Quintessence International, 07/2017

Objective: Many innovations have recently been implemented in the field of endodontics, often based on a variety of in-vitro/ex-vivo test setups. It was the goal of this research to compare different biofilm models for evaluating the effectiveness of rinsing solutions. Method and Materials: Three different models have been applied in this study, including petri dishes with nutrient medium, arrays of human dentin disks, and split bovine root segments. The susceptibility of biofilms formed by Enterococcus faecalis to commonly used endodontic irrigants was tested. Results: While citric acid 3% did not show an inhibitory effect on solid medium, mean maximum inhibition areolae of 9.8 ± 1.6 mm were found for sodium hypochlorite 3%. Fluorescein solution was shown to penetrate dentin tubules to a depth of 0.5 to 1 mm, indicating that the dentin tubules are not freely accessible, but clotted by E faecalis biofilms. Rinsing root canals with a combination of citric acid, hydrogen peroxide, chlorhexidine, and sodium hypochlorite removed bacterial biofilms from the dentin tubules only to a depth of 0.5 mm, while bacteria in deeper regions were not affected. Conclusion: Standard irrigating solutions inhibit bacterial growth; however, due to the morphology of the tooth, the effect of irrigating media is restricted to the root canal and the adjacent volume of dentin tubules. Results from standardizable diffusion tests seem not to be predictive for clinical performance of irrigating solutions. Keywords: debridement, dentin tubules, endodontic treatment, irrigation

Atherosclerosis is a progressive narrowing of arteries that may lead to occlusion as a consequence of lipid deposition. It underlies coronary heart disease, as well as myocardial and cerebral infarctions. Recent attention has been directed towards the potential contribution of chronic inflammatory processes that may amplify vascular inflammation in atherosclerosis, as it is recognized as a chronic inflammatory disease. In this category are two of the most prevalent oral diseases: periodontal disease and apical periodontitis (AP). There is increasing epidemiologic evidence for a positive association between periodontal disease and cardiovascular disease (CVD) as well as between AP and CVD. A review of the literature, as well as a potential mechanism for the linkage between AP and atherosclerosis, are presented in this article. Keywords: blood pressure, bone loss, heart disease, plaque

Objective: To introduce a novel split-thickness flap design without periosteal and vertical releasing incisions for horizontovertical ridge augmentation. Method and Materials: Three patients with generalized chronic periodontitis presented posterior partial edentulism with class C alveolar defects according to the horizontal, vertical, and combination (HVC) classification. In all three cases, implant placement and simultaneous horizontovertical ridge augmentation utilizing a novel split-thickness flap design was performed. Hard tissue reconstruction was followed by additional soft tissue grafting at membrane removal if optimal peri-implant soft tissue stability could not be ensured. Following abutment connection, fixed implant-retained partial dentures were fabricated. Results: The healing procedure after surgeries was uneventful in all cases, without any serious local or systemic adverse events. After 9 months of healing, complete pocket resolution without gingival recession was observed at neighboring teeth with periodontal attachment loss. A comparison of the mean bone to implant/screw contact at first surgery and at membrane removal demonstrated a mean crestal bone regeneration of 3.08 ± 1.25 mm. At 12 months after prosthetic loading, signs of positive bone remodeling and crestal bone maintenance were shown on intraoral radiographs in all cases. Radiographic results showed maintained alveolar crest contours during 60 months of follow-up in all three cases. Conclusion: The clinical and radiographic observations of the three presented cases demonstrate that the guided bone regeneration technique utilizing titanium membranes in combination with autologous and xenogeneic grafting materials applied with the presented split-thickness flap resulted in predictable three-dimensional reconstruction of hard tissues.

Planning oral rehabilitation that involves an interdisciplinary approach is challenging, especially when it includes changes in the morphologic aspects of teeth and the architecture of gingival tissues. Patients commonly complain about the esthetics of maxillary anterior teeth, especially when diastemata are present. A guideline known as the golden proportion can be used to establish adequate width distribution of anterior teeth. Tooth proportion is also affected by incisogingival tooth length, hence gingival contouring should be evaluated as well. In these situations, the width-to-height ratio of 0.75:0.78 in the maxillary anterior teeth could be used to obtain wax-ups and a surgical guide, resulting in a more predictable esthetic outcome. Therefore, this clinical report describes a protocol for the planning of a periodontal-restorative approach with two wax-ups and a surgical guide using the golden proportion width-to-height ratio of 0.75:0.78 for the treatment of maxillary anterior teeth with diastemata using minimum thickness lithium disilicate veneers. Keywords: dental ceramics, dental esthetics, periodontal surgery, veneer

Intrusive luxation is a severe trauma-related event with a high frequency of pulp necrosis and root resorption. A common complication following intrusion is tooth ankylosis, which can extend to progressive replacement root resorption. An increasing infraposition in growing individuals can also occur. Decoronation is a new conservative treatment for cases of tooth ankylosis in young patients who have not finished growing. In this surgical technique, the tooth crown is removed and the root with replacement resorption process remains inside the alveolus. This treatment allows the alveolar bone to continue to develop, thus preserving bone dimensions. The purpose of this article is to report a multidisciplinary case of a young patient with anterior open bite, dental ankylosis, and tooth infraposition affected by intrusive luxation. Decoronation was the treatment of choice for this patient. The patient was then referred to orthodontic treatment to maintain the space of the maxillary right central incisor and open bite correction. After 5 years of follow-up, good clinical and radiologic results were obtained. Keywords: ankylosis, dental trauma, replacement resorption

Most mesiodens remain impacted and can affect the growth and development of adjacent permanent teeth. Impacted mesiodens are usually located in an intraosseous position associated with complicated anatomical structures, necessitating minimally invasive surgical approaches. This article demonstrates a simple customized surgical stent for extraction of impacted mesiodens. Its use and advantages are described. Keywords: cone beam computed tomography, mesiodens, supernumerary tooth, surgical stent

Objective: The purpose of the study was to evaluate the relationship between mucous membrane pemphigoid and a state of hypothyroidism. The study included analysis of the dental charts of 40 subjects with clinically and histologically confirmed diagnosis of mucous membrane pemphigoid and 35 age- and gender-matched subjects, from the same clinic, with no diagnosis of vesiculo-ulcerative lesions. Results: Thirteen subjects from the pemphigoid group (32%) had a hypothyroid condition, compared to four subjects (11%) from the control group (P = .030). Within the mucous membrane pemphigoid subjects who had a history of hypothyroidism, 83% were females. Although cases of hypothyroidism and autoimmune blistering oral disorders such as lichen planus were described in the past, this is the first report of an association between mucous membrane pemphigoid and hypothyroidism. A case report describes a patient who presented with desquamative gingivitis and vesicular lesions, and was diagnosed with mucous membrane pemphigoid and Hashimoto's thyroiditis. Conclusion: The general dental provider should be familiar with mucous membrane pemphigoid and the potential association with hypothyroidism. Early diagnosis of hypothyroidism is significant because replacement may prevent a significant morbidity associated with this condition. Therefore, the general dental provider should be aware of oral conditions presented as desquamative gingivitis and their potential association with hypothyroidism. Keywords: hypothyroidism, mucous membrane pemphigoid

Objective: The aim of the present study was to assess the efficacy of laser therapy (LT) and antimicrobial photodynamic therapy (aPDT) as adjunct to mechanical debridement (MD) on the management of halitosis. Data Sources: In order to address the focused question "Is MD with adjunct LT and/or aPDT more effective in the management of halitosis compared with MD alone?" an electronic search without time or language restrictions was conducted up to January 2017 in indexed databases using the combination of different key words including photochemotherapy, lasers, light, photodynamic therapy, halitosis, and bad breath. The exclusion criteria included qualitative and/or quantitative reviews, case reports, case series, commentaries, letters to the editor, interviews, and updates. Results: Six randomized control trials were included and processed for data extraction. Results from all studies reported that MD with adjunct LT or aPDT is more effective in reducing halitosis and/or volatile sulfur compounds concentration associated with oral conditions compared with MD alone. One study reported a significant reduction in bacterial colony forming units on the dorsum of the tongue among patients with coated tongue receiving MD with aPDT compared with MD alone. Conclusion: The efficacy of aPDT and/or LT on halitosis management remains unclear. Further well-designed randomized clinical trials assessing the efficacy of mechanical debridement with LT or aPDT on the halitosis treatment are needed. Keywords: halitosis, lasers, periodontal disease, photochemotherapy, photodynamic therapy

Objective: To evaluate the effectiveness of chlorhexidine mouthwashes on the reduction of cariogenic bacteria on patients with moderate to high risk for dental caries. Data Sources: A systematic review of the literature was performed using Cochrane Library, Embase, PubMed, Scopus and Web of Science. The search was limited to articles in English, Spanish, and Portuguese, published until January 2017. The research question was formulated following the PICO strategy. The risk of bias was evaluated using the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. Conclusion: All the authors found statistically significant differences in Streptococcus mutans levels during and after the use of a chlorhexidine mouthwash. Although the results are suggestive, there is a clear need for the development of new studies with higher quality and with longer follow-ups, in order to assess whether the results translate into less development of dental caries and, consequently, whether or not these products should be incorporated into prevention protocols. Keywords: chlorhexidine, dental caries, Lactobacillus, mouthwashes, prevention, Streptococcus mutans