Quintessence International, 01/2007

Patients with microstomia who have to wear removable dental prostheses often face the difficulty of being unable to insert or remove the prosthesis because of the constricted opening of the oral cavity. This clinical report describes in detail the prosthodontic management of an edentulous patient with microstomia induced by scleroderma. Sectional-collapsible maxillary and sectional mandibular complete dentures were fabricated by means of sectional trays. With the use of palatal midline hinge and stud attachments, the sectional dentures were successfully and easily inserted and removed. Keywords: microstomia, scleroderma, sectional-collapsible complete denture, sectioned trays

Objective: The aim of this study was to assess the prevalence and intraoral distribution of oral mucosal lesions in a representative adult population (Study of Health in Pomerania/Germany). Method and Materials: The study sample comprised 6,267 randomly selected subjects who were scheduled for examination from 1997 to 2001 (population-based cross-sectional study; response rate: 69%; age range 20 to 81 years). Results: The prevalence of oral mucosal lesions was age dependent (5.56% in 20- to 29-year-olds to 19.55% in 70- to 81-year-olds) with an overall prevalence of 11.83%. The prevalence in men (12.20%) was slightly higher than in women (11.40%). Exophytic neoplasia was the most prevalent alteration (3.00%), followed by leukoplakia simplex (prevalence 2.85%). Premalignant lesions were found in 0.57% of the participants, with lichen ruber mucosae contributing the major part (0.48%). Exophytic neoplasia was most often situated in the buccal mucosa, the hard palate, or the mucosa of the lower lip. Conclusion: These data stress the importance of screening for oral mucosal lesions, especially because of a predicted increase in the number of elderly persons in industrialized countries. Keywords: distribution, oral mucosal lesions, prevalence, representative survey

Objective: The purpose of this investigation was to establish a connection between masticatory deficiency and pathomorphologic alterations of gastric mucosa in patients with dyspepsia. Method and Materials: In 40 dyspeptic, edentulous and partially dentate patients and in 40 dyspeptic control patients with good dental status, the Optosil masticatory function test was performed. Histopathologic changes of gastric mucosa and the severity of Helicobacter pylori infection were scored according to the updated Sydney Classification of Chronic Gastritis. Results: The comminution of Optosil particles after increasing the number of chewing strokes was significantly impaired in edentulous and partially dentate patients, indicating masticatory deficiency in this group. This masticatory deficiency group was subdivided into groups with a lower (subgroup 1) and higher (subgroup 2) degree of masticatory deficiency according to median X50 in the Optosil test. The endoscopic appearance of gastric mucosa in masticatory deficiency patients and in the control group suggested chronic gastritis. Higher inflammatory and infection scores were noted in subgroup 2 than in the control group and subgroup 1, especially in the antral part of the stomach. The differences between the antral part and the body of the stomach were significant only in subgroup 2. Conclusions: Masticatory deficiency in patients with dyspepsia was connected with more severe chronic inflammatory changes and H pylori infection of gastric mucosa, especially in the antrum of the stomach. Higher values of inflammatory and infection scores in the subgroup with a higher degree of masticatory deficiency suggest its causal role in the promotion of gastritis and H pylori infection. Keywords: chewing, gastritis, Helicobacter pylori, masticatory deficiency, Optosil test

Oral leukoplakia is a predominantly white lesion of the oral mucosa that cannot be clinicopathologically characterized as any other definable lesion. Any oral site may be affected by leukoplakia, the most common sites being buccal and alveolar mucosa, floor of the mouth, tongue, lips, and palate. To date there is no evidence of effective treatment of oral leukoplakia that may prevent recurrence. This case report describes a new surgical technique using a bilaminar connective tissue graft in the treatment of oral leukoplakia. During the regular periodontal recall visit, the clinical diagnosis of gingival leukoplakia at the maxillary left sextant was established in a 45-year-old patient. Histopathologic analysis suggested reactive hyperkeratosis. The patient agreed to a new surgical treatment of the lesion. Under local anesthesia a 20-mm-long bilaminar connective tissue graft was interposed between the affected tissue and the bone. Healing was followed by the disappearance of the white lesion within the borders of the underlying graft. Five years after therapy, the treated area remained intact, with no clinical sign of recurrence. Keywords: bilaminar connective tissue graft, leukoplakia, reactive hyperkeratosis, surgical treatment

Objectives: An epidemiologic study of 213 healthy children was carried out in 2 age groups (4 to 6 and 7 to 12 years) to determine the potential relationships between oral Candida and dental status. Method and Materials: For each child included, a dental examination and mycologic investigation were conducted. The dental examination determined the index values for decayed and filled primary teeth (df-t) and decayed, missing, and filled permanent teeth (DMF-T). Results: In the 4- to 6-year age group, the frequency of oral Candida in children with moderate and high df-t indexes was statistically higher than in caries-free children. By comparison, in the 7- to 12-year age group, high frequency of Candida was observed only in children with high dental indexes (both df-t and DMF-T), but it was not significant. Generally, the intensity of candidal carriage in Candida-positive children was low, and it was not varied as a function of dental caries. Candida albicans was more frequently isolated, and it was the only species present in caries-free children. Other identified species were observed in children with different values of dental indexes. Conclusions: Mycologic examination may constitute a contributory role for epidemiologic studies of dental caries, especially in children under 7 years of age. Keywords: age, Candida albicans, candidal carriage, children, dental caries

This case report describes the prosthodontic treatment for a 28-year-old man and a 16-year-old boy diagnosed with amelogenesis imperfecta. The aim of treatment was to reduce dental sensitivity and to restore esthetics and masticatory function. Because of the socioeconomic status of the patients, direct resin composite laminate veneers were used to improve the esthetics of their maxillary and mandibular anterior teeth. Clinical examination 12 months after treatment revealed no evidence of disorders associated with the restored teeth or their supporting structures. Definitive treatment outcomes in terms of function and esthetics satisfied the expectations of both the patient and the interdisciplinary team. Keywords: amelogenesis imperfecta, direct resin composite laminate veneers, enamel hypoplasia, enamel hypocalcification, esthetics

Objective: Cements possessing antibacterial properties may reduce bacteria-induced fixed partial denture complications. The purpose of this study was to evaluate the antibacterial properties of 4 dental cements using the direct contact test (DCT) and the agar diffusion test (ADT). Method and Materials: The ADT was performed using mitis salivarius agar plates. Each plate was evenly inoculated with freshly grown mutans streptococci. Two samples of each test material-RelyX ARC, Variolink II, GC FujiCEM, and Principle-were placed, and the inhibition halo obtained was measured after 48 hours. For the DCT, 8 samples were placed on the sidewalls of wells in a 96-well microtiter plate. After polymerization, freshly grown Streptococcus mutans cells (1 3 106) were placed on the surface of each sample for 1 hour at 37°C. Fresh medium was then added to each well, and bacterial growth was followed for 16 hours in a temperature-controlled spectrophotometer. Similarly prepared samples were aged in phosphate-buffered saline for 1 or 7 days and the DCT was repeated. Analysis of variance (ANOVA) and Tukey multiple comparisons were applied to the data. Results: In the ADT, GC FujiCEM showed an inhibition zone of 2.0 ± 0.3 mm, and Principle showed an inhibition zone of 1.2 ± 0.2 mm. In the DCT, freshly polymerized samples of GC FujiCEM and Principle exhibited potent antibacterial properties, while samples of Variolink II and RelyX ARC showed moderate antibacterial properties. Principle showed some antibacterial properties even after 1 day (P .001). Conclusion: None of the tested cements in this study possesses long-term antibacterial properties. Keywords: agar diffusion test, antibacterial, dental cements, direct contact test, Streptococcus mutans

Mandibular fractures are a rare complication after third molar removal. Symptoms show a wide variance. Treatment options range from prescription of a soft diet to surgical treatment by open reduction and internal fixation. This article describes a patient who presented a late mandibular fracture following third molar removal. The fracture was not detectable in radiographs at the time of fracture. Six weeks after the reported cracking noise, the patient presented a mandibular fracture with associated osteomyelitis. Treatment by open reduction and internal fixation and autologous iliac crest graft was performed via a submandibular approach. The delayed diagnosis of this pathologic fracture demonstrates the necessity of repeated radiologic controls to prevent osteomyelitis when a fracture is suspected. Keywords: complication, osteomyelitis, pathologic mandibular fracture, third molar

Objective: To investigate, in vitro, the effect of time on the 3-dimensional accuracy of open-tray implant impression copings made of polyvinyl siloxane and polyether impression materials. Method and Materials: Reference models with 4 internal connection implants were fabricated. Four sets of 71 direct impressions were made with square impression copings using an open-tray technique. One set of impressions was made with polyether material (material A) and each of 3 polyvinyl siloxane materials (materials B, C, and D). Three-dimensional changes in spatial orientation of the implant analogs were measured over 48 hours using an optical measurement device. Deviation values were summed over 4 points and averaged per impression. Global differences were tested with a nonparametric Kruskal-Wallis test followed by pairwise comparisons using the Mann-Whitney U test. Results: The mean dimensional accuracy of implant impressions significantly differed over time (P .001). Materials A and B were found to produce comparable results. For materials C and D there was a significant increase in deviations, with a maximum increase at 2 hours. Deviations for material C were comparable to materials A and B at 48 hours. Baseline values were not maintained by any material. Conclusions: Within the limits of this in vitro study, it can be concluded that time cannot be neglected as a factor affecting the accuracy of implant master casts. Keywords: dental implant, impression material, master cast, optical measurement, polyether, polyvinyl siloxane, precision, three-dimensional distortion

The hereditary condition known as ectodermal dysplasia is characterized by the absence or defect of 2 or more ectodermally derived structures. A case of a 6-year-old child with hypohidrotic ectodermal dysplasia with complete anodontia is presented. Common dental, oral, and physical conditions were taken into consideration. Clinical management consisted of removable complete dentures to improve psychologic development and to promote better functioning of the stomatognathic system. Keywords: child, complete anodontia, hypohidrotic ectodermal dysplasia, prosthetic treatment

Objective: Titanium ceramics has become a topic of interest for prosthetic applications, thanks to the documented biocompatibility of commercially pure titanium. A number of concepts have been presented, including metal frameworks produced by casting or milling and a number of materials and methods for veneering. However, the concept has not reached a clinical breakthrough since failures have been reported from clinical experiences. Method and Materials: A PubMed search on the following key words was performed: titanium ceramics, long-term results. Results: This review illustrates the fact that it is possible to have success with titanium ceramics on crucial criteria: fit and marginal adaptation, bond strength between metal and ceramics, and esthetic outcome. A review of clinical studies indicates a tendency for success rates to increase with time, which must be explained as a normal learning curve for a technical concept. The learning curve also includes development of materials and methods and the fact that there is a certain amount of technique sensitivity involved in the success rate for titanium ceramics. Conclusions: There is reason to believe that the outstanding clinical properties of titanium will further catalyze the development of titanium ceramics, and recent experiences clearly indicate that titanium ceramics, being a clinical product ready for use in fixed partial dentures, might already today challenge standard metal ceramics. Keywords: ceramics, dental porcelain, fixed partial denture, long-term results, state-of-the-art review, titanium

Congenital epulis of the newborn is a rare soft tissue manifestation that affects infants, involving predominantly the maxillary ridge. When identified, generally at birth, excisional biopsy is recommended to avoid feeding and respiratory disturbances. This article presents a case report of a female infant who was referred to an oral and maxillofacial surgery facility for removal of a fibrotic mass present on the mandibular alveolar ridge. Diagnosis and prompt intervention can prevent expected complications such as failure to thrive or respiratory difficulty. Pediatric and general dentists should be familiar with oral pathologies that may affect the newborn or infants so that early diagnosis and treatment can be accomplished. Keywords: benign tumor, congenital epulis, excisional biopsy, newborn

Objective: The purpose of this in vitro study was to investigate the effect of isopropyl alcohol and unfilled resin on the flexural strength of incrementally layered resin-based composite beams. Method and Materials: Five groups of 30 composite beams were fabricated in a 2 3 2 3 24-mm Teflon split-mold: group 1 (control group), a homogeneous resin composite beam; group 2, 2 increments with an air-inhibited layer between the increments; group 3, 2 increments with a Mylar strip placed against the composite interface during polymerization of the first increment; group 4, 2 increments with the first increment contoured with an isopropyl alcohol (70%) lubricated instrument; and group 5, 2 increments with the first increment contoured with unfilled resin lubricating the application instrument. Each increment was polymerized for 40 seconds on both front and back surfaces. The flexural strength of the composite specimens was determined using 4-point bending in an Instron universal testing machine. Results: The mean flexural strength in MPa and standard deviation were as follows: group 1: 142.5 (17.3); group 2: 98.2 (15.2); group 3: 105.9 (16.3); group 4: 103.4 (19.4); and group 5: 106.1 (21.3). One-way analysis of variance detected a statistically significant difference among the groups (P .001). Tukey's HSD post hoc tests determined that only group 1 was significantly different from the other 4 groups. Conclusion: The use of isopropyl alcohol and unfilled resin as instrument lubricants for incremental composite buildup seems to have little effect on the flexural strength of light-cured composite. Keywords: alcohol, composite, flexural strength, incremental layering technique, lubricant

Objective: The objective of this study was to investigate the effect of laser welding parameters (current [A], spot diameter [mm], and pulse duration [ms]) on the weld penetration depth by Nd:YAG laser into cast titanium and Ag-based and Au-based alloys. Method and Materials: Two cast blocks of each metal were laser welded with various parameters at their interface. The blocks were then separated, and the penetration depth into each metal was measured on the separated surface using a computer program. The data were statistically analyzed. Results: Increasing the current and decreasing the spot diameter increased the penetration depth into each alloy. No statistical differences in penetration depth were found for each metal among the pulse durations. Conclusion: The results suggested that, regardless of the pulse duration, the current and the spot diameter in relation to the power density (W/cm2) of the laser affected the weld penetration depth into each metal. Cast titanium produced more penetration depth compared to gold alloys because of its low thermal conductivity value and high rate of laser beam absorption. Keywords: adhesion, cast titanium, gold alloys, laser, welding

Objectives: The purpose of this study was to evaluate the influence of (1) the curing mode of resin composites and (2) activators for dual curing of the bonding on dentin bond strength. Methods: The light-curing resin composite Brilliant (B) and the self-curing resin composite Brilliant MH were bonded with the following adhesives (n = 10): OptiBond FL, Excite, Prime&Bond NT, OptiBond Solo Plus, Adper Prompt L-Pop, Clearfil SE Bond, Xeno III, and AdheSE. Excite, Prime&Bond NT, and OptiBond Solo Plus were also used in combination with activators for dual curing. Tensile bond strengths were measured after 24 hours of water storage (37°C), and fractured surfaces were analyzed in the scanning electron microscope. Results: Except for Excite/dual curing and Prime&Bond NT/dual curing, bond strengths with Brilliant MH were significantly lower than with Brilliant. Activators significantly increased bond strengths in Excite/Brilliant MH, but not in Prime&Bond NT/Brilliant MH and OptiBond Solo/Brilliant MH. Conclusions: This study confirms the incompatibility between self-curing resin composites and simplified bonding systems containing acidic components. Activators for dual-curing the bonding eliminated this chemical incompatibility only in 2 of 3 bonding systems. The use of these activators in combination with light-curing resin composites must be avoided. Keywords: dentin bonding, composite, bond strengths

Glycogen storage disease type I, also known von Gierke's disease, is a rare, severe autosomal recessive disorder due to a defect in liver, kidney, and intestinal mucosa. The existence of delayed development of the dentition, increased incidence of dental caries, taurodontism, and prolonged bleeding following dental procedures should lead clinicians to consider type I glycogen storage disease. A 10-year-old boy with glycogen storage disease type I whose condition was first diagnosed when he was 4 years of age, was referred to the clinic for multiple caries and evaluation of delayed tooth eruption. On physical examination, the patient was cooperative, with short stature, protuberant abdomen, and growth retardation. Laboratory findings indicated that blood levels of pyruvate, triglycerate, uric acid, and cholesterol were elevated. Intraorally delayed mixed dentition was evident, and approximal caries were found in teeth 55, 54, 52, 51, 61, 62, 65, 74, 84, and 85. The most significant radiographic finding was consistent with taurodontism of the molar teeth. Lateral and posteroanterior cephalometric films showed that dimensions of the craniofacial complex were strongly reduced. Evaluation of the patient's dental age was approximately 6 years. Keywords: caries, delayed dentition, glycogen storage disease type IA, taurodontism

IPS Empress 2 materials can be used for fabrication of short-span fixed partial dentures in the anterior region as well as single crowns. This clinical report describes the prosthodontic treatment of a 16-year-old male patient with missing permanent maxillary left and right incisors with IPS Empress 2 fixed partial dentures following orthodontic treatment. Keywords: all-ceramic systems, IPS Empress 2, fixed partial dentures

Objective: Subjective and objective measures were used to determine the relative efficacy of 10% and 35% carbamide peroxide gels in bleaching extracted human teeth. Method and Materials: Fifty-five teeth (premolars and molars) were sectioned longitudinally, and one-half of each tooth was assigned to group A (10%) and the other half to group B (35%). Prebleaching shades were evaluated subjectively by 5 experienced observers using standard shade tabs. Photographs were also taken with a calibrated digital camera. Luminosity, R, G, and B levels were determined with Photoshop software. The specimens were then bleached by either 10% or 35% carbamide peroxide, after which they were reexamined by the 5 observers and rephotographed. Results: All bleached specimens were subjectively assessed as "lighter," but there was no perceived difference in final shade between groups. Objective measurement showed that the greatest spread in the 0 to 255 scales was in the B levels. Mean (and range) of pre- and postbleaching B levels and their differences, by group, were group A, 96.2 (76.5 to 117.1), 113.6 (87.7 to 129.1), difference 17.4, and group B, 95.4 (72.1 to 118.8), 110.5 (88.0 to 138.5), difference 15.1. Statistics were performed using paired t tests. These pre- and postbleaching differences were significant (P .002). The difference between mean postbleaching B values was not significant (P = .479). The greatest change in luminosity occurred in initially dark teeth treated with 35% carbamide peroxide (P = .036). Conclusions: Subjective determinations suggest that the bleaching protocols tested were equally effective, but the objective measurements implied that the higher concentration of carbamide peroxide was more effective for darker teeth. Keywords: Adobe Photoshop software, bleaching, carbamide peroxide, discoloration, effectiveness, human observers, value (brightness)

The aim of this report is to present a combined treatment approach with gingivectomy and CO2 laser for the management of cyclosporine-induced gingival overgrowth in 4 cases. Four renal transplant patients were surgically treated for marked gingival overgrowth by means of gingivectomy and CO2 laser. Postoperatively, all patients were followed for bleeding, pain, infection during the early healing period, and recurrence of gingival overgrowth for 12 months. The healing was uneventful, and no signs of bleeding, postoperative pain, or infection were observed in any patient during the early healing period. In the 12th postoperative month, there was evidence of mild recurrence in 1 patient, while no sign of recurrence was observed in the other patients during the follow-up period. The advantages of this combined technique include satisfactory bleeding control and clear visibility during the procedure, as well as reduced postoperative pain and swelling. Keywords: carbon dioxide laser, cyclosporine A, gingival overgrowth/treatment, periodontal surgery

Objective: This study was designed to investigate the prognosis of restorative caries therapy applied in nursing home residents. Method and Materials: In 25 consecutive patients a total of 42 restorations were placed, 23 of composite resin (APX/SE Bond) and 19 of compomer (Dyract). The working conditions, such as patient cooperation, quantity of saliva, location of cavity margins, cavity size, and gingival inflammation, were evaluated prior to treatment. The restorations were evaluated qualitatively at baseline, after 6 months, and after 12 months.18 Results: At 12 months, all examined restorations were clinically acceptable (6 patients had died). There was no significant difference between the quality of the restorations in composite resin and compomer. The plaque scores increased significantly during the study period. Conclusions: The study showed that, within the limitation of a short-term follow-up, restorative caries therapy using composite resin or compomer was successful in nursing home residents although rubber dam was not used. Keywords: caries, composite resin, geriatric dentistry, nursing home residents