Orofacial characteristics in a child with Hajdu-Cheney syndrome

Hajdu-Cheney syndrome (HCS) also known as Cranio-skeletal dysplasia is a rare genetic disorder of bone metabolism. It is mainly characterized by acro-osteolysis and generalized osteoporosis. The other distinctive features include a dysmorphic face, short stature, aplasia of facial sinuses, and persistent cranial sutures. Although the condition begins to manifest since birth, the characteristic features become more prominent with age. This syndrome is usually recognized by dentists due to these craniofacial abnormalities. This case report aims to highlight a case of 6-year-old girl HCS who presented with aberrant facial features, premature exfoliation of teeth, unusual mobility of teeth and atypical root resorption in primary dentition.

Periodontal pockets: Predictors for site-related worsening after non-surgical therapy-A long-term retrospective cohort study

AIM

To evaluate site-related changes in periodontal pocket depth (PPD) after non-surgical periodontal therapy and to identify predictors for PPD changes in a retrospective patient data analysis.

MATERIALS AND METHODS

PPD, clinical attachment level, bleeding on probing, tooth mobility (TM), furcation involvement (FI), abutment status, adherence to supportive periodontal care (SPC) and SPC follow-ups were obtained from fully documented patient data before periodontal therapy (baseline, T0), after active periodontal therapy (APT, T1) and during SPC (T2). PPD changes were classified into deteriorated or unchanged/improved at the site level. Multi-level logistic regression analysis was performed to identify factors influencing PPD changes during SPC.

RESULTS

This retrospective study included 51 females and 65 males (mean T0 age: 54.8 ± 10.1 years, 25 smokers, 12 diabetics) suffering from Stage III/IV periodontitis. Evaluation outcome: T0/16,044 sampling sites/2674 teeth; T1/15,636/2606; T2/14,754/2459. During 9.0 ± 2.3 years SPC, PPD decreased (-1.33 ± 0.70 mm) by 21.8% of the sites, remained unchanged by 41.4% and increased (1.40 ± 0.78 mm) by 36.8%. Distopalatal FI (p < .001, odds ratio [OR]: 0.252, 95% confidence interval [CI] for OR: 0.118-0.540), residual pockets (p < .001, OR: 0.503, 95% CI: 0.429-0.590) and TM Degrees I-III (Degree I: p = .002, OR: 0.765, 95% CI: 0.646-0.905; Degree II: p = .006, OR: 0.658, 95% CI: 0.489-0.886; Degree III: p = .023, OR: 0.398, 95% CI: 0.180-0.879) correlated significantly with increasing PPD.

CONCLUSIONS

Over 75% of PPD remained unchanged or increased during SPC. Distopalatal FI, TM Degrees I-III and residual pockets after APT lead to worsening of periodontal pockets.

Tooth mobility restriction by multistranded and CAD/CAM retainers-an in vitro study

OBJECTIVES

Orthodontic retainers should restrict physiological tooth mobility as little as possible. While this has been investigated for multistranded retainers, there is a lack of data for novel CAD/CAM retainers. To address this, the present study compared the restriction of physiological tooth mobility in multistranded retainers and different CAD/CAM retainers.

MATERIAL/METHODS

One group of multistranded (n = 8) and five groups of CAD/CAM retainers (nickel-titanium (NiTi), titanium grade 5 (Ti5), polyetheretherketone (PEEK), zirconia (ZrO2), and cobalt-chromium (CoCr); each n = 8) bonded from canine to canine were investigated for their influence on vertical and horizontal tooth mobility using an in vitro model of a lower arch in a universal testing machine. Load-deflection curves were determined and statistically analysed.

RESULTS

All retainers restricted tooth mobility to varying extents. The retainers had less of an influence on vertical tooth mobility, with less of a difference between retainers (14%-38% restriction). In contrast, significant (P ≤ 0.05) differences were observed between retainers in the restriction of horizontal tooth mobility. ZrO2 retainers had the greatest impact, restricting horizontal tooth mobility by 82% (68 ± 20 µm/100N), followed by CoCr (75%, 94 ± 26 µm/100N) and PEEK (73%, 103 ± 28 µm/100N) CAD/CAM retainers, which had comparable effects on horizontal tooth mobility. Ti5 (54%, 175 ± 66 µm/100N) and NiTi (34%, 248 ± 119 µm/100N) CAD/CAM retainers had less of an influence on horizontal tooth mobility, and were comparable to multistranded retainers (44%, 211 ± 77 µm/100N).

LIMITATIONS

This is an in vitro study, so clinical studies are needed to draw clinical conclusions.

CONCLUSIONS

Multistranded and CAD/CAM retainers have different effects on tooth mobility in vitro. These effects should be further explored in future in vivo studies.

Advancements in Methods of Classification and Measurement Used to Assess Tooth Mobility: A Narrative Review

Evaluating tooth mobility is clinically significant, not only for diagnosing periodontal tissues but also in determining the overall periodontal treatment plan. Numerous studies related to tooth mobility have been conducted over the years, including the proposal of various classifications as well as the development of electronic devices for objective measurement. However, there is still no consensus on the measurement methods and criteria for assessing tooth mobility. In this study, we provide a comprehensive review of past and current tooth mobility classification and measurement methods. In order to propose a new method to intuitively evaluate tooth mobility based on previous studies, a digital approach capable of recording tooth micromovements induced by dynamic load should be considered.

An immediate implant approach to replace failing maxillary anterior dentition due to orthodontically induced severe root resorption

Incomplete orthodontic therapy can lead to severe root resorption, resulting in mobile and non-restorable teeth. This clinical report presents the diagnosis, treatment planning and oral rehabilitation of a young woman with failing dentition in the anterior maxilla due to orthodontically induced root resorption. The patient's chief complaint was mobile maxillary anterior teeth 2 years after discontinuing orthodontic treatment. Radiographic and clinical evaluations revealed a missing right first premolar and left premolars and grade III mobility from the right canine to the left lateral incisor. Due to a hopeless prognosis, extraction of the maxillary anterior teeth was planned, followed by grafting procedures. Four implants were immediately placed in the fresh sockets of the canine and central sites, and a removable provisional appliance was delivered to contour the soft tissues involved. The final restorations consisted of two three-unit layered zirconia implant-supported fixed dental prostheses. Well-planned immediate implant therapy and zirconia restorations can successfully replace mobile teeth with severe root resorption caused by external surface resorption from incomplete orthodontic treatment. Combining grafting procedures during implant placement can replace hard tissue lost due to extractions, whereas provisional restorations can re-establish optimal tissue architecture in the aesthetic zone. The present case offers insight into effective strategies for treating non-compliant or uncooperative patients with failing dentition due to orthodontically induced root resorption.

Relationship between Behavior and Periodontal Health Self-Perception in Diabetic and Non-Diabetic Patients from Transylvania, Romania-A Self-Report Study, including The Desire to Use a Mobile App for Oral Care Improvements

The study aimed to assess self-reported symptoms of periodontal disease (gingival bleeding, tooth mobility and halitosis) among diabetic and non-diabetic patients from Transylvania, Romania. Using statistical analysis methods, correlation between the aforementioned symptoms and diet, oral hygiene habits, stress, physical activity, and BMI (body mass index) were researched. Another secondary objective was to assess the impact of self-reported oral health, aesthetics, and halitosis on their life. Patients' willingness to use a mobile app for generating awareness of oro-dental complications, improving their knowledge of oro-dental health, and reminding them to visit the dentist based on an awareness-raising function, was also assessed. Methods: The study was based on an original self-administered questionnaire, applied to 182 subjects, in an unselected, randomized manner. A total of 110 questionnaires were applied in two dental offices and 72 questionnaires were applied in a public clinic for diabetic patients from Cluj-Napoca, Romania. Results: Warning signs and symptoms relevant to periodontal disease were identified by respondents, having statistically significant associations with the declared oral health-care habits, including interdental aids, vicious habits (nail biting, bruxism), etc. Some of these periodontal signs could be correlated with a certain lifestyle, such as the perceived stress, smoking status, practicing maintenance sports, and alcohol consumption. A total of 66% of the non-diabetics and 68% of the diabetics of the surveyed subjects consider a software application for generating awareness of oro-dental complications useful, and are willing to pay around EUR 6 for it. Conclusions: Having a medical condition such as diabetes makes patients pay more attention to dental health compared with non-diabetic patients. Patients expressed their desire to use a software application to help them to be aware of their condition and for improving their self-report capabilities, including their oral-health-related status.

The Impact of Progesterone and Estrogen on the Tooth Mobility

Background and Objectives: Progesterone and estrogen modify the bone metabolism directly related to the periodontium, this study aimed at answering the question whether fluctuations in the levels of these hormones or the use of their synthetic equivalents in modern contraceptives have a significant impact on the natural tooth mobility (TM) in its alveolus. Materials and Methods: Sixty healthy women who had never been pregnant and when interviewed reported either (1) having regular menstruations every 28-30 days or (2) taking oral two-phase two-ingredient hormonal contraceptives formed, respectively, groups M and S in the study. TM evaluated as the Periotest value (PTV) was checked in the menstruation, ovulation, and luteal phases of the menstrual cycle (group M) and on the days corresponding to the moment of the menstrual cycle in group S. Results: Although the PTV-s were within the limits of norm, the canines and the molars were always more stable than the other teeth. In group M, the TM was statistically comparable (p > 0.05) in the menstrual and ovulation phases, thus significantly increased (p < 0.001) in the luteal phase. The TM remained constant (p = 0.758) in all studies in group S. The results demonstrated that the canines and the molars in the luteal phase were significantly more mobile in group M than in group S (p < 0.001), although increased mobility of the teeth in group M affected the canines and the first molars to a significantly lesser degree than the other teeth. Conclusions: However, since women between 20 and 30 years old constitute the majority of ortho-dontic patients, possible determination of the optimum moment of force application in relation to the sex hormones cycle, namely, to its luteal phase, is clinically very promising.

Splint stiffness and extension effects on a simulated avulsed permanent incisor-A patient-specific finite element analysis

BACKGROUND/AIM

Splinting is an important procedure after avulsion. However, the role of splint stiffness and extension is not fully understood. The aim of this study was to evaluate the effect of splint stiffness and extensions on the mobility and stress on an injured tooth under physiological biting load.

MATERIALS AND METHODS

Three-dimensional (3D) finite element models were created from a cone beam computer tomogram of a patient with normal occlusion. An avulsion injury of the right central incisor was created with a 1000 N load application on the palatal of the injured tooth, causing increased socket width. Splints made from four materials were tested: 0.9 mm diameter wire-composite splint (WCS1), 0.4 mm diameter wire-composite splint (WCS2), 1.0 mm diameter nylon-composite splint (NCS), and a 2 mm high by 0.2 mm thick plastic strip composite splint (PSS). Three splint extensions (involving 6, 5, and 3 teeth) were evaluated. Mobility of the avulsed tooth and the maximum principal stress distributions in the adjacent teeth were calculated.

RESULTS

The injured incisor tooth mobility was not affected by the splint extensions. The NCS and PSS stabilized the avulsed incisor but allowed, respectively, 10 and 20 times more mobility under horizontal loading than the WCS1, which inhibited most mobility, while the WCS2 allowed double the mobility compared with WCS1. The NCS and PSS allowed more tooth mobility, mainly in the extrusion direction. Splints were 2-3 times more effective in limiting mobility under intrusive loads than extrusive loads. High levels of stress were found at the base of the composite attachments in the adjacent incisors.

CONCLUSION

Splinting an avulsed tooth to one or two teeth bilaterally using a nylon splint or a plastic strip is appropriate for tooth stabilization and should be recommended over the 0.4mm wire-composite splint, while the 0.9 mm orthodontic wire is too rigid and not recommended.

Periodontal Disease and Oral Health-Related Quality of Life in the Older Population in Indonesia

Introduction:

Despite being acknowledged as the second global burden of oral disease, periodontal disease has few epidemiologic studies in the literature, particularly for developing countries. Many previous studies have assessed the relationship between periodontal disease and oral health–related quality of life (OHRQoL), with patients attending dental clinic or hospitals rather than a general population. This study attempted to fill the knowledge gap in limited information about periodontal disease and OHRQoL, with reference to a general population in a developing country.

Objectives:

To investigate the relationship between OHRQoL and periodontal diseases in an older population in Indonesia.

Methods:

We invited 582 older people from community health centers. The 369 (63.4%) older people who agreed to participate consented to an oral health examination and a questionnaire capturing demographic, socioeconomic, behavioral, and Oral Health Impact Profile–14 (OHIP-14) data.

Results:

Almost 75% of the older people had generalized periodontitis; 3% had healthy periodontal status; and around 22% had localized periodontitis. There was a lack of statistical evidence for an association between periodontal disease status and OHRQoL. This result was based on the appraisal of the prevalence of the impact (Odds ratio [OR], 0.95 [95% CI, 0.54 to 1.59]; P = 0.77), difference in mean severities (0.07 [95% CI, –1.66 to 1.80]; P = 0.94), and extent of the impact (P = 0.996). However, we found evidence for a relationship between tooth mobility and OHRQoL for all of the OHIP assessments, including prevalence of the impact (OR, 1.87 [95% CI, 1.16 to 3.01]; P = 0.009), difference in mean severities (–2.98 [95% CI, –4.50 to –1.45]; P < 0.001), and extent of the impact (P = 0.001).

Conclusion:

There was a lack of statistical evidence for a relationship between periodontal disease status and OHRQoL in this society. However, we found evidence that tooth mobility, as a sign of periodontal disease progression, is related to OHRQoL.

Knowledge Transfer Statement:

The present study can be used by dentists, community health workers, and policy makers in Indonesia to understand the prevalence, severity, and extent of the negative impacts of periodontal disease on older people’s quality of life. In addition, this study provides information about factors that might considerably affect the oral health–related quality of life in this society, such as brushing habits, dental visit, family income, DMF-T status, and subjective appraisal toward dental health.

The impact of splinting mobile mandibular incisors on Oral Health-Related Quality of Life-Preliminary observations from a randomized clinical trial

AIM

To compare the Oral Health-Related Quality of Life (OHRQoL) of patients with mobile mandibular incisors before and after full-mouth disinfection (FMD) with and without splinting.

MATERIAL AND METHODS

Thirty-four periodontitis patients with ≥1 mobile mandibular incisor (degree II/III) were randomly allocated to the test or control group. All patients received FMD and the test group additional splinting of teeth 33-43. OHRQoL was assessed before (BL) and 3 months after FMD (RE) using the Oral Health Impact Profile (OHIP)-14. Data were compared within and between the groups (Wilcoxon test/Mann-Whitney U test).

RESULTS

Twenty-eight patients (13 test group/15 control group) were re-evaluated. FMD led to a reduction of the mean probing pocket depth (PPD; in mm) (test group: BL-PPD 3.89 ± 1.03, RE-PPD 2.82 ± 0.53; control group: BL-PPD 3.58 ± 0.66, RE-PPD 2.77 ± 0.59; each p ≤ .001), the mean clinical attachment level (CAL; in mm) (test group: BL-CAL 5.22 ± 1.38, RE-CAL 4.79 ± 0.85; control group: BL-CAL 4.58 ± 1.10, RE-CAL 4.41 ± 0.96; each p ≤ .05), and the mean OHIP-14 summary scores (test group: BL-OHIP 21.7 ± 11.06, RE-OHIP 9.9 ± 8.96, p = .0046; control group: BL-OHIP 16.8 ± 8.27, RE-OHIP 11.7 ± 8.55; p = .0217). The reduction of the OHIP-G14 scores was considerably higher in the test group but statistically not significant (p = .080).

CONCLUSIONS

The results show a positive impact of non-surgical periodontal treatment on OHRQoL and a possible tendency for further improvement by splinting mobile mandibular incisors.

Endodontic implications of a patient with arteriovenous malformation: a case report and literature review

AIM

To present the endodontic management of a patient diagnosed with a high-flow arteriovenous malformation (AVM) requiring root canal treatment and to discuss the relevant endodontic literature for this rare but significant problem.

SUMMARY

AVM is a complex communication of an artery and a vein in which the oxygenated blood is forced away from the intended tissue. The incidence of its occurrence in the face and neck is rare, and when present, the most common sign is gingival bleeding. Arteriovenous malformation is both a diagnostic and therapeutic challenge for dentists. Also, there is ambiguity regarding the precautions to be taken whilst doing endodontic procedures in such cases. Hence, there is a need to understand the disease process and its implications in order to prevent life-threatening complications during treatment. This case report highlights the successful endodontic management of a cariously exposed right maxillary second premolar in a patient diagnosed with high-flow AVM. On an orthopantomogram, the AVM was spreading in the left submandibular space involving the left ramus area. The clinical findings of limited mouth opening with inter-appointment swelling and trismus during treatment made the case unusual and challenging. This paper addresses the current understanding of the classification, diagnosis, clinical features and endodontic management, together with specific guidelines and recommendations whilst performing endodontic procedures in AVM cases.

KEY LEARNING POINTS

The classification and oral manifestations of AVM must be known and understood. Practitioners should be aware of the radiographic appearance of AVM. Recommended precautions should be taken when carrying out restorative and endodontic procedures in a patient with AVM. Antibiotic prophylaxis may be considered before endodontic treatment in a patient with AVM. Multidisciplinary treatment planning may be required.

Effects of different splinting times on surgically extruded teeth with a crown-root fracture: A randomized controlled trial

BACKGROUND/AIM

Clinical studies evaluating the splinting time for surgically extruded teeth with crown-root fractures are lacking. The aim of this study was to compare 2-week splinting versus functional splinting times after surgical extrusion.

MATERIAL AND METHODS

Children aged 8-13 years who presented with crown-root fractures were included. Surgical extrusion was performed, and teeth were splinted either for 2 weeks or until normal Periotest values were achieved (functional splinting time). The outcome measures were tooth mobility, tooth loss, root resorption, marginal bone resorption and ankylosis. Measurements were taken at baseline, weekly after splint removal, and after 1, 3, 6 and 12 months.

RESULTS

Nineteen patients were included in the analysis. Surgically extruded teeth splinted for 2 weeks showed significantly higher mobility directly after splint removal and at 1 month after splinting compared with the functional splinting time group. The mean differences for horizontal Periotest values were 14.96 (95% confidence interval: 8.52, 21.39) and 6.63 (95% confidence interval: 0.25, 13), respectively. The vertical Periotest values were 10.47 (95% confidence interval: 1.95, 18.99) and 4.81 (95% confidence interval: -1.57, 11.18), respectively. At the 3-, 6- and 12-month follow-up intervals, there were no statistically significant differences between the groups. One tooth in the 2-week splinting group was lost. None of the teeth had ankylosis, marginal bone resorption or root resorption.

CONCLUSIONS

Although both groups showed neither statistical nor clinically significant differences after 12 months, there was a significant difference immediately after splint removal, with greater tooth mobility in the 2-week splinting group. Thus, a functional splinting time (4-6 weeks) can be suggested for better healing and optimal stability to allow placement of the final restoration directly after splint removal.

Suppuration as diagnostic criterium of peri-implantitis

BACKGROUND

Suppuration (SUP) as a diagnostic parameter for monitoring dental implants is not yet well understood. The retrospective clinical and radiographic study was therefore performed to investigate the patient, implant, and site characteristics among individuals exhibiting SUP.

METHODS

Demographic characteristics and clinical parameters were recorded. Radiographic features were analyzed using cone-beam computed tomography. Peri-implantitis was defined based on the consensus report of Workgroup 4 of the 2017 World Workshop on the Classification of Periodontal and Peri-Implant Diseases and Conditions: probing depth (PD) ≥6 mm, presence of bleeding and/or SUP on gentle probing, and radiographic marginal bone loss (MBL) ≥3 mm. SUP was graded according to profuseness (dot versus line/drop) and time after probing (≥15 seconds versus <15 seconds after probing versus spontaneous). Simple binary logistic regression models were estimated using generalized estimation equations to explain the probability of SUP based on demographic, clinical, and radiographic variables.

RESULTS

A total of 111 eligible patients (n_implants  = 501) were assessed. Of them, 57 (n_implants  = 334) were diagnosed with peri-implantitis according to the established case definition, and of these individuals, 31 (n_implants  = 96) presented SUP. Therefore, the prevalence of SUP was 27.92% in the total sample size and 54.38% in peri-implantitis patients. Overall, 28.74% implants displayed SUP within patients with peri-implantitis. SUP was more frequently found at buccal sites (51%) and proved less prevalent at mesio-lingual sites (16.7%). Defect morphology (OR = 6.59; P = 0.004), PD (OR = 1.63; P = 0.024), and MBL (OR = 1.35; P = 0.010) were significantly associated with the presence of SUP. Likewise, defect morphology (P = 0.02), PD (P = 0.003), and MBL (P = 0.01) were significantly correlated with the grade of SUP.

CONCLUSION

The presence and grade of SUP are associated with peri-implant bone loss, probing depth, and defect morphology in patients with peri-implantitis.

A case of systemic precursor T-cell lymphoblastic lymphoma presenting with single tooth mobility

Lymphoblastic lymphoma, seen primarily in children or young adults, is a type of non-Hodgkin lymphoma that originates from B or T lymphocyte precursors and rarely occurs in the oral cavity. A case of systemic precursor T-cell lymphoblastic lymphoma mimicking periodontitis of a lower second molar in a 20-year-old adult is currently presented. The case was initially misdiagnosed as periodontal disease and treated with tooth extraction by a dentist. Re-evaluation of the patient due to worsening of symptoms lead to cone beam computed tomography scanning that thoroughly revealed an extended osteolytic lesion of the right mandible. Afterward, a biopsy was performed, thus reaching the diagnosis of precursor T-cell lymphoblastic lymphoma. This report discusses differences in epidemiology of T-cell and B-cell lymphoblastic lymphomas, as well as their various intraoral manifestations that are mimicking a large family of oral pathology. It also focuses on conventional imaging findings that imply malignancy, which are often neglected during routine radiology interpretation.

Self-Perception of Periodontal Health and Associated Factors: A Cross-Sectional Population-Based Study

The aim of this cross-sectional study was to explore sociodemographic, behavioral, and clinical factors associated with self-awareness of periodontal health. Data were collected from a representative sample of 736 adults (25–75 years old) in a city of Northern Italy who self-assessed gingival bleeding, oral malodor, and tooth mobility in a questionnaire and who underwent clinical periodontal examination and organoleptic evaluation. Approximately 50% of the subjects were aware of their actual gingival health status and oral odor. The logistic regression analysis revealed that females presented higher odds of correctly perceiving their gingival conditions and mouth odor, while those who were older and smokers had a greater probability of being less objective in reporting them. Tooth type and position in the dental arches were positively associated with self-perception of tooth mobility. These findings reflected a low level of self-awareness that may influence oral care-seeking behavior. Subjects may be unconcerned about their periodontal health condition or lack enough knowledge to be aware of it. This points to the need for planning strategies to improve education and knowledge about periodontal health, which, by enhancing self-perception of periodontal symptoms, could help everyone to seek treatment in the initial stage of the disease.

Associations of cytokine levels in gingival crevicular fluid of mobile teeth with clinical improvement after initial periodontal treatment

Studies suggest that analysis of gingival crevicular fluid (GCF) is useful for evaluating periodontal status. In this study, clinical variables related to tooth mobility, and multiple cytokine levels in proximate GCF, were measured at four time points during initial periodontal treatment: before treatment (baseline), after supragingival scaling, after occlusal adjustment, and after scaling and root planing (SRP); 20 teeth from 13 patients with periodontitis were included. Baseline interleukin (IL)-10 level in GCF was significantly higher around teeth that showed substantial improvement in periodontal epithelial surface area (PESA) after SRP than around teeth without PESA improvement. IL-3 and IL-16 levels in GCF at baseline were significantly higher around teeth with a periodontal inflamed surface area (PISA) of 0 mm² after SRP than around teeth without PISA improvement. In addition, baseline IL-7, IL-11, and IL-12p40 levels in GCF were significantly lower around teeth with decreased mobility after occlusal adjustment than around teeth without decreased mobility. These results suggest that pre-treatment cytokine levels in GCF are useful in predicting the effects of initial periodontal treatment.

Association of periodontal status with lung function in patients with and without chronic obstructive pulmonary disease visiting a medical hospital in Pune: A comparative study

BACKGROUND

The relationship between oral health and systemic conditions has been increasingly debated over recent decades with one such discussion existing about oral hygiene and periodontitis with chronic obstructive pulmonary disease (COPD). Hence, a study was conducted to assess and compare the oral hygiene status and periodontal status of age and gender-matched participants with and without COPD and to correlate oral hygiene status and periodontal status with lung function status among them.

MATERIALS AND METHODS

This hospital-based study included a study population of 117 participants (39 patients of COPD and 78 participants without COPD) 35-75 years of age with at least 20 natural teeth. Participant's demographic details and history of smoking were recorded. Lung function was recorded using a spirometer. Periodontal health was assessed by measuring Probing Pocket Depth (PPD), Clinical Attachment Loss (CAL), and Oral Hygiene Index (OHI) by a trained and calibrated examiner.

RESULTS

Higher mean of PPD, CAL, and OHI is being reported in the present study with 4.07 versus 3.50, 0.58 versus 0.24, and 5.24 versus 3.60, respectively, among patients with and without COPD which was statistically significant. The risk of having COPD was 0.4 times more in participants having poor oral hygiene and 0.07 times more in patients smoking. Smoking and oral hygiene, as independent variables, have a significant influence on COPD which is a dependent variable. A weak correlation was found of poor oral hygiene and loss of attachment among participants with COPD.

CONCLUSION

Periodontitis and respiratory disease share a common risk factor, i.e., smoking. Smoking has a definite relation with periodontitis and COPD. Oral hygiene is significantly associated with increased risk for COPD when age and gender effects have been matched and when adjusted for smoking. However, no association was found of PPD with COPD.

Quantitative tooth mobility evaluation based on intraoral scanner measurements

BACKGROUND

Tooth mobility assessment is subjective and current techniques require the translation of a continuous variable to a categorical variable based on the perception of the examiner. The aim of this study was to evaluate the reliability of a novel technique to assess tooth mobility.

METHODS

Three experienced periodontists were asked to push tooth #16 into a buccal position to in a typodont model with different mobility (M1-M2). Tooth position was obtained using an intraoral scanner and files were compared in metrology software. Mobility was calculated at three reference points at the cervical (C), middle (M), and occlusal (O) regions of the buccal surface of the tooth to determine the linear deviation in the three axes (x, y, and z). Reliability was determined by intraclass-correlation coefficient, differences between M1 and M2 determined by t test, and the analysis of variance (ANOVA) was used to compare the data at the C-M-O regions.

RESULTS

Excellent reliability was assessed by Cronbach alpha >0.9 on the x-y-z axes for both mobility tested, except for M1-C X (0.85), M1-M Y (0.89), and M2-M Z (0.89). The correlation between the examiners demonstrated excellent (˃0.90) or good (0.75˃ x ˂0.90) consistency, except for M1-C Y (0.73; examiner 1 to 2) and M1-M X (0.69; examiners 1 to 3). Significant changes were detected in all axes at the three reference points comparing M1 and M2, and a similar proportional change was observed between O-M-C reference points for M1 and M2.

CONCLUSION

A novel technique to assess tooth mobility based on intraoral scanner measurements provided reliable data in an in vitro experiment.

Evaluation and comparison of stress distribution around periodontally compromised mobile teeth splinted with different materials: Three-dimensional finite element analysis

Background

Progressive attachment loss around the teeth because of periodontal disease can result in increased tooth mobility. This adversely affects patient's comfort, function, and esthetics. Periodontal splinting helps in accomplishing stability by redistributing the functional and parafunctional forces. There are various materials that have been used for periodontal splinting. Fiber-reinforced composite, composite resin, and metal-reinforced composite are often used as splinting materials for periodontally compromised teeth. In our study, a comparison was done among these materials for their ability to distribute the stresses at different bone levels in mobile lower incisors splinted together with canines.

Materials and Methods

Five patients of age group 25-50 years with Grade 2 and 3 mobile incisors having 40% or more bone loss and firm canines with optimal bone support were selected. From the computed tomography scan of each patient, three models were developed demonstrating splinting of mandibular incisors and canines with metal-reinforced composite, fiber-reinforced composite, and composite resin. So in total, 15 models were developed and each one of them was subjected to vertical and transverse loads of 150 N. Pattern of stress distribution was observed in these models using three-dimensional finite element analysis.

Results

After splinting, the stress on the canine increased when bone levels around incisors decreased while stress on incisors reduced.

Conclusion

Tested splinting materials were successful in stress distribution, and metal-reinforced composite was found to be better than the other splinting materials.

A 42-Month Follow-Up of Double Root Fracture of a Lateral Mandibular Incisor

This case report describes the treatment of a double root fracture of a lateral mandibular incisor and its follow- up over 3.5 years.

The reason for the consultation was a tooth mobility following a fall that had occurred 2 days earlier. A test of pulp vitality for tooth 42 was positive. Periodontal probing at the level of the gingival sulcus confirmed the intactness of the epithelial attachment. Retro-alveolar radiographic examination revealed a double root fracture of tooth 42.

A semi-rigid extra-coronal splinting was performed and a light grinding of the incisal edge of tooth 42 was then carried out in light of the dislocation of the coronal fragment, and the occlusion was checked with a strip of articulating paper. The outcomes at 6 months revealed that pulp vitality was still preserved, consolidation of the apical fracture had occurred, and the coronal root fracture was starting to heal. The 1-year, 2-year and 3-year follow ups revealed preserved pulp vitality, an absence of a fracture line in apical images, and no root resorption.

This case report provides evidence for the preservation of vitality in the setting of a double root fracture.

To Splint or Not to Splint: The Current Status of Periodontal Splinting

Loss of tooth-supporting structures results in tooth mobility. Increased tooth mobility adversely affects function, aesthetics, and the patient's comfort. Splints are used to over-come all these problems. When faced with the dilemma of how to manage periodontally compromised teeth, splinting of mobile teeth to stronger adjacent teeth is a viable option. This prolongs the life expectancy of loose teeth, gives stability for the periodontium to reattach, and improves comfort, function and aesthetics. Although splinting has been used since ancient times, it has been a topic of controversy because of its ill effects on oral health, including poor oral hygiene and adverse effects on supporting teeth. There have been considerable advancements in the materials used for splinting, resulting in fewer ill effects. This article is intended to provide the clinicians with an updated overview of splinting, types and classification of splints, with their indications, contraindications,rationale and effects on oral health.

Periodontal status and oral health-related quality of life in elderly residents of aged care homes in Delhi

AIM

The aim of the present study was to explore the associations between clinical periodontal findings and oral health-related quality of life in elderly people residing in the aged care homes of Delhi, India.

METHODS

A cross-sectional study was carried out among 500 residents of aged care homes across Delhi. Data were collected by carrying out clinical oral examinations and by filling a self-administered questionnaire. Oral health-related quality of life was assessed by a pretested Hindi version of the Geriatric Oral Health Assessment Index (GOHAI-Hi). Periodontal status was assessed using the Community Periodontal Index - CPI, and loss of attachment and tooth mobility was assessed using a modified Miller's index.

RESULTS

Of a total of 500 participants, 221 (44.20%) were men and 279 (55.80%) were women The mean additive score GOHAI score was 41.57 ± 6.07 and the mean number of negative impacts or mean simple count GOHAI score was 6.27 ± 1.54. Mean GOHAI scores were significantly higher among men than women, and were found to be decreasing continuously with the increasing age categories. Tooth mobility and loss of attachment scores were found to be significantly associated with oral health-related quality of life, whereas Community Periodontal Index scores showed a negative correlation with it.

CONCLUSION

The geriatric population, especially those in aged care homes, is a special need group because of their inability to access dental care rather than some particular feature of their oral or general health The findings of the present study point to a need to improve access to oral healthcare for this elderly population.

Periotest values: Its reproducibility, accuracy, and variability with hormonal influence

Tooth mobility can be assessed by both subjective and objective means. The use of subjective measures may lead to bias and hence it becomes imperative to use objective means to assess tooth mobility. It has also been observed that hormonal fluctuations may have significantly influence tooth mobility.

Prognosis of teeth in the line of mandibular fractures

INTRODUCTION

The purpose of this study was to evaluate teeth involved in the line of fracture, clinically and radiographically, and their associated complications so as to indicate if they should be managed conservatively or extracted.

MATERIALS AND METHODS

Data were collected from patients records treated of mandibular fractures. It was included pre and postoperative panoramic radiographs, information such as demographic data, age, and sex, fracture location, mobility, and vitality of teeth in the line of fracture, teeth stabilizing the fracture segment.

RESULTS

The sample presented 25 patients with teeth in the line of mandibular fractures. A total of 16 patients teeth in the line of fracture were vital during the 6(th) week postoperative follow-up and 9 patients with their teeth in the line of fracture were nonvital of which 4 were endodontically treated and the rest 5 patients teeth in the line of fracture were extracted as they showed signs of infection.

CONCLUSION

This study demonstrated that the presence of teeth in the line of fracture is not a limiting factor for the treatment. Despite the risk of complications, tooth in the fracture line should be preserved for its merits. A regular clinical and radiological follow-up should be mandatory for at least a period of 1 year.

Increased tooth mobility because of loss of alveolar bone support: a hazard for zirconia two-unit cantilever resin-bonded FDPs in vitro?

This study evaluates in vitro the impact of increased abutment tooth mobility on survival of zirconia-based two-unit cantilever resin-bonded fixed dental prosthesis (RB-FDP) by long-term dynamic loading in a chewing simulator. Human maxillary central incisors (n = 32) were endodontically treated and alveolar bone loss was simulated: 0% (group B), 25% (group C), and 50% (group D). RB-FDPs were adhesively luted. Zirconia full crown two-unit FDPs served as control (group A). Specimens were exposed to simulated clinical function by two subsequent sequences of thermal-cycling (2 × 3.000) parallel to mechanical loading (1.2 × 10(6) load cycles) (TCML; first sequence: load 1-25 N; second sequence: load 1-50 N). Tooth mobility increased significantly as the simulated bone level decreased (p < 0.001). Log-rank tests revealed no significant differences between experimental groups (p = 0.479). The results support the assumption that zirconia-based two-unit cantilever RB-FDPs may be an appropriate treatment option, even if abutment tooth mobility increase because of alveolar bone loss. However, debonding of zirconia-based two-unit RB-FDPs will be a likely event, whereas fatal failures of the abutment teeth may not occur.

A study to evaluate mobility of teeth during menstrual cycle using Periotest

BACKGROUND AND OBJECTIVE

Over a century, an increased prevalence of gingival disease associated with increasing plasma sex steroid hormone levels has been reported. These situations present unique challenges to the oral health care professional. It is believed that hormonal fluctuations such as those associated with pregnancy, menstruation, and use of hormonal contraceptives lead to an increase in tooth mobility. However, this effect of female sex hormones on periodontal ligament and tooth supporting alveolar bone has rarely been investigated. So this study was undertaken to understand the effect on tooth mobility because of hormonal changes during the menstrual cycle.

MATERIALS AND METHODS

The mobility of index teeth 16, 13, 21, 23, 24, 36, 33, 41, 43, and 44 was measured with Periotest in 50 females at menstruation, ovulation, and premenstruation time points. Simplified oral hygiene index, plaque index, gingival index, and probing depth were also evaluated during the different phases of menstrual cycle for each subject participating in the study.

STATISTICAL ANALYSIS

The results of the study were subjected to statistical analysis. Data analysis was done by applying Z test for comparing difference between two sample means.

RESULT

The stages of menstrual cycle had no significant influence on the Periotest value. Despite no significant change in plaque levels, GI was significantly higher during ovulation and premenstruation time points.

CONCLUSION

No change in tooth mobility was seen during the phases of the menstrual cycle. However, an exaggerated gingival response was seen during ovulation and premenstruation time when the entire menstrual cycle was observed.