Maxillary Distomolar Associated with Dentigerous Cyst: An Unusual Entity

Supernumerary teeth may be encountered as an incidental finding on a radiograph. When impacted, they may be associated with clinical signs related to different problems such as failure of eruption, teeth displacement, root resorption or cystic lesions. They may occur in primary and permanent dentition, in both the maxilla and mandible and can be single or multiple in patients with syndromes. Mesiodens is the most commonly impacted tooth and appears between the central maxillary incisors in pediatric ages. Supernumerary teeth distal to the third molar are rare, usually impacted and referred to as a distomolar. A 46-year-old male consulted with the main complaint of pain on the left side of the maxilla. A panoramic radiograph revealed a right impacted maxillary fourth molar located posterior to the third molar associated with a pericoronal radiolucency. The supernumerary tooth was removed surgically under local anesthesia and the pericoronal lesion enucleated. Histopathological examination was consistent with the diagnosis of a dentigerous cyst associated with an impacted distomolar. Healing was uneventful, and the patients remained asymptomatic. The occurrence of a maxillary distomolar is rare and even rarer the association with a dentigerous cyst.

Total Edentulism and Its Epidemiological Surveillance in Oaxaca, Mexico from 2009–2019

Total edentulism is the loss of all teeth for any cause by a multifactorial process that involves biological and patient-related factors. Studies on edentulism and risk factors in Mexico are limited, and the epidemiological surveillance data is scarce and controversial since official governmental reports are not statistically representative of the country. We estimate the distribution for edentulism according to sociodemographic and socioeconomic variables in adults from a low-income state in 2003 and its progress in Mexico. We analyzed data from the National Performance Evaluation Survey in Oaxaca, Mexico, and the annual reports of the Epidemiological Surveillance System of Oral Pathologies in 2009–2019 using X2. Oaxacan patients older than 75 y.o. (17.9%, p < 0.05), those with lower schooling (11.2%), and diabetes (14.5%) presented the highest percentage of edentulism. We do not observe differences in edentulism between sex or residence (p > 0.05). From 2009 to 2019, country data reports the lowest rate of edentulism in adults over 20 y.o. (0.32%; 95% CI 0.18–0.48%) and the most affected population over 79 y.o. (7.29%; 95% CI 5.2–9.30%). As it is a cumulative phenomenon, it is necessary to establish better surveillance, prevention, and treatment programs to improve the oral health of older thus reducing edentulism.

Survival of Fiber-Reinforced Composite Resin Post-Restored vs. Cast Post-and-Core-Restored Teeth: A Retrospective Clinical Study

Objective: The question of whether classic cast post-and-core (CPC) or fiber-reinforced composite resin posts (FRCP) are the best clinical decision has still not been fully solved. Materials and Methods: One hundred and sixty-two teeth were restored with FRCP, and 162 CPC restored teeth were included in this study with a matched-pair design. In a primary analysis, the survival rates after one year (primary endpoint) were compared. The additional analysis included an evaluation of tooth- and construction-specific variables and an illustration of the survival up to 60 months via Kaplan-Meier curves. Results: FRCP showed lower failure risk considering the definitive prosthetic restoration and tooth type compared to CPC restored teeth. In total, 17 failures were observed in the FRCP group and 35 failures in the CPC group. A 60-month survival rate of 79.3% for FRCP and 64.5% for CPC was observed. Teeth serving as abutments for telescopic dentures were more likely to be affected by failure compared to teeth restored with single crowns. Conclusion: Within the limitations of this study, the FRCP showed a lower failure risk compared to the CPC, considering the definitive prosthetic restoration and tooth type within the observation period.

From Denture to the Final Implant-Supported Prosthesis Using a Full-Digital Protocol: A Dental Technique

Proper maxillomandibular relationship registration can be clinically challenging during a digital workflow in full-arch rehabilitations. This dental technique requires the manufacturing and use of a hybrid surgical guide custom scanning device, indicated to be used during implant placement surgery, in addition to being used to simultaneously register the maxillomandibular relationship and transfer the implants’ 3D positioning, ensuring a fully digital workflow in full-arch implant-supported prosthesis rehabilitation. The sequence of steps presented here will allow dentists and dental technicians to conduct rehabilitations from denture to the final implant-supported prosthesis using a full-digital protocol, using a minimal quantity of intraoral devices and digital tools.

Oral Squamous Cell Carcinoma Mimicking Medication-Related Osteonecrosis of the Jaws (MRONJ): A Case Series

(1) Background: Medication-related osteonecrosis of the jaw (MRONJ) is a potential adverse drug reaction of antiresorptive and/or antiangiogenic treatment. MRONJ is mostly diagnosed by anamnestic data, clinical examination and radiological findings, with signs and symptoms often unspecific. On the other hand, oral squamous cell carcinoma (OSCC) is characteristic for its pleomorphic appearance (e.g., ulcer, mucous dehiscence, non-healing post-extractive socket). We report three cases where OSCC mimicked MRONJ lesions. (2) Patients: Three patients undergoing amino-bisphosphonate treatment for osteoporosis presented with areas of intraorally exposed jawbone and unspecific radiological signs compatible with MRONJ. Due to the clinical suspicious of malignant lesion, incisional biopsy for histological examination was also performed. (3) Results: Histological examination of the tissue specimen revealed the presence of OSCC. All patients underwent cancer treatment. (4) Conclusions: Several signs and symptoms of OSCC may simulate, in patients with a history of anti-resorptive, MRONJ; for these reasons, it is important to perform histologic analysis when clinicians are facing a suspicious malignant lesion.

Social Determinants of Health-Related Quality of Life Outcomes for Head and Neck Cancer Patients

The influence of area-based and individual indicators of socioeconomic status (SES) on health-related quality of life (HRQOL) and patient concerns following head and neck cancer is complex and under-reported. The aim of this study is to use baseline data collected as part of a randomised controlled trial to provide greater detail on the attribution of SES to University of Washington Quality of Life version 4 (UWQOL v4), Distress Thermometer and European Quality of Life Five-Dimension Five-Level (EQ-5D-5L) outcomes. A total of 288 trial patients attended baseline clinics a median (Interquartile (IQR)) of 103 (71–162) days after the end of treatment. Area-based SES was assessed using the Index of Multiple Deprivation (IMD) 2019. Thirty-eight per cent (110/288) of patients lived in the most deprived IMD rank quintile. Less than good overall quality of life (31% overall) was associated with current working situation (p = 0.008), receipt of financial benefits (p < 0.001), total household income (p = 0.003) and use of tobacco (p = 0.001). Income and employment were significant patient level indicators predictors of HRQOL outcomes after case-mix adjustment. The number of Patient Concerns Inventory items selected varied significantly by overall clinical tumour clinical stage (p < 0.001) and by treatment (p < 0.001) but not by area IMD or patient-level deprivation indicators. In conclusion, interventions to improve employment and finance could make a substantial positive effect on HRQOL outcomes and concerns.

Effect of Abutment Type and Tightening Sequence on Torque Maintenance Capacity after Mechanical Cycling in Splinted Implant-Supported Restorations

The aim of this study was to compare the screw removal torque of mini-conical prosthetic components and straight trunnion of indexed morse taper implants after mechanical cycling. The sample consisted of 40 implants and 20 mini-conical prosthetic components (MC group) and 20 straight trunnion components (ST group). Each group consisted of 10 specimens, with 2 implants in each, and cobalt–chromium metallic crowns were screwed into each sample. The components of the MC group received a torque of 20 N-cm with a digital torque wrench, and after 10 min were retightened with the same value as the initial torque. The components of the ST group received a torque of 30 N-cm, with a digital torque wrench, and after 10 min, they were retightened with the same value. The screws of the respective crowns of the two groups received a torque of 10 N-cm and after 10 min were retightened with the same value. Each group was subjected to the fatigue test in a mechanical cycler at 2,000,000 cycles, with a load of 250 N and frequency of 4 Hz. At the end of the fatigue test, the loosening torque of each screw of the specimens was measured through a digital torque wrench. The data were analyzed by two-way ANOVA and a Tukey test. In both groups, there were loss of torque. The results showed no statistic difference between MC and ST groups (p > 0.05).

The Utility and Feasibility of Routine Use of a Patient-Reported Outcome Measure in Paediatric Dentistry

Within healthcare services, there is increasing emphasis to incorporate patient-reported outcome measures (PROMs), rather than relying solely on clinical outcomes. A 12-item caries-specific measure (CARIES-QC) has been developed and validated for children aged 5–16 years. To date, the routine use of PROMs in paediatric dentistry new patient clinics (NPC) has not been reported. The aim was to conduct a pilot study to assess the feasibility, utility and validity of routine use of a PROM in paediatric dentistry NPC in a UK teaching hospital. Children attending NPC over a four-week period were asked to complete CARIES-QC with an additional free-text box. Interviews were held with members of staff to assess the feasibility of using a PROM routinely. CARIES-QC was completed by 99 children. Almost half of the participants had caries (n = 49, 49.5%). CARIES-QC demonstrated good internal consistency (Cronbach’s alpha = 0.9) and reliability with the global question (r = 0.75, p = 0.01). Clinical staff valued the information provided by the PROM. An electronic delivery method would be beneficial to both clinical and administrative staff. CARIES-QC was able to capture impacts for children with a range of oral conditions. Its use aided treatment planning and future studies should investigate the use of an electronic delivery system to reduce the administrative burden.

Stress Distribution in Modified Veneer Crowns: 3D Finite Element Analysis

(1) Background: to propose a new approach for crown veneers, with the use of an aesthetic porcelain coating, only in part of the zirconia infrastructure, and to analyze its biomechanical behavior to minimize chipping failures. (2) Methods: a maxillary molar was modeled using CAD software, preparing for traditional crowns and veneer crowns with various lengths. Five groups were formed: M—control group (monolithic crown of ultra-translucent zirconia); B—conventional (bilayer crown of ultra-translucent zirconia and ceramic covering); V—veneer (ultra-translucent zirconia crown with reduction only in the buccal and application of covering ceramics); V1—ultra-translucent zirconia crown with buccal reduction and 1 mm occlusal extension for covering ceramic application); V1.5—ultra-translucent zirconia crown with buccal reduction and 1.5 mm occlusal extension for application of covering ceramics. A load of 600 N was performed axially to a fossa bottom to simulate parafunction, and 300 N to the cusp tip to obtain the maximum principal stress results. (3) Results: group B showed a higher stress concentration in the occlusal region of the restorations, while the other groups absorbed the stress and dissipated it throughout the crown, presenting a higher stress concentration in the interface region with the tooth. (4) Conclusion: the highly translucent zirconia ceramic only associated with buccal covering ceramic could add aesthetic gain and rigidity to the system and could be a good option to restore maxillary molars in patients who do not have parafunction.

Association between Diabetes and Dental Caries in Spanish Adults: A Cross-Sectional Study Including 23,089 Adults

The aim of the study was to investigate the cross-sectional association between diabetes and dental caries in a representative sample of 23,089 adults residing in Spain. Data from the Spanish National Health Survey 2017 were analysed. Diabetes (independent variable) and dental caries (dependent variable) were evaluated through a self-reported questionnaire. The association between diabetes and dental caries in the overall sample was assessed using logistic regression models adjusted for sex, age, marital status, education, smoking, alcohol consumption, obesity, hypertension, and hypercholesterolemia. The prevalence of dental caries was 20.6% in the overall population and was significantly higher in men and in young (≤40 years) and middle-aged adults (41–65 years) than in women and older adults (>65 years), respectively. After adjusting for control variables, there was a positive and significant association between diabetes and dental caries in the overall population (OR = 1.30, 95% CI = 1.15–1.46). The relationship between diabetes and dental caries was particularly strong in women (OR = 1.45, 95% CI = 1.22–1.71) and in adults aged ≤40 years (OR = 1.80, 95% CI = 1.05–3.05). In conclusion, in this large representative sample of Spanish adults, diabetes was associated with having a higher prevalence of dental caries, with females and younger adults at greatest risk. Patients with diabetes and dental practitioners should be aware of these associations and act accordingly. Future research should aim to investigate the mediating factors involved in the observed association between diabetes and dental caries.