -0.53]; p = .985) and 0.32 (n = 3; 95% CI [-0.19, 0.82]; p = .22), respectively. CONCLUSIONS: The prevalence of NG appeared to be significantly reduced in patients receiving antiretroviral therapy. No statistical significant difference was found in the prevalence of NP or periodontitis between the two groups.

Clinical evaluation of different alveolar ridge preservation techniques after tooth extraction: a randomized clinical trial.

OBJECTIVE: The aim of the present randomized controlled trial (RCT) was to evaluate the efficacy of different alveolar ridge preservation (ARP) techniques on dimensional alterations after tooth extraction, based on clinical measurements. BACKGROUND: Alveolar ridge preservation (ARP) is a common procedure in every day clinical practice, when dental implants are involved in treatment planning. In ARP procedures, a bone grafting material is combined with a socket sealing (SS) material in order to compensate the alveolar ridge dimensional alterations after tooth extraction. Xenograft and allograft are the most frequently used bone grafts in ARP, while free gingival graft (FGG), collagen membrane, and collagen sponge (CS) usually applied as SS materials. The evidence comparing xenograft and allograft directly in ARP procedure is scarce. In addition, FGG is usually combined with xenograft as SS material, while the evidence combing allograft with FGG is absent. Moreover, CS could probably be an alternative choice in ARP as SS material, since it has been used in previous studies but more clinical trials are required to evaluate its effectiveness. MATERIALS AND METHODS: Forty-one patients were randomly assigned in four treatment groups: (A) freeze-dried bone allograft (FDBA) covered with collagen sponge (CS), (B) FDBA covered with free gingival graft (FGG), (C) demineralized bovine bone mineral xenograft (DBBM) covered with FGG, and (D) FGG alone. Clinical measurements were performed immediately after tooth extraction and 4 months later. The related outcomes pertained to both vertical and horizontal assessment of bone loss. RESULTS: Overall, groups A, B, and C presented significantly less vertical and horizontal bone resorption compared to group D. No statistically significant difference was observed between allograft and xenograft, except for the vertical bone resorption at the buccal central site, where xenograft showed marginally statistically significantly reduced bone loss compared to allograft (group C vs group B: adjusted ß coef: 1.07 mm; 95%CI: 0.01, 2.10; p = 0.05). No significant differences were observed in hard tissue dimensions when CS and FGG were applied over FDBA. CONCLUSIONS: No differences between FDBA and DBBM could practically be confirmed. In addition, CS and FGG were equally effective socket sealing materials when combined with FDBA, regarding bone resorption. More RCTs are needed to compare the histological differences between FDBA and DBBM and the effect of CS and FGG on soft tissue dimensional changes. CLINICAL RELEVANCE: Xenograft and allograft were equally efficient in ARP 4 months after tooth extraction in horizontal level. Xenograft maintained the mid-buccal site of the socket marginally better than the allograft, in vertical level. FGG and CS were equally efficient as SS materials regarding the hard tissue dimensional alterations. TRIAL REGISTRATION: Clinical trial registration Number: NCT04934813 (clinicaltrials.gov).

The effect of mastic mouthwash on halitosis and oral hygiene in orthodontic patients: a randomized clinical trial.

BACKGROUND/OBJECTIVES: The aim of this trial was to investigate the effect of mastic mouthwash on halitosis using as a proxy the levels of the Volatile Sulfur Compounds (VSCs), and the effect on plaque and gingival indices in adolescents undergoing orthodontic treatment with fixed conventional labial appliances. SUBJECTS/METHODS: The study was a double-blinded, placebo-controlled, parallel-group, randomized clinical trial. Thirty patients with fixed orthodontic appliances were randomly allocated at a 1:1 ratio, to either the mastic-mouthwash or the placebo-mouthwash group. Eligibility criteria included ages between 13 and 18, active orthodontic treatment with fixed appliances, good general health, and total initial VSCs levels above 150 ppb. The primary outcome was the objective hydrogen sulfide (H2S) level, measured with the Oral ChromaTM device. The secondary outcomes were (1.) the methyl-mercaptan (CH3SH) and (2.) dimethyl sulfide [(CH3)2S] levels, measured with the same device, (3.) the subjective perception of the own malodour via questionnaires, and (4.) the oral hygiene assessed with the use of the Modified Silness and Löe Plaque Index (PI-M) and the Silness and Löe Gingival Index (GI) at baseline (T0) and after 2 weeks (T1). Stratified randomization by gender was used, and allocation was concealed with opaque numbered sealed envelopes. RESULTS: H2S level dropped from 221.00 ppb (T0) to 125.00 ppb (T1), and the difference between treatment groups was statistically significant in favour of the mastic group (coef: 72.34, 95% CI: 8.48, 136.27, P = 0.03). The levels of the other VSCs, the subjective measurements of oral malodour, and the oral hygiene indices did not differ between treatment arms. LIMITATIONS: The objective organoleptic assessment by a calibrated examiner was not performed. CONCLUSIONS/IMPLICATIONS: Mastic mouthwashes could be an alternative treatment for adolescent patients suffering from halitosis during orthodontic treatment with fixed appliances. REGISTRATION: The trial was registered at ClinicalTrials.gov (identifier: NCT05647369).

A Retrospective Multicenter Study on Short Implants With a Laser-Microgrooved Collar (≤7.5 mm) in Posterior Edentulous Areas: Radiographic and Clinical Results up to 3 to 5 Years.

PURPOSE: We aimed to retrospectively evaluate the radiographic and clinical results and the success rate of short implants with a laser-microgrooved collar (≤7.5 mm) placed in the posterior areas after up to 3 to 5 years of function and the possible influence of several variables-such as gender, periodontitis, smoking habit, location, implant stability at placement, and prosthetic fixation design-on implant marginal bone loss (MBL). MATERIALS AND METHODS: A chart review was used for this multicenter study, which involved 5 private dental clinics. All patients had been treated with short dental implants with a laser-microgrooved collar from January 2012 to December 2015. RESULTS: A total of 174 patients (99 male and 75 female patients; mean age, 51.6 ± 2.8 years) with 254 implants were evaluated. Seven short implants failed. The cumulative success rate was 97.2%, without a statistically significant difference between implants placed in the posterior maxilla and mandible. The mean MBL was 0.18 ± 0.7 mm at the mesial aspect and 0.19 ± 0.6 mm at the distal aspect. No statistical relationships were found between MBL and gender, periodontitis, smoking habit, location, implant stability at placement, and prosthetic fixation design. CONCLUSIONS: At the end of the 3- to 5-year follow-up period, short implants with a laser-microgrooved collar (≤7.5 mm) in the posterior areas yielded a relatively high cumulative success rate. The laser-microgrooved collar implant maintained stable marginal bone levels. No investigated variable was statistically associated with MBL.

A randomized controlled clinical trial on the effectiveness of three different mouthrinses (chlorhexidine with or without alcohol and C31G), adjunct to periodontal surgery, in early wound healing.

OBJECTIVES: The use of chlorhexidine (CHX) with or without alcohol has been recommended for a number of clinical applications. On the other hand, there is a plethora of widely subscribed antiseptics, such as agent C31G (alkyl dimethyl glycine/alkyl dimethyl amine oxide), which has not yet been evaluated postsurgically. The effectiveness of three different mouthrinses (CHX with and without alcohol, C31G) in plaque control and early wound healing was compared postoperatively. MATERIALS AND METHODS: In this, randomized, double-blind, controlled clinical trial 42 patients were allocated to three groups assigned to 2 weeks rinsing after non-regenerative periodontal flap surgery with or without osseous surgery with C31G (group A), alcohol-free CHX 0.12% (group B) or alcohol-based CHX 0.12% (group C). At days 7 and 14, plaque and early wound healing indices were recorded. At day 14, total bacterial counts were estimated utilizing real-time quantitative polymerase chain reaction (qPCR). Statistics included linear and generalized linear mixed models. RESULTS: At day 7, healing response was not significantly different among groups. At day 14, group A revealed the highest while group C demonstrated the lowest plaque index values (B vs A, odds ratio-OR = 0.18, p = 0.012; C vs A, OR = 0.01, p < 0.001; C vs B, OR = 0.06, p < 0.001). Group C demonstrated the lowest bacterial counts levels at day 14 (38.470 × 106, 48.190 × 106, and 3.020 × 106 for groups A, B, and C, respectively). At day 14, healing was significantly better in group C compared to B (p = 0.007). Group A showed no significant differences compared to other groups. CONCLUSIONS: (1) The presence of alcohol may increase the effectiveness of CHX in early wound healing, (2) C31G might be an alternative solution prescribed during early postoperative period after non-regenerative periodontal flap surgery. CLINICAL RELEVANCE: The present study found that active agent C31G displayed no significant differences to CHX formulations regarding periodontal wound healing improvement and might be used alternatively after non-regenerative periodontal flap surgery. In addition, an alcohol based 0.12% CHX mouthwash was more effective than an alcohol-free 0.12% CHX and C31G mouthrinse on plaque control in the absence of mechanical oral hygiene.

Esthetic rehabilitation through crown lengthening and laminate veneers.

AIM: To describe a digital workflow utilizing 3D printing technology to guide esthetic crown lengthening and control tooth preparation. CLINICAL CONSIDERATIONS: After the initial intraoral and face scans, an esthetic treatment plan was performed digitally based on the patient's personality and face type using artificial intelligence-based 3D smile design software. A 3D-printed tray relined with silicone over a 3D-printed model was used for the mock-up. A 3D-printed guide was implemented to assist esthetic crown lengthening by incorporating, simultaneously, information about the desired free gingival line and the alveolar bone level. Based on the initial planning, a set of reduction guides was 3D printed to check and correct the tooth preparation. Prior to the start of construction of the final monolithic restorations, their design was verified using 3D-printed prototypes. A stabilization splint was digitally designed and 3D printed to protect and maintain the final result. CONCLUSIONS: Technologic advances can improve the predictability of an interdisciplinary esthetic approach. Digital planning can be transferred to clinical reality using a digital workflow, utilizing a set of appropriate 3D-printed guides, which can help to control clinical procedures based on the initial planning. CLINICAL SIGNIFICANCE: By following the proposed step-by-step workflow, clinicians can achieve predictable results through an interdisciplinary approach, guiding both the periodontal plastic surgery and the restorative treatment after an individualized CAD/CAD procedure for 3D-printed guides.

Endothelial cells of oral pyogenic granulomas express eNOS and CD105/endoglin: an immunohistochemical study.

BACKGROUND: The pyogenic granuloma (PG) is a common localized hyperplastic lesion of the oral cavity. The purpose of the present study was to investigate the immunohistochemical expression of endothelial nitric oxide synthases (eNOS) and CD105/endoglin in oral PGs, to evaluate their involvement in the angiogenetic pathways of the lesion. MATERIALS AND METHODS: Ninety-three PGs were included in the study. Sixteen tumors were further sub-classified as pregnancy tumors (PT) and seventeen as pyogenic granulomas with fibrosis (PGFM). Immunohistochemical expression of eNOS and CD105/endoglin was quantified by computerized image analysis with a semi-automated system. Percentage of staining and number of objects (positive vessels) were recorded for each case. RESULTS: Intense eNOS expression was seen in 92 of 93 lesions. A statistically significant association was found between eNOS percentage of staining/eNOS positive vascular spaces (objects) and age of the patients (9% increase per decade of life). Approximately 40% less eNOS positive objects were recorded in PGFM compared with PGs. Intense membranous CD105/endoglin expression was seen in all cases. The percentage of CD105/endoglin staining was statistically increased in PGs compared with PT. Approximately 40% less CD105/endoglin objects were found in PGFM compared with PGs; 56% more CD105/endoglin objects were found in tongue lesions, compared with gingival lesions. There was no statistically significant correlation considering percentage of staining and number of objects between CD105/endoglin and eNOS. CONCLUSIONS: It is suggested that eNOS and CD105/endoglin are involved in the angiogenetic pathways of PG.

Detection Accuracy of Bone Defects Depending on Exposure Settings of Cone Beam Computed Tomography.

Despite the widespread use of cone beam computed tomography (CBCT), few articles have been published to assess the accuracy in detecting alveolar bone defects using different CBCT exposure settings. A human cadaver with rounded bone defects in various locations was scanned using a CBCT scanner at different settings. Four examiners twice studied 1,500 cross-sectional digital and printed slices for defect presence, location, and size. High-resolution zoom mode achieved the highest overall accuracy. Moreover, apical location of the defects significantly affected overall accuracy. Bone defect detection depends upon exposure settings of CBCT scans. Exposure settings and field of view dimensions should be individualized per case.

Periodontal Regeneration with Enamel Matrix Derivative in the Management of Generalized Aggressive Periodontitis: A Case Report with 11-Year Follow-up and Literature Review.

OBJECTIVES: Aggressive periodontitis (AgP) represents an uncommon but rapidly advanced inflammatory process, which involves the destruction of periodontal tissues. This study aimed to report a case of generalized AgP (GAgP), where the treatment approach consists of the utilization of the full-mouth disinfection protocol (FMDP) in conjunction with flap curettage and regenerative appliance of enamel matrix derivatives (EMDs). The associated literature was also reviewed. MATERIALS AND METHODS: A 19-year-old female patient was diagnosed with GAgP. The treatment was initiated with FMDP and administration of antibiotics. Afterward, open flap debridement was performed, and EMD was selected as the regenerative material for the reconstruction of the periodontal defects. Over an 11-year period and during all the phases of the treatment, the outcomes were regularly evaluated with clinical measurements and radiographic controls. RESULTS: The 11-year results demonstrated no recurrence of disease, and the patient's periodontal health exhibited evident improvement. Overall, the pocket depths presented satisfactory reduction while the clinical attachment loss (CAL) was improved. Both our limited experience and available literature data revealed that the use of EMD in AgP treatment contributes to bone fill of the intrabony defects as well as regeneration of the destructed periodontal apparatus. CONCLUSIONS: Although the outcomes of this treatment approach have not been widely evaluated, it seems that the use of EMD may be an effective means of periodontal regeneration in patients with GAgP. Additional prospective studies with adequate number of GAgP patients are essential to thoroughly assess the effectiveness of this approach.