Quintessence International, 10/2016

Background: With the Minamata Convention the use of mercury will be phased down, and this undoubtedly will have an effect on dental treatment regimens and economic resources. Composite resin restorations are considered viable alternatives to amalgam fillings; however, these will not be covered completely by health insurance systems in many countries. Recently, a high-viscosity glass-ionomer cement (hvGIC) processed with a resinous coating (RC) has been introduced, and has been marketed as a restorative material in load-bearing Class I cavities (and in Class II cavities with limited size), thus serving as a possible alternative to amalgam fillings. Objective: To evaluate the literature on this treatment approach, and to focus particularly on the clinical performance of the hvGIC/RC combination. Search Strategy: The Cochrane Library as well as Ebsco, Embase, PubMed, and Scopus databases were screened. Moreover, relevant abstracts published with dental meetings were reviewed. Selection Criteria: All available randomized clinical trials focusing on the hvGIC/RC approach (published either as full-texts or abstracts until June 2016) were selected. Moreover, single-group studies using hvGIC/RC were included. Data Collection and Analysis: Screening of titles and abstracts, data extraction, and quality assessments of full-texts according to Oxford scoring were performed. Results: Regarding failure rates, minor differences between hvGIC/RC and GIC or composite resins as comparators could be observed in seven clinical studies. The hvGIC/RC combination showed high survival rates (with only few catastrophic failures) of up to 6 years. Conclusion: Class I retention rates of hvGIC/RC seem promising, but further high-quality clinical studies are clearly warranted. Keywords: amalgam, Class I and Class II cavities, clinical trial, composite resin, high-viscosity glass-ionomer cement, Minamata Convention, minimum intervention dentistry, resin coating

Objective: This research evaluated the periodontal conditions of teeth with restored and non-restored non-carious cervical lesions (NCCLs). Method and Materials: Thirty-seven patients presenting at least two contralateral teeth with NCCL (one restored and another non-restored) were selected. Non-restored NCCL teeth were classified as a control group, while the contralateral teeth restored within at least 3 months with a Class 5 restoration located near the gingival margin were classified as the test group. The periodontal parameters analyzed were visible plaque, probing depth, bleeding on probing, gingival recession, clinical attachment level, and width of keratinized tissue. Restorative parameters such as finishing/polishing, overhanging margins, and terminal restoration level were also examined. Statistical analysis included the comparison of periodontal and restoration parameters between groups as well as associations between these parameters. Data were statistically analyzed by the Wilcoxon, Fisher's exact, Chi-squared, and Mann-Whitney tests. The significance level was set at 5% (? .05). Results: Statistically significant differences between test and control groups were observed for visible plaque (P = .002), bleeding on probing (P = .041), and width of keratinized tissue (P = .009). Other clinical parameters such as probing depth (P = .812), gingival recession (P = .571), and clinical attachment level (P = .484), as well their associations did not show any statistically significant differences (P > .05). Conclusion: Restorative treatment (Class 5) of teeth with NCCL partially influenced the clinical parameters. Keywords: non-carious cervical lesions, periodontal disease, plaque, restoration

Objective: Chemical root conditioning is a procedure to remove the smear layer, which influences periodontal healing. The purpose of this study was to determine the effect of using ethylenediaminetetraacetic acid (EDTA) as a root conditioning agent on periodontal surgery outcomes. Method and Materials: The databases searched from their earliest records to February 2015 included Pubmed, Embase, the Cochrane library, and ISI Web of Science. Quality assessment of the methodologies of all the included studies and data was performed with Review Manager software. Probing depth (PD) and clinical attachment level (CAL) were analyzed using inverse variance. Results: The evaluation of the three articles that met the inclusion criteria showed that the differences between the EDTA groups and the control groups were not statistically significant (6 months PD: mean difference [MD] = ?0.15 mm, Z = 1.09, P = .27; CAL: MD = 0.15 mm, Z = 0.89, P = .37). Conclusion: EDTA was not able to significantly improve the PD and CAL. A positive outcome of using EDTA as a root conditioning agent was not evident. Thus, future research should focus on EDTA in combination with other drugs or a better alternative drug to EDTA. Keywords: ethylenediaminetetraacetic acid (EDTA), meta-analysis, periodontal surgery

Objective: The splint technique of implant-supported restorations is a popular impression method; however, in-vivo studies showing the advantage of this method are scarce. The objective was to compare radiographic fit of the metal frameworks fabricated according to splinted or nonsplinted impression techniques. The null hypothesis was that splinting techniques would result in more accurate impressions. Method and Materials: A retrospective analysis was performed on 71 patients who had undergone multi-implant-supported rehabilitation in the years of 2012 to 2013. The treatment was carried out by three senior dentists or by residents in the department of Oral Rehabilitation at the Hebrew University Hadassah Medical Center. Each senior and the residents under his guidance treated patients consistently by only one different impression method: (1) no splint; (2) splinted transfers with pattern resin over dental floss scaffold; (3) splinting of transfers to impression tray with pattern resin. Orthoradial radiographs were used to determine if the metal framework fit the implant abutments. Results: In total, 81 impressions and 285 implants were included in the study; 56 impressions were done by seniors and 25 by residents. There was no difference in success between the three methods when done by seniors (P = .76). The fixation to tray method was found to be significantly unsuccessful in the hands of residents (P = .01). Conclusion: Because the splint methods were not found to be more accurate, splinting the transfers might be an unnecessary step. Splinting of transfers to the impression tray is not recommended for inexperienced dentists. Keywords: advanced general dentistry program, multi-unit implant impressions, ragiodraphic fit accuracy, selective laser melting, splint

The dimensions of maxillary first molars were investigated and measured using cone beam computed tomography (CBCT) to examine the effectiveness of immediate placement of implants in the maxillary molar area. The CBCT images of 68 patients were collected. The dimensions of the maxillary first molar sockets were measured in both sagittal and coronal aspects, as well as the height of the alveolar bone crest (ABC) to the sinus membrane (SM) at optimal implant position. Sinus membrane and maxillary first molar relationships were analyzed sagittally and coronally. Interradicular bone presence and root intrusion into the sinus (IRS) were also noted. No statistically significant relationship was observed between IRS and age or sex. However, IRS was significantly related to sagittal type, as a type 1 sagittal relationship was characterized by greater root intrusion. The socket dimensions of male subjects were statistically significantly greater than those of female subjects, both coronally and sagittally. Changes in the socket dimensions were not significantly related to age in the sagittal plane. However, coronal plane measurements did increase with age. ABC-SM measurements decreased with age, but these changes were not statistically significant. These results showed that the socket dimensions in the maxillary first molar area are adequate for wider implant placement, but an implant longer than 8 mm increased the risk of perforation. All oral surgeons should be familiar with these anatomical variations so they can adopt appropriate additional practices and inform patients about the risks before operating. Keywords: cone beam computed tomography, extraction sockets, immediate implants

Objective: The aim of this retrospective study was to investigate whether self-reported allergy to penicillin may contribute to a higher rate of postsurgical infection and implant failure. Method and Materials: This retrospective, non-interventional, open cohort study reports on implant survival and infection complications of 5,576 implants placed in private practice by one periodontist, and includes 4,132 implants that were followed for at least 1 year. Logistic regression was applied to examine the relationship between self-reported allergy to penicillin and implant survival, while controlling for potential confounders such as smoking, implant site, bone augmentation, loading protocol, immediate implantation, and bone level at baseline. The cumulative survival rate (CSR) was calculated according to the life table method and the Cox proportional hazard model was fitted to data. Results: Out of 5,106 implants placed in patients taking penicillin it was found that 0.8% failed, while 2.1% failed of the 470 implants placed for patients with self-reported allergy to penicillin (P = .002). Odds of failure for implants placed in penicillin-allergic patients were 3.1 times higher than in non-allergic patients. For immediate implant placement, penicillin-allergic patients had a failure rate 10-times higher than the non-allergic cohort. Timing of implant failure occurring within 6 months following implantation was 80% in the penicillin-allergic group versus 54% in the non-allergic group. From the 48 implant sites showing postoperative infection: penicillin-allergic patients had an infection rate of 3.4% (n = 16/470) versus 0.6% in the non-allergic group (n = 32/5,106) (P .05). Conclusion: Self-reported penicillin allergy was associated with a higher rate of infection, and primarily affected early implant failure. Keywords: dental implants, failure, immediate, infection, penicillin allergy, socket, survival

A case of recurrent, clinically innocuous, but painful papules involving the tongue dorsum of a 25-year-old man is presented. The lesions were interpreted to represent a transient lingual papillitis. This a poorly understood, but benign and self-limited condition involving the tongue fungiform papillae, which does not appear to be widely recognized. Keywords: lingual, papillitis, tongue lesions, tongue sensitivity

Invasive cervical resorption (ICR), a destructive form of external root resorption, is characterized by invasion of the fibrovascular tissue. This phenomenon is very rare and appears in 0.02% of the general population where the leading factors are orthodontics in addition to trauma, restorations, and bleaching. Heavy orthodontic force may increase the incidence to 1%. One of the main concerns regarding ICR is that it is often misdiagnosed with conventional diagnostic tools. In recent decades, a cone beam computed tomography (CBCT) imaging technique has become more common and can lead to a more accurate diagnosis and treatment plan. This case report describes a possible association between orthodontic treatment and ICR of a 14-year-old male, 18 months post orthodontic treatment. ICR in the mandibular right canine was diagnosed and verified by CBCT, and underwent combined endodontic-periodontal treatment. However, after orthodontic forced eruption was performed on this tooth to improve the bone defect, ICR was diagnosed on the mandibular right second premolar. The possible association between orthodontic treatment and ICR is discussed, as ICR was noted following orthodontic treatment on both occasions. This case report stresses the importance of ICR early detection by close attention to periodic radiographic checkups during orthodontic treatment. The use of modern diagnostic tools is highly recommended in suspicious cases. Conclusion: A case is described in which the patient underwent two types of orthodontic treatment in the mandible at different time periods and developed ICR in two different teeth. Keywords: cone beam computed tomography, invasive cervical resorption, orthodontic treatment