Cyanoacrylate Versus Laser in the Treatment of Dentin Hypersensitivity: A Controlled,Randomized, Double‐Masked and Non‐Inferiority Clinical Trial

Background: Dentin hypersensitivity (DH) is a painful, exaggerated response to normal stimuli, such as cold, sweetness, and brushing. The aim of the present controlled, randomized, double‐masked, non‐inferiority clinical trial is to evaluate the effectiveness of cyanoacrylate in the treatment of DH when compared to the application of low‐intensity laser. Methods: The study includes 434 sensitive teeth from 62 patients. A total of 216 teeth were treated with laser and 218 with cyanoacrylate. A numeric rating scale was used to record the parameters of pain related to the stimuli at baseline and after the treatment at intervals of 24 hours and 30, 90, and 180 days. Results: Both groups had significant reductions in DH. However, there was no significant difference between the two groups ≤6 months. Intragroup analysis showed that the effect of cyanoacrylate obtained at 24 hours remained for 90 days in response to air‐jet test and 30 days for cold‐spray test. There was a statistically significant difference between all other intragroup comparisons at the time intervals (P <0.001). Conclusions: It was concluded that cyanoacrylate is as effective as low‐intensity laser in reducing DH. In addition, it is a more accessible and low‐cost procedure and can be safely used in the treatment of DH.     

迪散脱敏剂治疗牙本质过敏临床观察

目的对比评价迪散特效牙齿脱敏剂与常规脱敏剂治疗牙本质过敏的临床疗效。方法因(牙合)面磨耗致牙本质过敏的第一、第二磨牙900颗,平均分为实验组(迪散脱敏剂组)、对照Ⅰ组(Gluma脱敏组)、对照Ⅱ组(75％氟化钠甘油组)。同时取离体牙36颗,平均分成3组,标本制作方法与临床组相同,进行扫描电镜观察结果实验组总有效率95.66％;对照Ⅰ组为85.67％;对照Ⅱ组为60.33%。实验组疗效优于两对照组,差异有显著性(P<0.01)。结论迪散特效牙齿脱敏剂可用作脱敏材料。     

脉冲Nd:YAG激光促进氟保护漆治疗牙齿敏感症临床观察

目的　观察脉冲Nd :YAG激光促进氟保护漆治疗牙齿敏感症的临床疗效。方法　用计算机程序控制脉冲Nd :YAG激光照射经涂一层氟保护漆的牙齿敏感症患牙 ,并分别与单纯涂一层氟保护漆或单纯脉冲Nd :YAG激光照射的疗效相比较。结果　涂氟保护漆加脉冲Nd :YAG激光照射治疗牙齿敏感症优于单纯涂保护漆或单纯脉冲Nd :YAG激光照射 ,疗效有显著性差异 (P <0 .0 5 )。结论　涂氟保护漆和脉冲Nd :YAG激光照射的联合应用是一种治疗牙齿敏感症较为有效的手段     

Antibacterial Efficacy of MTAD Final Rinse and Two Percent Chlorhexidine Gel Medication in Teeth with Apical Periodontitis: A Randomized Double-blinded Clinical Trial

IntroductionClinical assessment of the efficacy of novel root canal disinfection protocols is an important focus in endodontic research. This randomized double-blinded study assessed the antibacterial efficacy of a final rinse with BioPure MTAD (MTAD) and intracanal medication with 2% chlorhexidine gel (CHX) in teeth with apical periodontitis.MethodsCanals in 30 teeth (single-rooted and multi-rooted) were prepared by using 1.3% NaOCl, rinsed with MTAD or saline in random sequence, medicated with CHX for 7 days, irrigated with 1.3% NaOCl, and filled. Bacteriologic root canal samples were obtained by aspiration before (1A) and after (1B) canal preparation, after the final rinse (1C), after CHX was flushed (2A), and after final irrigation (2B). Bacteria were enumerated by epifluorescence-microscopy (EFM) by using 2 staining methods and by colony-forming-unit (CFU) counts after 14 days of incubation.ResultsBacterial counts (EFM) in 1B were greater than 95% decreased from 1A. Low bacterial densities in 1B, 1C, 2A, and 2B did not differ significantly from each other. EFM counts were consistently higher than CFU counts.ConclusionsThe final rinse with MTAD and medication with CHX did not reduce bacterial counts beyond levels achieved by canal preparation with NaOCl.     

Effects of Ozone Therapy on the Early Healing Period of Deepithelialized Gingival Grafts: A Randomized Placebo‐Controlled Clinical Trial

Background: This study evaluates the effects of ozone therapy (OT) on the early healing period of deepithelialized gingival grafts (DGG) placed for non‐root coverage gingival augmentation by laser Doppler flowmetry (LDF). Methods: Thirty‐three patients were assigned to study groups: 1) test: DGG + OT; or 2) control group: DGG alone. Thirty patients completed the study. Ozone was applied on DGGs placed in the recipient bed and donor site immediately after surgery and at days 1 and 3 post‐surgery. Blood perfusion in the recipient site was measured by LDF on the day of surgery and at 1, 2, 3, 6, 8, 10, and 13 days after surgery. Quality of life (assessed by the Oral Health Impact Profile‐14) and pain at donor/recipient sites (assessed by visual analog scale) were also investigated. Results: Increase in blood perfusion units in the test group was significantly higher than control group at 1, 2, 3, 6, and 8 days post‐surgery (P <0.001). Significant differences occurred between test and control groups in terms of visual analog scale values during the first week post‐surgery for both donor and recipient sites (P <0.05). The ozone‐treated group showed significantly higher quality of life than control group on postoperative day 6 (P = 0.002). Conclusions: OT enhanced blood perfusion units in the first postoperative week. This outcome is also consistent with improvement in wound healing, accompanied by an increase in quality of life and decrease in postoperative pain in the test group.     

Single‐Tooth Implants with Different Neck Designs: A Randomized Clinical Trial Evaluating the Aesthetic Outcome

Aim: To evaluate the aesthetic outcome of single‐tooth implants in the aesthetic zone with different neck designs from a professional's and patient's perception. Materials and Methods: Ninety‐three patients with a missing anterior tooth in the maxilla were randomly assigned to be treated with an implant with a smooth neck, a rough neck with grooves or a scalloped rough neck with grooves. Implants were installed in healed sites. One year after definitive crown placement (18 months post‐implant placement), photographs were taken and the aesthetic outcome was assessed according to two objective aesthetic indexes: pink esthetic score/white esthetic score (PES/WES) and implant crown aesthetic index (ICAI). A questionnaire was used to assess the aesthetic outcome and general satisfaction from a patient's perception. Standardized radiographs were taken to measure marginal bone level changes. Results: One implant was lost. Although there was a significant difference in marginal bone loss between the different implant neck designs (smooth neck 1.19 ± 0.82 mm, rough neck 0.90 ± 0.57 mm, scalloped neck 2.01 ± 0.77 mm), there were no differences in aesthetic outcome. According to the professional's assessments using PES/WES and ICAI, 79.3% and 62% of the cases showed acceptable crown aesthetics, and 59.8% and 56.5% of the cases showed acceptable mucosa aesthetics. Overall, patients were satisfied about the aesthetics of the mucosa (81.5%) and crown (93.3%), and general patient satisfaction was high (9.0 ± 1.0 out of a maximum of 10). According to the professional's assessment, a pre‐implant augmentation procedure was associated with less favorable aesthetics of the mucosa. Conclusion: This study shows that the aesthetics of single‐tooth implants in the maxillary aesthetic zone appears to be independent of the implant neck designs applied but dependent on the need for pre‐implant surgery.     

Evaluation of Ozone Therapy in Endodontic Treatment of Teeth with Necrotic Pulp and Apical Periodontitis: A Randomized Clinical Trial

IntroductionThe aim of this study was to compare the effect of different application techniques of ozone on the prevalence of postendodontic pain in patients undergoing single-visit root canal treatment.Methodshundred eight patients with necrotic pulp in single-rooted teeth and apical periodontitis participated in the trial. A standard single-visit endodontics protocol was followed with 5.25% sodium hypochlorite and rotary nickel-titanium files. After shaping and cleaning, patients were randomly allocated into the following groups: group 1 (n = 21), ozone treatment with no activation (NA); group 2 (n = 22), ozone treatment with manual dynamic activation (MDA); group 3, (n = 21), ozone treatment with passive ultrasonic activation (PUA); group 4 (n = 23), ozone treatment with sonic activation (SA); and group 5 (n = 21), no ozone treatment (the control group). Patient levels of discomfort were recorded at 6 different time intervals using the visual analog scale (VAS). Comparison of the mean difference between the groups and time intervals was performed using 2-way analysis of variance followed by a post hoc Bonferroni test. The level of significance was set at 5%.ResultsVAS scores were highest for the control > NA > MDA > SA > PUA groups. A statistically significant reduction in VAS scores was observed in the PUA and SA groups in comparison with the NA, control, and MDA groups. Timewise comparison showed a highly significant decline in VAS scores at all time intervals (P < .001).ConclusionsUltrasonic and sonic activation of ozone resulted in less pain in patients undergoing single-visit endodontics compared with no ozone treatment.     

Effect of Foraminal Enlargement on Postoperative Pain in Necrotic Single-Rooted Teeth: A Randomized Clinical Trial

IntroductionThe aim of this study was to evaluate pain perception, pain medication intake, and sealer extrusion after single-visit root canal treatment of asymptomatic teeth with or without foraminal enlargement. The correlation between sealer extrusion and pain was also investigated.MethodsOne hundred forty necrotic, single-rooted teeth were divided into 2 groups (n = 70): foraminal patency (FP), in which treatment was performed up to 1 mm short of the apex, and foraminal enlargement (FE), in which treatment was performed up to the apex. The canals were instrumented using WaveOne Gold files (Dentsply Maillefer, Ballaigues, Switzerland), irrigated with 2.5% sodium hypochlorite, and filled using the single-cone technique and AH Plus sealer (Dentsply Maillefer). A visual analog scale was used to record pain 24, 48, and 72 hours and 1 week postoperatively. The presence or absence of sealer extrusion was recorded.ResultsPain levels were significantly higher for FE than FP at 24 hours (P < .05), namely 0.3 ± 0.9 versus 0.1 ± 0.1; no difference was found at 48 hours, namely 0.1 ± 0.5 versus 0.0 ± 0.0 (P > .05). No pain was reported 72 hours or 1 week postoperatively in either group. Although all patients requiring pain medication at 24 hours were from the FE group, the difference between FE and FP was not statistically significant with respect to this variable (P > .05). Nevertheless, the intake amount was significantly higher in FE than in FP at this time point (P < .05). Sealer extrusion occurred more frequently in FE than FP, namely 57.14 % versus 14.29% (P < .05). There was no association between pain and sealer extrusion (P > .05) or between pain and sex, age, or tooth type (P > .05).ConclusionFE was related to higher pain levels 24 hours postoperatively and to higher rates of filling material extrusion; however, there was no association between filling material extrusion and postoperative pain.     

Relief of Injection Pain During Delivery of Local Anesthesia by Computer‐Controlled Anesthetic Delivery System for Periodontal Surgery: Randomized Clinical Controlled Trial

Background: Pain from local anesthetic injection makes patients anxious when visiting a dental clinic. This study aims to determine differences in pain according to types of local anesthetizing methods and to identify the possible contributing factors (e.g., dental anxiety, stress, and sex). Methods: Thirty‐one patients who underwent open‐flap debridement in maxillary premolar and molar areas during treatment for chronic periodontitis were evaluated for this study. A randomized, split‐mouth, single‐masked clinical trial was implemented. The dental anxiety scale (DAS) and perceived stress scale (PSS) were administered before surgery. Two lidocaine ampules for each patient were used for local infiltration anesthesia (supraperiosteal injection). Injection pain was measured immediately after local infiltration anesthesia using the visual analog pain scale (VAS) questionnaire. Results from the questionnaire were used to assess degree of pain patients feel when a conventional local anesthetic technique (CNV) is used compared with a computer‐controlled anesthetic delivery system (CNR). Results: DAS and PSS did not correlate to injection pain. VAS scores were lower for CNR than for CNV regardless of the order in which anesthetic procedures were applied. VAS score did not differ significantly with sex. Pearson coefficient for correlation between VAS scores for the two procedures was 0.80, also indicating a strong correlation. Conclusion: Within the limitations of the present study, relief from injection pain is observed using CNR.     

Local Minocycline Effect on Inflammation and Clinical Attachment During Periodontal Maintenance: Randomized Clinical Trial

Background: Minocycline microspheres (MMs) are being used to treat residual inflamed periodontal pockets during periodontal maintenance therapy (PMT), but evidence for efficacy from randomized clinical trials is lacking. The purpose of this study is to evaluate the effect of MMs plus scaling and root planing (SRP) on these sites. Methods: Sixty patients with chronic periodontitis on 6‐month PMT intervals to be followed for 1 year were randomized (51 completed the study) into two statistically similar groups, SRP + MM (aged 66.8 years) and SRP alone (aged 67 years), to treat a ≥5 mm posterior interproximal pocket during PMT with a history of bleeding on probing (BOP). Group treatments were applied to the site at baseline and 6 months. Clinical attachment levels (CALs; primary outcome), probing depths (PDs), plaque, and BOP also were recorded at baseline and 6 and 12 months. In addition, gingival crevicular fluid was analyzed for an inflammation index ratio of interleukin (IL)‐1β/IL‐1 receptor antagonist (ra) using enzyme‐linked immunosorbent assays. Results: All clinical parameters improved significantly (P <0.005) from baseline in both groups with no differences between groups at any time point. CAL decreased 17% (0.9 ± 0.8 mm) and 13% (0.7 ± 0.9 mm) in SRP + MM and 11% (0.7 ± 1.1 mm) and 21% (1.2 ± 0.9 mm) in SRP at 6 and 12 months, respectively. The odds of having BOP decreased 90% (down to 38% of patients) and 95% (26%) in SRP + MM and 82% (42%) and 82% (41%) in SRP at 6 and 12 months, respectively. IL‐1β/IL‐1ra decreased a significant 61% (P = 0.009) only in SRP + MM at 6 months. Conclusions: SRP of inflamed moderate pockets during 6‐month PMT, with or without MMs, improves CALs, along with PDs and BOP over a 1‐year period. The use of MMs did not result in an additional benefit over SRP alone.     

The Effect of the Bass Intrasulcular Toothbrushing Technique on the Reduction of Gingival Inflammation: A Randomized Clinical Trial

ObjectivesThe primary objective of this randomized controlled clinical trial was to investigate the effect of the Bass Intrasulcular Technique (BIT) on reducing gingival inflammation at 4 and 12 weeks compared with the toothbrushing techniques commonly used.Methods and MaterialsAfter receiving ethical approval from the Tufts Health Sciences Institutional Review Board, 55 subjects were invited to participate in the study. Only the subjects who presented with bleeding on probing (BoP) were enrolled. The test group (BT) was instructed on how to use the BIT, and the control group (NI) received no brushing technique instructions. Clinical measurements (probing depth, plaque score, BoP) of each tooth were recorded at 4 and 12 weeks. The toothbrushes of all participants were photographed and assessed by two blinded examiners using the ImageJ software. The statistical significance between the cohorts' BoP and their plaque score results was assessed via hierarchical logistic regression. The analyses were performed using the SAS software (version 9.4; SAS Institute, Cary, NC).ResultsForty-eight participants were eligible to participate and were randomly assigned to one of the two groups (N = 24). The BT group showed significantly smaller percentages of BoP than the NI group at 4 (BT = 12.4% and NI = 31.4%) and 12 (BT = 11.6% and NI = 43.8%) weeks. The difference in plaque scores at 12 weeks was statistically significant (P = .0003) between the two groups. At 12 weeks, the Mann-Whitney U Test indicated that the difference between the groups in terms of toothbrush area was statistically significant (P = .043).ConclusionsWithin the limitations of this randomized controlled clinical trial, the BIT used by participants in the BT group was significantly more effective in reducing gingival inflammation as determined by BoP than the techniques used by participants who had no instructions on brushing techniques; at 12 weeks, the BT group experienced less toothbrush deformation than the control group.Clinical RelevanceBIT should be recommended particularly to patients exhibiting BoP and periodontal diseases.     

不同脱敏方法治疗牙本质过敏症的临床疗效观察

目的 观察2种不同脱敏方法治疗牙本质过敏症的作用，并探讨其作用机制。方法 随机抽样，取牙本质过敏症患牙160颗，分成2组。试验组80颗为深低温冷冻组，对照组用熨热疗法治疗。结果 试验组近期有效率96．4％，而对照组仅为75％，其间有显著性差异（P＜0．01）。结论 深低温冷冻是一种安全，有效的治疗牙质过敏症的好方法。     

Effect of Surgical Defect Coverage on Cervical Dentin Hypersensitivity and Quality of Life

Background: Root exposure due to gingival recession (GR) can cause cervical dentin hypersensitivity (CDH), which is characterized by tooth pain. The aim of this study is to evaluate the effect of surgical defect coverage on CDH and quality of life in patients with GR. Methods: Twenty‐five GRs in maxillary canines and premolars were treated with coronally positioned flap plus connective tissue graft. GR dimensions, amount of keratinized gingiva, and clinical attachment level were evaluated. CDH was assessed by thermal and evaporative stimuli. Quality of life was assessed by use of the Oral Health Impact Profile‐14 (OHIP‐14) questionnaire. All parameters were evaluated at baseline and after 3 months. Results: Statistically significant reduction in CDH (P <0.001), significant reduction in impact of oral health on quality of life (P <0.001), and significant changes in periodontal parameters were observed after 3 months. Mean defect coverage of 67.90% was achieved, with full coverage in 11 cases. Percentage defect coverage showed no correlation with air blast–stimulated CDH (P = 0.256) or cold stimulus (P = 0.563). The OHIP‐14 physical disability dimension was correlated with the amount of keratinized tissue (P = 0.010) and also with defect coverage (P = 0.035). Conclusions: Surgical defect coverage may reduce CDH and improve patient quality of life, by keratinized gingiva augmentation and impact on physical disability, irrespective of amount of defect coverage.     

Influence of an Audiovisual Resource on the Preoperative Anxiety of Adult Endodontic Patients: A Randomized Controlled Clinical Trial

IntroductionThe expectation of undergoing endodontic treatment can cause anxiety in patients. Anxiety is described as a transient emotional state closely related to pain, fear, and imbalance of the organism. The clinician commonly must use some type of tool to alleviate the patient’s preoperative anxiety before treatment can be applied. The aim of this study was to evaluate the influence of an audiovisual resource on the preoperative anxiety of adult patients undergoing endodontic treatment.MethodsOne hundred sixty endodontic patients were randomly divided into experimental and control groups (n = 80) and then assessed at 2 preoperative time points separated by a 10-minute interval. After the first assessment, the patients in the experimental group watched a video of their own choice obtained from the Internet to provide them with a relaxing experience. In both groups and at both time points, the assessments consisted of collecting the patients’ vital signs (diastolic blood pressure, systolic blood pressure, and heart rate) and data regarding their subjective perception of anxiety using a visual analog scale.ResultsThere were no significant differences between the groups regarding the vital sign variation observed between the 2 assessment time points. However, the variation in the scores obtained on the visual analog scale was significantly greater in the experimental group (P < .05), indicating a greater reduction in the level of preoperative anxiety in this group.ConclusionsThe preoperative use of an audiovisual resource was associated with a decrease in the perception of anxiety by patients undergoing endodontic treatment.     

Adjunctive Local Delivery of Aloe Vera Gel in Patients With Type 2 Diabetes and Chronic Periodontitis: A Randomized,Controlled Clinical Trial

Background: Herbal agents such as Aloe vera (AV) have been used in medical and dental therapy for thousands of years. AV has anti‐inflammatory, antioxidant, antimicrobial, hypoglycemic, healing‐promoting, and immune‐boosting properties. This study aims to investigate the clinical effectiveness of locally delivered AV gel used as an adjunct to scaling and root planing (SRP) in the treatment of patients with type 2 diabetes mellitus (T2DM) and chronic periodontitis (CP). Methods: Sixty patients with probing depth (PD) ≥5 mm and clinical attachment level (CAL) ≥3 mm were randomly divided into two groups. All patients underwent SRP. Placebo gel was locally delivered to group 1 and AV gel to group 2. Full‐mouth plaque index (PI), modified sulcus bleeding index (mSBI), PD, and CAL were recorded at baseline and 3 and 6 months. Results: Patients in group 2 showed significantly greater mean reductions in PI, mSBI, and PD and mean gain in CAL compared with those in group 1 from baseline to 3 months. Gain in CAL was significantly greater in group 2 at all time intervals versus group 1. Conclusion: Adjunctive use of locally delivered AV gel, in comparison to locally delivered placebo gel, is associated with greater reduction in PI, mSBI, and PD as well as more gain in CAL in patients with T2DM and CP.     

Effect of Flapless Surgery on Single‐Tooth Implants in the Esthetic Zone: A Randomized Clinical Trial

Background: Implant therapy is a highly predictable treatment option; however, insufficient data exist to show whether flapless implant surgery provides better esthetic outcomes and less bone loss than implant surgery with a flap approach. Methods: In this randomized, controlled study comparing the flapless and traditional flap protocol for implant placement, 24 patients received a single implant in the anterior maxillary region. A cone beam computed tomography–aided surgical guide was used for implant placement surgery for both groups. Implants were restored using a one‐piece, screw‐retained ceramic crown at 3 months. Radiographic and clinical measurements were assessed at baseline (implant placement) and at 3 (crown placement), 6, 9, and 15 months. Clinical parameters evaluated were plaque index, gingival index, papillary index (PPI) (0 = no papilla, 1 = less than half, 2 = more than half but not complete, 3 = complete fill, and 4 = overfill), marginal tissue levels, biotype, width of keratinized tissue, and soft tissue thickness. Results: Implant success rate was 92% in both groups. Mean PPI values for the flap control group and flapless test group were 2.38 ± 0.51 versus 2.31 ± 0.48 at crown placement (P = 0.68) and 2.52 ± 0.52 versus 2.64 ± 0.54 at 15 months (P = 0.42), respectively. PPI increased over time in both groups, although the flapless group had a significantly larger change in PPI from crown placement to 6 and 9 months (P <0.01). Crestal bone levels in the flap group were more apical in relation to the implant platform than those in the flapless group for the duration of the study. No differences among groups were noted for all other measurements. Conclusions: Both flapless and flap implant placement protocols resulted in high success rates. A flapless protocol may provide a better short‐term esthetic result, although there appears to be no long‐term advantage.     

Effect of Low-level Laser Therapy on Postoperative Pain after Root Canal Retreatment: A Preliminary Placebo-controlled,Triple-blind,Randomized Clinical Trial

Introduction

Low-level laser therapy (LLLT) is a practical, nonpharmacologic technique for reducing pain. This study evaluated the effect of LLLT on postoperative pain after root canal retreatment (RCR).