Quintessence International, 09/2017

Objective: The restoration of non-caries cervical lesions has long been a challenge. Until recently, compomers were the restorative materials of choice. The aim of this in-vivo study was to evaluate the long-term clinical performance of Dyract restorations in non-caries cervical lesions. Method and Materials: Forty-two patients with Dyract restorations of non-caries cervical lesions performed in 1995 by the same operator were included in this in-vivo retrospective study. After 20 years, restorations were evaluated by two calibrated examiners following the USPHS criteria modified by Ryge. Results: After 20 years, 38 of the 54 restorations included in this study remain in service (70.4%). Debonding was the cause of all failures. Marginal adaptation and marginal discoloration were the categories with poor values. Conclusion: Dyract restorations can be considered a treatment option for non-caries cervical lesions, because they show good long-term clinical performance for 20 years. Clinical Relevance: Dyract restorations continue to be an option to restore non-caries cervical lesions, due their good long-term clinical performance and the ease of the clinical procedure. The survival rate of these Dyract restorations was high after 20 years (70.4%). However, the limitations of marginal discoloration, marginal adaptation, and color match should be considered. Keywords: class V, compomer, Dyract, longevity, non-caries cervical lesion, polyacid-modified composite resin

Papillon-Lefèvre syndrome (PLS) is a rare autosomal recessive disorder that exhibits palmoplantar keratosis and early severe periodontitis. The oral disease affects both the primary and permanent dentitions leading to premature exfoliation of teeth. Various etiologic factors, such as genetic mutations, immunologic alterations, and bacteria have been implicated in PLS. Genetic mutations leading to the loss of function of cathepsin C (CTSC) gene, located on chromosome 11q14, is considered pivotal in this condition. The present case series describes PLS in three siblings, with consanguineously married parents, who live in a remote area of Yemen. The affected children presented with prominent palmoplantar keratosis and early periodontitis with only a few remaining teeth. The severity of skin lesions in all patients exhibited seasonal variations. Based on their clinical findings, a diagnosis of PLS was made. Dentists have a significant role in the early diagnosis and management of PLS patients. Keywords: consanguinity, palmoplantar keratosis, Papillon-Lefèvre syndrome, periodontitis, cathepsin C

The prosthodontic management of complex rehabilitations requires several stages of treatment including one or more provisional restorations. The design and adjustments of the provisional are made to achieve an optimal functional and esthetic outcome for the patient. However, the adjustments needed are both time and cost consuming. Therefore, once a satisfactory provisional is made, the information should not be lost during the following stages of treatment. The purpose of this clinical case is to illustrate "digital cross-mounting," a procedure used to precisely transfer information from the provisional to the final fixed rehabilitation in a digital workflow. Keywords: cross-mounting, digital workflow, full-arch rehabilitation, intraoral scanner, monolithic zirconia

Objective: This systematic review aimed to investigate the influence of gene polymorphisms on the development of gingival overgrowth in renal transplant patients treated with cyclosporin A. Method and Materials: Electronic and hand literature searches were conducted by two independent reviewers in MEDLINE-Pubmed, Cochrane Library, ISI Web of Science, and SCOPUS Elsevier for prospective (case-control studies, cohort studies), cross-sectional, and retrospective studies published up to June 2016 (first week) in any language. Data were reviewed and extracted in duplicate independently. Methodologic quality assessment of the included studies was performed during the data extraction process. Results: Due to the estimated high risk of bias and the heterogeneity of the included studies in regards to the variety of medications administered to study patients, a systematic review of the literature and not a meta-analysis of the data was performed. Fourteen articles meeting study inclusion criteria were selected for data extraction that examined the association between various genetic polymorphisms and gingival overgrowth in kidney transplant patients receiving cyclosporin A. Interleukin-1A, interleukin-10, transforming growth factor-β1 and androgen receptor gene polymorphisms may have a significant effect on an individual susceptibility to cyclosporin A-induced gingival overgrowth in renal transplant patients. Conclusion: Genetic polymorphisms seem to affect the development of cyclosporin A-induced gingival overgrowth in renal transplant patients. Pharmacogenetics and pharmacogenomics have the potential to determine the clinical outcome of a medication, the drug efficacy, and adverse drug reactions such as gingival overgrowth. Keywords: cyclosporin, gingival overgrowth, genetic predisposition

Osteosclerotic lesions are a common finding on dental radiographs. They are considered developmental variants of a normal bone architecture and they usually do not need any treatment. The purpose of this article is to present a rare case of osteosclerotic lesion of the mandible causing trigeminal neuropathy by compression of the alveolar nerve. The pain started with dental hypersensitivity of the mandibular right first molar. Later on, signs of irreversible molar tooth pulpitis developed. Endodontic therapy and apicoectomy did not resolve the pain, which later intensified, and painful neuropathy localized to inferior alveolar nerve developed; therefore, surgical decompression was indicated. Treating a dental patient with neuralgic pain is always a challenge, especially if there is no obvious source or reason for this type of pain. A clear evaluation and treatment protocol are important to minimize the patient's morbidity and avoid unnecessary overtreatment. Keywords: alveolar nerve decompression, mandible, neuropathy, osteosclerosis, trigeminal nerve

Cone beam computed tomography (CBCT) was introduced to the dental profession at the beginning of the new millennium and has become an integral part of dental practice, especially within the surgical specialties. With advances in technology and the introduction of new-generation digital detectors, the concomitant increase in pixel resolution provided the ability to discern fine details of the anatomy. This article focuses on the methodology of CBCT interpretation and reporting. Details of reviewing the volume thoroughly are described with relevant citations. The article summarizes the overall methodical interpretation of CBCT data that is essential to every dentist who uses the technology. Keywords: cone beam computed tomography, interpretation, report

Objective: The objective of this split-mouth randomized controlled study was to compare the 2-year clinical performance of two restorative techniques and materials for posterior permanent carious teeth. Method and Materials: After signing informed consent, 30 patients aged between 7 and 16 received two Class 1 restorations on cavities on permanent first or second molar teeth performed with one of two systems: incrementally placed conventional posterior composite resin (Herculite Ultra, Kerr), and sonic-resin placement system (SonicFill, Kerr) with single-component self-etch adhesive system (Kerr) according to the manufacturers' directions. Two blinded observers evaluated the restorations at three times (baseline, and after 1 and 2 years) according to the US Public Health Service modified criteria. Kruskal-Wallis test and Mann-Whitney U-test were used to compare the clinical performance of the restorative systems. Results: The restorative systems showed similar clinical performance at 2 years. At the end of 2 years in both groups, one restoration's marginal staining Alpha ratings decreased. In the same period, two restorations in the conventional group and one in the SonicFill group received Bravo ratings for color match and surface roughness scorings. Conclusion: The sonic-resin placement system demonstrated similar results to incrementally placed conventional composite resin in terms of clinical success. Considering the advantages of providing up to 5 mm in a single layer, and the adjustability of the viscosity, bulk-fill composite restorations seem to be a good alternative to posterior Class 1 composite restorations. Clinical Relevance: This study suggests that a new dental material for bulk-fill technology exhibits similar clinical success to incrementally placed composite resin. Keywords: adhesive, bulk-fill, composite, dentistry, resin, restorative

Objective: The aim of this study was to examine any potential association between demographic characteristics, socioeconomic status, dental insurance, and medical and tobacco history between patients that received endodontic treatment or extraction and implant treatment in a university dental clinic. Method and Materials: Dental charts of patients who received root canal treatment and implant therapy were retrieved from the University of Minnesota School of Dentistry records. Age at the time of the procedure, gender, medical history, tobacco use, dental insurance status, zip code, and type of treatment provided were recorded. Patients who had both treatment modalities were excluded from the analysis. Results: A total of 8,540 records of patients with a mean age of 50.66 years who have received either endodontic treatment (73.6%) or implant therapy (26.4%) were included. A statistically significant (P .05) association was found between endodontic treatment or implant treatment as related to age, socioeconomic status, high blood pressure, asthma, thyroid disorders, arthritis, artificial joint, osteoporosis, depression, anxiety, cancer, and cancer treatment. Nonsmokers were significantly more likely to select a treatment plan with implants rather than an endodontic therapy. Conclusion: Within the limitations of this retrospective study, demographic parameters, insurance status, smoking, and medical history significantly affected the treatment selection between implant and endodontic treatment in a university setting. Keywords: endodontics, epidemiology, implantology, insurance, socioeconomic factors