Dentists and dental staff have an increased risk of airborne infection with pathogens such as SARS-CoV-2 since they are exposed to high levels of droplets and aerosols produced during specific dental procedures. Hence, new guidelines such as patient screening and temperature control, air purification, space, surface and hand sanitizing and the use of protective equipment and physical barriers have been successfully implemented. In addition, the use of teledentistry has expanded considerably in pediatric dentistry, orthodontics, oral medicine and periodontics in order to address oral and dental health issues during the COVID-19 pandemic while minimizing virus transmission. Thus, teleconsultation, telediagnosis, teletriage, teletreatment and telemonitoring have emerged as valuable tools not only in the delivery of care, but also in the academic and research training of dental health professionals. This narrative review summarizes the current literature on the impact of the pandemic on dental care, dental staff and dental education, with an emphasis on how newly emerging protocols and technologies can be successfully utilized as integral parts of various branches of the dental practice and their future implications without compromising patient care.
Inlay-retained dental bridges can be a viable minimally invasive alternative when patients reject the idea of implant therapy or conventional retained full-coverage fixed dental prostheses, which require more tooth preparation. Inlay-retained dental bridges are indicated in patients with good oral hygiene, low susceptibility to caries, and a minimum coronal tooth height of 5 mm. The present study aims to evaluate, through the finite element method (FEM), the stability of these types of dental bridges and the stresses on the supporting teeth, under the action of masticatory forces. The analysis revealed the distribution of the load on the bridge elements and on the retainers, highlighting the areas of maximum pressure. The results of our study demonstrate that the stress determined by the loading force cannot cause damage to the prosthetic device or to abutment teeth. Thus, it can be considered an optimal economical solution for treating class III Kennedy edentation in young patients or as a provisional pre-implant rehabilitation option. However, special attention must be paid to its design, especially in the connection area between the bridge elements, because the connectors and the retainers represent the weakest parts.
Periodontitis is one of the most common immune-mediated inflammatory conditions resulting in progressive destruction of periodontium. Metalloproteinase-9 (MMP-9), an enzyme that is involved in the degradation of gelatin and collagen and present in the gingival crevicular fluid, is markedly increased in periodontitis. The aim of the study is to evaluate the effects of periodontal treatment either alone or in combination with orthodontic treatment on MMP-9 levels. In this study, 60 individuals were subjected to periodontal treatment (PD) or periodontal treatment combined with orthodontic treatment (POD). Both periodontal and periodontal plus orthodontic treatments significantly improved clinical parameters and lowered MMP-9 levels compared to control group. However, the combination of periodontal with orthodontic treatment further improved clinical parameters and enhanced the lowering effect on MMP-9 levels compared to periodontal or control groups alone. Finally, the degree of malocclusion significantly affected the effect of the treatment on MPP-9 levels with PD treatment having the most pronounced effect. We concluded that salivary MMP-9 can serve to accurately predict the level of inflammation in affected periodontal tissues during orthodontic treatment that is also associated with the type of malocclusion, making it a viable diagnosis tool in monitoring the progression of the periodontium during orthodontic treatment.
Fixed prosthodontic dental restorations can potentially affect the periodontal tissues and vice versa, the periodontium can influence the longevity and esthetic appearance of dental restorations. We proposed an investigation on total bacterial load, specific periodontal pathogens, and periodontal clinical parameters in patients with dental fixed prosthesis and different degrees of periodontal tissue loss that followed photoactivation therapy (PDT) adjunctive to scaling and root planing. The study was conducted on 160 subjects, which were randomly assigned to scaling and root planing (SRP) alone (52 subjects, 256 sites), SRP and chlorhexidine rinsing (58 subjects, 276 sites), and SRP plus PDT (50 subjects, 318 sites). Periodontal parameters (plaque index, bleeding on probing, probing depth, and clinical attachment loss), followed by total bacterial load and specific periodontal pathogens (Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola) were examined in each patient at baseline, one and six months after. PDT exerted significant improvements both in clinical and microbiological load after one month, and these results were maintained 6 months after when compared to chlorhexidine rinsing or SRP alone, especially in severe periodontitis cases. Photoactivation therapy as an adjunctive periodontal therapeutic method was efficient in offering supplementary periodontal improvements in the clinical and microbiological parameters of patients with fixed dental prosthesis, particularly in severe periodontitis cases.
Orthodontic treatment in patients with no periodontal tissue breakdown vs. horizontal bone loss should be approached with caution even though it can bring significant benefits in terms of periodontal recovery and long-term success. We used the finite element method (FEM) to simulate various clinical scenarios regarding the periodontal involvement: healthy with no horizontal bone loss, moderate periodontal damage (33%) and severe horizontal bone loss (66%). Afterwards, forces of different magnitudes (0.25 N, 1 N, 3 N, and 5 N) were applied in order to observe the behavioral patterns. Through mathematical modeling, we recorded the maximum equivalent stresses (σ ech), the stresses on the direction of force application (σ c) and the displacements produced (f) in the whole tooth–periodontal ligament–alveolar bone complex with various degrees of periodontal damage. The magnitude of lingualization forces in the lower anterior teeth influences primarily the values of equivalent tension, then those of the tensions in the direction in which the force is applied, and lastly those of the displacement of the lower central incisor. However, in the case of the lower lateral incisor, it influences primarily the values of the tensions in the direction in which the force is applied, then those of equivalent tensions, and lastly those of displacement. Anatomical particularities should also be considered since they may contribute to increased periodontal risk in case of lingualization of the LLI compared to that of the LCI, with a potential emergence of the “wedge effect”. To minimize periodontal hazards, the orthodontic force applied on anterior teeth with affected periodontium should not exceed 1 N.
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