Quintessence International, 10/2005

The long-term clinical and esthetic success of implant-supported restorations is determined by osseointegration and optimal remodeling of peri-implant soft tissues. Complications of soft-tissue management are often caused by fibrotic regeneration of oral mucosa after multiple surgical procedures. Knowledge of the proliferative processes in wound healing is necessary to attain adequate soft-tissue conditions. Successful reconstruction of peri-implant soft tissues is feasible even in fibrotic conditions when appropriate surgical techniques are selected. The pleiotropic proliferative cytokine TGF-b is involved in the regulation of all phases of wound healing and tissue remodeling. The isoform TGF-b1 is a cytokine associated with the development of fibrotic tissue. Overexpression of TGF-b1 causes scarring and fibrosis, and results in limited clinical success of intraoral soft-tissue management. Experimental therapeutic approaches with neutralizing antibodies to block TGF-b1 resulted in less scarring and a reduction of fibrosis. Further molecular biologic research of cell-matrix-cytokine interactions in wound healing will provide highly specific antifibrotic therapeutic approaches in the future. Keywords: fibrosis, implants, soft tissue, transforming growth factor-beta, wound healing

Objective: The aim of this study was to evaluate the degree of conversion and Vickers surface hardness of resin cement under a simulated ceramic restoration with 3 different curing units: a conventional halogen unit, a high-intensity halogen unit, and a light-emitting diode system. Methods and Materials: A conventional halogen curing unit (Hilux 550) (40 s), a high-intensity halogen curing unit used in conventional and ramp mode (Optilux 501) (10 s and 20 s, respectively), and a light-emitting diode system (Elipar FreeLight) (20 s, 40 s) were used in this study. The dual-curing resin cement (Variolink II) was cured under a simulated ceramic restoration (diameter 5 mm, height 2 mm), and the degree of conversion and Vickers surface hardness were measured. For degree of conversion measurement, 10 specimens were prepared for each group. The absorbance peaks were recorded using the diffuse-reflection mode of Fourier transformation infrared spectroscopy. For Vickers surface hardness measurement, 10 specimens were prepared for each group. A load of 200 N was applied for 15 seconds, and 3 evaluations of each of the samples were performed. Results: Degree of conversion achieved with Optilux 501 (20 s) was significantly higher than those of Hilux, Optilux 501 (10 s), Elipar FreeLight (20 s), and Elipar FreeLight (40 s). For Vickers surface hardness measurement, Optilux 501 (20 s) produced the highest surface hardness value. No significant differences were found among the Hilux, Optilux 501 (10 s), Elipar FreeLight (20 s), and Elipar FreeLight (40 s). Conclusion: The high-intensity halogen curing unit used in ramp mode (20 s) produced harder resin cement surfaces than did the conventional halogen curing unit, high-intensity halogen curing unit used in conventional mode (10 s) and light-emitting diode system (20 s, 40 s), when cured through a simulated ceramic restoration. Keywords: ceramic restoration, curing units, degree of conversion, hardness, resin cement, Vickers' hardness

Diabetes mellitus is an etiologically and clinically heterogeneous group of metabolic disorders that share the commonality of hyperglycemia. Long-term hyperglycemia produces tissue damage, which ultimately manifests as microvascular and macrovascular disease, and neuropathy. The presence of macrovascular disease should alert clinicians to the possibility that the patient may have coronary artery disease, particularly because coronary artery disease and myocardial ischemia are likely to be silent. Elderly patients with diabetes mellitus are also more likely to develop congestive heart failure. Patients with unstable coronary syndromes, decompensated heart failure, and symptomatic cardiac arrhythmias are at increased risk of perioperative cardiovascular complications (myocardial infarction, heart failure, and sudden death) while undergoing noncardiac procedures. In addition, clinicians must avoid the risk of hypoglycemic episodes. Oral health care providers can expect to be called upon to care for patients with this progressively debilitating disease. To provide competent care to patients with diabetes mellitus, dental clinicians must understand the disease, its treatment, and the impact the disease and its treatment may have on the patient's ability to undergo and respond to dental care.

This article presents the long-term follow-up of a female patient who suffered pulp exposure during removal of a large caries lesion from the mandibular right first molar. The clinical decision to perform direct pulp capping was made. The tooth was treated with 5% chlorhexidine, etched with 37% phosphoric acid, and then restored with Heliomolar composite after application of Gluma dentin adhesive. The patient was followed for more than 8 years. Keywords: clinical follow-up, clinical report, compound resins, conservative treatment, dentin adhesion, direct pulp capping, pulp exposure, pulp vitality

Objective: The treatment of choice for odontogenic cysts is surgery, and when the cysts are infected, preoperative antibiotic coverage is needed. However, the diffusion of antibiotics is a matter of controversy because of the low vascularization of the cystic epithelium. The aim of the present study was to determine the antimicrobial action of amoxicillin and metronidazole on infected odontogenic cysts. Methods and Materials: Ten odontogenic root cysts were punctured before and after antibiotic treatment in 2 patient groups. Group 1 consisted of 5 patients treated with 500 mg amoxicillin at 6-hour intervals, and group 2 consisted of 5 patients treated with 400 mg metronidazole at 8-hour intervals, for 7 days. After this period, the patients were submitted to surgery for enucleation. The fluid collected was seeded onto culture media for counts of total bacteria and facultative anaerobic bacteria. Results: The results showed that the amount of bacteria present in the fluid was significantly higher than the amount isolated after antibiotic treatment. Also, most of the microorganisms present in the fluid collected before antibiotic administration were strict anaerobes. Conclusions: Both antibiotics reduced the number of bacteria in the cystic fluid, showing that they did diffuse into the lesions at sufficient concentrations to exert their antimicrobial action. Keywords: amoxicillin, metronidazole, odontogenic cyst, odontogenic infection

Objective: The aim of this study was to evaluate the efficacy of a spray containing an antimicrobial solution for toothbrush disinfection. Methods and Materials: Three different solutions were sprayed on toothbrush bristles among 30 adults after they had brushed: (1) basic formulation (base) plus chlorhexidine; (2) base only, and (3) sterile tap water (control). Each solution was tested for 1 week. After that, the toothbrushes were collected and sonicated in Letheen Broth, diluted in 10-fold series, and plated on selective and nonselective media for detection of anaerobes, aerobes, streptococci, and gram-negative bacilli. After incubation, the colonies of those microorganisms were counted. Presence of mutans streptococci on the bristles was also confirmed. Results: Spray 1 produced a significant reduction in the microbial contamination of toothbrushes for all the microorganisms, spray 2 provided some reduction of contaminants, and spray 3 demonstrated the least antimicrobial effect. Conclusion: The antimicrobial spray with chlorhexidine proved to be an effective and practical means for toothbrush disinfection. Keywords: antimicrobial agent, bacterial contamination, biofilm, chlorhexidine, disinfection, oral hygiene aids, spray, toothbrush

Objective: Treating teeth with adhesive agents before placing a provisional restoration can prevent tooth sensitivity. This study evaluated the bond strength of resin cements to dentin treated with 2 adhesive agents and 2 provisional cements. Methods and Materials: Extracted human molars were prepared by exposing dentin and were treated with either Prime & Bond NT or Clearfil SE Bond. After a simulated impression technique, the teeth were provisionalized with either a eugenol or noneugenol temporary cement. Teeth were cleaned for bonding by either mechanical removal of the cement or use of an acid conditioner. Panavia F and Calibra resin cements were used to cement nickel/chrome/beryllium alloy to the tooth surfaces, and the specimens were debonded. Mean shear bond strengths for each group were calculated. Results: Mean shear bond strengths ranged from 26.6 ± 5.8 MPa for Calibra bonded to dentin treated with Prime & Bond NT, a noneugenol cement, and mechanically cleaned, to 10.6 ± 4.4 MPa for Panavia F bonded to unlined (no adhesive) dentin treated with a eugenol cement and mechanically cleaned. Of the 14 groups tested, significant differences were observed related to the adhesives and resin cements. Both temporary cements reduced the bond to dentin not treated with a resin adhesive. Use of an acid conditioner for cleaning the temporary cement also reduced bond strengths in all groups. Conclusions: Placement of a dentin adhesive before provisionalization may prevent the temporary cement from affecting the bond of the final resin cement to the tooth. For the products used in this study, use of phosphoric acid to clean the tooth surface is not recommended. Keywords: adhesive liner, bond strength, provisional cement, resin cement

Objective: The purpose of this research was to study the cases of inflammatory fibrous hyperplasia (IFH) at the Clinic of Semiology, Department of Bioscience and Oral Diagnosis, São José dos Campos Dental School, State University of São Paulo, Brazil. Methods and Materials: A total of 141 clinical file cards indicating a final diagnosis of IFH, from the archives of the Department of Bioscience and Oral Diagnosis and dated from 1979 to 2001, were included in the study. Of these files, 50 indicated a diagnosis of denture-induced fibrous hyperplasia. Sex, age, race, duration, and clinical features that confirm their classification in the non-neoplastic proliferating process were analyzed statistically. Results: Of the 50 analyzed cases of denture-induced lesion, 22% occurred in men and 78% in women. Patients in the age group of 41 to 50 years presented the highest frequency of the lesion. Conclusions: Inflammatory fibrous hyperplasia occurs more frequently in women (71.63%), and denture-induced lesions appear mainly in patients over 40 years of age (70% of cases). Patients with denture-induced hyperplasia reported pain associated with the lesion (70%). Keywords: denture, diagnosis, hyperplasia, inflammation, medical examination, medical history