Quintessence International, 02/2004

The maxillary canine has a long path of eruption, and the frequency of its impaction is second only to that of third molars. It usually impacts palatally or buccally, and the etiologies of these two types of impaction are quite different. This article highlights the importance of a meticulous radiographic examination and describes the surgical procedure used to treat a permanent maxillary canine impacted buccally to the lateral incisor but palatally to the central incisor.

Dental bleaching represents an effective, conservative, and relatively low-cost method for improving the appearance of discolored pulpless teeth. Among the bleaching techniques, the walking bleach technique with sodium perborate associated with water or hydrogen peroxide stands out because of its esthetic results and safety. A modified walking bleach technique with the use of 37% carbamide peroxide as the bleaching agent is presented. Additionally, the adverse effects of dental bleaching in the following restorative procedures are discussed, showing the advantages with the use of 37% carbamide peroxide.

A male patient presented for maxillary and mandibular complete-arch prostheses. A total of eight all-ceramic restorations, eight metal-ceramic crowns, and four metal-ceramic fixed partial dentures were placed. The restorations were examined for marginal integrity, anatomic form, surface, and color for a period of 12 months. All restorations were in function at the end of the evaluation period. There was no adverse event. No substantial difference between the all-ceramic onlays and the metal-ceramic crowns was apparent. The all-ceramic restorations exhibited the least plaque growth. Bleeding on probing was minimal at both restoration types. The marginal integrity of the all-ceramic restorations was considered to be nearly as precise as that of the metal-ceramic crowns.

The keystone of the architecture of the oral cavity is saliva; however, it is rarely acknowledged as a vital physiologic secretion. Saliva plays three major roles

Labial mucosal fenestration of the root apex is an uncommon occurrence. An unusual case involving a maxillary right first premolar is described. When presented, the tooth was nonvital with the buccal root apex readily seen through a soft tissue and bone fenestration. Conventional endodontic treatment with gutta percha failed to resolve the problem. Periodontal surgery with a laterally positioned pedicle flap was thus scheduled. At the 1-month recall, complete healing was evident in the surgical site, and the fenestrated area of the maxillary right first premolar was filled with healthy mucosal tissue. One-year postoperatively, the mucosa remained covered, and there was radiographic evidence of bone infilling in the periapical region.

Oral mucositis is a frequently occurring and debilitating complication of cancer therapy. Many treatments have already been discussed regarding the management of this condition, but some reports show little evidence supporting the effectiveness of some of these interventions. The role of the general practitioner in the prevention and management of chemotherapy- and radiotherapy-induced mucositis is critical. The general practitioner must collaborate with the oncologist, and the oncologist must consult with the patient's general practitioner to ensure comprehensive treatment of this condition. Working knowledge of the vast number of substances used for the treatment of oral mucositis is mandatory for health care providers. This article presents a concise and updated review of the types of therapies used for cancer treatment-induced oral mucositis, providing clearly defined guidelines for the general practitioner.

Concentrated potassium nitrate has been used to lessen the pain caused by aphthous stomatitis. The problem with this approach is that it can have difficulty penetrating into the deeper layers of mucosae or skin, and for this reason, its beneficial affects are not routinely predictable. When dimethyl isosorbide is added to potassium nitrate in an aqueous hydroxyethyl cellulose gel, it enhances the capacity of potassium nitrate to more completely permeate these tissues and predictably promote rapid pain control and aphthae healing.

Objective: Based on a randomized, population study (Study of Health in Pomerania [SHIP]), the objective of the present study was to determine incidence of signs and symptoms of temporomandibular disorders (TMD) in adults 20 years or older and to compare the data with TMD prevalence of other exclusively random sample studies that fulfilled criteria similar to those of this study (age >= 20 years, age range >= 40 years, sample size >= 500 subjects, equal gender distribution). Method and materials: Men and women (n = 7,008) 20 to 79 years of age from mid- and small-sized towns in a rural region in northeast Germany were randomly sampled from resident registry office files. The response rate was 68.8%. Adults between the ages of 20 and 81 years (n = 4,289) were clinically and anamnestically examined. Results: Half of the subjects (49.9%) had one or more clinical signs of TMD, but only 2.7% were subjectively aware of temporomandibular joint (TMJ) pain symptoms. Women showed higher frequency for all signs and symptoms of TMD than men. However, these differences were not significant for all signs and symptoms in all age groups. The influence of age on TMD signs and symptoms was less pronounced. The prevalence for the following variables found in the present study compared to those of other comparable, random sample studies was: clinical examination; (TMJ) tenderness to palpation (5% versus 2% to 6%); masticatory muscle tenderness (15% versus 19% to 21%); joint sounds (25% versus 15% to 25%); limited maximum mouth opening 40 mm (9% versus 5% to 8%); pain upon movement of the mandible (1% versus 1% to 3%); irregular jaw movements (deviation, deflection) (28% versus 28%); interview: subjective joint sounds (9% versus 11% to 13%); and subjective TMJ pain (3% versus 4% to 7%). Conclusion: The TMD incidence in the current study agreed quite well with the other studies based on random samples with similar subjects and design. The large range of prevalence for signs and symptoms of TMD documented in reviews and meta-analyses could therefore not be confirmed.

Objective: The aim of this study was to perform a qualitative assessment of the personal video monitor (PVM) as an accessory to the dental operating microscope (DOM). Method and materials: The PVM was attached to a color video monitor, which was already attached to a DOM through a beam splitter. One faculty clinician performed a complete oral examination on a patient wearing a binocular inclinable lens adapted to the DOM under different magnifications, while a second faculty watched the procedure simultaneously using a PVM. After completing the examination, the operators exchanged the viewing devices and repeated the procedure. Results: When compared to a standard binocular lens attached to the DOM, the second operator using the PVM had an unencumbered view of his surroundings and was able to make head movements freely. However, when comparing the resolution of the standard binocular lens to the PVM, the binocular lens provided a sharper picture with better illumination, especially when using higher magnification. Statistical analysis was not incorporated, as the goal of this experiment was to qualify rather than quantify the established PVM resolution, in this initial analysis. Conclusion: The authors concluded that the PVM attached to the video camera and the DOM allowed a second operator to watch the procedure, and it could be used as an important teaching tool. Another application is that the patient may wear the PVM while the procedure is in progress. However, the resolution in the PVM needs to be significantly improved in order to achieve an adequate level of efficiency in four-handed microdentistry.

Objective: The aim of this study was to evaluate the morphology of the resin-dentin interface formed in vivo with two posterior resin composite placement techniques (incremental and bulk). Method and materials: After approval from the patients, 12 Class II cavities with margins in enamel (2.5 × 2.5 × 4.5 mm) were prepared in caries-free premolars scheduled to be extracted for orthodontic reasons (n = 6). The cavities were restored with Single Bond + Filtek P60 as a bulk condensable technique or Single Bond + Filtek Z250 as an oblique incremental technique. After 1 week, the teeth were extracted with minimal trauma to the restored area. After the teeth were sectioned, a polyvinyl siloxane impression was taken from the resin-dentin interface to control for artifacts created during preparation for scanning electron microscopy. The specimens were subsequently processed for and observed under a scanning electron microscope to assess gap formation. Results: The mean percentage of gap formation was 6.1% for teeth restored with the incremental placement technique and 18.7% for teeth restored with the bulk placement technique. The difference was statistically significant. Conclusion: The incremental placement of posterior resin composites may still provide better seal than the new bulk condensable technique.