Is the Mandibular Condyle Involved in Medication-Related Osteonecrosis of the Jaw? Audit of a Single Tertiary Referral Center and Literature Review

Background: Medication-related osteonecrosis of the jaw (MRONJ) may manifest as exposed mandible bone. Recent reviews of the incidence of MRONJ report primarily as exposed cortical bone of the mandibular body, ramus, and symphysis with no reports of condylar involvement. Objective: The aim of this study is to analyze the topographical incidence of MRONJ, comorbidities, demographics data, and clinical characteristics of patients diagnosed with MRONJ between 2014 and 2019 in the Maxillo-Facial Surgery Department University of Campania “Luigi Vanvitelli”, and compare these results with published reports. Methods: Data on 179 patients were collected for the study, including gender, age, underlying malignancy, medical history, and specific lesion location-identifying premaxilla and posterior sectors area involvement for the maxilla and symphysis, body, ramus, and condyle area for the mandible. A literature review was performed in order to compare our results with similar or higher sample sizes and find if any condylar involvement was ever reported. The research was carried out on PubMed database identifying articles from January 2003 to November 2020, where MRONJ site distribution was discussed, and data were examined to scan for condylar localization reports. Results: 30 patients had maxillary MRONJ, 136 patients had mandibular MRONJ, and 13 patients had lesions located in both maxilla and mandible. None of the patients reported condylar involvement, neither as a single site nor as an additional localization. Literature review results were coherent to our findings showing no mention of condylar MRONJ. Conclusion: Results do not show reports of condylar involvement in MRONJ. Although the pathophysiology of the disease has not been fully elucidated, two possible explanations were developed: the first one based on the condyle embryogenetic origin; the second one based on the bisphosphonate and anti-resorptive medications effects on the different vascular patterns of the mandible areas.

Comparison of an Air-Fed Mask System with Hospital-Issued Personal Protection Equipments for Dental Aerosol Protection During the COVID-19 Pandemic

Aim: A pilot study was conducted with the aim of developing a system to protect the eyes, nose, and mouth from the aerosol generated from a high-speed dental handpiece during the COVID-19 pandemic. Background: The SARS-CoV-2 virus is known to be present in the saliva of an infected individual during the contagious viral shedding phase of the disease. The use of rotary dental instruments places oral health practitioners at risk of contracting COVID-19 from infected individuals. In particular, it is very difficult to protect the mucous membranes of the face against the extremely fine aerosol produced from a high-speed dental handpiece. Objectives: This study aimed to develop and test a novel PPE system for use during the COVID-19 pandemic. An air-fed spray-painting mask was used under a plastic hood to protect against the aerosol from a high-speed dental handpiece. This was found to be superior compared to hospital-issued N-95 masks and eye protection in our test model. Methods: Subjects donned various forms of PPE whilst using a high-speed dental handpiece in a confined cubicle. The efficacy of each form of PPE was evaluated by adding fluorescein to the water coolant supply line of a high-speed dental handpiece before checking for facial contamination with an ophthalmology slit lamp. Results: Under our test conditions, the N-95 mask did not prevent nasal and mouth contaminations, but the combination of an air-fed mask with a sealed hood prevented these contaminations. Although goggles worn tightly did prevent contamination, the air-fed mask system was far more comfortable and did not fog up. Discussion: Under the rigorous test conditions of our model, we found hospital-issued PPE ineffective. We also found the single strategy of using positive airflow into a face mask ineffective, even with extremely high levels of airflow. Complete protection was only achieved reliably by the combination of physically sealing off the face from the surrounding airspace and using the air-fed system to provide an external source of air to breathe. We effectively made the clinical equivalent of a dive bell helmet. The air-fed mask is supplied by a standard dental air compressor and is simple to install for someone familiar with the technical aspects of compressors. The compressor does not rely on a filter and proves effective with cheap and easily accessible disposable items. Conclusion: Under rigorous testing conditions, the developed air-fed mask system with a sealed hood on low flow performed better than hospital-issued PPE against high-speed dental aerosol protection. The developed system protects the operators from the air of the room contaminated with aerosol and brings in safe air from the outside for them to breathe.

The Use of Magnetic Resonance Imaging in Diagnostics of Radix Paramolaris: A Case Report

Background and Objectives: This case report aims to present a rare morphological variation of Radix Paramolaris (RP) diagnosed using Magnetic Resonance Imaging (MRI) to discuss its morphological associations and possible implications on dental treatment. Radix paramolaris is a buccally located supernumerary root of the permanent mandibular molars. It is very rare in the European population, with a prevalence below 4%. Case Presentation: A 7-year-old boy with severe Class II malocclusion is presented. The first phase of orthodontic treatment consisted of therapy with a removable activator appliance. Before the second phase of treatment, unilateral radix paramolaris on the second right permanent mandibular molar was discovered. Results: Supernumerary root was diagnosed using a 3T whole-body MRI system. This case confirmed the association between supernumerary roots and increased buccal crown cusps in a mandibular molar. Furthermore, it demonstrated the effectiveness of non-invasive MRI as a complementary diagnostic tool, offering clear advantages in diagnosing rare morphological variations such as supernumerary roots. Unlike conventional radiography, MRI is able to distinguish the soft tissues, including the dental pulp, and does not emit ionizing radiation. Conclusion: To diagnose a supernumerary root and the state of its pulpal tissue, a precise radiographic and clinical examination is required since awareness of exact root morphology can be of paramount importance in clinical decision-making for several dental procedures.

Evaluation of the Effect of Cold Plasma Treatment on the Microshear Bond Strength of Composite Resin Restorations to Dentin using Different Adhesive Systems and the Effect of Thermocycling

Introduction: Currently, non-thermal plasma is used to modify the enamel and dentin surfaces to improve the bonding surface to dental composite resins. Non-thermal plasma creates a hydrophilic surface, decreases the contact angle, and improves the bonding quality. The present study aimed to evaluate the microshear bond strength (µSBS) of composite resins to dentin using different adhesive systems. Materials and Methods: Bovine incisor teeth were randomly assigned to three groups of G-Premio, Clearfil SE Bond, and Adper Single Bond adhesive groups after preparation. Each group was divided into two subgroups in terms of argon plasma surface preparation, and each subgroup was divided into two groups in terms of thermocycling (n=12). The microshear bond strength of the samples was determined using a universal testing machine. Three-way ANOVA was used to analyze the effect of the adhesive, plasma preparation, and thermocycling. Post hoc Tukey tests were used for two-by-two comparisons of µSBS. Statistical significance was set at P <0.05. Results: The results of the µSBS test showed that the application of plasma resulted in a significant increase in the mean µSBS in the G-Premio group, with no significant increase in the Clearfil SE bond and Adper Single groups. The effect of thermocycling after plasma application was significant only in the Adper Single group. Conclusion: The application of plasma might increase the bond strength of composite resins to dentin. However, further studies are necessary.

Perspectives of Dental Practitioners Regarding Their Readiness for Medical Emergencies: A Study in Saudi Arabia

Background: Training dental practitioners on emergency preparedness and response is essential for the successful management of medical emergencies. Objectives: To assess the perceptions of dental practitioners in Saudi Arabia about their readiness to manage medical emergencies in the dental practices. Methods: This cross-sectional survey was conducted among dental practitioners working in 52 dental centers in Saudi Arabia. Questionnaires mainly gathered data on the measures taken by dental practitioners to prevent medical emergencies, BLS certification, availability of essential drugs and equipment, and perceptions of dental practitioners regarding the adequacy of their training for medical emergencies. Results: Of the total 270 participants, the majority reported that they take medical history (94%), perform visual inspection (90%), consult with patients’ physician when needed (89%), and modify treatment plan as necessary (94%). However, only 19% of them routinely take baseline vital signs for their patients and 52.6% have valid BLS certification. Only 29.6% and 16.3% of dental practitioners have reported that they have all essential drugs and equipment, respectively. Conclusion: The preventive measures for medical emergency appears to be deficient because most dental practitioners are not routinely taking baseline vital signs for their patients. This important issue is combined with shortage of BLS certification among dental practitioners and inadequate availability of all medical emergency drugs and equipment in dental practices.

Flipped Classroom Experiences in Clinical Dentistry – A Strategic Mini-Review

Background: Pedagogy in dental education has evolved over the decades. Today, many alternative modes of content delivery are being used as an adjunct to the traditional classroom. A flipped classroom is one among those that are being explored for teaching clinical dentistry. Objective: This mini-review is aimed at evaluating the available evidence in the efficacy of flipped classrooms and its related aspects in the learning curve of clinical dentistry. Methods: A thorough literature search on electronic databases for all the studies focusing on the following evidence-based question: “Is Flipped classroom in clinical dentistry a useful mode of pedagogy delivery? was performed. A combination of MeSH terms using Boolean operators “AND,” “OR:” FLIPPED [All Fields] AND (“dental health services” [MeSH Terms] AND “health” [All Fields] AND “services” [All Fields]) OR “dental” [All Fields]) AND (“learning” [MeSH Terms] OR “learning” [All Fields]). Specific terms such as “Perio” OR “Prostho” OR “Restorative” OR “Ortho” OR “Oral medicine” OR “Maxillofacial surgery” OR “Pediatric” OR “endo” was also used. Data from these articles addressing the aim of this study was extracted. Results: A total of 16 articles were considered for the review. The majority of the studies considered flipped classroom as a successful model of pedagogy. The most common mode of outside classroom activity was pre-recorded videos. In-classroom activities, a combination of seminars, interactive discussions, and quiz were explored. Time constraints, lack of faculty development programs are considered to be negative factors for the success of the flipped classroom. Conclusion: Within the limitation of the study, flipped classroom can be adapted as a method of pedagogy in clinical dentistry.

COVID-19 Pandemic Driven Knowledge, Attitude, Clinical Practice, Distress Reactions, and Post-Traumatic Growth of Dental Care Providers in Riyadh City, Saudi Arabia: A Cross-Sectional Study

Objective: The present study aimed to assess knowledge, attitude, clinical practices, distress reactions, and post-traumatic growth of dentists during the COVID-19 pandemic in Riyadh City. Methodology: An online questionnaire was developed to assess various dental professionals from both governmental and private sectors during the early COVID-19 outbreak in Riyadh City, Saudi Arabia. The questionnaire was framed to assess the demographic variables, knowledge, attitude, and clinical practices towards handling the COVID-19 pandemic. Furthermore, the general anxiety disorder-7 (GAD-7), worry questionnaire items, short form of post-traumatic growth inventory (PTGI-SF), and life satisfaction questionnaire items were developed to assess the anxiety, worries, post-traumatic growth, and life satisfaction of dental care providers following the traumatic events. Data were analysed using SPSS 22.0 and R environment ver.3.2.2. Continuous measurement results were presented as mean ± SD, and categorical measurements results were presented in number (%). Results: Our study's significant findings revealed that a majority of the dentists were in the age group of 21-30 and practiced general dentistry. The study participants in age groups 51–60 and 41–50 years old showed more liability in perceiving COVID-19 as an extremely dangerous disease than 31–40 and 21–30 age groups. The majority of respondents (63.4%) had an anxiety scale score of greater than 40, followed by 22.8% with scores 20-40 and 13.9% with scores less than 20, respectively. The mean scores for the GAD-7 and the worry items were 8.24 ± 3.21 and 13.92 ± 4.77, respectively. The data showed that most survey participants had adopted moderate post-traumatic changes during the pandemic, as evident by their mean score of 34.17 ± 3.40. The life satisfaction of the participants was neutral, as demonstrated by their mean score of 20.16 ± 4.03. Conclusion: This study’s findings delineated that the COVID-19 pandemic situation has influenced dentists' mental health, with a moderate level of anxiety, and worries among other psychological symptoms. Furthermore, there was adequate knowledge regarding the COVID-19 among dentists; however, the pandemic affected the financial conditions of the respondents. There was a moderate level of post-traumatic growth and neutral life satisfaction of the dental providers.

Effect of Die Materials on Marginal and Internal Adaptation of Zirconia Copings: An In Vitro Study

Aim: Close adaptation of cemented CAD/CAM restorations to their abutments is highly dependent on precise impressions and accurate replicas of teeth and adjacent oral tissues. This in-vitro study compared the effect of two die materials, as physical replicas of prepared teeth, on internal and marginal adaptations of zirconia copings to their corresponding abutments. Materials and Methods: A virtual model simulating a prepared premolar was designed and used for the milling of thirty identical metal models. Impression was taken of all models by Polyvinyl siloxane material. Fifteen impressions were poured in with Type IV stone and the other fifteen with polyurethane resin to make dies. All dies were scanned, and for each of them, zirconia coping was designed and milled. The copings were cemented to their corresponding metal models. Marginal gap between each coping and its metal model was measured at 20 points with a stereomicroscope (×60). Then the specimens were sectioned into two halves, and the internal gap was measured at seven points, including right and left cervico-axial, mid-axial, occluso-axial, and mid-occlusal. The data were analyzed with an independent T-test and repeated measure ANOVA at a 95% confidence level (p<0.05). Results: Mean value of marginal gap for Type IV stone and Exakto-Form groups were 54.31 ± 4.11 μm and 56.25 ± 4.24 μm, respectively. Mean values of the internal gaps for both groups ranged from 48 μm to 120 μm. Conclusion: Based on the results of this study, an internal and marginal adaptation of zirconia copings designed on digitized polyurethane and Type IV stone dies are clinically acceptable.

Serum Alkaline Phosphatase and Calcium in Relation to Periodontal Status among Perimenopausal and Postmenopausal Women

Background: Menopause is a physiological phenomenon that occurs in aging women. Periodontal disease is associated with menopausal status. Alkaline phosphatase (ALP) plays a role in general and periodontal bone turnover. Calcium is essential for the maintenance of bone and teeth, and serum ALP and calcium are specific bone markers related to the acceleration of bone mass loss in elderly women and periodontitis. Objectives: The aim of this study was to correlate the levels of serum ALP and calcium with periodontal status in perimenopausal and postmenopausal women with periodontitis. Methods: A total of 22 perimenopausal and 49 postmenopausal women underwent a full periodontal examination assessing the pocket depth, number of teeth lost, clinical attachment loss, plaque index, calculus index, and papillary bleeding index. Using these measurements, the subjects were divided according to periodontal severity. Serum ALP and calcium were measured using the Enzyme-Linked Immunosorbent Assay (ELISA) method. A correlation between serum ALP and calcium to periodontal status was investigated. Results: Serum ALP was significantly correlated with the severity of periodontitis, clinical attachment loss, and the number of teeth lost among perimenopausal and postmenopausal women (p < 0.05). Serum calcium levels were not correlated with periodontal status. Conclusion: Postmenopausal women tended to have more periodontal breakdown, and the level of serum ALP was increased in severe periodontitis.

Dimensional Stability of Elastomeric Impression Material After Disinfection Via Immersion and Microwave Irradiation

Aims: This study aimed to evaluate and compare the dimensional stability of two elastomeric impression materials, namely polyvinyl siloxane (PVS) and vinyl siloxanether (VSE), subjected to chemical immersion and microwave irradiation for disinfection. Materials and Methods: Sixty discs of PVS and VSE impression materials each were prepared using a stainless-steel test die and ring in accordance with ANSI/ADA Specification No. 19. Twenty discs of each impression material were disinfected by chemical immersion for 10 min; another 20 discs were subjected to dry microwave irradiation for 3 min. The other 20 discs served as a control group. Dimensional stability measurements were then performed using an image analyzer at 20× magnification. The data were analyzed by one-way analysis of variance (α=0.05) and Bonferroni (post hoc) test for multiple comparisons to detect significant differences between the groups. Results: When subjected to microwave irradiation, both PVS and VSE showed dimensional changes, but the changes were within the limit of 1.5% set by ANSI/ADA (P<0.00). VSE showed markedly better results than PVS for both disinfection methods. The immersion disinfection method resulted in a higher average percentage of linear dimensional changes than both the microwave irradiation and the control for VSE and PVS impression materials. Conclusion: VSE exhibited excellent dimensional stability than PVS under both chemical immersion and microwave irradiation. Microwave irradiation using conventional microwave ovens can be used in clinical settings as an alternative to other disinfection techniques because the dimensional changes of the elastomeric impression materials subjected to microwave irradiation have been observed to be within the clinically acceptable limit set by the ANSI/ADA standard.