Randomized clinical trial to determine if changes in dentine tubule occlusion visualized by SEM of replica impressions correlate with pain scores:in vivo assessment of tubule occlusion

PURPOSE: To quantify dentin tubule occlusion and correlate this with pain reduction in vivo. METHODS: This was a single-center, randomized two treatment, examiner-blind, parallel study. 20 participants with confirmed dentin hypersensitivity (DH) were evaluated by Schiff Air Blast, VAS Air Blast and replica impression of the tooth surface to visualize tubule occlusion at baseline and following 4-week twice daily use of either an occluding toothpaste (8% strontium acetate, 1,040 ppm fluoride) or a non-occluding toothpaste (1,450 ppm fluoride). RESULTS: Both treatments increased tubule occlusion significantly from baseline to 4 weeks (P= 0.01) with significant decreases in pain score only seen with the occluding toothpaste (Schiff, P= 0.01; VAS, P= 0.01). Schiff pain score after 4 weeks was markedly reduced following treatment with the occluding toothpaste as compared to the non-occluding toothpaste, (P= 0.05) with no significant differences between the pastes for occlusion score or patient reported VAS, although the scores favored the occluding toothpaste. CLINICAL SIGNIFICANCE: Occlusion scores as obtained by replica impression techniques with SEM imaging correlate significantly with DH pain scores confirming proof of concept. With further refinement, this technique could be used to accurately quantify tubule occlusion in vivo and the associated pain reduction achieved by occluding toothpastes

Randomized controlled trial to study plaque inhibition in calcium sodium phosphosilicate dentifrices

Objectives To evaluate the effect of three calcium sodium phosphosilicate (CSPS)/sodium monofluorophosphate containing dentifrices, compared to positive and negative controls on plaque re-growth in a non-brushing model, after 4 days of twice daily use, as determined by plaque area and Turesky plaque index (TPI). Methods This was an exploratory, single-centre, examiner-blind, randomised, controlled, five treatment period, crossover, plaque re-growth study, with supervised use of study products. Twenty-three healthy adult volunteers were randomized to receive experimental 5% CSPS dentifrice; two marketed 5% CSPS dentifrices; active comparator mouthrinse and negative control dentifrice. At the start of each treatment period, zero plaque was established by dental prophylaxis and study products were dispensed as either dentifrice slurries or mouthrinse, twice daily for the next 4 days. No other forms of oral hygiene were permitted. After 96 h, supra-gingival plaque was determined by plaque area (direct entry, planimetric method) and TPI. Changes from zero plaque were analysed. Results For both measures, plaque re-growth at 96 h was significantly lower following treatment with active comparator mouthrinse and significantly higher following treatment with the experimental 5% CSPS dentifrice, compared to all other treatments. There were no statistically significant differences between the three other treatments, except between the marketed 5% CSPS dentifrices, for overall plaque area. Conclusions The comparator mouthwash was significantly more effective at preventing plaque accumulation than the dentifrice slurries. The three marketed dentifrices contained sodium lauryl sulphate and were more effective at reducing plaque re-growth than the experimental dentifrice formulated with a tegobetaine/adinol surfactant system. Clinical relevance The CSPS containing dentifrices tested in this study showed no significant chemical-therapeutic anti-plaque benefits compared to a negative control dentifrice. However, sodium lauryl sulphate-containing dentifrices controlled plaque more effectively than a tegobetaine/adinol-containing CSPS dentifrice suggesting that the impact of surfactant selection on anti-plaque activity of formulations warrants further investigation

BSP implementation of the 2017 classification of periodontal diseases: a practice retrospective

Introduction The new world classification of periodontal diseases and conditions was developed in 2017. The British Society of Periodontology and Implant Dentistry (BSP) implemented the classification in a series of papers published in the British Dental Journal in January 2019. Aims and objectives This study aimed to investigate if the BSP implementation was workable in general dental practice and to reveal if any lessons were learnt from its regular use two years following its release. Materials and methods This was a cross-sectional, retrospective, non-intervention analysis of a patient population (n = 891) drawn from a complete list of a private dental surgeon. Diagnostic and demographic data were drawn from the patient records, collated and analysed using SPSS Statistics v26. Results Diagnoses derived from the new classification were identified for 92% of subjects, indicating a high level of implementation. In total, 20.9% of subjects were diagnosed with periodontitis, and of these, 57% were unstable, 39% stable and 4% in remission. The mean bleeding on probing score across the cohort was 7.7%. Moreover, 76% of the non-periodontitis patients were diagnosed with 'clinical gingival health', 23% with localised gingivitis and 1% with generalised gingivitis. Conclusion The new classification has been found to be readily implemented in a general practice setting. Use of the new classification allows for close monitoring of periodontal status, and as a result, close monitoring of the effectiveness of pathways of care

The effects of age and sex on mandibular bone graft donor sites

Objectives Intra‐oral bone grafting relies on 3‐Dimensional understanding of mandibular anatomy. This study assessed the bone volume at the two most common intra‐oral bone harvesting sites, the retromandibular and symphyseal regions, and assessed the impact of age and sex on the available bone at these sites. Materials and Methods Demographic and anatomical data were collected from Cone Beam Computer Tomographs (CBCT’s) of 200 randomly selected, fully dentate participants (100 male / 100 female) between the ages of 24 and 86 years. Statistical analysis was conducted with SPSS V25, using ANalysis of COVAriance (ANCOVA) to determine the effects of age and sex on the measurements at the donor sites. Results At retromandibular sites, women have a broader alveolar crest with a narrower mandible at the level of the IDC. There is a statistically significant difference, between the sexes, in bone width from the buccal cortex to the IDC. Men have a significantly greater distance from the outer buccal plate to the IDC. There is no difference in any measured dimension at the symphyseal region. There is a statistically significant reduction in bone volume with increasing age at both mandibular sites of 0.03 ‐ 0.05mm annually, irrespective of tooth loss. Conclusion Anatomical variability due to sex and bone reduction with age are both important findings in dental implantology, which must be considered when treatment planning and selecting bone grafting sites in the mandible. This study reinforces the importance of pre‐operative CBCT in planning bone grafting procedures

Prevalence of gingival recession and study of associated related factors in young UK adults:Recession Prevalence in UK young adults

Objectives To determine the prevalence of gingival recession (GR) and associations with dentine hypersensitivity (DH), erosive toothwear (BEWE), gingival bleeding (BOP) and periodontal pocketing (PPD) in young European adults. Materials and Methods This is a secondary analysis using data collected from 350 UK participants enrolled in a European cross sectional study of 3187 young adults. GR, BOP, PPD, DH (participant and clinician assessment) and BEWE were recorded. A questionnaire assessed demographics, oral hygiene and lifestyle habits. Results 349 participants completed the study. GR, BOP and PPD showed the same pattern of distribution, prevalence increasing from incisors to molars in upper and lower arches for buccal and palatal scores. Every participant exhibited recession affecting at least 1 tooth, 42% having a maximum recession of 4–8 mm. There was a significant and linear association demonstrating an increase in maximum recession with age. DH and BEWE produced a similar pattern to buccal periodontal indices, the premolars being most affected. Maximum recession correlated significantly with maximum DH (participant and Schiff), PPD, BOP, BEWE (scores of 2/3), BMI (≥25 kg/m2) and unsystematic brushing motion. 94% of the study population exhibited some BOP at one or more sites. 5% of the population had periodontal pocketing ≥4 mm, 46% had DH and 80% BEWE 2/3. Conclusion Widespread recession and gingivitis with minimal periodontal disease was observed. Every participant exhibited at least one tooth with recession. Many teeth did not exhibit DH despite prevalent recession and severe erosive toothwear. Recession correlates to a number of oral and lifestyle variables. Clinical Significance Recession in young adults is multifactorial and highly prevalent. It can result in DH and consequential increase in demand for treatment relating to both pain and aesthetics. Further research is needed to understand the underlying aetiology to prevent recession occurring

A randomised clinical trial to determine the abrasive effect of the tongue on human enamel loss with and without a prior erosive challenge

Objectives To investigate the abrasive effect of the tongue on human enamel loss with and without a prior dietary acid challenge in an in situ model. Methods A single centre, single blind, randomly allocated, split mouth, four treatment regimen, in situ study in healthy adult volunteers was undertaken. Twenty four subjects wore two lower intra-oral appliances each fitted with 4 human enamel samples 6 h/day for 15 days. The samples were treated with either 50 ml orange juice or water for 5 min ex vivo 4 x/day; prior to being licked or not licked with the subject's tongue for 60 s. There were 2 samples per group per subject. Surface loss was measured by contact profilometry. Results 23 subjects completed the study with no adverse events. The mean loss of enamel at 15 days was: 0.08 μm for water without licking, 0.10 μm with water and licking; 1.55 μm with orange juice alone, 3.65 μm with orange juice and licking. In the absence of erosive challenge, licking had no detectable effect on enamel loss p = 0.28. Without licking, orange juice had a highly significant effect on loss compared to water, p < 0.001. Erosive challenge followed by licking more than doubled the loss of enamel p < 0.001. Conclusions When enamel was exposed to orange juice prior to licking, tissue loss as a result of tongue abrasion of the eroded surface was increased, and double that of the erosive challenge alone. Licking enamel with the tongue had no perceptible effect on enamel loss in the absence of the erosive challenge. Clinical significance Enamel wear resulting from tongue abrasion on tooth surfaces softened by acid challenge, can be an unavoidable consequence of oral function. This may account for the pattern of erosive toothwear on palatal and occlusal tooth surfaces, reinforcing the importance of restricting the frequency of dietary acid challenge in susceptible individuals

The use of non-surgical interventions in patients with periimplantitis; a systematic review and meta-analysis

Objectives: To systematically assess the efficacy of different non‐surgical treatment methods to manage peri‐implantitis reported to date in the literature, together with its correlation with time following therapy. Materials and Methods: A systematic literature review was undertaken to identify randomised control trials of the non‐surgical management of peri‐implantitis published up to November 2019. The search was limited to English language human studies containing follow‐up periods of ≥3 months and for sample size of 10 or more patients. A meta‐analysis was implemented for the following clinical parameters: Peri‐implant pocket depth (PPD), bleeding on probing (BOP), clinical attachment level (CAL), radiographic bone loss (RBL) and mucosal recession (MR). Results: Twelve articles met the inclusion criteria. Two principal treatment modalities were identified; mechanical debridement and laser therapy, with two adjunctive therapies antimicrobial and antiseptic agents. Non‐surgical interventions (ultrasonic scalers, Er:YAG laser and powdered air‐abrasive devices) showed significant clinical improvement in the short term (<3 months). Clinical benefit was demonstrated with the adjunctive use of antimicrobial agents in the short term but diminished with time. Antiseptic agents alone have no significant effect. Non‐surgical therapies applied in these studies failed to arrest mucosal recession, peri‐implant bone loss or reduce the counts of viable pathogens in the long term. Conclusion: The evidence demonstrate that the clinical parameters of peri‐implantitis, i.e. BOP, PPD and CAL may all be improved by simple mechanical debridement, using either ultrasonic instrumentation or Er:YAG laser therapy; adjunctive antimicrobial and antiseptic therapy. Further randomised control trials in this area are, however, required