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The Novel iMPACT Tool and Quadrant Protocol for Peri-Implantitis: Surface Refinement and Re-Osseointegration Validated by SEM/EDS and Long-Term Clinical Case Reports
No full textBackground and Objectives: The goal of this study was to introduce a novel device, the iMPACT implant planer, designed to machine (create a complete smooth surface) contaminated implant surfaces intraorally, promoting peri-implant tissue healing and possible re-osseointegration, and the new Quadrant protocol, evaluating them in vitro and clinically. The null hypothesis was that there would be no improvement in the clinical parameters for the implants with peri-implantitis (PI) treated with the new protocol and tool. Materials and Methods: The Quadrant protocol was used in conjunction with the iMPACT tool, which primarily functions to remove biofilm and microbial contaminants from the exposed implant surface, while simultaneously preparing the surface through standardized implantoplasty, thereby enhancing the potential for re-osseointegration. An in vitro analysis was developed, and three medium/long-term cases were presented, detailing the procedures and outcomes. Results: The in vitro assessment showed smooth surfaces after treatment. Different areas presented minimal particles (\u3c1 μm) on the implant surface, with a high content of titanium (Ti) and tungsten (W). In case 1, severe and advanced peri-implantitis around implants #46 and #47 was found. A combination of resective (Quadrant + iMPACT) and regenerative surgery was used for treatment, along with a buccal single flap (BSF). Significant clinical and radiographic improvements were observed at 14 and 43 months postoperatively, including vertical bone gain with re-osseointegration and stable probing depths (PDs). In the second case, a severe PI and prosthesis instability were observed. Resective (Quadrant + iMPACT) and regenerative procedures were applied. At 3 and 12 months postoperatively, clinical and radiographic evaluations demonstrated significant improvements with re-osseointegration, including PDs reduced to 0–1 mm and a vertical bone gain of approximately 6.5 mm. In case 3, mandibular implants from 42 to 47 exhibited inflammation, suppuration, and moderate-to-severe bone loss. Just resective surgery (Quadrant + iMPACT), without grafting, was performed. At 6- and 12-month follow-ups, clinical and radiographic assessments showed the resolution of inflammation, stable bone levels, and healthy peri-implant gingiva. Conclusions: Favorable outcomes were achieved using the iMPACT and Quadrant protocols in the three clinical cases, resulting in re-osseointegration when combined with regenerative procedures. The favorable medium/long-term outcomes achieved, despite the patient’s complex medical history and, at times, inconsistent oral hygiene, underscore the potential efficacy of such interventions
Lingual Cyst with Respiratory Epithelium: An Update of Scientific Literature
No full textTongue (lingual) cysts occurring on the dorsal or ventral surfaces present as swellings. These swellings could cause difficulty in eating, drinking, speaking or breathing. Lingual cyst with respiratory epithelium (LCRE) is a rare developmental cyst of which about 23 case reports exist in the literature. This report aimed to document a case of LCRE from our centre to update the literature and to distinguish it from other cysts of the tongue with or without respiratory epithelium in addition to other content. We present a case of lingual cyst in a 4-year-old boy of 4 years; histopathologic features revealed a cystic lesion lined by columnar ciliated epithelium with goblet cells, focal areas of squamous epithelium and areas of inflammation in the connective tissue. This confirms a diagnosis of LCRE. A discussion on the clinical and microscopic features that distinguishes it from the other tongue cyst is presented, and the need for an appropriate nomenclature is highlighted
Interactive E-Learning Module: Enhancing Panoramic Radiograph Interpretation Skills of Dental Students
No full textObjectives: Two interactive e-learning modules were developed, focusing on dental panoramic radiograph (DPR) interpretation and a virtual dental clinic (VDC) for communication skills. The aim of the study was twofold: to quantitatively evaluate the effectiveness of the modules in enhancing students\u27 skills in interpreting DPRs and complying with reporting standards in clinical practice, and to qualitatively assess students\u27 perceptions of the module\u27s effectiveness. Methods: A mixed-methods cohort study was conducted over four weeks and included forty-five dental students in their final year. Students were assessed using objective structured radiographic interpretation and objective structured clinical examination assessments before (baseline) and after the e-learning modules. Student perceptions of the modules were evaluated quantitatively using an online questionnaire and qualitatively in focus group discussions. Quantitative data were analyzed using a Wilcoxon signed rank test. Qualitative data from focus group discussions were analyzed using thematic analysis. Results: After the modules, students’ DPR interpretation skills improved for reporting radiographic findings (all p \u3c 0.01), anatomical landmark identification (all p \u3c 0.05), and pathology detection (all p \u3c 0.05). Communication skills improved for reduced jargon usage (p \u3c 0.01). Compliance with DPR reporting increased from 63.3% before to 81.3% after the module (p = 0.03). Students indicated positive perceptions of the modules, highlighted their flexibility, and provided reinforcement. Conclusion: The e-learning modules with DPR and VDC significantly enhanced student skills in DPR interpretation and clinical communication. These findings support the integration of e-learning modules in dental curricula to improve diagnostic accuracy, knowledge retention, and communication skills
Management of Medication-Related Osteonecrosis of the Jaw in Multiple Myeloma Patients With Pentoxifylline and Tocopherol: Case Reports
No full textMedication-related osteonecrosis of the jaw (MRONJ) is a well-known side effect of bone-modifying agents such as antiresorptive medications including pamidronic and zoledronic acids (intravenous bisphosphonates) and denosumab (anti-RANK ligand humanized monoclonal antibody). The major risk factor for the precipitation of MRONJ in a patient taking antiresorptive medication is dentoalveolar trauma such as dental extractions. Management of MRONJ in oncology patients is exceptionally challenging. In this report, two multiple myeloma patients with longstanding advanced-stage MRONJ were successfully managed with combined pentoxifylline–tocopherol treatment pre- and postextraction/sequestrectomy. In conclusion, based on this report and other published reports, it appears that the use of combined pentoxifylline–tocopherol protocol in the management of MRONJ is effective
Assessing the Psychosocial Impacts of Whole-Genome Sequencing Outcomes on Orofacial Cleft Caregivers in Nigeria: A Mixed-Methods Study
No full textObjective: To investigate the behavioral outcomes of children with clefts and the psychosocial impact and mental health experiences of their caregivers regarding unintended outcomes of genomic sequencing, that is, secondary genetic findings (SFs). Design: Convergent parallel mixed methods. Setting: The cleft and immunization clinics at the Lagos University Teaching, Hospital, Nigeria. Participants: In total, 127 cases and 158 control caregiver child dyads (quantitative) and 22 caregivers of children with clefts (qualitative). Main Outcome Measures: Standardized questionnaires were used to assess caregiver-reported mental health, quality of life (QoL), and their children\u27s behavioral difficulties. In 2 focus groups, participants shared their perspectives on genomic testing outcomes, including SFs, mental health, and expectations in the context of clefts. Results: Compared to the control group, caregivers of children with clefts reported poorer mental health, lower QoL and more behavioral difficulties in their children. Also, they believed that introducing genomic testing outcomes, including SFs, may exacerbate existing burdens. Following qualitative data analyses, 5 themes emerged—genetics knowledge/awareness, stressors, cognitive appraisals, coping/support strategies, and negative impact/positive gains. Both qualitative and quantitative results showed that caring for children with clefts required significant financial resources placing substantial stress on caregivers. Conclusions: These findings highlight the importance of addressing caregivers’ psychosocial needs and the need for proactive measures to prepare for the return of genomic sequencing outcomes to patients and research participants, particularly in resource-limited settings like Africa, where such support may be lacking
Digital Analysis of Dentogingival Factors Influencing the Gingival Margin Position in the Esthetic Zone
No full textObjectives: To investigate the correlation between gingival thickness (GT) and buccal bone thickness (BBT), as well as the effects of GT, BBT, bone crest level (BC), and tooth position on the buccal gingival margin location of maxillary teeth in the esthetic zone. Materials and Methods: Periodontally healthy subjects with prior cone beam computed tomography and intraoral scans for dental implant planning were included. The hard and soft tissue measurements were retrospectively analyzed digitally. Pearson\u27s correlation and ANOVA were used to evaluate the correlations between clinical/anatomical crown height ratios (CCH/ACH), gingival and buccal bone thicknesses, and the distance between the CEJ and BC (CEJ-BC). Results: Forty-two subjects with 252 teeth were analyzed. A positive correlation was found between GT and BBT (p \u3c 0.001). GT and BBT were negatively correlated with CCH/ACH (p = 0.006 and p = 0.004, respectively), while CCH/ACH showed a positive correlation with CEJ-BC (p \u3c 0.001). Conclusions: Within the limitations of our study, we concluded that gingival and buccal bone thicknesses were positively correlated. A thicker gingival phenotype and higher coronal bone crest were linked to a more coronal gingival margin in the esthetic zone
Evaluation of Condyle–Fossa Relationships in Adults with Various Skeletal Patterns Using Cone-Beam Computed Tomography
No full textThis study assessed the condyle–fossa relationships in adults with different skeletal patterns using cone-beam computed tomography (CBCT). A total of 135 adult participants were included in the analysis of the CBCT images. Participants were categorized based on gender, age, race, and skeletal patterns. The measurements of the temporomandibular joint spaces were taken, which include the anterior (AS), superior (SS), posterior (PS), medial (MS), central (CS), and lateral (LS) spaces. Additionally, the dimensions of the condyle were assessed, including mediolateral thickness (MLT), anteroposterior thickness (APT), articular slope (ArS), and the vertical height of the fossa (VHF). These measurements were then compared. The average ratios of AS:SS:PS and MS:CS:LS were 1.00:1.61:1.18 and 1.00:1.15:0.79, respectively. The average values of most measurements were significantly higher in males than in females. The average value of APT was significantly higher in the late age group than in others, but there was no statistical difference according to race. The average values of PS, CS, and LS were significantly higher on the left side than on the right, while the average value of AS was significantly higher on the right side than on the left. The average values of SS, CS, and MLT were significantly higher in hypodivergent than in hyperdivergent skeletal patterns, while the average values did not show any statistical differences based on horizontal skeletal patterns. The average values of SS and CS in the Class II horizontal skeletal group were significantly lower in hyperdivergent individuals compared to other vertical skeletal patterns. In adults, statistical differences in condyle–fossa relationships were observed based on gender, age, sides, and skeletal patterns, but no differences were identified according to race
Trends Among Orthodontists- In-office Vs. Commercial Clear Aligners
No full textIntroduction: The purpose of this study is to investigate the usage of in-office versus commercial clear aligners (CAs) among private practitioners.
Methods: An anonymous electronic survey was distributed to a random sample of practicing America Association of Orthodontists members in North America, asking about CA usage and case selections for in-office and commercial CA.
Results: Ninety five responses were analyzed. Ninety one (95.8%) use a CA system in their practice. Orthodontists prefer using CAs for mild to moderate crowding (96.8%) or spacing (80.9%), anterior open bite (73.4%), expansion (64.9%), and sagittal correction (64.9%). A small number fabricate their aligners in-office (27.4%). Nearly half (49.5%) believed that they would increase their use of in-office CAs in the future.
Conclusions: In-office CAs are a cost efficient system that enhances clinician control with decreased turn around time, showing similar results to fixed orthodontic appliances and commercial CAs. In-office CAs are a great option for clinicians, as there is an increased desire to integrate the system, allowance of full customization of treatment, and complete doctor control
Oral Nicotine Pouches: Histology of Oral Mucosa with Chronic Use
No full textObjective: Oral Nicotine Pouches (ONP’s) are a new generation of tobacco-free nicotine pouches, which are used recreationally. Unlike snus and smokeless tobacco, ONP’s contain pharmaceutical-grade nicotine as their major ingredient, along with flavorings, buffers, and preservatives. Limited research has examined the impact of ONP use on oral tissues. The purpose of this case-series study was to perform histologic evaluation of oral mucosa in chronic ONP users. Diagnostic status of oral mucosa in chronic users is critical for assessing overall risk for adverse outcomes from recreational ONP use.
Methods: Individuals who self-reported ONP use were recruited for the study. Chronic ONP use was defined as more than 100 days of continuous usage. Data collected included self-reported ONP use, duration/frequency of use, and concurrent alcohol use. Subjects received an oral examination and a 4mm punch biopsy using local anesthesia. Biopsy locations were dependent on either presence of clinically affected tissue or site of most common use. Selected sites were photographed prior to the procedure. Biopsies underwent standard histologic analysis and were given a diagnosis from a board-certified pathologist.
Results: Ten male participants, ages 22-29 years, used an average of 7.1 pouches/day with an average duration of 4 years of use. The majority of the cases (n=9, 90%) demonstrated epithelial hyperplasia, hyperkeratosis, and chronic mucosal inflammation. A single case showed reactive atypia, which warrants long term clinical follow up. A second case captured a minor salivary gland which showed atrophy and the deposition of amorphous eosinophilic material, similar to what is seen in tobacco pouch keratosis. All cases were negative for epithelial dysplasia and carcinoma. Seven participants reported an average increase of 4.71 pouches when consuming alcohol.
Conclusion: Chronic ONP use produces an inflammatory response at the site of pouch placement
Value Discrepancy of Zirconia Post-Sintering Compared to Manufacturer’s Shade Tab
No full textBackground: Zirconia is an excellent material for crowns, but clinical observations have shown that post-sintered zirconia often appears lighter than indicated on the manufacturer’s shade tab. This discrepancy is particularly noteworthy when working in the esthetic zone. This in vitro study aims to assess the difference in value between post-sintered zirconia and the corresponding value reported by the manufacturer.
Methods: Three types of zirconia (Yttria Multi-Layered [YML], Super-Translucent Multi-Layered [STML], and Ultra-Translucent Multi-Layered [UTML]) were milled in shades A1, A2, and A3, polished, sintered, and re-polished according to manufacturer instructions. Crown values were measured with a spectrophotometer and compared to the manufacturer\u27s Vita Classic shade tab. These values were converted to 3D Master shades for analysis of value alone.
Results: A Chi-Squared test (X²(5, N = 108) = 62.61, P \u3c 0.001) indicated the percentage of agreement between the post-sintered crown values to the manufacturer\u27s reported value for the zirconia blocks. Shades A3 showed the most agreement (72.2%), while A1 showed some agreement (33.3%) and A2 showed the least agreement (5.6%). In other words, the value of shade A3 showed no significant difference from the standard tabs, while A1 and A2 exhibited significant discrepancies.
Conclusion: Findings show a discrepancy in post-sintered zirconia values compared to values reported by the manufacturer in shades A1 and A2 but not A3. This finding is important for clinicians, as it can aid in making a more informed decision during shade selection, ultimately impacting patient satisfaction. Additionally, this highlights the need for the manufacturer to develop a shade guide tailored specifically to the zirconia materials, ensuring more accurate shade matching