Quintessence International, 08/2012

Objective: To evaluate the clinical performance of zirconia-based cantilever fixed dental prostheses (FDPs). Method and Materials: Twenty-one cantilever FDPs with three or four units were designed to replace one premolar or incisor (no canines). The FDPs were divided into 11 zirconia cantilever FDPs (test group) and 10 metal-ceramic cantilever FDPs (control group) and randomly assigned to patients. The results documented included failures, complications, plaque accumulation, and esthetic performance. Statistical analysis was performed using the Mann-Whitney U and chi-square tests. Results: During the 2-year observation period, a total of five clinically relevant complications in four patients occurred: three endodontic problems (two in the test group and one in the control group) and two veneer chippings (both in the test group). Plaque accumulation on the abutment teeth was not significantly different among groups. The esthetic performance of all FDPs was acceptable. Conclusion: Stability and esthetic performance were acceptable for all-ceramic cantilever FDPs fabricated with zirconia. A longer observation period and larger sample size are necessary to make valid predictions about the longevity of these restorations. Keywords: cantilever, FDPs, randomized, zirconia

Objective: Common methods for matching tooth shade can be classified into two categories: visual and instrumental measurements. This systematic review evaluated these two methods in terms of precision and accuracy using the agreement percentage rate. Method and Materials: The following databases were searched for studies comparing different shade-matching methods: MEDLINE (PubMed), Embase, and Google Scholar. Reference lists of relevant articles were also searched. Screening, data abstraction, and quality assessment were conducted independently and in duplicate. Results: Twenty-six studies were included. Seventeen studies provided data on the precision of the evaluated shade-matching methods, eight provided data on accuracy, and one provided data on both precision and accuracy. Conclusion: Instrumental measurements using a spectrophotometer may provide the most precise and accurate shade-matching outcomes. However, the limitations of the available articles suggest that high-quality studies are still needed verify this claim. Keywords: colorimeter, digital imaging, shade matching, spectrophotometer, visual

The use of ceramic veneers to restore crowded teeth in the maxilla has been widely discussed in the literature. However, the use of this technique in the mandible has received little attention. Therefore, this case report describes the treatment of crowded mandibular anterior teeth using ceramic veneers. The primary treatment challenge in this region is the reduced tooth structure available for rehabilitation. Proper communication between the clinician and dental technician is required to achieve clinical success. This article presents a straightforward treatment plan and restorative technique that includes both the clinical and laboratory sequences necessary for predictable and stable postoperative outcomes. Keywords: anterior esthetics, ceramic veneers, crowded teeth, mandibular incisors

Objective: To evaluate the therapeutic potential of one-stage, full-mouth, ultrasonic debridement (FMUD) as a treatment for type 2 diabetic patients with generalized severe chronic periodontitis. Method and Materials: Sixteen patients diagnosed with generalized severe chronic periodontitis and type 2 diabetes mellitus were allocated to the diabetic group; another 15 subjects with periodontitis but without metabolic disorders were placed in the nondiabetic group. Both groups were treated using the FMUD protocol, a unique 45-minute session of ultrasonic debridement of all sites presenting periodontal disease. Patients were analyzed for the following parameters: plaque and bleeding indices, gingival recession, probing depth, and clinical attachment level. Further, diabetic subjects were assessed using fasting plasma glucose (FPG) and glycosylated hemoglobin (HbA1c) tests. Patients were evaluated at 3 and 6 months for all parameters. ANOVA and the Tukey test were used for data analysis (P .05). Results: Both groups showed improved periodontal health after treatment. There were no significant differences between the groups for any of the parameters assessed (P > .05). Diabetic subjects treated with FMUD had a clinical response similar to that of nondiabetic subjects at all pocket depths. No adverse effects or medical disturbances were observed in either group during treatment. FPG and HbA1c levels remained unaltered after treatment. Conclusion: Within the limitations of this study, FMUD promoted clinical improvements in patients with type 2 uncontrolled diabetes and generalized severe chronic periodontitis. Keywords: chronic periodontitis, diabetes mellitus, full-mouth, glycemic control, one-stage, ultrasonic debridement

Objective: To investigate the efficacy, tolerability, and long-term color stability of tooth whitening using two different bleaching techniques: an at-home tray technique (5.0% H2O2) and an over-the-counter strip technique (5.3% H2O2). Method and Materials: Thirty subjects were included in this two-cell, parallel, examiner-blinded, randomized clinical trial. Shade evaluations were performed with a value-oriented VITA shade guide. The null hypothesis was that there would be no differences between the groups and no improvements from baseline with regard to tooth shade. Bleaching sensitivity, gingival irritation, and patient acceptance were recorded on a visual analog scale (VAS). Scanning electron microscopy (SEM) was performed to detect any enamel surface changes. Results: After bleaching, both treatments demonstrated significant improvements in tooth shade (P .001 for both groups). At the 18-month recall, tooth shade remained significantly lighter than at baseline (P = .006 for tray group; P = .001 for strip group). However, a relapse of the tooth shade was observed compared with the immediate postbleaching result (P .05). VAS data yielded no significant differences between groups regarding bleaching sensitivity and gingival irritation. None of the teeth studied showed detectable enamel surface changes. Patient acceptance was statistically significantly higher in the tray group compared with the strip group (P .05). Conclusion: Both techniques demonstrated significant and comparable levels of tooth shade improvement after 2 weeks and 18 months. Each treatment caused similar, transient oral adverse effects. Keywords: follow-up, hydrogen peroxide, long-term stability, randomized clinical trial, shade relapse, tooth bleaching

Objective: Burning mouth syndrome (BMS) is a common chronic pain condition that lacks a satisfactory treatment approach. This systematic review was designed to examine the effects of acupuncture or acupoint injection on the management of BMS and to evaluate the evidence supporting the use of acupuncture therapy for BMS in clinical practice. Method and Materials: The following databases were searched for relevant articles: Cochrane Oral Health Group Trials Register (July 2011), Cochrane Central Register of Controlled Trials (issue 7, 2011), MEDLINE (1966 to June 2011), and electronic medical database from the China-National Knowledge Infrastructure (1979 to June 2011). Articles were screened, and the quality of the included trials was assessed independently by two reviewers. Results: After screening, nine studies with 547 randomized patients were included in this review. All nine articles were published in Chinese and were clinical trial studies with a Jadad score 3. Their results showed that acupuncture/ acupoint injection may benefit patients with BMS. The evidence supported the efficacy of acupuncture/acupoint injection therapy in reducing BMS pain and related symptoms. Conclusion: In light of the positive outcomes reported, the use of acupuncture therapy for BMS patients warrants further research. Keywords: acupoint, acupuncture, burning mouth syndrome, pain, therapy

Objective: To microbiologically evaluate the efficacy of cotton and polytetrafluoroethylene (PTFE) tape used as spacer materials. Method and Materials: Twenty-six extracted human molars were restored using either cotton or PTFE tape as spacers under a standardized provisional restorative material (Cavit). The teeth were incubated for 7 days in a culture of Streptococcus gordonii or in liquid media alone. The spacers were removed and tested for bacterial contamination. The access cavities were also evaluated for bacterial contamination. Results: Nine of 10 teeth with cotton spacers and one of 10 teeth with PTFE spacers were positive for S gordonii growth. The nine teeth in the cotton group also showed contamination of the access cavities. Conclusion: Even under optimal conditions, cotton spacers may cause leakage into the access cavities. Cotton fibers may serve as a route for bacterial contamination of the access cavities and root canal space. In contrast, PTFE tape did not provide an avenue for bacterial contamination. Keywords: cotton, endodontics, PTFE, spacer

Objective: The short-term and overnight effect of three treatment regimens on oral halitosis were investigated: toothbrushing with a reference toothpaste, toothbrushing with reference toothpaste and tongue cleaning, and toothbrushing and tongue cleaning with a tooth-and-tongue gel. Method and Materials: Fifty-four subjects meeting the inclusion criteria for bad breath were enrolled in the study. All subjects received each of the three treatment regimens in a balanced design. Efficacy was assessed by organoleptic ratings and volatile sulfur compound (VSC) measurements 5 and 60 minutes after first application and overnight after 7 days of repeated use. Results: The combination of toothbrushing and tongue cleaning with tooth-and-tongue gel provided the best results in terms of organoleptic ratings and VSC measurements at all time points compared to the other treatment regimens. Conclusion: The use of tooth and tongue gel for both toothbrushing and tongue cleaning showed a positive short-term and overnight effects after 7 days of use. This treatment regimen is a promising approach to control halitosis. Keywords: halitosis, organoleptic, tongue cleaner, tongue gel, toothpaste, VSC

Objective: To evaluate the genotoxic effects of x-rays on gingival and buccal epithelial cells during panoramic dental radiography using the micronucleus test. Method and Materials: Eighty otherwise healthy subjects who required a diagnostic panoramic radiograph and met the selection criteria were included in the study. Epithelial cells were obtained from the maxillary anterior gingiva and buccal mucosa by gentle scraping with a wooden spatula immediately before exposure and again 10 days after exposure. Cytologic preparations were made according to the Papanicolaou staining method and analyzed under a light microscope for micronucleus count. Results: The mean ± SD micronucleus count of gingival epithelial cells was 1.08 ± 0.76 before radiographic exposure and 1.6 ± 0.93 after exposure. This increase was statistically significant (P .05). Similarly, there was an increase in the postexposure micronucleus count in the buccal mucosa, but this increase was not significant (P > .05). A significant correlation was observed between the age of subjects and micronucleus count, although no such correlation was found between sex and micronucleus count. Conclusion: Although radiation-related effects from panoramic radiography were reduced compared with full-mouth intraoral periapical radiographs or radiotherapy, the results of this study show that genotoxic effects do take place. Thus, radiographs should be taken with adequate protection measures and only when the potential benefit outweighs the potential risk. Keywords: DNA damage, micronucleus test, panoramic radiography, radiation hazard

Objective: Periodontitis is an infection that results from an imbalance between periodontopathic microorganisms and the local and systemic host defense. This study analyzed saliva samples of patients with periodontitis for several biomarkers of host response. Method and Materials: Saliva was collected from 13 patients with chronic periodontitis, seven patients with aggressive periodontitis, and 13 periodontally healthy control subjects. Diverse markers of host response representing innate and adaptive immune response as well as antioxidative variables were determined. Results: Patients with aggressive periodontitis had significantly higher values of lipid peroxidation and cathepsin C activity in saliva. The highest activities of neutrophil elastase, proteinase 3, and superoxide dismutase were measured in chronic periodontitis patients. Levels of antimicrobial peptides HNPs 1-3 were significantly highest in chronic periodontitis patients than in aggressive periodontitis or control subjects. Immunoglobulin G levels directed against Aggregatibacter actinomycetemcomitans were highest in aggressive periodontitis patients, while those directed against Porphyromonas gingivalis were highest in chronic periodontitis patients. Immunoglobulin A levels directed against these periodontopathogens did not differ among the groups. Conclusion: Chronic periodontitis patients showed higher levels of markers primarily associated with combating infection. The levels of markers known mainly for tissue damage were higher in aggressive periodontitis patients. Neutrophil-related markers may be able to identify and differentiate patients with periodontitis. Keywords: antioxidative variables, biomarkers, immunoglobulins, periodontitis, PMNs, saliva