International Poster Journal of Dentistry and Oral Medicine, 04/2013

In India, medicinal plants form the basis of many indigenous traditional systems of medicine. The natural alternatives for root canal irrigants are biodegradable and safe with fewer side effects. Sodium hypochlorite (NaOCl) has long been the irrigant of choice for endodontic procedures as it dissolves necrotic and vital tissue.It has an unpleasant odour and taste and it is highly toxic to periapical tissues. Azadirachta indica (neem) is one of the most versatile medicinal plants with wider antibacterial spectrum. Morinda citrifolia (MCJ) commonly called as Noni has a broad range of antimicrobial, antitumour and immune enhancing effects. When compared to NaOCl, Noni is less toxic and equally effective in removing the smear layer. Aim: To compare the antimicrobial efficacy of sodium hypochlorite (2%), neem leaf extract (3%) and Morinda citrifolia (6%) against E. faecalis and C. albicans using the agar diffusion method. Material and methods: Group 1- Sodium hypochlorite (2%) Group 2- Alcoholic neem leaves extract (3%) Group 3- Morinda citrifolia (6%) The stock cultures of E. faecalis and C. albicans were used for the study. The cultures were grown overnight at 37C in BHI broth for E.fecalis and peptone agar for C. albicans. They were spread onto the agar plates. Agar well diffusion method was done. Each of the test specimens was added to the respective wells and incubated. Zone of inhibition was measured for each solution after 24 hours. The cultures were repeated for three times and the average values were found. Results: Inhibition zones for E. fecalis- Neem (18mm) > NaOCl (14mm) > Morinda (12.5mm) Inhibition zones for C. albicans- Neem (9mm) >NaOCl (7.5mm) > Morinda (6mm) Conclusion: In vitro observation of neem's effectiveness appears promising and being a herbal product, it is expected to be safe to use neem leaf extract clinically as an endodontic irrigant. Keywords: Anti-microbial efficacy, Azadirachta indica, Morinda citrifloia

Objectives: Zirconium-dioxide(ZD) frameworks are established for posterior fixed-partial-dentures (FPD). Main problem in clinical practice is chipping. Monolithic materials as lithium-disilicate (LS2) do not need to be veneered and might solve the problem, but are not indicated for posterior FDPs by manufacturer. Aim of the present study is the comparison of fracture-strength (FS) of posterior zirconia based and LS2 FDPs before and after aging. Methods: 16 three-unit LS2 FDPs (e.max CAD, Ivoclar Vivadent) and 32 three-unit ZD frameworks (Organic Zirkon, R+K CAD/CAM Technology) were fabricated by using computer-aided design and manufacturing (CAD/CAM). 16 ZD frameworks were conventionally veneered (VZ) with low fusing veneering porcelain (IPS e.max Ceram, Ivoclar Vivadent) and 16 overpressed (OZ; IPS e.max ZirPress, Ivoclar Vivadent). All FDPs were cemented using glass ionomer cement (Ketac cem Aplicap, 3M Espe). 8 FDPs per group were artificially aged (mastication simulation: 1.2 mio cyclesx50N, thermal cycling 10000x5°/55°C). FS of all FDPs were tested in an universal testing machine until fracturing at a test speed of v=1mm/min (Zwick 010, Zwick) and statistically analyzed (ANOVA, T-Test, p0.05). Results: FS of OZ before aging was 1609N±427N and after aging 1685N±480N, followed by VZ (1541N±438N/1557N±643N) and LS2 (1293N±237N/1131N±374N). After aging one LS2 abutment and 2 cusps fractured. 5 zirconia based veneering porcelain only showed superficial cracks. There were no significant differences between FS before and after aging, as well as between the different materials. Conclusion: All FS were above 1000N before and 900N after aging. LS2 FDPs showed good results compared to zirconium-dioxide based FDPs. Chipping of veneered porcelain did not appear. Further clinical tests are required. Keywords: ceramics, CAD/CAM, fixed partial dentures, zirconia, lithium disilicate glass ceramics

Objectives: For fixed prosthodontics and implants, polyvinyl-siloxane-materials (PSM) and polyether-materials (PM) are mainly used. Manufacturers provide a wide range of PSM and PM with different degrees of Shore-A-hardness (SH). It is supposed that the force needed to remove impressions from both teeth and casts correlate highly with the stiffness of the impression-materials (IM). Currently there is no data on the removal forces of modern IM in scientific literature. The aim of the present study was to examine the correlation between SH and removal-forces (RF), as well as separation-forces (SF) of dental IM. Methods: Two PM, nine PSM and three vinylsiloxanether-materials (VSM) were investigated. Impressions were made of a model made from polyurethane resin (Polyurock, Metalor Dental AG) based on a master model with full dentition (UK T 16 KaVo). Forces and SH were recorded during removal (Zwick 005, Zwick GmbH) of the IM from the polyurethane-model of the teeth and separation from each poured cast. At the same time SH was measured at the sample which was set in the Petri dish. Results: FS and SF ranged from 290.8(SD 21.1)-497.8(SD 28.1)N and 111.4(SD 13.5)-200.2(SD 11.7)N, respectively, and differed significantly between materials (p0.001). No values could be determined for Impregum soft (3M Espe) because after a strain of more than 1500N, the holding device broke out of the polyurethane model. SH ranged from 44.8(SD 0.2)-69.6(SD 0.4)N at the time of removal and 50.9(SD 1.1)-70.3 (SD 0.3)N at the time of separation. No correlation was found between RF and SH. Only a slight correlation was found between SF and SH. Conclusion: In-vitro-results show that SH of clinically used IM does not correlate with RF nor with SF from the cast. Keywords: impression material, Shore-A-Hardness, removal forces, in-vitro

Aim: This poster presents a clinical case of a young female patient with dentinogenesis imperfecta. Dentinogenesis imperfecta is a hereditary disease that affects both the primary and permanent dentition. Early diagnosis and treatment can prevent the loss of teeth, the loss of vertical dimension of occlusion, and also avoid the appearance of special problems such as aesthetic and functional aspects, with psychological consequences on patients. Three types of dentinogenesis imperfecta are described in the literature. Type I is considered when dentinogenesis imperfecta joins with the osteogenesis imperfecta, type II do not presents this association, while in the case of type III the pulp chamber of the teeth are larger than usual. The most difficult situation for the prosthetic reconstruction is the one without any root canals, like the patient presented in our case. Case report: The patient came to the dental office seeking for full oral rehabilitation. After the clinical and radiological examination, the diagnosis was dentinogenesis imperfecta type II. She was already missing teeth on both arches, with major overerruptions and changes of DVO and intemaxillary relations. Radiological examination showed the absence of the root canals which increases the difficulties of the treatment. The patient was fully rehabilitated using fixed metal-ceramic restorations (crowns and bridges). Discussion: The treatment of dentinogenesis imperfecta represents a challenge for the dentist, the purpose of the treatment being the aesthetically and functional rehabilitation of the patient. Conclusions: In order to prevent the emergence of further complications it is recommended that the treatment of dentinogenesis imperfecta start as earlier as possible, at the same time being indicated a close collaboration between the clinicians: orthodontist, therapist and prosthetician. The esthetic and functional results are more and more difficult to obtain if the treatment begins in later stages. Keywords: dentinogenesis imperfecta, late prosthetic reconstruction, esthetic, functional results

Aim: The purpose of this study is to investigate the most commonly extracted teeth, leading to single edentulous spaces. The data were gathered from a private dental clinic in Bucharest, in a period of six years, starting with 2005. Methods: The study included 100 patients, 38 men and 62 women, with ages between 19 and 74 years. Data were registered about age, gender, type of extracted tooth and restoration of the edentulous spaces in two situations: at the first visit of the patients in the dental clinic and at the end of the treatment. The patients were split into 5 groups according to age. For data analyses were used EPI Info programs and Microsoft Excel. The study was conducted over a period of 6 years (2005-2011). Results: During the period of the study it was found that the patients showed 188 single edentulous spaces. The results showed that the teeth most frequently extracted were represented by first lower molars, followed by first upper molars. In descending order they were followed by upper premolars, maxilar incisives, lower premolars, mandibular incisives, canines and second upper molars, while second lower molars have registered a rate of 1%. Mandibular canines were present at every patient. The study is relevant statistically, p0.05. Conclusions: Frequent loss of both lower and upper first molars may be due to early eruption of these teeth, so it is mandatory to give a special attention in order to prevent the loss of these teeth. Keywords: single edentulous space, first lower molars, first upper molars

On January 12th 2010, a Richter magnitude 7.0 earthquake struck Haiti. An estimate of 200.000 people had been reported dead, about 300.000 injured, 1.000.000 homeless, over 280.000 buildings collapsed or severely damaged. Since 2006, the minimum requirement of an orderly temporary burial for disaster victims is guidelined by the WHO, PAHO, IFRC and ICRC as the procedure of choice in cases when a disaster victim identification (DVI) process cannot start immediately. It was not reported that any of the international community's authorities took responsibility for an orderly temporary burial of the deceased for the purpose of this guidelines. As long ago as 1980, the Interpol resolution adopted in the course of the 49th General Assembly session in Manila recognised the identification of an individual's human remains as a basic human right. After the 2010 Haiti earthquake, an extensive DVI mission has never been established. Keywords: Disaster, Disaster Victim Identifikation, DVI, Earthquake, Failed States, Haiti, Interpol, Mass Graves, MINUSTAH, Temporary Burial, United Nations.

Sporting activities present a high risk of dental injury in children and adolescents, the mixed dentition period presenting the highest prevalence of dental injuries. The epidemiological data and the knowledge of coaches and parents on sport related trauma management are almost uninvestigated in Romania. In this respect, the aim of the study was to gather epidemiological data about dental trauma in mixed dentition children who practice sport activities. 348 children participating in organized sports activities were examined in the period January-July 2011 during the annual clinical evaluation at the Sportsmen Ambulatory in Bucharest. Consent for the examination was obtained from the coaches/parents. The traumatic dental injuries were assesed according to IADT's criteria. Data was statistically analized using SPSS 10 for Windows (SPSS Inc., Chicago, USA). The loss or damage of teeth structures involves, beside aesthetic problems, high financial expenses immediately or in time. Although crown fractures without pulpal involvement are most frequent, it is important to remember that, in mixed dentition period, young permanent incisors have open apices. Even in minor traumas, the absence of treatment can lead to further complications. The high prevalence of sports related dental trauma advocates the use of oral protectors as efficient means in preventing these events. The children were distributed in 11 sports, football being the most practiced (44%). The traumatized children were found in 6 types of sports. The prevalence of dental trauma was 14.36%. The male/female ratio was 6.14/1. A ratio of 1.3 affected teeth per children was found. The most common type of dental injury was the enamel fracture (66.15%). The maxillary central incisors were found to be the most affected. 74% of traumas were produced during organized sports activities. Keywords: mixed dentition, dental injuries, sports

The placement of the implants on totally edentulous young patients increases dramatically the functionality of their complete dentures. Dental education around the world is giving more and more space in the dental schools curriculum and in CME programs to learn to treat patients with dental implants, which is a much better training than the courses sponsored by implant companies. This case report is showing a young male patient with a massive bone loss due to periodontal disease who was successfully rehabilitated, both functionally and esthetically, using two implant supported overdentures. The patient came to the dental clinic seeking for full oral rehabilitation. After the clinical and radiological examination, we extracted the few irrecoverable remaining teeth, the patient becoming totally edentulous. Over the healing period he wore two interim complete conventional dentures. His main request was to obtain the best possible retention for the final restorations. Together we decided to restore the arches using overdentures which are creating a natural esthetic and an enhancing facial appearance and compensating for lost soft and hard tissues better than fixed prosthesis. The bone quantity and quality was evaluated using a CT scan and four implants were inserted on each arch. After a period of six month we fabricated the overdentures on implants using stud ball attachments. Young patients in totally edentulous situations pay a lot of money for denture adhesive and fabrication of new conventional complete dentures. The overdentures on implants are a much better treatment option for them both from the financial point of view and also for the main benefit that implants are preventing the further bone loss in areas where tooth are missing. The improved function increases the range of food that the patient can eat, and also his general health. Keywords: bone loss, implants, overdentures

Aim: The goal of this study was to evaluate if patients with a compromised dentition, rehabilitated with a full-arch implant-supported immediate loading prosthesis, present an improvement of chewing ability and gastric emptying rate. Methods: This is a preliminary report. Four patients (3 men, 1 woman - mean age 58 year) referred to the Department of Implant Prosthesis of the University of Genoa presenting a compromised dentition and were enrolled in this study. The dental arch to be treated had no more than 6 remaining teeth, patients were not affected by gastric disorders, had a proper body index, and did not assume any prokinetic or anticholinergic drugs. Before enrollment, patients underwent an urea breath test (AB analitica srl) to evaluate the presence of Helicobacter pylori (Hp). In fact, Hp could be a confounding agent in the execution of the gastric emptying breath test. Hp affected patients were treated with the association of Esomeprazole, Clarithromycin, Amoxicillin and probiotic for ten days. After 3 weeks a new breath test was done to evaluate the bacterium eradication. Before and 2 months after surgery, chewing ability and gastric emptying rate of patients were evaluated. Chewing ability was evaluated according to the Holthoff-Slagter protocol. Patients were invited to chew 8 Optosil cubes (Heraeus Kulzer). Test food was collected after 40 chewing strokes and dried. The obtained particles were sieved on a stack of 5 sieves, with apertures of 4.75, 4, 2, 1, 0.5 and a bottom plate. The amount of test food on each sieve and on the bottom plate was weighed. Trituration performance was expressed as the amount of particles below 4.75 mm recovered after subjects chewed. Gastric emptying was measured by means of the 13C-octanoic acid breath test. 100 mg of Octanoic acid were added in a test meal of 250 kcal. This consisted of one egg cooked with butter (10 g), ham (21 g), 2 slices of bread and 250 ml of water. The 13CO2 samples (collected every 15 min for 4 hours) were measured by means of an isotope radio mass spectometer. The time required for half of the gastric contents to transit through the pylorus (T1/2) was evaluated. Results: After the full-arch immediate loading rehabilitation, the improvement of trituration ability was of 242% (median value) and T1/2 improved of 51%. Conclusion: The results of this preliminary study indicate that full-arch implant-supported immediate loading prostheses improved patients' masticatory efficiency and gastric emptying rate. Keywords: chewing, gastric emptying, implant

Introduction: The aim of this study was to investigate the bond strength between a CoCr alloy and 18 different veneering porcelains using additional acoustic and optical sensors. Material and Methods: The veneering porcelains (1=Vintage Halo, 2=IPS Classic V, 3=Creation CC, 4=GC Initial MC, 5=Imagine Reflex, 6=VMK 95, 7=Antagon Interaction, 8=Omega 900, 9=Carat, 10=Starlight Ceram, 11=EX-3, 12=HeraCeram, 13=VM 13, 14=Duceram Kiss, 15=Vintage, 16=IPS d.Sign, 17=Nuance 850, 18=IPS InLine) fused to Ankatit U (62.3Co-25.2Cr-6Mo-5W) were tested with 10 specimens each according to ISO 9683. In the 3-point-bending device a microphone capsule was incorporated to capture synchronously an acoustic signal of crack initiation in addition to the force signal. Furthermore, a video was recorded at a magnification of 200 times during the bending test in order to identify the start of debonding of the veneering ceramics. Results: All of the investigated veneering porcelains exceeded the bond strength limit of 25 MPa required by the standard. The values ranged from 29.4 ± 2.5 (#18) until 39.6 ± 2.3 MPa (#1). The acoustic signals indicated an earlier failure of bond strength (crack initiation) before reaching the maximum force. Based on the acoustic signals the values reached from 11.52 ± 12.85 (#10) to 38.76 ± 3.66 MPa (#1). With the optical sensor system it was not possible to accurately detect the start of crack initiation since the available magnification of 200 was too low. Conclusion: Additional recording of the acoustic signal supports the detection of the real crack initiation. Supported by ANKATIT-ANKA Guss GmbH. Keywords: Bond strength metal to porcelain

Aim: The purpose of this comparative study was to evaluate the correlation between two radiographic methods used to evaluate skeletal maturation, hand-wrist analysis method and cervical vertebrae analysis method, of skeletal Class II malocclusion patients at puberty growth spurt. Materials and Methods: Digital Hand-wrist radiographs and digital lateral cephalograms from 37 Syrian adolescent untreated skeletal Class II patients (19 females and 18 males) at puberty averaged 13.12 years were obtained. Skeletal maturation stage of each hand-wrist radiographs were evaluated using the method described by Fishman, whereas skeletal maturation stage of cervical vertebrae were evaluated using the method described by Hassel and Farman. To define the relationship between the two used method, Spearman's correlation coefficient was calculated. Results: The number and percentage of patients were calculated according to the SMI and CVMI indices. The skeletal maturation index (SMI) stages and cervical vertebrae maturation index (CVMI) stages were not related, and Spearman's correlation coefficient was found to be not statistically significant (rs = 0.25, P > 0.05). Conclusion: Within the limits of this study, the cervical vertebrae maturation method might mislead the clinician when treating adolescent skeletal Class II patients at the pubertal growth spurt since it is not correlated with hand wrist skeletal maturation method. Keywords: Skeletal Maturity Index, Hand-Wrist, Lateral Cephalogram, Cervical Vertebrae, Class II Malocclusion

Introduction: Successful clinical attempts have been carried out to support fixed functional appliances by using skeletal anchor plates placed in the symphysis to avoid mandibular incisors protrusion. Aim: The purpose of the present study, that used cone beam CT, was to clarify the anatomical features of the mandibular anterior region to help identify a safe zone to apply skeletal anchor plates. Materials and Methods: Study sample consisted of 9 patients with skeletal Class II. Considering the lower occlusal plane as a reference, numerous measurements related to the mandibular anterior region were evaluated in axial and buccolingual cross-sections. Results: The measurements of right and left sides were not significantly different (P >.05). Mental foramen was directed inward and downward in all patients, and close to second premolar root in most cases. Bone height was 11mm below the mental foramen, and 8.2mm below the mandibular canal. Bone height was the biggest below the central incisor root 17.4 mm, and the smallest below the root of canine 12.6mm. The mean cortical bone thickness at the lower margin ranged between 2.9-3.6mm. The bone below the root of the central incisor was characterized by the smallest width 8.9mm, and in the same time the biggest width 13.2mm. The mean of the mesiodistal width of the anterior region was 23.9mm. Conclusion: Safe zone extends distally for 21mm horizontally starting from the midline, and 8mm vertically over the lower margin region of symphysis. The area below the foramen was risky because the presence of the mandibular dental canal. Keywords: Safe Zone, Skeletal Anchor Plates, Symphysis, Mental Foramen, Cone Beam Computerized Tomography

Introduction: A passive fit between dental implants and prosthetic framework is particularly important in immediate loading protocols to avoid dangerous stresses on periimplant bone. A luting technique is used by some authors [1] to lute implant cylinders to the metal framework in full-arch immediately loaded implant prostheses and has been claimed to allow a good passive fit. But the adhesive strength of this luting technique has not been evaluated yet. The aims of this preliminary in vitro study were: 1) to create an appropriate experimental set-up for the evaluation of the adhesive strenght between the luting agent and the metal components; 2) to evaluate if implant cylinders with different heights (5 or 10mm) can affect the adhesive strength. Material and Methods: The samples to be tested are composed of two cylinders each: the implant cylinder (internal cylinder) (type IV titanium alloy) and the customized cylinder simulating part of the prosthetic framework (external cylinder) (commercial gold alloy). The two cylinders have been fixed with a luting agent (CEKA SITE) with a standard thickness of 0.2mm. In order to fix the sample to the testing machine, the internal cylinder has to be screwed to an implant analogue, using standard screws. In the first experimental set-up (Test 1) an universal testing machine (Instron) with a 10 kN load cell was used to carry out pull-out tests. The software version Plus Windows 98, Series IX version 8, was employed for data acquisition and processing. A cross-head speed of 2 mm/min was applied. In the second experimental set-up (Test 2) a compression load was applied to the internal cylinder using the universal Instron machine and a customized stainless steel device. The load values applied were recorded in kN. Results: During Test 1 (pull-out test) a failure of the internal screw was observed. No damage to the metal-luting agent interface was evident. During Test 2 (compressive test) the maximum load of 300 kN was reached when the deformation of the specimen began, due to lateral components of the applied force. Conclusions: The weak points of the sample appeared to be the cylinder-abutment screw in pull-out tests, and the metal framework in compressive tests. It is necessary to design an alternative experimental set-up to record the strength of the adhesion. Preliminary data suggest that this luting technique provides enough adhesive strength for clinical use. Keywords: passive fit, luting tecnique, prosthetic framework, testing machine, adhesive strength

Background and Aim: The main objective in modern implantology is to maintain and support peri-implant osseous and soft tissue structures to combine long-term osseointegration with an esthetic and natural peri-implant mucosa. The major advantages of immediate implant insertion are a reduced treatment time, a fewer number of sessions and the minimally invasive procedure. In contrast to the mainstream findings it has been shown in previous reports that immediate implant installation is even successful even when the facial bony wall is defect or absent. The aim of this case series is to prove a new surgical approach through a combination of immediate implant installation, immediate provisionalization and immediate facial reconstruction by autogenous bone and connective tissue grafting in situations with facial bone deficiencies and severe gingival recessions. Methods and Materials: Eight patients (mean age 53.1 years, range 34-67 years, 4 males, 4 females) received a total of 8 OsseoSpeed implants (1 OsseoSpeed, 1 OsseoSpeed TX, 6 OsseoSpeed Profile TX, Dentsply Implants, Mölndal, Sweden) which were immediately inserted into extraction sockets with facial bone deficiencies of various dimensions (2 total, 6 partial loss of facial wall) and severe gingival recessions of at least 3 mm in height. Implants were aligned in contact to and slightly below the palatal bony wall of the extraction sites. Connective tissue grafts were harvested from the palate. In the recipient sites a tunnel was created by intrasulcular incisions at the implant and adjacent teeth sites and supraperiostal preparation without any vertical incisions or papilla separations. The connective tissue grafts were placed within the tunnel and covered by the coronal positioned split flap. Facial gaps between implant surface and the connective tissue grafts were grafted with autogenous bone chips. All implants were immediately provisionalized with a temporary crown without occlusal contacts. Implants in diameters 3.0 (n=1), 3.5 (n=1) and 4.5 (n=6) with lengths of 15 (n=5) or 17 mm (n=3) were used. Implant success rates, marginal bone levels, mucogingival changes and the Pink Esthetic Score (PES) were assessed per implant. Results: The reason for teeth removal was an endodontic failure (n=1), an external root resorption (n=1), a long-axis or horizontal root fracture (n=3), and periodontitis (n=3). Seven implants were placed in the anterior maxilla (2 canines, 5 incisors) and one in the anterior mandible (1 incisor). All implants were still in function at the final follow-up (survival rate: 100%). The mean follow-up period was 23 months (range 10-63 months). CB-CTs were recorded preoperatively and at the final examination. The preoperative distance from the cemento-enamel junction to the marginal bone level was 8.02 ± 1.97 mm (range 4.9-10.5 mm) at the facial aspect; the distance between the implant shoulder and the marginal bone was 0.82 ± 0.91 mm (range 0-2.5 mm) at the final examination. The mean PES ratings improved significantly from pre-op 8.75 ± 1.75 (range 5-10) to 11.5 ± 1.51 (range 9-13) at the final follow-up (p = 0.011). The width of the attached gingiva/mucosa improved significantly from pre-op 2.63 ± 0.92 mm (range 1-4 mm) to 4.13 ± 1.25 mm (range 2-6 mm) in the final examination (p = 0.026). Mean pre-op gingival recession of the condemned teeth was 4.62 ± 1.19 mm (range 3-6 mm). The height of the mucosal recession at the implant sites improved significantly to 1.13 ± 0.99 mm (range, 0 to 2 mm) in the final examination (p = 0.011). Conclusions: Within the limitations of this case series, single teeth rehabilitation patients can be treated with a favorable esthetic outcome, improved mucogingival conditions and stable marginal bone levels using the immediate implant placement and provisionalization approach even when facial bony defects and severe gingival recessions have to be reconstructed by autogenous bone and connective tissue grafting at the same time. Keywords: immediate implant placement, immediate provisionalization, immediate reconstruction, bone grafting, soft tissue grafting, autogenous, tunnel technique