Quintessence International, 07/2009

As a group, odontomas are the most common odontogenic neoplasms. This case report illustrates the benefits of cone beam computed tomography, in terms of treatment planning and surgical technique, to localize a large maxillary odontoma and accurately establish its relationship with the maxillary sinus and molar. Keywords: complex odontoma, cone beam computed tomography, odontogenic tumor

Objective: The etiology of nicotinic stomatitis is strongly linked with nicotine compounds; however, high temperature can be synergistic to the damage of tobacco compounds. The aim of the present study was to evaluate the separate and combined effects of smoking and heat applied by hot drinks as predictors for the development of nicotinic stomatitis in a population from southern Brazil. Method and Materials: In a case-control study, 53 patients of both sexes with a median age of 43 years (18 to 83 years) with the clinical diagnosis of nicotinic stomatitis were selected consecutively. They were paired with 53 control subjects, matched for sex, race, and smoking and tea, maté (chimarrão), alcohol, and coffee consumption. The collected data were analyzed by means of descriptive statistics; chi-square test and risk estimation were also employed. The independent variables considered significant were analyzed using a multivariate model of multinomial logistic regression (P .05 was considered statistically significant). Results: Nicotinic stomatitis was more prevalent in smokers (60.00%) than nonsmokers (39.21%) (OR = 2.32; CI 95% 1.06-5.06), and in subjects who drank hot drinks (maté drink and regular tea or coffee) than in subjects who did not drink this combination (OR = 2.84; CI 95% 1.05-7.63). Conclusion: The combination of smoking and heat from hot drinks could best predict the appearance of nicotinic stomatitis. Keywords: heat, nicotinic stomatitis, smoking, tea

This case report presents a maxillary third molar with a C-shaped canal system. This is the first known description of a maxillary third molar with C-shaped anatomy. This unique pulp chamber morphology was observed under the operating microscope. Root canal treatment consisted of cleaning and shaping combined with ultrasonic irrigation with sodium hypochlorite. A calcium hydroxide dressing was applied between appointments. Obturation of the root canal system was performed with warm vertical condensation. The complexity of this canal morphology requires the prudent clinician to perform strict measures to achieve satisfying results. Keywords: C-shaped, maxillary third molar, operating microscope, root canal morphology

Objective: Indirect composites are promising alternatives as veneering materials for zirconium dioxide (zirconia) ceramic frameworks. This study evaluated the effects of priming agents and a high-flow bonding agent on the short-term bond of an indirect composite material to a zirconia framework material. Method and Materials: Indirect composite (Estenia C&B) was bonded to particle-abraded zirconia samples (Katana, n = 144) using no (control) or 1 of 8 priming agents: All Bond 2 Primer B (ABB), Alloy Primer (ALP), Clearfil Ceramic Primer (CCP), Clearfil Photo Bond (CPB), Clearfil Photo Bond with Clearfil Porcelain Bond Activator (CPB+Activator), Estenia Opaque Primer (EOP), Porcelain Liner M Liquid A (PLA), and V-Primer (VPR) with or without a high-flow bonding agent (Estenia C&B Opaque). Shear bond strength was tested after 24-hour wet storage. Data were analyzed with Levene test for equality of variance, Dunnett T3 multiple comparison, and Mann-Whitney U test (P = .05). Results: Mean bond strengths without the high-flow bonding agent application varied from 0.1 to 13.6 MPa, whereas bond strengths with bonding agent application ranged from 0.1 to 24.2 MPa. CPB+Activator (containing phosphate MDP and silane) and CPB (containing MDP) revealed the significantly highest bond strength among the 9 groups without high-flow bonding agent application (P .05). Application of the high-flow bonding agent significantly increased bond strengths (P .001). Conclusion: Primers containing either the functional phosphate monomer MDP or an MDP-silane combination provide superior resin bonds of Estenia C&B composite to Katana zirconia. An intermediate high-flow bonding agent further improves the bond between these materials. Keywords: all-ceramic, bond strength, bonding agent, functional monomer, indirect composite, zirconia

Objectives: To analyze the expression of tenascin, fibronectin, collagens I and III, osteonectin, and bone morphogenetic protein 4 (BMP4) in the extracellular matrix of pulp tissue in primary teeth during physiologic root resorption. Method and Materials: Eighteen teeth were decalcified and equally distributed into 3 groups (group I, teeth with two-thirds root length; group II, teeth with one-third root length; and group III, teeth lacking the root). Results: Immunohistochemical analysis showed that all the proteins were expressed. Tenascin, collagen I, and osteonectin showed strong and broad reactivity in group I, with weaker and rare reactivity in groups II and III. The expression of fibronectin, collagen III, and BMP4 did not vary with root resorption phase. Conclusion: The expression of tenascin, collagen I, and osteonectin was reduced in the extracellular matrix and odontoblasts during root resorption. This fact may be related to the decreasing pulp response to damage and treatment during the progression of root resorption. Keywords: dentin matrix, endodontics, immunohistochemistry, primary teeth, pulp, proteins

Objective: To evaluate and compare shear bond strength and marginal leakage of a new self-etch sealant to enamel of human permanent teeth versus those of a conventional sealant. Method and Materials: Forty-four premolar crowns were mounted to expose flat lingual surfaces and randomly assigned to 1 of 2 test groups: conventional sealant (group 1, control) and self-etch sealant (group 2). Sealants were expressed into hollow plastic cylinders placed on the mounted teeth and polymerized according to manufacturers' instructions. Shear bond strength was measured at a crosshead speed of 0.5 mm/min. Another 44 premolars were randomly assigned to either group 1 or group 2 for microleakage testing. Sealants were applied to the occlusal groove as per manufacturers' instructions, and specimens were thermocycled, stained, sectioned, and examined for marginal leakage. Results: The bond strength of conventional sealant to enamel was significantly (P .05) higher than that of self-etch sealant. The conventional sealant showed significantly (P .05) lower microleakage than the self-etch sealant. Conclusions: Pending clinical validation, the new self-etch sealant under investigation provides lower bond strength and greater marginal leakage than the control (sealant application following standard acid etching). Keywords: enamel bond strength, microleakage, sealants, self-etch adhesive

Objective: Third molar removal is a frequent surgical procedure. Common complications associated with third molar surgery are well-recognized and frequently explained to patients during the process of informed consent. The general dental practitioner, as well as the oral and maxillofacial surgeon, must be familiar with all possible complications. This systematic review serves as a reminder of the unusual complications of this routine procedure. Method and Materials: Studies were located using systematic searches in Medline and the Cochrane Library electronic databases, as well as hand searching of key texts, references, and reviews relevant to the field. Key words included third molar, wisdom tooth, complications, unusual, and rare. References from the relevant articles were also doublechecked. The review was limited to English- and German-language articles published within the last 18 years. Results: Frequently detected, well-known complications are permanent nerve damage and immediate or late mandibular fractures. Twenty-four other complications were identified in 22 articles. Among these complications were inflammatory processes, abscess formation, and displacement of teeth and instruments. Single case reports describe asphyxial death after postextraction hematoma, life-threatening hemorrhage, brain abscess, epidural abscess, benign paroxysmal positional vertigo, subcutaneous and tissue space emphysema, subdural empyema, and herpes zoster syndrome. Conclusion: To achieve good patient care, it is necessary to realize the variety of possible complications. Rare complications must be recognized early so that adequate therapy can be immediately ensured. Keywords: adverse effects, complications, extraction, rare, removal, third molar, unusual, wisdom tooth

Objectives: This retrospective study evaluated the clinical performance and long-term survival of glass-ceramic lithium disilicate all-ceramic restorations in anterior and posterior areas over a 10-year period. Method and Materials: Following a consistent protocol over 10 years, 261 lithium disilicate crowns (IPS Empress 2, Ivoclar Vivadent), including 101 anterior (38.7%) and 160 posterior (61.3%), were cemented using an adhesive technique and observed by the clinician who prepared and luted them. The data were analyzed using the Kaplan-Meier test. The clinical evaluation adopted the California Dental Association (CDA) modified criteria after recalling all patients between January and May 2008. Results: Six crowns failed and were replaced, 4 due to chipping and 2 due to core fracture. The overall survival rate was 95.5%. Conclusion: In this retrospective evaluation, lithium disilicate ceramic restorations had a low clinical failure rate after up to 120 months. Keywords: adhesive luting, all-ceramic crown, esthetic dentistry, glass-ceramic, lithium disilicate, retrospective evaluation, single crowns

Crohn disease is a chronic granulomatous inflammatory disease of the gastrointestinal tract of unknown etiology. Oral lesions are significant, as they may occasionally precede intestinal and systemic manifestations. In this retrospective study, clinical and histopathologic data were reviewed from the files of 5 patients with Crohn disease diagnosed at the Department of Oral Medicine and Maxillofacial Pathology School of Dentistry, Aristotle University, Thessaloniki, Greece, and Division of Stomatology and Oral Surgery, Faculty of Medicine, University of Geneva, Switzerland. In the 5 patients, clinical signs included erosions, deep ulcers, cobblestoning of the buccal mucosa, mucosal tags, and lip swelling. Histopathologic examination revealed a granulomatous inflammation with noncaseating granulomas and deep fissuring of the oral mucosa. In all 5 patients, oral lesions were the early signs of the disease. The diagnosis of Crohn disease was confirmed by a colonoscopy and a biopsy of colonic lesions. Oral lesions may be significant and/or initial signs of Crohn disease. Recognition of the lesions may provide an early diagnosis. Keywords: chronic inflammatory bowel disease, cobblestoning, Crohn disease, mucosal tags, noncaseating granulomas, oral lesions, oral ulcers

Transplantation of one's own teeth from one site to another is called dental autotransplantation. Because tooth transplantation allows dentofacial development and maintains alveolar bone volume, it is a viable treatment method, especially in young patients with missing teeth or tooth agenesis. Three cases are presented in which missing or agenetic teeth were replaced by autotransplantation of impacted teeth. This article illustrates the option of using impacted teeth as a viable reservoir for autotransplantation in young patients with missing permanent teeth. Keywords: autotransplantation, dentofacial development, impacted teeth, treatment method, young patient

Objective: To compare the conventional lingual access to labial access preparation in mandibular anterior teeth in terms of achieving a straight-line access to the apex with maximum conservation of coronal tooth structure. Method and Materials: One hundred extracted human mandibular incisors with intact crowns and patent root canal configuration were collected, numbered, and weighed in a microbalance. Each tooth was radiographed in a labiolingual direction, traced, evaluated, and assigned into 1 of 5 classes as per the classification given by Zillich and Jerome (1981).The frequency of types of canal configuration in each class was determined as a percentage. The teeth were randomly divided into 2 groups of 50 teeth. Access was prepared lingually in group 1 and labially in group 2 to achieve a straight-line access to the apex. The amount of tooth tissue lost as a result of access preparation was measured for all teeth. Results: A total of 71 teeth had their tracing projections buccal and buccoincisal. The tooth tissue lost during lingual access was significantly more than that lost during labial access preparation (P .001). Conclusion: A labial access opening for endodontic treatment of mandibular incisors would facilitate straight-line access to canals more consistently and conservatively. Keywords: labial access, lingual access, mandibular incisors, straight-line access, tooth-tissue loss

Objective: To provide a preliminary comparison of traditional clinical neurosensory examination (CNE) and current perception threshold (CPT). Method and Materials: This is a retrospective chart audit of patients with trigeminal nerve injuries related to dental treatment who were evaluated with both CNE and CPT assessments (electrical stimulus tests) after presenting with altered sensation involving either the inferior alveolar nerve (IAN) or lingual nerve (LN) distributions. The tests were performed on the anterior two-thirds of the tongue for LN injuries and the lower lip and chin for IAN injuries. Results were defined as hyper-, hypo-, or normal sensory response. Results: Twelve charts were reviewed; 10 of the 12 nerve injuries occurred secondary to mandibular third molar extraction affecting 7 LN and 5 IAN branches. Following LN injuries, the C, and A-delta fibers assessment demonstrated hyposensitivity in the affected nerve territory in CPT and the CNE tests with the exception of 1 normal nerve response in 5-Hz CPT. Within the LN injury group, good correlation was observed between the CNE and CPT tests with the exception of brush stroke and 250-Hz CPT stimuli. Following IAN injuries, sensory testing results were more varied. A-beta fiber evaluation demonstrated hyposensitivity to VF in all patients and in 4 of 5 for brush test. One patient was hypersensitive for the brush test. The response to 2,000-Hz electrical stimulus demonstrated hyposensitivity in 3 patients, hypersensitivity in 1 (the same patient that was hypersensitive for brush), and normal sensitivity in 1 patient. Good correlations were found only between the CPT 5-Hz and heat and cold tests. Only 1 patient (IAN injury) reported pain that was hypersensitive for heat, cold, pinprick, brush, and 250-Hz and 2,000-Hz stimuli. Conclusion: Following LN injuries, CNE and CPT tests provided similar findings. More disparity was observed between the CNE and CPT methods in the IAN injury evaluation. For LN injury assessments, CNE alone appears to be adequate for assessing nerve injuries. Keywords: nerve injuries, neurosensory testing, trigeminal nerve injuries

Conservative, esthetic restorative dentistry has become an essential component in modern clinical dental practice. This article reviews the literature regarding the fiber-reinforced resin-bonded fixed partial dentures. A clinical case illustrates the technique. The main supportive framework is a U-beam and reinforcing rod composed of unidirectional, pretensed quartz fibers bound in an epoxy resin matrix. This composite resin restoration is ideal as an interim solution when an implant is being considered for placement in the undetermined future or as a medium to long-term restoration in certain clinical cases where occlusal forces are controlled and the abutment teeth in good health.

Objective: To investigate the effects of porcelain treatment techniques on the color change of feldspathic porcelain before and after exposure to distilled water, coffee, red wine, and cola and examine the surface texture of the porcelain with field-emission SEM. Materials and Methods: Test specimens were prepared in the form of discs 15 mm in diameter by 2-mm thick and divided into four groups: Naturalglaze, dual-ion exchange, overglaze and polishing. The specimens were prepared according to their group and stored in red wine, coffee, and cola. After removal, the specimens were dipped in distilled water. Color measurements were made with a spectrophotometer, and color differences were determined using the CIE-LAB system. Statistical analysis was made with SPSS 13.5. Results: Immersion time and types of surface treatment were significant factors for color stability (P .01).