Evaluación de la capacidad de un nuevo colutorio de inhibir la formación del cálculo dental supragingival

Introducción: El cálculo dental supone un problema para la salud oral ya que incrementa la acumulación de placa y toxinas bacterianas e impide su adecuada eliminación debido a la rugosidad de su superficie favoreciendo de esta manera a la evolución de la enfermedad periodontal. Objetivos: Este trabajo pretende estudiar la magnitud de cálculo formado tras el empleo de un colutorio antisarro a base de pirofosfatos para analizar así su eficacia y los efectos adversos sobre diversos aspectos de la cavidad oral. Material y método: Se realizó un ensayo clínico aleatorizado, cruzado y a doble ciego. Todos los individuos utilizaron un colutorio B (pirofosfatos) y un colutorio A (placebo) con las mismas propiedades organolépticas, para que ni investigador ni individuo pudieran diferenciarlos. Se registraron tanto variables generales como parámetros salivares (flujo, ph y composición de la saliva), una muestra de placa subragingival, se midió la magnitud de cálculo formado (índice de Volpe-Manhold, peso y volumen), se analizaron los tejidos blando y duros y se valoró la percepción de los colutorios por parte del paciente. Resultados: el calcio, el flujo salivar y el pH tendieron a incrementarse más con el colutorio test B; pero no puede hablarse de una reacción definitivamente distinta a la ejercida por el placebo A. Para el sodio, cloro o potasio, la influencia fue nula por parte de los dos colutorios y en otros como la urea, el ácido úrico y el fósforo, se vio una evidente alteración; pero semejante con ambos colutorios que tendían a disminuir los valores en saliva. Respecto al análisis microbiológico de la placa bacteriana supragingival ni términos de prevalencia ni de carga absoluta, los colutorios inducían variaciones relevantes en las especies bacterianas estudiadas. Para los parámetros de medición de la magnitud de cálculo, los 3 disminuyeron significativamente con el colutorio test B desde la medida basal a la final, aunque el volumen tuvo una disminución similar para el test y para el placebo. Ningún colutorio produjo efectos adversos sobre mucosas y dientes y fue percibido como más efectivo el colutorio test B. Discusión: La metodología empleada por ser novedosa no pudo compararse con otros estudios. Los resultados corroboran la efectividad de los pirofosfatos que ya se había reflejado en estudios anteriores, aunque con esta nueva formulación los parámetros de cálculo disminuyeron en mayor proporción. Conclusiones: El colutorio test y el placebo modifican ciertos parámetros en la composición química de la saliva, destacando la disminución de la urea, ácido úrico y fósforo. El calcio, el flujo salival y el pH aumentan tras el uso el colutorio test. En cuanto al análisis bacteriano ni en términos de prevalencia ni de carga absoluta los resultados son significativos. El colutorio test parece tener influencia en la magnitud del calculo formado, reflejándose de forma significativa en una disminución del índice de V-M y del peso. No se encontraron alteraciones en mucosas y dientes, hubo una buena tolerancia de los colutorios por parte de los pacientes y fue percibido como mas eficaz el colutorio test.Introduction: Dental calculus is a problem for oral health because it increases the accumulation of plaque and bacterial toxins and this causes the progression of periodontal disease. Objectives: The aim of this paper is to study the magnitude of dental calculus formed upon the use of a mouthrinse based on pyrophosphates and analyze their effectiveness and adverse effects on various aspects of the oral cavity. Material and Methods: This study it´s a randomized clinical trial and double-blind crossover. All individuals used a mouthrinse B (pyrophosphates) and a mouthrinse A (placebo) with the same organoleptic properties. General variables were recorded, salivary parameters (flow, pH and composition of saliva), a microbiological sample of subragingival plaque, magnitude of calculus formed was measured (Volpe-Manhold index, weight and volume), soft and hard tissues were analyzed and perception of mouthrinses by the patients. Results: Calcium, salivary flow and the pH tended to increase over the test B mouthrinse; but without significative differences between mouthrinse A and B. For the sodium, chloride and potassium, no reaction was influenced by the two mouthrinses and other like urea, uric acid and phosphorus, tended to decrease, but this alteration was similar for both mouthrinses. The microbiological analysis of supragingival plaque revealed that in terms of prevalence and absolute load, mouthrinses didn´t induced significant variations in bacterial species studied. For the measuring parameters, the magnitude calculus decreased significantly with mouthrinse test B from baseline to final measurement, although the decrease of volume was a similar for test and placebo. The moutrinses didn´t produced adverse effects and mouthrinse test B was perceived as the most effective. Discussion: The methodology used for this study could not be compared with other studies because it has never been made in others. The results corroborate the effectiveness of pyrophosphate in the decrease of dental calculus reflected in previous studies, but with this new formulation the results were better tan in the other studies. Conclusions: The test and placebo mouthrinses change certain parameters in the chemical composition of the saliva, emphasizing the decreased of urea, uric acid and phosphorus. Calcium, salivary flow and pH increase after the use test mouthrinse. The use of mouthrinse doesn´t change microbiological aspects. The mouthrinse test decreases significantly the calculus formed reflected in the VM index and weight. No alterations in teeth and soft tissue were observated after the use of the mouthrinses. There was good tolerance of mouthwashes by patients and mouthrinse test was perceived as more effective

Assessment of the capacity of a pyrophosphate-based mouth rinse to inhibit the formation of supragingival dental calculus. a randomized double-blind placebo-controlled clinical trial

This study aimed to analyze the efficacy of an anti-calculus mouth rinse and its possible adverse effects on the mucosa and teeth. This randomized double-blind placebo-controlled clinical trial included 40 patients with treated and managed periodontal disease, all with a history of rapid calculus formation. Patients used a pyrophosphate-based test mouth rinse (B) or a placebo (A). A range of parameters were measured for: saliva (saliva flow, pH and chemical composition); calculus (Volpe-Manhold [V-M] index, weight, and volume); adverse effects on mucosa and teeth; and the patients? subjective perceptive of mouth rinse efficacy. The test mouth rinse B produced reductions in urea, uric acid, and phosphorous, calcium, saliva flow, and increases in pH. V-M index and calculus weight decreased after using the test mouth rinse. Calculus volume decreased with both mouth rinses. No changes to the mucosa or teeth were observed. Patients perceived that the test mouth rinse was more effective. The test/B and placebo mouth rinses both modified certain parameters in saliva composition, particularly reductions in urea, uric acid, and phosphorous. Calcium tended to increase after using the test-B mouth rinse. The results did not demonstrate the anticalculus efficacy of the pyrophosphate-based mouth rinse or positive effects on saliva flow or composition. This field requires further research, as no product has been developed that prevents calculus formation completely

The Influence of Keratinized Mucosa on the Nonsurgical Therapeutic Treatment of Peri-Implantitis

Objective: The main objective of this study aimed to evaluate the response to treatment in implants with peri-implantitis regarding the presence or absence of keratinized mucosa. Materials and Methods: One hundred implants with peri-implantitis were treated non-surgically at the Prosthodontics and Occlusion Teaching Unit of the University of Valencia. Records were registered at day zero (recession, bleeding on probing, suppuration, probing depth, bone loss and plaque index), at 1, 3 and 6 months. Results: In both groups, a slight increase in recession and disappearance of suppuration took place, and no bone loss was observed during the following 6 months. However, after an initial reduction, probing depth, bleeding on probing and plaque index increased again in the group without keratinized mucosa (KM). Conclusions: Implants with KM presented better results after non-surgical treatment as well as in their medium-term evolution, although it would be advisable to increase the number of samples in order to achieve greater scientific evidence and standardization in the treatment protocol. Clinical relevance: The role of keratinized mucosa in the development of peri-implantitis has been mentioned in many publications, but less has been emphasized regarding its influence on the success of the treatment of this pathology. The presence of keratinized mucosa has been found to play a key role in the evolution of the non-surgical treatment of peri-implantitis. The amount of keratinized mucosa should be considered in the treatment of peri-implantitis, as well as when planning connective tissue grafts accompanying the decontamination of implants in the absence of keratinized mucosa.Odontologí

Implant-Supported Fixed Partial Dentures with Posterior Cantilevers: In Vitro Study of Mechanical Behavior

Rehabilitation with dental implants is not always possible due to the lack of bone quality or quantity, in many cases due to bone atrophy or the morbidity of regenerative treatments. We find ourselves in situations of performing dental prostheses with cantilevers in order to rehabilitate our patients, thus simplifying the treatment. The aim of this study was to analyze the mechanical behavior of four types of fixed partial dentures with posterior cantilevers on two dental implants (convergent collar and transmucosal internal connection) through an in vitro study (compressive loading and cyclic loading). This study comprised four groups (n = 76): in Group 1, the prosthesis was screwed directly to the implant platform (DS; n = 19); in Group 2, the prosthesis was screwed to the telescopic interface on the implant head (INS; n = 19); in Group 3, the prosthesis was cemented to the telescopic abutment (INC; n = 19); and in Group 4, the prosthesis was cemented to the abutment (DC; n = 19). The sets were subjected to a cyclic loading test (80 N load for 240,000 cycles) and compressive loading test (100 KN load at a displacement rate of 0.5 mm/min), applying the load until failure occurred to any of the components at the abutment–prosthesis–implant interface. Subsequently, an optical microscopy analysis was performed to obtain more data on what had occurred in each group. Results: Group 1 (direct screw-retained prosthesis, DS) obtained the highest mean strength value of 663.5 ± 196.0 N. The other three groups were very homogeneous: 428.4 ± 63.1 N for Group 2 (INS), 486.7 ± 67.8 N for Group 3 (INC), and 458.9 ± 38.9 N for Group 4 (DC). The mean strength was significantly dependent on the type of connection (p < 0.001), and this difference was similar for all of the test conditions (cyclic and compressive loading) (p = 0.689). Implant-borne prostheses with convergent collars and transmucosal internal connections with posterior cantilevers screwed directly to the implant connection are a good solution in cases where implant placement cannot avoid extensions.Odontologí

Microtensile Bond Strength of CAD-CAM Restorative Dental Material Blocks to Resin Cement: An In Vitro Study

Introduction: Today’s dentistry frequently employs bonded partial restorations, which are usually fabricated in ceramic materials. In the last decade, hybrid materials have emerged that attempt to combine the properties of composites and ceramics. Objectives: To evaluate in vitro, by means of a microtensile test, the bond strength between CAD-CAM restorative materials and the cement recommended by their manufacturer. Material and Method: From blocks of CAD-CAM restorative material bonded to composite blocks (Filtek 500®), beams with a bonding area of approximately 1 mm2 were made and divided into four groups: EMAX (IPS e.max CAD® lithium disilicate), VE (VITA Enamic® polymer-infiltrated ceramic matrix), LUA (Lava Ultimate® nano-ceramic resin with sandblasting protocol) and LUS (Lava Ultimate® nano-ceramic resin with silica coating protocol). In each group, perimeter (external) or central (internal) beams were differentiated according to the position in the block. The samples were tested on the LMT 100® microtensile machine. Using optical microscopy, the fractures were categorized as adhesive or cohesive (of the restorative material or composite), and the data were analysed with parametric tests (ANOVA). Results: The LUS group had the highest results (42 ± 20 MPa), followed by the LUA group (38 ± 18 MPa). EMAX had a mean of 34 ± 16 MPa, and VE was the lowest in this study (30 ± 17 MPa). In all groups, the central beams performed better than the perimeter beams. Both EMAX and VE had the most adhesive fractures, while LUA and LUS had a predominance of cohesive fractures. Conclusions: Lava Ultimate® nanoceramic resin with the silica coating protocol obtains the best bond strength valuesOdontologí

Correlation between Polysomnographic Parameters and Tridimensional Changes in the Upper Airway of Obstructive Sleep Apnea Patients Treated with Mandibular Advancement Devices

The effectiveness of mandibular advancement devices has been solidlydemonstrated in the past. They are considered a valid alternative treatment to continuous positiveairway pressure for patients with obstructive sleep apnea. Nevertheless, the relationship betweenpolysomnographic parameters and the increase in the volume of the upper airway in patients with ob-structive sleep apnea syndrome has not been clearly established so far. This study aimed to determinethe impact of these oral appliances upon the volume of the airway after the device titration phase andcorrelate it with the degree of mandibular advancement and the improvement of polysomnographicparameters.Odontologí

Analysis of Predisposing Factors for Rapid Dental Calculus Formation

Background: Calculus accumulation varies widely between individuals. Dental calculus has been associated with the principal periodontal diseases. The aim of this study was to analyze individual characteristics, and salivary and microbiological parameters among patients considered to be rapid calculus formers and patients who form calculus slowly. Methods: Individual characteristics were recorded in a sample of 74 patients (age, sex, smoking, periodontal diagnosis, and dental crowding), as well as salivary parameters (unstimulated saliva flow, pH, and biochemical analysis of saliva) and microbiological parameters (by means of semi-quantitative polymerase chain reaction (PCR) analysis). Results: A statistically significant association (p = 0.002) was found between the rate of calculus formation and the diagnosis of periodontal disease. A greater presence of dental crowding was observed among the group of rapid calculus formers. Urea and phosphorus levels were higher among rapid calculus formers. Regarding microbiological parameters, differences were found in Streptococcus mutans, this being higher in the group of slow formers. Conclusions: Rapid calculus formation appears to be linked to patients diagnosed with more severe periodontal diseases. Rapid calculus-forming patients present more dental crowding and a lower proportion of S. mutans

Retrospective Study of the Association between Peri-Implantitis and Keratinized Mucosa

1. Background: Peri-implantitis affects a high percentage of patients treated with dental implants. Among the risk factors that can cause this pathology, limited evidence exists regarding the absence of keratinized mucosa. The main objective of this study was to compare the amount of keratinized mucosa around healthy implants versus implants in patients with peri-implantitis, in order to analyze its influence on esthetics and the development of this pathology, and to study the possible influence of keratinized mucosa on various clinical parameters. 2.&nbsp;Methods: A retrospective case-control study was carried out in which 203 implants were evaluated, 103 of which presented a healthy peri-implant state, versus 100 which had peri-implantitis. The following elements were recorded: keratinized mucosa, recession, plaque index, bleeding, suppuration, probing depth, and bone level. 3.&nbsp;Results: Keratinized mucosa was present in 51% of the peri-implantitis group versus 97.1% of the healthy implants. In implants without keratinized mucosa, both recession and plaque index, bleeding on probing (96.2%), suppuration (57.7%), mean probing depth and bone level were higher. Implants without keratinized mucosa presented worse esthetics. 4. Conclusions: Absence of Keratinized mucosa around dental implants seems to be associated with the appearance of peri-implantitis modifying certain clinical parameters: there is a greater probability of recession, bleeding, suppuration, deficient hygiene, greater probing depth and greater bone loss in implants without keratinized mucosa

Enamel Wear of Antagonist Tooth Caused by Dental Ceramics: Systematic Review and Meta-Analysis

Background: This systematic review and meta-analysis aimed to evaluate the wear of the antagonist tooth in ceramic restorations. Material and methods: This study was carried out based on Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) recommendations; it was also registered in PROSPERO (register number: CRD42022316252). Three databases were consulted in the literature search, Embase, Scopus, and Web of Science. The citation searching was conducted by two researchers independently. The clinical studies that evaluated wear in antagonist teeth concerning ceramic restoration were included. Twelve articles were selected after eliminating duplicates ones and applying the inclusion criteria, and two were chosen through citation. Fourteen articles were considered for the qualitative and quantitative analysis (meta-regression and meta-analysis). Results: The mean linear wear of the antagonist tooth in relation to feldspathic was 8.914 μm, for lithium disilicate it was 0.018 μm, and for zirconia it was 0.257 μm. The mean volumetric wear of the antagonist tooth in relation to feldspathic was 0.273 mm3, for hybrid ceramic it was 0.030 mm3, for lithium disilicate it was 0.018 mm3, and for zirconia it was 0.014 mm3. The mean natural tooth wear was 0.7974 μm per month. Tooth wear caused by zirconia at six months was 31.755 μm, at 12 months it was 24.648 μm, and at 24 months it was 20.662 μm. Conclusions: Feldspathic produces greater wear of the antagonist tooth from ceramic restorations linearly and volumetrically. In addition, zirconia generates the least wear that will decrease over time, and it will be equal to or less than the natural wear in the tooth

Efficacy of Miniscrews in Gaining Prosthetic Space for a Dental Implant to Replace the Mandibular First Molar: A Case Series

Background: The objective of this case series was to evaluate the efficacy of miniscrews to upright the lower second molar as a result of early loss of the lower first molar in order to permit rehabilitation by means of an implant-supported single crown. Methods: The case series included ten patients who each received a miniscrew placed distal of the second molar in order to straighten the tooth; the prosthetic space gained (sufficient to allow implant placement in the edentulous space) and the change in angulation obtained were analyzed. The changes produced by miniscrews were evaluated in radiographs. Results: Statistical analysis identified significant improvements in angulation (p = 0.005) and significant amounts of space gained (p = 0.005) as well as a strong correlation between these two parameters (r = &minus;0.93; p &lt; 0.001). Conclusions: The use of miniscrews alone without the intervention of other orthodontic methods to straighten a mesialized lower second molar in order to replace a missing first molar with an implant significantly improves both the angulation of the molar and the prosthetic space available