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Objectives: To explore the efficacy of Hyaluronic acid as an adjunctive in treatment of gingival recessions (GR)., Materials and Methods: A systematic literature search was performed in several electronic databases, including Medline/ PubMed, Embase, CENTRAL and LILACS. Recession improvement was evaluated through multiple outcome variables. The Cochrane Risk of Bias tool and the ROBINS-I tool were used to assess the quality of the included trials. Weighted Mean Differences (WMDs) and 95% confidence intervals (CIs) between test and control sites were estimated through meta-analysis using a random-effect model for the amount of Relative Root Coverage (RRC)., Results: A total of 3 randomised studies were deemed as eligible for inclusion. Their data were also used for pooling the effect estimates. Overall analysis of RRC (3 studies) presented a WMD of 7.49% (p = 0.42; 95% CIs -10.88, 25.86) in favour of adjunctive use of hyaluronic acid during Coronally Advanced Flap (CAF) technique, although statistical significance was not reached. Statistical heterogeneity was found to be high (I 2  = 80%)., Conclusions: Within their limitations, the present data indicate that the local application of Hyaluronic acid does not lead to additional clinical benefits when used as an adjunctive to the treatment of GR with CAF. However, due to the high heterogeneity among the studies, additional well-designed RCTs are needed to provide further evidence on this clinical indication for the use of Hyaluronic acid., Clinical Relevance: In the frame of the current review, the adjunctive use of Hyaluronic acid does not additionally improve the clinical outcomes obtained during treatment of GR with CAF., (© 2024. The Author(s).)

Objectives: The aim of this randomised, controlled, split-mouth trial was to assess the masking results in initial caries lesions (ICL) that were either resin infiltrated or fluoridated during treatment with fixed orthodontic appliances., Methods: Adolescent patients (age range:12-18years) with fixed orthodontic appliances who had developed ICL [ICDAS 1 or 2 (International Caries Detection and Assessment System)] during orthodontic treatment were consecutively recruited and randomly assigned to either resin infiltration with up to 3 etching procedures (Group:Inf) or to 3-monthly application of a fluoride varnish (Group:FV). Both interventions were performed according to the manufacturer's recommendations. Primary and secondary outcomes (ΔE, ICDAS, DIAGNOdent) included the evaluation of the appearance of the ICL before (T 0 ), 1 week after (T 1 ) treatment and at the last appointment before debonding (T 2 )., Results: Fifteen patients (8females, 7males) with 57ICL were included. Mean (SD) observation time at the last appointment before debonding was 0.5 (0.3) years. At T 0 FV and Inf did not differ significantly in ΔE (median ΔE 0,FV (25th/75th percentiles):11.6 (8.7/20.3): ΔE 0,Inf :15.1 (11.4/19.5); p T0  = 0.135), ICDAS (p T0  = 0.920) and DD (p T0  = 0.367). At T 1 and T 2 ΔE values (p T1 <0.001, p T2 <0.001), ICDAS scores (p T1 <0.001, p T2 <0.001) and DIAGNOdent values (p T1  = <0.001, p T2  = <0.001) for Inf were significantly reduced whereas ΔE values (p T1  = 0.382, p T2  = 0.072) and ICDAS scores (p T1  = 0.268, p T2 <0.001) for FV remained unchanged., Conclusions: Resin infiltration effectively masked ICL during treatment with fixed orthodontic appliances both immediately after application and at the last appointment before debonding. Furthermore, the visual appearance of fluoridated lesions was not as satisfactory as that of the infiltrated ones at both T 1 and T 2 ., Clinical Significance: Resin infiltration effectively masked ICL during treatment with fixed orthodontic appliances both immediately after application and at the last appointment before debonding. Furthermore, the visual appearance of fluoridated lesions was not as satisfactory as that of the infiltrated ones immediately after first application as well as half a year after application., Trial Registration: German Clinical Trials Register (DRKS-ID: DRKS00011797)., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: H.M.-L is appointed as inventor for patents of an infiltration technique for dental caries lesions, held by Charité-Universitätsmedizin Berlin, and receives royalties from DMG, the manufacturer of Icon. All other authors declare no conflicts of interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: The aim was to elucidate the magnitude of alterations in systemic blood counts in healthy patients during the first 14 days after fixed orthodontic appliance placement., Methods: This prospective cohort study consecutively included 35 White Caucasian patients starting orthodontic treatment with fixed appliances. The mean age was 24.48 ± 6.68 years. All patients were physically and periodontally healthy. Blood samples were collected at 3 time points: (1) baseline (exactly before the placement of appliances), (2) 5 days after bonding, and (3) 14 days after baseline. Whole blood and erythrocyte sedimentation rates were analyzed in automated hematology and erythrocyte sedimentation rate analyzer. Serum high-sensitivity C-reactive protein levels were measured by the nephelometric method. Standardized sample handling and patient preparation procedures were adopted to reduce preanalytical variability., Results: A total of 105 samples were analyzed. All clinical and orthodontic procedures were performed without complications or side effects during the study period. All laboratory procedures were performed per protocol. Significantly lower white blood cell counts were detected 5 days after bracket bonding, compared with baseline (P <0.05). Hemoglobin levels were lower at 14 days than baseline (P <0.05). No other significant shifts or alteration patterns were observed over time., Conclusions: Orthodontic fixed appliances led to a limited and transient change in white blood cell counts and hemoglobin levels during the first days after bracket placement. The fluctuation of high-sensitivity C-reactive protein levels was not significant, demonstrating a lack of association between systemic inflammation and orthodontic treatment., (Copyright © 2023 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: Objective of this trial was to assess the masking results in initial caries lesions (ICL) that were resin infiltrated during fixed orthodontic treatment in comparison to contralateral teeth that were fluoridated only., Trial Design: A randomized, controlled, split-mouth trial., Methods: Adolescent patients (age range: 12-18 years) with fixed orthodontic appliances who had developed ICL [ICDAS 1 or 2 (International Caries Detection and Assessment System)] during orthodontic treatment were consecutively recruited and randomly assigned to either resin infiltration (Icon) with up to 3 etching procedures (Inf) or to a fluoride varnish (Tiefenfluorid) (FV). Both interventions were performed according to the manufacturer's recommendations. Outcome assessors were blinded to the applied intervention. Primary and secondary outcomes included the evaluation of the appearance of the ICL before (T0) and 1 week after (T1) treatment by digital photographs (ΔE), laser fluorescence readings (DD), and ICDAS scores., Blinding: Due to the treatment nature neither the operators nor the patients could be blinded. However, outcome assessors and the statistician were blinded., Results: Fifteen patients (9 female) with 60 ICL were included (mean age: 14.6 years). At baseline FV and Inf did not differ significantly in ΔE (median ΔE0,T (25th/75th percentiles):10.7(9.1/20.9): ΔE0,I:13.4(10.3/18.5); P = 0.469), DD (P = 0.867) and ICDAS (P = 0.521). One-week after treatment (T1) ΔE values (P < 0.001), DD values (P < 0.001), and ICDAS scores (P = 0.014) for Inf were significantly reduced, whereas ΔE values (P = 0.125) and ICDAS scores (P = 0.073) for FV remained unchanged., Limitation: Natural remineralizing in the standard interventional control group cannot be observed yet, since up to 6 months are needed to naturally remineralize ICL., Conclusions: Based on our short-term data, resin infiltration effectively masked ICL during treatment with fixed orthodontic appliances. Fluoridation was not able to immediately improve the visual appearance of ICL. Further longer-term assessment should focus not only on the aesthetic outcome, but also on the caries inhibitory effect of resin infiltration during treatment with fixed orthodontic appliances., Trial Registration: German Clinical Trials Register (DRKS-ID: DRKS00011797)., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

The curve of Spee (CoS) is an important parameter for an individualized treatment plan. The available information regarding a potential association of the depth of the curve of Spee with various skeletal craniofacial characteristics is conflicting and it is also unknown whether certain craniofacial parameters affect the duration of the levelling phase of orthodontic treatment. A prospective sample of 32 patients with mild to moderate crowding that underwent orthodontic treatment with full fixed appliances was used to study these topics. The craniofacial characteristics were captured on pre-treatment lateral cephalometric radiographs and measurements of the CoS were performed on the initial 3D digital dental models using the Viewbox 4 software. Non-parametric statistics and Spearman's correlations were applied. Weak negative correlations were detected between the CoS depth and the SNA and SNB angles. There was no other association between the CoS and craniofacial parameters, including various anteroposterior measurements. Furthermore, there was no significant association of any craniofacial parameter with the duration of the levelling. Contrary to certain clinical beliefs, it can be argued that the craniofacial characteristics are not associated with the CoS and the time required for its levelling in subjects with moderate pre-treatment CoS depth.

Objectives: The aim was to retrieve the threshold of gingival thickness (GT), where the attribute of gingival translucency through probe visibility was altered., Methods: In 200 patients, the soft tissue thickness was evaluated at both central mandibular incisors using ultrasound quantification (USD). Additionally, probe visibility was determined using a standard periodontal probe (PB) (CPU 15 UNC, Hu-Friedy), inserted 1 mm deep into the gingival sulcus. Frequencies and relative frequencies were calculated. Repeatability analyses and receiver operating characteristics (ROC) were conducted to determine the USD cut-off point for probe visibility., Results: Regression model indicated that the probe was not visible at a thickness of 0.82 mm for the mandibular left central incisor (95% CIs 0.77, 0.86) and became visible at a thickness of 0.69 mm (95% CIs 0.65, 0.72). The respective values for the mandibular right central incisor were 0.82 mm (95% CIs 0.77, 0.87) and 0.70 mm (0.68, 0.74). ROC analysis confirmed the retrieved regression results by indicating the best fitting balance for specificity and sensitivity at a thickness of 0.8 mm for both mandibular incisors., Conclusions: In the frame of the current study, the data revealed that gingiva becomes non-transparent at a thickness of approximately 0.8 mm., Clinical Relevance: Probe visibility at mandibular incisors for the discrimination between thin and thick soft tissues was correlated with a gingival thickness of 0.8 mm and a high repeatability., (© 2022. The Author(s).)

Purpose: To summarise the available data on the effects of chlorhexidine (CHX) mouthwash in treating gingivitis during treatment with fixed orthodontic appliances., Materials and Methods: Multiple electronic databases were searched up to December 7th, 2021. Only randomised controlled trials (RCTs) were eligible for inclusion. The quality of the included RCTs was assessed with the Cochrane risk of bias tool for randomised trials (RoB 2.0). After data extraction and risk of bias assessment, differences were recorded in several oral hygiene indices in time and mean percentage change in those indices using different antimicrobial solutions., Results: Fourteen studies were deemed eligible for inclusion, reporting on a total of 602 patients with an age range of 11-35 years. The experimental solution was a 0.06%, 0.12%, or 0.2% CHX mouthwash with the control either a placebo mouthwash or a selection from a variety of mouthwashes. Treatment duration varied from 1 day to almost 5 months and the follow-up period varied from 1 min to 5 months. Chlorhexidine mouthrinses led to reduced plaque accumulation and gingival inflammation during orthodontic treatment, while at the same time, some of the control group mouthrinses were deemed equally effective. No statistically significant difference was detected in the meta-analysis between CHX and mouthwashes with propolis/probiotics/herbs in terms of the gingival index at 3 to 4 weeks (mean difference 0.07, 95% CI: -0.18, 0.31, p = 0.59)., Conclusion: Chlorhexidine mouthwash in orthodontic patients successfully controls gingival inflammation and bleeding when compared to untreated controls, but is equally effective as other mouthrinses where various oral health indices are concerned.