Oral, Volume 3, Issue 4 (December 2023) – 11 articles

The purpose of this study is to report a case of idiopathic osteosclerosis of the mandible and to discuss the differential diagnosis of this lesion. A 17-year-old female was referred to the University Hospital of Geneva by her orthodontist following the fortuitous finding of a radio-opaque lesion in the right posterior mandible at the apex of tooth 44. Intraoral clinical examination revealed no abnormalities of the oral mucosa. Tooth 44 was asymptomatic and reacted positively to the sensitivity test. The orthopantomogram revealed a well-defined unilocular radiodense lesion, surrounded by a thin radiolucent border, measuring 10 × 33 mm, located in the IV quadrant, related to the apex of tooth 44. Differential diagnoses mainly included cementoblastoma, focal cemento-osseous dysplasia, ossifying fibroma, condensing osteitis and idiopathic osteosclerosis. The biopsy material allowed a diagnosis of idiopathic osteosclerosis. The proposed treatment was therefore a “wait and see” approach. After 2 years of follow-up, the patient was asymptomatic, and healing was complete without any neurosensory complications. Our case underlines the differential diagnosis complexity of radio-opaque lesions associated with teeth. Full article

A partial or complete pulpotomy is a type of vital pulp therapy (VPT) that aims to remove the inflamed, infected pulp, leaving behind healthy, vital pulp that is capable of healing. VPT has gained renewed popularity as a treatment option in permanent mature posterior teeth with irreversible, moderate to severe pulpitis; its high success rates matching that of root canal treatment (RCT). There is currently no consensus regarding diagnostic and prognostic predictors of success of pulpotomies for managing such cases. Therefore, we conducted a scoping review to identify and analyze how these factors affect the outcome of treatment. A literature search using the PRISMA guidelines was undertaken using PubMed and Scopus on 7 July 2023. A total of 22 studies met the inclusion criteria and were qualitatively analyzed by two reviewers. The following diagnostic and prognostic factors were recognized and discussed; presenting signs and symptoms, periapical diagnosis, bleeding time, indicators of inflammation (bleeding time, concentration of inflammatory biomarkers), patient age and medical status, the depth, activity and location of caries, and restorative factors. Based on the studies assessed, there is limited evidence to support their prognostic value. Further research is necessary to identify solid predictors of outcome. Full article

Skeletal Class II is a common malocclusion affecting the Caucasian population and characterized, in most cases, by a convex profile and mandibular retrusion. Therefore, the treatment plan often requires the use of functional appliances to promote mandibular advancement. In particular, the Herbst appliance is recommended because of its efficiency and minimal need for compliance. However, in addition to skeletal favorable effects, undesired dental compensations could prematurely reduce the overjet needed for a proper orthopedic outcome. The combination of this appliance with skeletal anchorage and elastic ligatures in the lower or both, in the upper and the lower arch, enables effective control of unfavorable tooth movements, improving the therapeutic potential of such a treatment. These improvements have significantly shifted the main focus on facial aesthetics rather than dental occlusion, with the creation of innovative treatment protocols and a new diagnostic approach to Class II malocclusion. Full article

Periodontitis is a common non-communicable inflammatory disease that leads to the destruction of periodontal tissues and tooth loss. Initiated by the plaque biofilm, there is a strong innate immune response with an abundance of neutrophils in the periodontium of affected individuals. Previous reports have shown that the intracellular concentration of glutathione in peripheral blood neutrophils from periodontitis patients and the chemotactic ability of these cells are compromised. Furthermore, other studies have described that in oxidative stress conditions neutrophil chemotaxis is aberrant and causes the glutathionylation of F-actin, a key player in chemotaxis. In this study, the effects of glutathione-modulating compounds were assessed in neutrophils isolated from healthy donors, showing that the perturbation of glutathione homeostasis decreases the chemotaxis of neutrophils. Following this, the intracellular glutathione status and chemotactic ability of neutrophils isolated from periodontitis patients was compared to that of age- and sex-matched controls. A decrease in glutathione and chemotactic ability were confirmed. Finally, the proteome of these neutrophils was explored, demonstrating a change in the abundance of proteins involved in glutathione homeostasis. Together these data suggest that peripheral blood neutrophils from periodontitis patients are compromised in their ability to cope with oxidative stress and move. Full article

Forensic dentistry is still an emerging field in Pakistan. The lack of scientific literature on the topic may lead to difficulties in situations where age estimation has a significant part such as in criminal and civil litigation. In mass disasters such as earthquakes and accidents, the correct investigation of the chronological age can be less troublesome if population-specific evidence is available. This is the rationale that justifies dedicated dental age estimation studies. This cross-sectional study aimed to test the time efficiency, validity and applicability of four dental age estimation methods: two invasive (Bang and Ramm and Lamendin) and two non-invasive (Kvaal and Cameriere) in an adult Pakistani population. A total of 37 teeth collected from a dental hospital in Islamabad, Pakistan, were used. Teeth included the central and lateral incisors, canines, and first and second premolars of males and females. Results were calculated using a Microsoft Office 2007 excel spreadsheet. Overall, Kvaal’s method mean absolute error between chronological and estimated ages (MAE: 12.33) showed the highest variation and Bang and Ramm showed more accurate results in comparison with other methods (MAE: 4.80). It was both time-efficient and practical to use. It can be stated that these were preliminary cross-sectional outcomes and that studies with larger samples are necessary. Full article

Healthcare organisations around the world have embraced the valuable role that patient experience plays in the improvement of health care delivery. Engaging with patients is a vital component of understanding how to deliver safe, high-quality, respectful health care that is person-centred and efficient. In oral health services, patient experience is historically predominantly reported as challenging, which is most commonly associated with past traumatic experience with poor oral health treatment. Additionally, the high out-of-pocket costs associated with oral health treatment can mean that people disengage with these services, thereby worsening their oral health conditions. Consequently, oral health has an enormous task to reduce the negative perceptions and experiences. This demands innovative and subtle ways to navigate and address patient and service challenges. Exploring and acknowledging the myriad of historical challenges that exist for oral health patients and utilising these experiences to support change will ensure person-centred improvements are designed and implemented. Therefore, this perspective paper defines patient experience and proposes how oral health patient experience can be improved using the concept of meaningful engagement with a focus on the Australian context. We identified two important concepts that impact oral health patient experience and explored how these concepts may play a role in improving oral health services through improved patient experience. The first concept is person, patient, and user which focusses on general patient experience journey in a general health care setting. The second concept is preservice, current service, and post service which relates to an oral health patient’s experience journey in an oral health service setting. Our findings suggest that the practitioner–patient relationship and use of technology are central to patient engagement to improve patient experience. Full article

We investigated the effects of lithium disilicate ceramic thickness and translucency on the degree of polymerization of light-cured resin cement using the measure of hardness. Lithium disilicate specimens of three translucencies (low, medium and high) were prepared to four thicknesses (0.5, 1.0, 2.0 and 3.0 mm). A light-cured resin cement was cured through each of the ceramic specimens using a handheld curing light for 50 s. A 3D printed jig was used to achieve a uniform thickness of the resin cement. Directly cured resin cement was used as the control. Hardness was measured using nano-indentation to determine the degree of polymerization of the resin cement. Two-way ANOVA and Tukey post hoc tests were used to evaluate interaction between translucency and thickness. Hardness values from control specimens were assessed using the two-tailed t-test with the Bonferroni approach. The translucency of the specimens significantly influenced the hardness (p < 0.001), where a negative linear relationship between cement hardness and ceramic thickness was present for low translucency and high translucency. However, at a 0.5 mm thickness, all specimens showed similar hardness regardless of the translucency. The translucency of ceramics affected the hardness, and hence polymerization, of light-cure resin cement. However, the effect of increased thickness was a more significant factor. Full article

The advent of osseointegration has offered a quantum shift in treatment planning patients with missing teeth. Patients with a terminal dentition or edentulous arch have become candidates for a fixed rehabilitation with immediate function. A striking limitation of this modality, however, has been the mechanical failure rate of the reconstructions, especially the interim prostheses. This clinical report describes a completely digital workflow and additive manufacturing of an interim complete arch fixed implant prosthesis, immediately placed after extraction. The prosthesis is supported by four immediately loaded implants on the maxillary arch, using stackable guides and the use of a novel 3D printed high-performance UDMA to improve precision, efficiency, and prosthetic stability. Full article

Introduction: The provision of dental care for paediatric patients with inherited bleeding disorders (IBD) can present a challenging scenario for dentists. Although patients with a low bleeding risk can safely receive preventive procedures in the community, many dentists lack confidence when treating this cohort. Consequently, most patients with IBD are seen in hospital dental clinics. There is currently no protocol for shared delivery of primary dental care for paediatric patients with IBD in Australia. Aim: To provide a narrative review of the protocols for oral health management of paediatric patients with inherited bleeding disorders. Materials and methods: An electronic search of four databases relating to the oral health management and outcomes of paediatric patients with IBD was conducted. Results: Thirty-eight papers were included in this review. Several patient and clinician factors in accessing and providing dental care for paediatric patients with IBD were identified. IBD specific considerations for the provision of safe dental care were discussed relating to elective and emergency dental management principles. There was a paucity of paediatric specific protocols for dental management of children with IBD, with only one paediatric specific shared care protocol identified in this review. Conclusions: This review has highlighted the need for further exploration into patient and clinician related barriers and enabling factors in accessing and providing primary dental care for paediatric patients with IBD. The development of a shared model of care between community and hospital dental clinics may improve both clinician and patient experiences in providing and accessing safe dental care. Full article

Odontogenic cysts can lead to bone destruction that can hamper the dental implant placement in the ideal 3D position. Different biomaterials and techniques that allow bone regeneration are described in the literature, each with its advantages and disadvantages. This clinical case with 18 months of follow-up aims to show the enucleation of an odontogenic cyst following the guided bone regeneration with the fence technique, which allows the placement of the dental implants in the ideal 3D position, reducing morbidity and the number of surgeries. It involved a fifty-year-old male patient with a cyst in the second sextant who needed implant rehabilitation. During the first surgery, the odontogenic cyst (proven by histological analysis where there was reported a non-keratinized stratified squamous epithelium) was enucleated and a guided bone regeneration using the fence technique was performed. The fence technique combines the xenograft, the collagen membrane and an osteosynthesis plate that is molded and fixed to the intervention area to ensure sufficient space for bone tissue regeneration. After six months, two dental implants were placed in the region of tooth 11 and 21, then rehabilitated nine weeks later. The fence technique guaranteed the recovery of the bone morphology and the placement of the dental implants in the ideal 3D position. This technique allows for the handling of complex cases, avoiding the need of autologous bone. Full article