Quintessence International, 02/2016

Objective: The efficacy of flowable composite in improving marginal adaptation or reducing microleakage is not fully understood. The purpose of this study was to systematically evaluate existing evidence to verify whether an application of flowable composite as a liner provided less microleakage in Class 2 composite restorations. Method and Materials: PubMed, ISI (Web of Science), and Scopus databases were searched according to the selected keywords, up to 15 Feb 2015, without any restriction on date or language. Full texts of published articles that seemed to meet primary criteria for inclusion in this research were obtained. Data of studies were extracted if they were assessed as high or moderate level of evidence. Due to the variation of methods used in different studies, they were divided into five groups: groups 1 and 2, studies that evaluated the effect of flowable composite as a liner on dentinal or enamel margins and applied flowable composite on all of the cavity wall margins; groups 3 and 4, studies that evaluated the effect of flowable composite as a liner on dentinal and enamel margins and applied flowable composite only on gingival margin; and group 5, clinical studies. Results: The initial search yielded 1,370 publications. After hand searching, six extra studies were included in the review. The abstracts of all were read independently by AB and SG. After methodologic assessment and evaluation of the level of evidence, 18 studies were selected for this study. The results of this study indicate that flowable composite liners have no significant effect on microleakage of composite restorations in all of five groups. Conclusion: Application of flowable composite as a liner in composite restorations cannot reduce microleakage or improve clinical performance. Keywords: composite restoration, flowable composite, meta-analysis, microleakage, systematic review

Objective: To explore the effect of full-mouth disinfection (FMD) on glycemic control and insulin resistance in type 2 diabetes mellitus (DM). Method and Materials: Sixty dentate patients who were never-smokers with type 2 diabetes mellitus were recruited for the study. Based on clinical examination they were divided into two groups: one with chronic periodontitis and the other without chronic periodontitis. Periodontal parameters Plaque Index (PI), Gingival Index (GI), and probing pocket depth (PPD) were evaluated. Blood samples were assessed for the levels of fasting glucose (FG), insulin, and C-reactive protein (CRP), and insulin glucose ratio was calculated using a mathematical equation (HOMA-IR). All parameters were assessed at baseline, and at 3 months and 6 months after FMD. Results: The results showed a significant reduction in PI, GI, PPD, FG, and HOMA-IR from baseline to 6 months. The CRP levels were constant throughout the study period. Conclusion: Within the limitations of the present study it can be concluded that FMD contributes to significant reduction in insulin resistance, thereby improving the glycemic control in type 2 diabetes mellitus patients. Keywords: insulin resistance, full-mouth disinfection, glucose level, type 2 diabetes mellitus

Esthetic full-mouth rehabilitation represents a great challenge for clinicians and dental technicians. Computer-aided design/ computer-assisted manufacture (CAD/CAM) technology and novel ceramic materials in combination with adhesive cementation provide a reliable, predictable, and economic workflow. Polychromatic feldspathic CAD/CAM ceramics that are specifically designed for anterior indications result in superior esthetics, whereas novel CAD/CAM hybrid ceramics provide sufficient fracture resistance and adsorption of the occlusal load in posterior areas. Screw-retained monolithic CAD/CAM lithium disilicate crowns (ie, hybrid abutment crowns) represent a reliable and time- and cost-efficient prosthetic implant solution. This case report details a CAD/CAM approach to the full-arch rehabilitation of a 65-year-old patient with toothand implant-supported restorations and provides an overview of the applied CAD/CAM materials and the utilized chairside intraoral scanner. The esthetics, functional occlusion, and gingival and peri-implant tissues remained stable over a follow-up period of 3 years. No signs of fractures within the restorations were observed. Keywords: CAD/CAM, full-mouth rehabilitation, hybrid ceramic, lithium disilicate, monolithic, screw-retained implant-crown

Restoring failing anterior teeth with a dental implant is considered a complex treatment even with thorough biologic knowledge of the situation. The goal is to produce a result in which the labial soft tissues and the papillae remain stable over time. Treatment of the fresh extraction socket in the alveolar ridge presents a challenge in everyday clinical practice. Regardless of the subsequent treatment, maintenance of the ridge contour will frequently facilitate all further therapeutic steps. Socket seal surgery and socket preservation in combination with immediate, early, or delayed implant placement can be valuable procedures for single tooth replacement. However, their potential as ridge preservation techniques in these different situations still needs to be demonstrated. The use of these procedures is illustrated in three consecutive cases. Keywords: delayed implant placement, early implant placement, immediate implant placement, socket preservation, socket seal surgery

Mandibular repositioning devices (MRDs) increase the patency of the upper airway by repositioning the mandible forward, resulting in displacement of the oropharyngeal tissues preventing upper airway collapsibility. Mandibular anterior repositioning is counteracted by muscle force from the temporalis muscle. A 39-year-old man had an osteolytic lesion with fracture of the coronoid process of the mandible secondary to wearing a MRD for sleep apnea. Continuous stress generated on the coronoid process temporalis muscle resulted in osteolysis and fracture of the coronoid process on the patient's right side, resulting in swelling and limited ability to open his mouth. The patient was managed with intravenous antibiotics to control the osteomyelitis and surgical debridement, with removal of the coronoid process of the mandible. It is unclear why the fracture only occurred on the right side. Pathologic fracture of the coronoid process due to chronic stress and secondary osteomyelitis is a rare severe complication of treatment for obstructive sleep apnea syndrome with a MRD. Keywords: complications, mandible, mandibular fracture, mandibular repositioning device, sleep apnea

Necrotizing sialometaplasia (NS) is a self-limiting, ulcerated, benign process, affecting minor salivary glands most commonly in the palate. The comorbidity of eating disorders with NS is rare. We present a patient with bilateral NS who suffered from frequent episodes of vomiting. Review of the literature revealed a handful of such cases. The possible role of vomiting in the pathogenesis of NS is argued. Keywords: eating disorders, necrotizing sialometaplasia, vomiting

Objective: Implantable cardiac pacemakers and cardiac defibrillators (ICDs) have been introduced in the care of patients with cardiac dysrhythmias. Most dental practitioners demonstrate extreme caution when treating patients with ICDs. This paper presents a review of the available literature on these devices and how they interact with dental electrosurgery and ultrasonic device use. Results: Based on the analysis of the literature, this view is not corroborated by the current clinical data, and appears to be misguided. While further in-vivo studies are needed to truly determine the true level of risk, the evidence suggests that there is no contraindication for electrosurgery or ultrasonics use in patients with ICDs. Conclusion: Using the precautions stated in this analysis, the risk of any deleterious effect on ICD function is minimal. Keywords: electrosurgery, implantable cardiac devices, side effects, ultrasonic

Objective: Vital tooth preparations may cause irreversible thermal damage to the pulp. The manufacturing techniques of dental burs may decrease heat production and minimize the risk of overheating and trauma to the dental pulp. Strauss (Raanana, Israel) has introduced "premium" diamond burs, claiming superior efficiency and longevity. We sought to determine the safest preparation methods by performing a comparison of intrapulpal temperature increases caused with "standard" and "premium" burs. Method and Materials: Three types of diamond burs (F1R, F21R, and K2) were tested on extracted human teeth (n = 8 teeth per bur type). Premium and standard manufacturing techniques were compared for each bur type (n = 24 teeth per group; total 48 teeth). An intrapulpal thermocouple was used to measure the temperature during the procedure. Comparisons were analyzed with the t test and one-way ANOVA. P ≤ .05 was considered significant. Results: All premium burs demonstrated lower temperature increases compared to the standard burs (P ≤ .001 for F21R and K2, P = .086 for F1R). The temperature increases with premium burs were similar for different bur shapes, but the temperature increases with standard burs depended on the bur shape (P .001). Conclusion: Using premium diamond burs for tooth preparation may reduce the risk of pulp tissue damage, and thus reduce postoperative pulp-associated complications. Keywords: diamond dental burs, heat production, pulp, tooth preparation