Mini-Implant-Assisted Simultaneous Torquing Extrusion Retraction Spring for Ectopic Canines

Orthodontic management of ectopic canines is quite challenging and time consuming due to the presence of thin buccal cortical bone. Sectional mechanics provide distal and extrusive force on canine but without any torque control. So, palatal root torquing during canine retraction is needed to increase the buccal cortical bone thickness and to avoid bone dehiscence and gingival recession. This article describes an innovative spring which provides 3-dimensional control by simultaneous retraction, extrusion, and torquing of ectopic canine.

Gene expression of inflammatory immune factors and clinical parameters in diabetes and nondiabetes patients with periodontal disease

Objective: This study evaluated clinical, glucose, and immunological parameters in patients with type 2 diabetes mellitus (DM) compared to those without systemic alterations (NDM), both with generalized chronic periodontitis. Methodology: Twenty-one patients were selected with indications of tooth loss. Surgeries were performed using the Widman flap modified to obtain a gingival collar at 1 mm from the gingival margin. Before the surgical procedure, the following clinical parameters were evaluated: pocket probing depth (PPD), gingival recession (GR), clinical attachment level (CAL), and bleeding on probing (BOP). Fasting glucose levels (FGL) and glycosylated hemoglobin Hba1c (HbA1c) were also assessed. During the surgery, gingival tissue samples were collected and frozen for later laboratorial analysis. The samples were processed to obtain mRNA, cDNA and determine the gene expression of the immune parameters IL-1-β, IL-6, TNF-α, IL-10 and NF-kB by real-time polymerase chain reaction (RT-PCR). Data were analyzed statistically considering p<0.05. Results: The clinical and glucose parameters BOP, FGL, and HbA1c were statistically higher in the DM group. RNAm levels of IL-1β, TNF-α, and NF-kB were higher in the DM group (p<0.05). Conclusion: The presence of diabetes and hyperglycemic status increase the levels of pro-inflammatory immune factors and severity of the periodontal disease.

Coronally Advanced Flap with Connective Tissue Graft for Treating Orthodontic-Associated Miller Class III Gingival Recession of the Lower Incisors: A One-Year Retrospective Study

(1) Background: To assess the clinical outcome of coronally advanced flap combined with connective tissue graft for the treatment of orthodontic-associated Miller Class III gingival recession of the lower incisors. (2) Methods: This study included 15 patients who had undergone orthodontic treatment prior to development of recession. Measurements of recession depth, recession width, probing depth, and width of keratinized tissue were performed clinically immediately before surgery and after one year. In addition, digital measurements of recession depth, recession width, and root coverage esthetic score were performed on intraoral photographs. (3) Results: Significant reduction was observed for probing depth, recession depth, and recession width at one year, with significant increase in width of keratinized tissue. Mean root coverage was 83 ± 24% for recession depth, while complete root coverage was achieved in 10 out of 21 recessions (48%). The average root coverage esthetic score at 12 months was 7.1 ± 2.6. An interaction was found between initial recession depth and mean root coverage. (4) Conclusions: Within the limitations of this study, our results confirm that combination of coronally advanced flap and connective tissue graft is effective in reducing post-orthodontic Miller Class III recessions of the mandibular incisors, even when the correction of the tooth malposition, is unattainable.

Modified Coronally Positioned Flap for Isolated Gingival Recession, Evaluated with Root Coverage Esthetic Score System

Background: Various modifications of the coronally displaced flap have been proposed in the literature with the attempt of treating gingival recession. This study is undertaken to evaluate the predictability of the modified coronally positioned flap in isolated gingival recession not only in terms of root coverage but also with the esthetic outcome. Materials and Methods: Fifteen isolated gingival recessions with at least 1mm of keratinized tissue apical to the defect were treated with a modified coronally advanced flap. All recessions fall into Miller class I. The clinical re-evaluation was performed 3 months and 1year after the surgery. Statistical analysis was performed using statistical application software (SPSS16.0). Multivariate ANOVA was used for analysis. Results: At the 1-year examination, the average root coverage was 94.6% of the pre-operative recession depth. There was a mean clinical attachment gain of 3.3±0.1 mm at 1 year follow-up.The average increase of keratinized tissue between the baseline and the 1-year follow-up amounted to 1.53±0.13 mm. Root coverage esthetic score (RES) was recorded at the end of follow-up period. 13/15 cases showed RES score of 9 and 2/15 cases showed RES score of 6. Conclusion: The modified coronally advanced surgical technique is effective in the treatment of isolated gingival recession in the upper jaw.

A Comparative Clinical Study of Er:YAG Laser and Hand Instruments in the Treatment of Moderate Chronic Periodontitis

Introduction: Moderate chronic periodontitis is the most common periodontal disease. The treatment of this condition should aim at achieving a biocompatible root surface and decontamination of the pocket, thereby restoring the health status. Aim: In the present study, the aim was to examine the clinical effectiveness of fibreless Er:YAG laser used for scaling and root planing and to compare it with a conventional treatment with Gracey curettes. Materials and methods: The study included 909 periodontal pockets which were treated in a split-mouth design with either Gracey curettes or with Er:YAG laser (1.5 W). Probing pocket depth (PPD), gingival recession (GR), clinical attachment level (CAL), bleeding on probing (BoP), and plaque index were recorded. Results: There was a considerable decrease of PPD, CAL, BoP, and plaque presence values at 1 and 3 months after therapy in both treatment groups. Sites treated with Er:YAG laser demonstrated mean CAL gain of about 1.00 mm and 0.44 mm at the first and third month, respectively. In the control group, there was also significant gain of CAL of about 1.33 mm at the first and 0.30 mm at the third month. Significant difference was observed in all parameters between both groups in favour of the laser treatment. Conclusions: The results of the present study suggest that the Er:YAG laser shows clinical effectiveness in the treatment of moderate chronic periodontitis. It can be used as a single treatment modality for subgingival scaling and root planing resulting in greater improvements in all recorded data in contrast to conventional treatment.

Detailed three-dimensional orthodontic tooth repositioning to improve restorative outcome:

ABSTRACT The case describes the interdisciplinary treatment of a 23-year-old woman with a Class III malocclusion, missing an upper right lateral incisor, abrasion of the maxillary incisal edges, anterior gingival margin discrepancies, and gingival recession. Initially, the patient was treated with fixed appliances combined with orthognathic surgery. The extraction of the upper left lateral incisor and bilateral canine substitution plan was chosen. At the end of the surgical and orthodontic treatment, the restorative treatment with six veneers was accomplished to improve smile esthetics. Despite the missing lateral incisors, the patient showed a natural, good-looking final result. A symmetric incisal plane was established, a functional occlusion with average vertical and horizontal overlap was set, and the bone scallop and consequently the gingival margins were leveled. The interdisciplinary approach hid all of the initial esthetic defects of the case. The result highlights how to obtain a remarkable improvement of the smile outcome with a well-functioning masticatory system.

Retrospective Study Regarding Orthodontic Retention Complications in Clinical Practice

At the end of any orthodontic treatment, retention is a necessary phase. Unfortunately, the current retention devices and the lack of proper oral hygiene on the part of patients lead to the accumulation of dental plaque, periodontal inflammation, and gingival retraction. Our retrospective study included 116 adult patients wearing various types of orthodontic retainers. To quantitatively determine the accumulation of dental plaque, we used the Quigley–Hein plaque index modified by Turesky and the Navy plaque index modified by Rustogi. Another studied parameter was related to the gingival recession associated with retention devices. We had investigated the correctness of patients’ dental hygiene, their preferences for auxiliary means of oral hygiene, the consistency with which they wear the mobile retainers, and respect the orthodontist’s instructions; we also investigated the inconveniences and the accidents that may occur during the retention period. Statistical analysis showed that plaque accumulation is significantly lower in the case of mobile retainer than fixed retainer wearers; the exception was the Hawley plate, where the interdental plaque was more than in all the other studied retainers. Periodontal recessions were more frequent in the case of fixed retainer wearing. Flossing was the most commonly used auxiliary mean for oral hygiene. The compliance of women in wearing vacuum-formed retainers was better than that of men. Patients with a class III history had more plaque accumulation, and class II/1 had the most problems related to detachment/damage of fixed retainers. Mobile retainers proved better results for oral hygiene, but fixed retainers cannot be waved.

Alveolar Bone Morphotype in Orthodontic Patients

Orthodontic treatments have been described as a risk factor for the development of gingival recessions. This descriptive and cross-sectional study was performed to evaluate the alveolar bone morphotype of the upper and lower anterior of 33 orthodontic treatment of candidate patients. The images were obtained from a high-resolution cone beam computerised tomography. Then, the thickness of the alveolar bone plate of teeth was measured in six levels, recording the presence of dehiscences and fenestrations. A total of 2,334 sites were evaluated. The average thickness of the maxillary alveolar bone at the buccal surface was 0.70, 0.62 and 1.43 mm at the cervical, middle and apical levels, respectively, while in the mandibular teeth it was 0.53, 0.50 and 2.96 mm. At the palatal and lingual surfaces, the bone was thicker than the buccal except at the apical level of the mandible. Most of the examined sites were measured less than 1 mm (n = 1,235, 52.9%), associated with high prevalence of bone dehiscences (57.6%) and fenestrations (33.3%), particularly in skeletal Class III patients. The observed bone morphotype involved a high vulnerability to bone resorption, and the subsequent gingival recession occurrence, face to orthodontic movements.

The Potential of Hydroxyapatite Toothpaste towards the Hypersensitive Tooth

Dental hypersensitivity is a communal problem that we may often encounter in the daily life of both men and women, especially in the elderly who can unconsciously affect every daily activity. Dentin hypersensitivity is defined as sharp pain caused by stimulation of exposed dentin and unprotected dentin by enamel which can be caused by attrition, abrasion, crown fracture, gingival recession, and orthodontic trauma. Aim: The aim of this study was to analyse the potential of hydroxyapatite toothpaste towards the hypersensitive tooth through literature review. Method: This study analyzed 35 journals from each database PubMed, Ebsco, Google Scholar, ResearchGate, Wiley Online Library, and other international journal websites with keywords hydroxyapatite, hypersensitive dentin, remineralization. Conclusion: Toothpaste containing hydroxyapatite was more effective than toothpaste without hydroxyapatite in inducing tooth remineralization process. The use of toothpaste containing hydroxyapatite in the long term and routine for 15 days is more effective in reducing dental hypersensitivity.