Current Dentistry - Current Issue

Fibro-osseous lesions (FOLs) are a poorly defined but pathologically diverse group of lesions affecting the craniofacial bones and jaw. They are mostly characterized by the replacement of bone by a benign connective tissue matrix, which may contain foci of mineralization in the form of woven bone or cementum-like round acellular intensely basophilic structures. These lesions, although diverse, often present similar clinico-pathological and radiographic features. This often leads to difficulty in diagnosis and management. Definitive diagnosis is often reached only by incisional or excisional biopsy in resource-limited settings. Epidemiologically, the incidence and prevalence of different FOLs have been variable depending on the region. Reports from Africa indicated that FOLs make up to 10% of all oral biopsies, while others have given lower figures. A good understanding of the pathogenetic mechanism for FOLs is important, and state of the art molecular approaches are bound to improve the diagnosis and delineation of various entities that fall under the FOL category. Not least, the classification and nomenclature of these lesions by the World Health Organization (WHO) have changed significantly over the years. Hence, we have presented in this review a robust discussion on the pathobiology, emerging molecular markers, diagnostic challenges, future perspectives and recent changes to the classification/nomenclature of FOLs by WHO. In addition, we also discussed the diagnostic bottlenecks encountered during diagnosis of FOL in Africa.

Background: Platelet concentrates (PC) are blood-derived products for local application able to stimulate regeneration in soft and hard tissues, mimicking the physiological healing process. Their efficacy in oral surgical procedures is controversial and limited.

Objective: The study aims to critically analyze the available evidence for the effect of autogenous PC on wound healing of different oral surgical sites reported by more recent clinical studies.

Methods: Electronic and manual searches in three databases (Medline, Web of Science, Scopus) were performed to identify the clinical studies from January 2017 to December 2017 which reported the actual oral surgical indications and the benefit of local application of PC. All human studies evaluating PRP or PRF in a randomized controlled trial, case series, case report and systematic review were included. All animal, histologic and in vitro studies were excluded.

Results: Fifty-two studies were selected. The use of PRF was proposed in treating many oral surgical sites. Data availability with regard to the effect of PRF on new bone formation in GBR and horizontal/vertical bone augmentation procedures varied from abundant to absent. Positive results concerning the effect of PRF on potential post-surgical complication (pain, swelling and trismus) were reported.

Conclusion: Few clinical indications could be determined: the literature on the topic was contradictory and the published data were difficult to interpret. Positive results were generally recorded for soft tissues and periodontal wound healing. No real benefit of PC application on bone regeneration was evidenced.

Background: The final goal of color measurement or shade specification in dentistry is the reproduction by prosthetic materials of all important appearance characteristics of natural oral structures. The application of color science in dentistry is an objective way to measure and evaluate such structures and dental materials in clinical practice and dental research.

Methods: Literature on color science was reviewed to present new metrics to evaluate color differences of dental materials and dental structures. Visual acceptability and perceptibility values of color differences are reviewed and new whiteness indexes to describe whiteness in dentistry are presented.

Results: In the last decade, the CIELAB 50:50% perceptibility and acceptability thresholds were set to 1.2 and 2.7, respectively, and the CIEDE2000 50:50% perceptibility and acceptability thresholds were set to 0.8 and 1.8 The CIEDE2000 color-difference formula became increasingly popular in dentistry. Developments in color science have led to the description of tooth whiteness and changes in tooth whiteness based on whiteness indexes, with the most relevant being the W1D whiteness index, which is a customized index based in CIELAB color space.

Conclusion: The application of color science in dentistry has allowed the precise description of tooth color and whiteness. The revised and new CIEDE2000 color-difference formula is expected to fully replace the outdated CIELAB formula in almost all dental applications. Recent psychophysical studies have reported values of visual thresholds and new whiteness indexes, which can serve as quality control tools to guide the selection of esthetic dental materials, evaluate clinical performance, and interpret visual and instrumental findings in clinical dentistry, dental research, and subsequent standardization.

Objectives: Treatment and perioperative dental management in patients on anti-thrombotic medications poses a serious challenge to dental professionals due to perceived risk of bleeding complications. This article aims to study the anticoagulant / antiplatelet drugs currently available on the market, review contemporary oral anti-thrombotic treatment and offer management guidelines in such situations based on the review of pertinent literature.

Material and Methods: Science Direct and Ovid databases, PubMed, Scopus and product literature were accessed to review relevant literature with respect to current anti-thrombotic drugs, indications for their use in medical conditions, complications related to their use and drug interactions. The search covered studies published in medical and dental journals in English with a relevant impact factor over a period of 10 years. Meta analyses, systematic reviews, randomized trials, cohort based and case-control studies and society-based guidelines were considered. Key words utilized in the search criteria included Warfarin, Coumarin, Aspirin, P2Y12 inhibitors, Prasugrel, Clopidogrel, Ticagrelor, Hemorrhage, Anti-thrombin, Platelet aggregation inhibitors and International Normalized Ratio (INR) and were validated by the MeSH dictionaries.

Results: Dental practitioners today, are faced with the challenge of conducting surgical procedures on patients who are on anti-thrombotic medications for a variety of medical/ surgical co-morbid conditions. Although there is consensus amongst various studies regarding continuation of warfarin in therapeutic ranges for dento-alveolar surgery, there is insufficient evidence to reach a consensus in those groups who are at intermediate or high risk of bleeding. However, most studies and published literature do agree that there is no real increased risk of bleeding complications during conduct of these procedures if the patient’s INR is less than 3.5 along with adequate haemostatic measures.

Conclusion: Regardless of the procedure to be performed, every case needs to be titrated on its individual merit based on both patient and surgical factors. Further, it is recommended that INR values should be established at least 72 hours prior to the surgery, which admits a margin of safety for dose modification if necessary. A meticulous case history with complementary hemostatic tests and adoption of adequate local hemostatic measures hold the key to not having the necessity to modify the antiplatelet or anticoagulation treatment in most cases. Additionally, the advent of newer anticoagulants and antiplatelets have raised the requirement of dedicated Randomized Clinical Trials to answer the specific clinical questions of bleeding risk versus thrombo-embolic complications in the perioperative management of such patients.

Background: Dental resin composites undergo chemical and mechanical degradation. Thus, the orthodontist should evaluate aged composite restoration surfaces to select the appropriate protocol to successfully bond orthodontics accessories.

Objective: This study evaluated the shear bond strength (σ) of metal (M) and ceramic (C) brackets bonded to aged resin-based composite restorations (ACR) after different surface treatments.

Methods: ACR specimens (N=160) were fabricated and divided into 8 experimental groups (n=20) as follows: Mo (control)- M bonded to ACR; MA- M bonded to ACR after acid etching using 38% phosphoric acid for 20 s (A); MB- M bonded to ACR after surface roughing using a twelve-bladed bur (B); MBA- M bonded to ACR after B and A; Co (control)- C bonded to ACR; CA- C bonded to ACR after A; CB- C bonded to ACR after B; CBA- C bonded to ACR after B and A. All specimens were stored for 24h before σ testing. Data were statistically analyzed using one-way ANOVA and Tukey post-hoc (α=0.05). Fracture surfaces were examined to determine the failure mode.

Results: The surface treatments (A, B and BA) produced similar σ values (p>0.05) to ACR when using the same bracket type. M bracket showed greater σ than C bracket (p<0.05), probably because of different mechanical retention inherent from bracket type. Inhomogeneous stress distribution generated complex failures.

Conclusion: Considering the needs of an orthodontic treatment and the surface treatments evaluated, sufficient bond strength was produced to ACR, irrespective of bracket type.

Objective: This study aimed to assess possible differences in results provided by two shade guides and a spectrophotometer used to measure the color changes during tooth bleaching.

Methods: Fifty-six patients underwent two sessions of in-office tooth bleaching with a 35% hydrogen peroxide with a week of an interval between them. The color evaluation was performed using shade match with two guide scales (Vita Classical, and Vita Bleach Guide) and a spectrophotometer providing CieLab data. The color was assessed at baseline and 7 days after each session, and 30 days after the last session. Data from scales were arranged in scores according to lightness (lowest to highest) and the color changes were calculated based on baseline data. For CieLab data, ∆L, ∆a, ∆b, and ∆E were calculated for each assessment time. Differences between the color changes observed in each session were assessed by Wilcoxon test (α = 0.05). Friedman`s test and One-way repeated measures ANOVA were used to analyze color changes among the assessment times. Spearman`s test was used to evaluate the correlation between the shade guide scores and data from Cielab.

Results: All methods of color measurement demonstrated any additional effect of second bleaching session on color change, and stable color after 30 days (p < 0.001 for all methods). Both shade guide scales presented low correlation coefficients with ∆L, and moderate coefficients with ∆b, ∆a, and ∆E.

Conclusion: Despite the weak/ moderate correlation among the methods used to measure tooth color, all methods showed similar results of tooth bleaching effectiveness.

Background: Copaifera multijuga are widely used as medicinal plants in Brazil. Of the various ethnopharmacological indications of copaiba oleoresins, the antimicrobial activity had been highlighted.

Objective: This study aimed to evaluate the oleoresin and the hydroalcoholic extract of leaves from Copaifera multijuga against oral pathogens in the sessile and in the planktonic modes.

Methods: Standard strains from the American Type Culture Collection and clinical isolates which cause both cariogenic and endodontic infections were used. Was evaluated in terms of its Minimum Inhibitory Concentration (MIC) values by the broth microdilution method in 96-well microplates, Minimum Bactericidal Concentration (MBC) and biofilm eradication assay.

Results: The Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) assays showed that the oleoresin was effective against some the bacterial strains. Assessment of the antibiofilm activity of hydroalcoholic extract of leaves from C. multijuga against the evaluated microaerophilic bacteria in the sessile mode gave IC50 values of 318.0 and 695.6 μg/mL against S. mitis (ATCC 49456) and A. actinomycetemcomintans (ATCC 43717), respectively. As for the assayed anaerobic bacteria, the hydroalcoholic extract of leaves gave IC50 of 4554.0, 2218.0, and 600.1 μg/mL against F. nucleatum (Clinical isolate), P. gingivalis (ATCC 33277), and P. micros (Clinical isolate), respectively, whereas the oleoresin afforded IC50 of 357.1 μg/mL against P. gingivalis (ATCC 33277).

Conclusion: The oleoresin and hydroalcoholic extract of leaves displayed satisfactory activity against the main oral pathogens in both sessile and planktonic modes. The oleoresin and hydroalcoholic extracts of leaves from C. multijuga are potential candidates for the development of new products for dental and oral care.

Background: Dental caries is still a major public health problem. The use of fluoride is one of the most effective ways to prevent tooth decay.

Objective: The purpose of this research was to investigate the effectiveness of fluoride entrapped in chitosan nanoparticles in vivo.

Methods: Sodium fluoride was loaded in chitosan via ionic gelation of tripolyphosphate nanoparticles. Characterization of nanoparticles was investigated by using the zeta potential, size of particles, loading capacities, encapsulation efficiency, and Fourier Transforms Infrared Spectroscopy. Chitosan/fluoride nanoparticles were fabricated by a method of fluoride/chitosan cross-linking with tripolyphosphate.

Results: The size of nanoparticles was 219 nm. According to the zeta potential results, by adding sodium fluoride to chitosan/tripolyphosphate nanoparticles reducing the number of positive charges of chitosan, the result was diminished zeta potential from +30.8 mV to +14.9 mV. The optimum drug loading and percentage of entrapment efficiency were 70% and 30% respectively. Fourier transform infrared spectroscopy confirmed linked among tripolyphosphate, chitosan and fluoride nanoparticles. In vitro characterization of nanoparticles demonstrated higher fluoride uptake ability and smooth releasing profile.

Conclusion: It is suggested that fluoride/chitosan nanoparticles synthesized in our study may be a promising means of delivering fluoride for the early prevention of tooth decay.

Background: The causes of mandibular condylar hypoplasia can be congenital or acquired in nature. Cited local causes of acquired hypoplasia include trauma, infection and irradiation. We report a case of hypoplastic condyle that was attributed to temporomandibular joint (TMJ) disc displacement without reduction (DDwoR).

Clinical Presentation: A 16-year-old male presented with restricted mouth opening and right TMJ pain for 6 months. He was subsequently diagnosed with DDwoR. Conservative treatment comprising self-care and moist-heat therapy was administered and he was followed for 27 months without any further interventions. During this period, transitions from “normal†morphology to condylar flattening / erosion, and eventually a re-modeled smaller “normal†right TMJ were observed.

Conclusion: The present case provided initial support that DDwoR could be a plausible cause of condylar hypoplasia in adolescents / young adults.