Quintessence International, 01/2009

Objective: To determine the prevalence, location, and distribution of sinus tracts in patients referred for endodontic consultation. Method and Materials: This cohort study included 1,119 subjects referred for endodontic consultation, 108 of whom presented with sinus tracts. Following clinical and radiographic examination, the diameter of the rarifying osteitis lesion on the radiograph was measured and the path and origin of the sinus tracts determined. Signs and symptoms, tooth site, buccal/lingual location, and diameter were recorded. Data were statistically analyzed using Pearson chi-square test. Results: Sinus tracts originated mainly from maxillary teeth (63.1%); only 38.9% originated from mandibular teeth. Chronic periapical abscess was the most prevalent diagnosed origin (71.0%). Broken restorations were highly associated with the presence of sinus tracts (53.0%). The most frequent site of orifices was buccal (82.4%), followed by lingual or palatal (12.0%). Orifices on the lingual aspect of the gingiva were observed in mandibular molars. There was an 86.8% correlation between the occurrence of an apically located sinus tract and apical rarifying osteitis (P .01). Conclusion: Sinus tract in the lingual or palatal aspect of the gingiva is relatively common. Practitioners should look for signs of sinus tract during routine examination. Keywords: location, prevalence, sinus tract, teeth

A young patient with dentinogenesis imperfecta and a dentition severely compromised by discolorations, abrasion, and breakage of enamel on several teeth was prosthodontically treated with CAD/CAM-manufactured all-ceramic restorations. To reduce treatment risk, preparations were limited paragingivally. Maxillary anterior teeth and premolars were restored with adhesively luted ceramic crowns. All other teeth were treated with zirconiabased restorations luted with a self-etching resin-based material. Considering the deficient pretreatment situation, the use of tooth-colored restoration and luting materials yielded a satisfying functional and good esthetic result. The patient is highly satisfied, even though 3 minor chippings occurred shortly after the completion of treatment. Keywords: CAD/CAM, Cerec 3D inLab, dental anomalies, dentinogenesis imperfecta, esthetics, Vita In-Ceram YZ, Vita Mark II, zirconia

Objective: Topical antibiotics may overcome shortcomings of mechanical therapy for localized persistent periodontitis. This double-center, single-blind, randomized controlled study aimed to evaluate the microbiologic profile and clinical parameters of persistent periodontal pockets after treatment with tetracycline solution. Method and Materials: Thirty-seven patients who had at least 4 nonadjacent sites of persistent periodontal pockets with probing depth of at least 5 mm and bleeding on probing were randomly assigned to test and control groups. In the test group, 2 teeth received 4 applications of tetracycline solution (100 mg/mL) with a microbrush (T), while the other 2 teeth received the same treatment plus 1 session of scaling and root planing (SRP+T). In the control group, 2 teeth received 1 session of scaling and root planing (SRP), and the other 2 teeth received 4 applications of saline with a microbrush plus 1 session of scaling and root planing (SRP+S). Clinical parameters of probing depth, bleeding on probing, visible plaque index, gingival bleeding index, gingival recession, as well as clinical attachment level and subgingival plaque samples (evaluated by polymerase chain reaction) were measured at baseline and 1, 3, and 6 months. Results: All therapies yielded statistically significant data on clinical measurements with no significant differences among groups. Presence of bacteria decreased in both groups, but only in the test group was a significant decrease of Porphyromonas gingivalis, Tannerella forsythia, and Actinobacillus actinomycetemcomitans noted up to 6 months. Conclusion: Tetracycline applied with a microbrush may be an alternative treatment for persistent periodontitis that can probably be mediated by reduction of microorganism proliferation. Keywords: comparative study, periodontal disease/drug therapy, periodontal disease/microbiology, tetracycline/therapeutic use

Malignant melanoma is a neoplasm of melanocytic origin that arises from a benign melanocytic lesion or de novo from melanocytes within otherwise normal mucosa or skin. Melanoma arising from the mucosal surfaces of the head and neck is a very rare disease and is considered among the most deadly of all human neoplasms. Although it comprises 1.3% of all cancers, malignant melanoma of the oral cavity accounts for only 0.2% to 8.0% of all reported melanomas. Because most mucosal melanotic lesions are painless in their early stages, the diagnosis is unfortunately often delayed until symptoms resulting from ulceration or growth are noted. Oral malignant melanoma has an extremely poor prognosis. For prevention of oral mucosal melanomas, any solitary pigmentation that has no obvious explanation should be always biopsied. The case of a 40-year-old man with primary malignant melanoma of the maxillary gingiva is reported. Keywords: melanocytes, oral malignant melanoma, pigmented areas

Objective: To determine the susceptibility of teeth to darken after bleaching with 35% hydrogen peroxide and 16% carbamide peroxide. Method and Materials: Thirty-eight premolars were covered with varnish and the mesiobuccal facets polished up to 0.04 µm, leaving a flat surface. Thirty-six of these premolars were then randomly assigned to 3 groups and the shade of the polished surfaces recorded using a Vita shade guide set in a value disposition. According to the manufacturers' instructions, 12 samples were bleached with 35% hydrogen peroxide (in-office group) and 12 samples with 16% carbamide peroxide (at-home group). The 12 samples in the control group were not bleached. Two days later, the shades of the bleached teeth were recorded; all samples were immersed in silver nitrate 50% for 4 hours, rinsed, and fixed (using a dithioxamide solution) for 24 hours. Polished surfaces were cleaned and the samples' shade recorded and analyzed using ANOVA. The remaining 2 premolars were bleached the same as those in the test group and analyzed using atomic force microscopy. Results: The mean shade values were 6.2, 3.7, and 10.9 for in-office samples; 8.8, 1.7, and 6.1 for at-home samples; and 7.8 and 9.4 for the control group. After pigmentation, the at-home group had a lighter shade than the in-office group (P = .001). Atomic force microscopy showed no significant surface differences. Conclusion: While all the samples were susceptible to pigmentation, this tendency was greater following application of 35% hydrogen peroxide. Keywords: atomic force microscopy, at-home bleaching, in-office bleaching, peroxide, pigmentation, tooth bleaching

Objective: Actinobacillus actinomycetemcomitans is a major periodontal pathogen. This research was aimed at investigating the prevalence of A actinomycetemcomitans in Chinese chronic periodontitis patients and periodontally healthy adults. Method and Materials: A total of 116 chronic periodontitis patients and 111 periodontally healthy adults were included. In each periodontitis patient, subgingival plaque samples were collected from 2 molar sites with the deepest pockets and 1 periodontally healthy site. The samples of periodontally healthy adults were obtained from the mesiobuccal site of 1 maxillary first molar. A actinomycetemcomitans was detected by 16S rRNA polymerase chain action. Pocket depth, clinical attachment loss, and bleeding on probing of the sampled sites were recorded. Results: A actinomycetemcomitans was detected in only 1 site (0.90%) of periodontally healthy subjects. For chronic periodontitis patients, the prevalence of periodontitis sites (33.62%) was significantly higher than that of healthy sites (0.90%) (P .05); the occurrence showed a decreasing trend as patient age increased: highest in the 20- to 35-year-old group (44.12%), followed by the 36- to 55-year-old group (36.36%) and 56- to 75-year-old group (22.73%) (P .05). A actinomycetemcomitans was most frequently detected in sites with pocket depth 7 mm or more and clinical attachment loss 6 mm or more (P .05) and more often detected in sites that exhibited bleeding on probing (37.07%) than those that did not (7.41%) (P .05). Conclusions: A actinmycetemcomitans was more frequently detected in periodontitis sites than in periodontally healthy sites. For chronic periodontitis patients, a higher prevalence was associated with the severe sites than moderate and mild sites. A actinomycetemcomitans is considered to be a major pathogen in the etiology of chronic periodontitis. Keywords: Actinobacillus actinomycetemcomitans, chronic periodontitis, polymerase chain action

Objective: Odontoma is a tumorlike malformation (hamartoma) that contains odontogenic epithelium with odontogenic ectomesenchyme. Frequency and distribution of odontogenic tumor among a Portuguese population were analyzed and compared with previous reports. Method and Materials: A total of 65 odontogenic tumor cases were collected from the files of the Department of Pathology of Hospital São João, Porto, Portugal, and the Institute of Molecular Pathology and Immunology of the University of Porto (IPATIMUP), from January 1993 to December 2006. Of these cases, 48 were retrieved and analyzed. The final diagnosis of each case was based on the 2005 WHO histopathologic classification of odontogenic tumors, and to the authors' best knowledge, the present series represents the first study on odontomas in a northern Portuguese population. Results: Of the 65 odontogenic tumors cases, 64 (98.5%) were benign and 1 (1.5%), an ameloblastic carcinoma, was malignant. Odontoma was the most frequent odontogenic tumor (73.9%), followed by unicystic ameloblastoma (7.7%) and calcifying cystic odontogenic tumor (7.7%). Of the 48 odontomas (26 males and 22 females), 34 (70.8%) were compound and 14 (29.2%) were complex. Most odontomas (72.9%) occurred in patients under the age of 30, with a peak incidence in the second decade of life. Twenty-eight (58.3%) odontomas were in the maxilla and 20 (41.7%) in the mandible (P .05). Twentyeight (58.3%) of the 48 odontomas were associated with 33 impacted teeth, including 31 permanent teeth, 1 primary tooth, and 1 supernumerary tooth. The maxillary central incisor (n = 6; 19.4%) and the maxillary canine (n = 6; 19.4%) were most commonly associated with odontoma, followed by the mandibular canine (n = 5; 16.0%) and maxillary third molar (n = 4; 12.9%). Conclusion: This study provides clinical and pathological information on odotogenic tumors in a nothern Portuguese population. Keywords: odontoma, odontogenic tumor, Portuguese

Objective: To compare the effect of clinicians on the behavioral pain reaction of children who received local anesthesia with a conventional technique and a computerized device (Wand, Milestone Scientific). Method and Materials: One hundred four children aged 6 to 12 years who needed operative dentistry using infiltrative anesthesia in the mandible and maxilla were selected for this study. The patients were divided into 2 groups, each assigned to a different clinician, and received anesthesia either by the Wand or conventional technique. Two experienced pediatric dentists performed all injections. During the injection, the modified behavioral pain scale was used for objective evaluation of the children. Results: Chi-square analysis revealed no statistically significant difference in the behavior of children when receiving the Wand or conventional technique within each dentist and between dentists (P > .05). Conclusion: There seemed to be no difference in perceived pain between the Wand and conventional injection performed by experienced clinicians in school-age children. Keywords: computerized anesthetic device, local anesthesia, traditional syringe, wand

Objective: To analyze the clinical and histopathologic features of all cases diagnosed as lipomas in the oral cavity in a Brazilian population. Method and Materials: From 2002 to 2006, 26 cases of intraoral lipoma were studied. Clinical features obtained from biopsy records and microscopic slides were reviewed according to the World Health Organization and other cases previously described. Results: Mean age was 54.6 years (range, 29 to 91 years) with predilection for women. The buccal mucosa was the most common location (n = 9), followed by the tongue (n = 7), lower lip (n = 4), floor of the mouth (n = 3), retromolar area (n = 2), and buccal sulcus (n = 1). Histologically, the lesions were defined as classic lipomas (n = 15), fibrolipomas (n = 7), intramuscular lipoma (n = 2), spindle-cell lipoma (n = 1), and sialolipoma (n = 1). Follow-up information was available in 20 cases. No case recurred during a 6- to 12-month period. Conclusion: The benign nature of intraoral lipomas is supported by its bland histopathologic appearance and the absence of recurrences following complete local excision. Keywords: buccal mucosa, histopathology, lipomas, tongue

This article describes a technique for the delivery of local anesthetic to the masseteric nerve just before it innervates the masseter muscle. As the mandibular division (V3) of the trigeminal nerve exits foramen ovale, the anterior division of V3 along with the masseteric nerve travels in the infratemporal fossa. Eventually, the masseteric nerve passes through the mandibular notch to innervate the masseter muscle. With the aid of a cadaveric dissection, an infiltration technique for the regional blockade of the masseter muscle was devised. The masseteric nerve block is an effective technique for obtaining anesthesia in the whole masseter muscle. This peripheral nerve block provides another modality for the treatment of acute and chronic masseter muscle pain. The masseteric nerve block can also be used diagnostically to verify the source of pain. Keywords: masseter muscle, masseteric nerve block, peripheral nerve block, trigeminal nerve block