Quintessence International, 04/2017

Objective: The aim of the present study was to evaluate the antimicrobial influence of different root canal filling techniques using gutta-percha and an epoxy resin-based sealer in experimentally infected root canals of extracted human teeth. Method and Materials: In total, 96 intact sterilized, permanent human anterior teeth and premolars with single patent root canals were prepared and infected with a clinical isolate of Enterococcus faecalis. After 72 hours, all root canals were sampled using three sterile paper points. The tooth specimens were randomly divided into three groups and a control of 24 specimens each, according to the respective obturation techniques: lateral condensation (LC group), ProTaper Thermafil (PT group), and vertical compaction technique (VC group). AH Plus was used as sealer. The control group was left untreated (without root canal filling). After 7 days root canal fillings were removed and collected. The root canals were sampled using three sterile paper points and dentin chips were obtained from the root canal walls. The samples were cultured on blood agar, and colony forming units were counted. Results: All root canal filling techniques significantly reduced bacterial viability, eliminating more than 99.9% of E faecalis. In the LC group, three (13%) root canals were culture negative. In the PT group, 21 (88%) root canals and in the VC group 15 (54%) were culture negative. Conclusion: All root canal filling techniques significantly reduced E faecalis in root canals. In cases where warm filling techniques can be applied, these should be preferred to cold obturation. Keywords: bacteria, gutta-percha, lateral compaction, sealer, Thermafil, vertical compaction

Objective: The tissue-dissolving and bactericidal activity of sodium hypochlorite (NaOCl) can be increased by warming the NaOCl solution without concurrently increasing its toxicity. The present study was set up to determine if and to what extent a heated liquid reaches the apical region. Method and Materials: A temperature sensor was introduced from the apical aspect into a human canine 22 mm in length prepared to size 40.04. At 37°C in the incubator the canal was irrigated with water 10 times each at temperatures of 10°C, 21°C, 45°C, 60°C, and 37°C (control group). The apical temperature curve was recorded with a one-second resolution from the time the irrigation started until at least 2 minutes after its end. Results: None of the measurements yielded the same temperature in the apical region as that of the coronally introduced liquid. At 60°C, a maximum value of 52.2°C ± 1.39°C, and at 10°C, a minimum value of 16.09°C ± 0.39°C, was achieved apically. At 1 minute after the end of active rinse cycle, the temperature at the apical probe differed only 4.8°C to 0.9°C ± 1.41°C from the initial value (about 37°C). Only with the cold 10°C solution was the temperature difference higher, at 7.5°C ± 2.14°C. Conclusion: The benefit of heating irrigants accrues primarily during the period of active rinsing; immediately after the end of the rinsing cycle, body temperature is reached again. A positive aspect to be noted is that an irrigant stored at room temperature is quickly warmed to 37°C in the root canal by the temperature of the body. Keywords: disinfection, heating, irrigation, rinsing, root canal, sodium hypochlorite, temperature, tissue dissolution

The periodontal therapy of severely damaged teeth that have advanced bone loss, a significant degree of mobility, and often tooth migration and elongation, frequently exposes the dental clinician to difficult decisions regarding the appropriate therapy for the patient. Extensive rehabilitation, with the replacement of periodontally hopeless teeth, has biologic, prognostic, and financial limitations. A possible alternative in such cases is the transreplantation of periodontally hopeless teeth. Ankylosis of the tooth is induced by appropriate extraoral pretreatment and thus the mobility disappears and the alveolar bone is reformed. This little-known technique is described step by step, with reference to a clinical case. Keywords: guided tissue regeneration, implantology, interdisciplinary treatment, periodontology, transreplantation

Objective: To compare the thickness of buccal bone around single dental implants placed in the anterior maxilla (premolar to premolar) inserted with different placement protocols. Data Sources: An electronic search was conducted using MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), and EMBASE, from January 1980 to July 2015. Mean buccal bone thickness around single dental implants was measured and correlation with implant placement protocols, loading protocols, and augmentation method was assessed. A Q-test was used to access the homogeneity of levels of effect. A univariate meta-regression analysis was used for further investigation of the between-study heterogeneity. Two randomized clinical trials and 12 cohort studies were included for statistical analysis. The difference in buccal bone thickness for implants placed with different implant placement protocols (early vs immediate vs delayed) was not statistically significant (P > .05). Loading protocols (immediate vs delayed) also did not significantly influence the thickness of buccal bone. Descriptive analysis showed different buccal bone thickness for dental implants that received different bone grafting materials at the time of placement. Conclusion: Different implant placement and loading protocols may not significantly affect the thickness of the buccal bone around single dental implants in the anterior maxilla. Different bone graft materials at the time of implant placement may have an effect on buccal bone thickness. Keywords: bone graft, buccal bone thickness, CT imaging, dental implants, early placement, facial bone thickness, immediate implant

Root canal treatment of immature teeth is considered a great challenge for both the dentist and the patient. The thinness of the root canals walls and the lack of an apical barrier leads to unpredictable treatment results. Revascularization is a novel promising treatment option in the field of regenerative endodontics for management of immature necrotic permanent teeth. This case presents a successful treatment of an 8-year-old patient with a partially necrotic, immature permanent mandibular right first molar pulp by revascularization. The revascularization procedure was performed in two appointments using nitrous oxide sedation to reduce the child's anxiety during treatment. Following root canal disinfection with NaOCl, a triple antibiotic paste (ciprofloxacin, metronidazole, and minocycline) was applied into the canal. One week later, induction of bleeding, application of MTA, and tooth restoration using a stainless steel crown were performed. At the subsequent follow-up appointments (3, 9, and 16 months) the tooth was asymptomatic. After 2 years a radiographic assessment revealed complete periapical healing and apical closure, as well as increase in root length and dentin thickness. Conclusion: This case supports the evidence of revascularization as a biological treatment option for the management of necrotic young permanent teeth. Keywords: antibiotic paste, children, immature permanent tooth, nitrous oxide, partially necrotic pulp, regenerative endodontic treatment

Objectives: The aim of this study was to evaluate implant survival rate and to measure peri-implant bone changes in full-arch rehabilitations with immediate placement and immediate loading implants with platform switching and Morse taper connection, in addition to platelet-rich fibrin (PRF) and buccal bone augmentation, after 4 years of follow-up. Method and Materials: In this retrospective controlled study, patients who had been fully rehabilitated with immediate placement and immediate loading implants were evaluated 4 years post-loading. Implants with platform switching and Morse taper connections were used (In-Kone Universal System, Global D) and PRF and buccal bone augmentation were applied. The radiographic bone loss was calculated by subtracting the bone level at baseline (BLT0) from that at the 4-year follow-up (BLT4) in immediate and delayed implants. Measurements were made at the distal, mesial, vestibular, and oral sites of the implants and the deepest value was recorded. Implants placed in extraction sites and implants placed in healed sites were considered. A comparison between the groups was performed using the Mann-Whitney test. The implant survival rate was calculated using the Kaplan-Meier analysis. Results: In total, 42 patients (28 females and 14 males; average age 55.8 years old, age range 45 to 77) were recruited to this study. A total of 334 implants were put in place (226 in the maxilla, 108 in the mandible). The implant survival rate was 97.8% for the maxilla and 98.1% for the mandible, 98.3% for immediate implants and 96.9% for delayed implants. No statistically significant differences (P > .05) in the mean radiographic bone loss (mBL) were observed when comparing the immediate and delayed implants and the anterior and posterior implants. Statistically significant differences were found in the mBL between the mandibular and maxilla implants in the vestibular (P = .01) and mesial (P = .001) sites. Conclusion: Within their limits, the present results suggest that rehabilitation with platform switching and taper connection implants, in addition to buccal bone augmentation and the use of PRF, can lead to predictable results. Keywords: bone loss, dental implant, dental implant-abutment connection, immediate dental implant loading, survival rate

The salivary gland duct cyst (SGDC) is not commonly encountered on the floor of the mouth and few well-documented case reports are available. To increase the knowledge of this lesion, this report features a diminutive SGDC in a 54-year-old man. Commentary is offered as to the relevance of the affected patient's antecedent history of cholelithiasis. Keywords: floor of mouth, minor salivary gland, mucous retention cyst, salivary gland duct cyst

Background: This report describes four cases of cracked tooth syndrome secondary to traumatic occlusion that mimicked trigeminal autonomic cephalalgias. All patients were referred by general practitioners to the Orofacial Pain Clinic at Nihon University Dental School for assessment of atypical facial pain. Clinical Presentation: Case 1: A 51-year-old woman presented with severe pain in the maxillary and mandibular left molars. Case 2: A 47-year-old woman presented with sharp, shooting pain in the maxillary left molars, which radiated to the temple and periorbital region. Case 3: A 49-year-old man presented with sharp, shooting, and stabbing pain in the maxillary left molars. Case 4: A 38-year-old man presented with intense facial pain in the left supraorbital and infraorbital areas, which radiated to the temporoparietal and maxillary regions. All cases mimicked trigeminal autonomic cephalalgias, a group of primary headache disorders characterized by unilateral facial pain and ipsilateral cranial autonomic symptoms. Trigeminal autonomic cephalalgias include cluster headache, paroxysmal hemicrania, hemicrania continua, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing/short-lasting neuralgiform headache attacks with cranial autonomic features. Pulpal necrosis, when caused by cracked tooth syndrome, can manifest with pain frequencies and durations that are unusual for pulpitis, as was seen in these cases. Conclusion: Although challenging, differentiation of cracked tooth syndrome from trigeminal autonomic cephalalgias is a necessary skill for dentists. Keywords: cracked tooth syndrome, orofacial pain, trigeminal autonomic cephalalgias

Objective: This case report presents cone beam computed tomography (CBCT) three-dimensional (3D) assessment of the buccal bone associated with an implant. Method and Materials: A patient who had immediate implant replacement of a maxillary incisor received a CBCT examination after 6 months. The scanned volume was then subjected to segmentation of the buccal bone associated with the implant and to its three-dimensional rendering. Results: Virtual reconstruction allowed volumetric assessment of the buccal plate, and of the buccal marginal bone level. Conclusion: Creating a 3D virtual volume permits a comprehensive evaluation of the anatomical information contained in the CBCT dataset. Keywords: bone quantity, bone volume rendering, cone beam computed tomography