Quintessence International, 01/2004

Amelogenesis imperfecta is a hereditary developmental disorder of the dental enamel, in both primary and permanent dentition. The main clinical characteristics are extensive loss of tooth tissue, poor esthetics, and tooth sensitivity. Transmission of the gene takes place by either autosomal, dominant X-linked, or recessive modes. This clinical report describes a treatment sequence based on a multidisciplinary approach. A 21-year-old girl with hypoplastic amelogenesis imperfecta was referred to the Ege University School of Dentistry clinic. She was concerned about the poor appearance and sensitivity of her teeth. The patient presented with an anterior open bite, although orthodontic treatment had been completed previously. Periodontal gingivectomy of her posterior teeth followed by endodontic treatment where indicated was proposed. The prosthodontic treatment consisted of metal ceramic fixed partial dentures of precious alloy. At the end of treatment, function and esthetics were improved to a level acceptable to both the patient and the dental team.

Objective: This in vivo pilot study investigated the role of argon laser irradiation and combined fluoride and argon laser treatment in accelerated natural caries development in sound enamel surfaces beneath plaque-retentive orthodontic bands. Method and materials: Five patients (3 female, 2 male, ages 19 to 28 years) requiring tooth extraction prior to orthodontic treatment, participated in the study. Buccal surfaces were treated with either: (1) argon laser (250 mW for 10 seconds, ARGO-MOD); (2) topical fluoride (0.5% fluoride ion, Thera-Flur-N) followed by argon lasing; or (3) no treatment (control). Orthodontic bands with plaque-retentive slots on buccal surfaces were placed on the teeth slated for extraction (n = 14). Following a minimum of 5 weeks of intraoral exposure, the teeth were extracted for laboratory analysis. The teeth underwent serial longitudinal sectioning (12 sections per tooth). The sections were imbibed in water, and lesion depths were determined with each section, using polarized light microscopy. Comparisons were made among treatment groups (analysis of variance, Duncan's multiple range test for paired samples). Results: Mean lesion depths were: 261 ± 24 µm for the no treatment control group (n = 84 sections); 147 ± 18 µm for the argon laser group (n = 24 sections); and 99 ± 12 µm for the fluoride and argon laser group (n = 60 sections). Both the argon laser (44%) and the fluoride and argon laser groups (62%) had significant lesion depth reductions compared to controls. The addition of fluoride treatment prior to argon lasing resulted in a 32% reduction in lesion depth compared to argon laser treatment alone. Conclusions: Within this clinical pilot study, in vivo natural caries formation was affected significantly by a single exposure to low fluence argon laser irradiation. Topical fluoride treatment in combination with argon lasing provided an even greater degree of resistance against in vivo enamel caries development. A simple technique for reducing the caries susceptibility of enamel may be a clinical reality.

Objectives: Resin composites can be proposed for the restoration of incisal edges. If a progressive wear or an old fracture is responsible for the loss of the incisal edge, the bonding substrate is likely to be sclerotic dentin, surrounded by enamel. The purpose of the study was to measure under laboratory conditions, the shear bond strength of three adhesive systems to the enamel and dentin exposed on the edge of incisors as a result of a long-time wear or an old fracture. Method and materials: Thirty extracted human incisors were selected. The teeth had to exhibit some exposed dentin on their edges, a result of old fractures or wear. The 30 specimens were randomly divided into three groups. In each group, a different adhesive system was tested for the ability to efficiently bond a resin composite restoration to the dental substrate. A three-step system (Scotchbond Multipurpose Plus), a one-bottle adhesive (Scotchbond 1), and a self-etching adhesive (Prompt-L-Pop) were compared. The shear bond strength of the restored samples was measured under a loading machine. The pattern of failure that each sample underwent as a result of loading was assessed under a stereomicroscope. Results: The highest values of bond strength were yielded by Scotchbond Multipurpose Plus (28.14 MPa), followed by Scotchbond 1 (16.15 MPa), and Prompt-L-Pop (9.26 MPa). These differences were statistically significant (P .05). The most frequent pattern of failure was the combined adhesive-cohesive in resin fracture. Conclusion: Adhesive systems involving phosphoric acid etching of the substrate were more dependable than a self-etch adhesive when bonding a resin composite restoration to worn or fractured incisal edges.

Objectives: To evaluate the microleakage in Class II resin restorations at different margins and the polymerization shrinkage of the composites used. Method and materials: Four standardized Class II (3 3 5 3 2 mm) cavities were prepared in 32 teeth. The sample had the gingival margin either 1 mm below or above the cementoenamel junction. Teeth were divided and restored according to the following protocols: (1) Single Bond + P60; (2) Prime & Bond NT + Surefil; (3) Bond-1 + Alert; and (4) Prime & Bond 2.1 + TPH. After 7 days, the specimens were thermocycled (500 cycles between 5 to 55°C with a 15-second dwell time), immersed in 0.5% methylene blue for 24 hours, sectioned, and evaluated (both surfaces) at the gingival margin by two examiners, using a 0 to 3 marginal infiltration score system. The polymerization shrinkage of the composites (n = 6) was evaluated by the disk deflective method. Microleakage data was evaluated by nonparametric repeated measures ANOVA. The percentage of polymerization shrinkage was evaluated by ANOVA and Tukey's test. Results: Only protocol 3 showed a significant difference between enamel and cementum margin. No difference was detected among the protocols in the enamel margin. Only protocol 1 provided a good seal in the cementum margin. All packable composites showed lower polymerization shrinkage than the hybrid tested. Conclusion: All protocols are able to prevent dye penetration in enamel margins; however, protocol 1 is preferable to reduce the microleakage in the cementum margin. The packable composites showed lower polymerization shrinkage compared to the hybrid resin.

A 45-year-old woman needing a Class V restoration in a mandibular molar without attached gingiva is presented. In an interdisciplinary intervention, transurgical restoration was accomplished, including flap surgery with a slight ostectomy and restoration with a bonding system and a resin composite. A 1-year clinical evaluation showed satisfactory marginal adaptation and restoration contour associated to gingival tissue health.

This article presents an unusual case of major recurrent aphthous stomatitis that was refractory to multiple topical and systemic immunosuppressive therapies. Ultimately, thalidomide was selected despite its well-recognized adverse potential, and was successful in producing remission of ulcers. Strict clinical protocols were followed for this therapy in collaboration with numerous medical providers. This case illustrates the ability of multiple oral health and medical providers to collaborate in the diagnosis, management, and follow-up of a patient with an oral vesiculoerosive disease.

The Hallermann-Streiff syndrome (HSS) is a rare congenital disorder characterized by dyscephaly, birdlike facies, hypoplastic mandible, congenital cataracts, microphthalmia, hypotrichosis, skin atrophy, proportionate short stature, and dental anomalies. A case of a 29-year-old man with atypical HSS with neither cataracts, hair and skin alterations, nor short stature is reported, with special consideration to oral findings and dental management. Dental extractions, scaling, restorations, and endodontics were performed under local anesthesia. Later, orthodontic rehabilitation with fixed brackets was carried out. Finally, a removable partial denture for the maxillary arch was designed using transparent acrylic, and this also served as a retention splint. Young patients with HSS and other similar syndromes must be involved in personalized oral health prevention programs as early as possible. Despite numerous systemic anomalies, some of these patients may undergo conventional dental procedures under local anesthesia in the dental office.

The aim of this study was to investigate the cross-infection control procedures used by Turkish orthodontists. A questionnaire was mailed to 268 orthodontists to determine the attitude toward infection-control procedures. Responses were received from 194 orthodontists, and the reply data were analyzed. Of the 194 orthodontists who completed and returned the questionnaire, 77.3% had been vaccinated for hepatitis B, and 24.2% always wear a mask when treating their patients. While 48.5% of the respondent orthodontists always wear gloves, 4.1% never wear gloves.