Quintessence International, 06/2016

Objectives: The aims of this clinical study were to compare internal three-dimensional (3D) adaptation of porcelain laminate veneers (PLV) with minimal tooth preparation and without tooth preparation (prepless) and to evaluate the clinical outcomes at baseline and following 6, 12, and 24 months after luting. Method and Materials: Thirty-one prepless PLV and 31 PLV with minimal tooth preparation were fabricated using lithium disilicate glass-ceramic material and placed in 12 patients (8 women, 4 men; 18 to 40 years old). All PLV were luted with an adhesive luting system (Variolink veneer). A silicone replica was obtained to measure internal adaptation of each PLV using a low viscosity polyvinyl siloxane impression material just before luting. Silicone replicas were scanned in x-ray micro computerized tomography (micro CT). Clinical evaluations took place at baseline (2 days after luting) and following 6, 12, and 24 months after luting. Marginal integrity, marginal discoloration, secondary caries, tooth sensitivity, and fracture were evaluated following FDI criteria. Replica scores were analyzed using Mann-Whitney U and Student's t test (α = .05). Kaplan-Meier statistical analysis was done for the survival rate of PLV. FDI criteria scores were analyzed using Pearson's chi-square test (α = .05). Results: The median marginal gaps for PLV-without-tooth-preparation and PLV-with-minimal-tooth-preparation groups were 100 μm and 140 μm respectively. There was a statistically significant difference between the two groups with respect to marginal gap (P = .04). The mean internal adaptation for the PLV-without-tooth-preparation group was 217.17 ± 54.72 μm, and was 170.67 ± 46.54 μm for the PLV-with-minimaltooth- preparation group. There was a statistically significant difference between the two groups (P = .001). Based on FDI criteria, 100% of the PLV were rated satisfactory during the 2-year period. Conclusions: In this in-vivo study, mean and median values of marginal gap and internal adaptation for PLV with minimal tooth preparation and PLVs without tooth preparation were within a clinically acceptable range. A 100% success rate was recorded for all PLV during the 2-year period. Keywords: adhesive cementation, micro CT, minimal invasion, porcelain laminate veneer

Objective: This retrospective study aimed to collect information about the long-term outcome of apexification treatment with mineral trioxide aggregate (MTA) of teeth with open apices. Method and Materials: A total of 98 teeth in 79 patients (m:f = 1:1.3) who had completed endodontic apexification treatment with MTA between September 2005 and January 2014 at a university dental clinic were considered. Both initial treatments and retreatments of former root canal treatments other than apexification were included. All patients were invited for a standardized follow-up visit. Data regarding age, sex, tooth type, reason for treatment, detailed treatment protocol, clinical and radiographic findings, treatment quality, and outcome were also collected from the patients' records. Descriptive statistical analysis was performed. Results: In the majority of cases, endodontic treatment was related to trauma with fracture (45/98, 45.9%) and luxation injuries (20/98; 20.4%), followed by unknown causes (12/98; 12.2%), retreatments (7/98; 7.1%), hypophosphatasia (7/98; 7.1%), and caries (1/98; 1%). In the beginning, the Periapical Index (PAI) showed pathologic findings with a PAI > 2 in approximately 50% of cases, while 25% presented with minor or an absence of findings. At the end of the observation period, more than 90% showed clinical-radiographic success, whereas eight teeth were associated with an elevated PAI. Only 5% of cases needed further dental treatment, such as root-end surgery or retreatment of the root canal treatment. Conclusion: Within the limits of this retrospective investigation, clinical and clinical-radiographic success of the apexification treatment appears to make this a good and reliable treatment option for teeth with open apices. Keywords: apexification, apical barrier technique, dental trauma, endodontic treatment, mineral trioxide aggregate, open apex

This case report discusses a patient suffering from chronic periodontal disease and diagnosed with a hopeless central incisor. The intention was to show the possibility of gaining new clinical attachment via regenerative surgery in a tooth with 100% bone loss around the root. Treatment of hopeless and questionable teeth in periodontal patients has become an ideological matter. On the one hand, dental implants have proved to be a reliable solution to replace lost teeth; on the other hand, newly emerging evidence suggests that successful periodontal treatment of teeth diagnosed as hopeless is possible. Here we describe surgical, orthodontic, and restorative treatments that led to clinical attachment gain and achieved clinical success over a three-year follow-up period. Keywords: bone grafting, case report, hopeless tooth, periodontal regeneration

Objective: To evaluate the clinical efficacy of Verbena officinalis Linn decoction for patients with chronic generalized gingivitis in a double-blind randomized controlled multicenter clinical trial. Method and Materials: The patients in the test group and the control group were instructed to brush and floss. Additionally, the patients in the test group were asked to rinse their mouths with a V officinalis L decoction. The primary clinical outcome was the Gingival Index (GI). The GI and Plaque Index (PI) were measured at baseline (day 0), day 14, and day 28. Results: Two hundred and sixty patients participated (control group = 130, and test group = 130). The clinical features of both the test and control groups were improved progressively throughout the time durations of day 0, day 14, and day 28 represented by highly significant decreases in both GI and PI (P .001). The Mann-Whitney test revealed significant differences between the control and test groups for GI and PI at the 14-day examination and the 28-day examination (P .001). At the beginning of the clinical trial, nonsignificant clinical differences were found following the statistical analyses of both GI (P = .981) and PI (P = .920) between the test and control groups. Conclusions: The tested V officinalis L decoction demonstrated efficacy in reducing tested indices and thus has a promising ameliorative effect for treating patients with chronic generalized gingivitis. Clinical Significance: V officinalis L decoction has good clinical results with no adverse effects. Keywords: chronic generalized gingivitis, decoction, double-blind, randomized controlled multicenter clinical trial, Verbena officinalis Linn

Esthetic treatment of stained arrested caries lesions (ACLs) has mostly been done using invasive restorative techniques. The aim of this paper was to propose and report the efficacy of a conservative approach based on dental bleaching to esthetically treat these lesions, both experimentally (extracted teeth) and clinically. In a laboratory experiment, ten extracted human teeth with stained ACLs in either pit and fissure or smooth surface were selected and treated with 15% carbamide peroxide gel, 4 h per day, for a total of 6 days. The second part of the paper reports a clinical case of pit and fissure-stained ACLs in four posterior teeth, which were treated with 40% hydrogen peroxide in-office bleaching. Digital photographs were taken in both parts to document the efficacy of the treatment. The lesions showed noticeable increase in color lightness indicating the efficacy and suitability of the proposed approach. By using the conservative clinical technique presented, the esthetics of most stained ACLs could be improved, eliminating the need for invasive restorative treatments. Keywords: arrested caries lesion, bleaching, carbamide peroxide, color change, esthetics, hydrogen peroxide

Objective: To determine the longest upright and tilted implant that can be placed in posterior mandibular teeth (second premolars [2PM], first molars [1M], and second molars [2M]) in case of immediate implant placement (IIP), respecting a safe distance from the inferior alveolar canal (IAC) and the submandibular fossa, using cone beam computed tomography (CBCT) scans. Method and Materials: In CBCT scans of 118 subjects, the following were measured: distance from the tooth apex to the IAC (DTC), lateromedial width of the mandible, classification of mandibular cross-sectional morphology, upright and tilted implant placement simulation, tilting angle that allowed placement of the longest implant. Results: The DTC has shown to be greater for 1M, shorter for 2PM, and even shorter for 2M. Between 70% and 88% of all 2PM, 1M, and 2M present less than 6 mm of DTC. The cross-sectional morphology of the mandible had a tendency to be classified as "undercut" in more posterior regions. For both 4.0- and 5.0-mm implants, more posterior regions resulted in a greater difference in length between the upright and tilted implants. The tilting angle was greater for the more posterior regions. Most of the relationships between age/sex and the morphometric parameters were weak. Conclusion: Lingual concavity is a common clinical finding at the posterior mandibular region, and its occurrence varies according to the tooth type. The great majority of the 2PM, 1M, and 2M present limited available bone between the root apex and the IAC, which stresses the need for careful attention when IIP is planned in this area. Keywords: cone beam computed tomography, dental implants, inferior alveolar nerve, mandibular canal, morphometric measurements, submandibular fossa

Sjogren's syndrome (SS) is a systemic autoimmune disease that has several oral manifestations, with reduced salivary flow being the most prevalent. As a result of the dry mouth and irritated oral tissues, dental treatment may be challenging. In particular, a patient's satisfaction with removable prosthesis may be limited. This case report and the literature review discuss the feasibility of implant-supported dental prostheses. The clinical and functional advantages provided by implant prostheses might outweigh the slightly lower overall implant success rate in SS patients. The impacts of SS on dental treatment are summarized in this review. Keywords: dental implant, dry mouth, oral, prosthesis, rehabilitation, Sjogren's syndrome

Background: Ankyloglossia or tongue-tie is a congenital oral anomaly with short, tight, and thick lingual frenulum. It may be asymptomatic or can cause movement limitations of the tongue, speech and articulation difficulties, breastfeeding difficulties in neonates, as well as periodontal and malocclusion problems. The etiopathogenesis of ankyloglossia is unknown; it can occur either as a sole anomaly in the vast majority or in association with other craniofacial anomalies. Objectives: The aims of this paper were (1) to provide a comprehensive review on the criteria for clinical assessment and diagnosis, etiology and inheritance, and the therapeutic options of ankyloglossia; and (2) to demonstrate the treatment of ankyloglossia by means of frenuloplasty in three cases. Review: The available evidence from the literature indicates that among neonates, children, and adults the prevalence of ankyloglossia is low and in some cases remains undiagnosed. The early clinical assessment, diagnosis, and treatment are beneficial for the patients and their mothers. Conclusions: Frenuloplasty is a safe, quick, effective, and economical method and for this reason the parents should not hesitate towards frenulum release. More clinical studies are needed to confirm the benefits of the surgical interventions and to compare the results with those obtained using nonsurgical therapy or with untreated cases.