Quintessence International, 06/2019

Objective: The purpose of the present study was to compare levels of the biomarkers lactate dehydrogenase (LDH) and free hemoglobin in the saliva of different groups of smokers for early diagnosis of periodontitis and their clinical relevance for use as a screening tool. Method and materials: Eighty cigarette smokers were divided into light ( 10 cigarettes/day) moderate (10 to 19 cigarettes/day) and heavy (≥ 20 cigarettes/day) smokers. Stimulated saliva samples were obtained by the expectoration method and evaluated for LDH and free hemoglobin levels. Clinical parameters were recorded after saliva collection using the modified Community Periodontal Index (CPI). Results: Salivary free hemoglobin level was higher in light smokers compared to heavy smokers (mean 363.89 ± 295 µmol/L in light vs mean 79.55 ± 37.41 µmol/L in heavy, P = .001) and positively correlated with CPI score. There was no control group to prevent bias with free hemoglobin results in healthy individuals. Salivary LDH levels were higher in light smokers (411.24 ± 18.62 IU/L) compared to heavy smokers (313.26 ± 23.98 IU/L). However, a significant correlation between free hemoglobin, LDH, and CPI score (clinical parameters) was seen between the three groups of smokers (P .01). Conclusions: Within the limitations of this observational study, there was a progressive reduction in free hemoglobin and LDH levels from light smokers to heavy smokers. However, the severity of periodontal disease conditions increased as the severity of smoking habit increased. Keywords: lactate dehydrogenase, periodontitis, salivary hemoglobin, smoking

Objective: To evaluate clinically and microbiologically the outcomes following the combined application of InGaAsP diode laser and Er,Cr:YSGG laser for nonsurgical treatment of chronic periodontitis (ChP). Method and materials: Forty-two patients (age 45.31 ± 9.78 years, 22 female, 23 smokers) with ChP were randomly treated with subgingival debridement (SD) by means of ultrasonic and hand instruments (control group, n = 21) or with InGaAsP followed 1 week later by InGaAsP + SD + Er,Cr:YSGG (test group, n = 21). In the test group, a second laser treatment was performed for all residual sites (bleeding sites with probing depth [PD] ≥ 4 mm) 2 months after the first laser therapy. At baseline and 6 months after therapy, periodontal clinical and microbiologic parameters were evaluated. Results: Six months after therapy, statistically significant clinical and microbiologic improvements (PD reduction, clinical attachment level [CAL] gain, quantitative reduction of periopathogens) were observed in both groups compared to baseline. However, the use of InGaAsP followed by SD and the adjunctive use of an Er,Cr:YSGG laser, yielded statistically significantly higher clinical (PD, CAL, bleeding on probing, number of sites with PD ≥ 5 mm, PD ≥ 6 mm, PD ≥ 7 mm) and microbiologic (Porphyromonas gingivalis, Treponema denticola, Tannerella forsythia, Prevotella intermedia, Peptostreptococcus micros, Fusobacterium nucleatum) improvements (P .05) compared to SD alone. Conclusions: In patients with ChP, the adjunctive use of InGaAsP and Er,Cr:YSGG to SD may additionally improve the clinical and microbiologic parameters obtained with SD alone, thus representing a valuable approach in nonsurgical periodontal therapy. Keywords: chronic periodontitis, diode laser, Er, Cr:YSGG, InGaAsP, laser treatment, nonsurgical periodontal therapy

Objective: This prospective clinical study evaluated the clinical performance of one-, two- and multi-surface composite resin inlays over a 12-year period on premolars and molars. Method and materials: One clinician placed 113 indirect composite resin inlays (Signum, Heraeus Kulzer) in 30 patients that were bonded using a three-step bonding system and composite resin luting cement. Evaluations were made at 3 and 12 years by another clinician who was not involved in the placement of the restorations, using the modified US Public Health Service (USPHS) criteria. Data were analyzed using a nonparametric statistical test (Mann-Whitney U test) followed by Bonferroni correction (alpha = .05). Results: Fourteen patients could not be followed, yielding to the follow-up of 99 restorations. After 12 years, compared to the 3-year follow-up, tooth integrity, secondary caries, and sensitivity criteria showed significant change, while other parameters did not show significant difference (P > .05). Parameters such as loss of marginal integrity, loss of restoration integrity, loss of surface polish, and secondary caries received more frequently delta scores. At the 3-year follow-up, the clinical performance of one- or two-surface inlays did not show significant difference from multi-surface ones (P = .6317), but at the 12-year follow-up, the results were more favorable for multi-surface inlays. Overall, the failure rate at 12 years was 12%. Conclusions: Adhesively bonded indirect composite resin inlays showed acceptable long-term clinical results in terms of function, but surface and margin characteristics changed over time. Keywords: adhesion, composite resin, indirect composite, inlay, restorative dentistry

Accident-related dental dislocations must be considered as part of an emergency treatment. The use of tooth-colored fixation composites makes the splint seem less noticeable in everyday life. However, this makes it more difficult to remove without damaging the tooth's enamel surface. In order to better visualize the transition between composite and the tooth , the fluorescent properties of some composites can be advantageous. This article will explain the individual steps of a rapid and minimally invasive splint removal, using the so-called Fluorescence- aided Identification Technique. Keywords: composite detection, Fluorescence-aided Identification Technique (FIT), removal of trauma splints, Titanium Trauma Splint (TTS), traumatology

Overeruption with simultaneous alveolar deficiency is not uncommon but very difficult to treat. In mild cases of overeruption without opposing alveolar deficiency, selective removal of enamel from the overerupted teeth may be an option, yet not advocated. Extraction of the overerupted teeth should be avoided if the teeth are intact with sufficient bone support. The Schuchardt operation is a good option for cases limited to the overeruption. In cases of overeruption with simultaneous opposed alveolar deficiency, it is suggested to perform simultaneous maxillary and mandibular surgical procedures: alveolar segmental operation, followed by a sandwich osteotomy on the opposing arch. This article presents a posterior segmental osteotomy in the maxilla and a simultaneous sandwich procedure in the mandible utilizing the bone graft removed from the maxilla. The results showed good functional and esthetic outcomes. This method preserves the native teeth. It also utilizes an autogenous bone graft that is harvested regardless of the interpositional graft and spares a second surgical site. In addition, it allows for a one-stage procedure which enables for both treatment of the overeruption and augmentation of the opposing arch. Keywords: bone graft, bone resorption, interpositional, overeruption, Schuchardt, sandwich

Objectives: The aim of the present study was to evaluate the topographic relationship between mandibular third molars and the mandibular canal in panoramic tomography and cone beam computed tomography (CBCT). Method and materials: Records of all patients visiting for removal of a mandibular third molar between January 2014 and December 2015 were evaluated retrospectively. In panoramic tomography, the relationship of the roots to the mandibular canal was diagnosed according to the literature. In CBCT scans, the panoramic plane was rebuilt and orthogonal images to that plane were analyzed. Results: A total of 56 mandibular third molars were eligible for the study. Superimposition of tooth apex and mandibular canal (Class I) was similarly often found in both radiographic techniques (P = .22). In contrast, contact of tooth apex and mandibular canal (Class II) was significantly more often seen in CBCT scans than in panoramic tomography (P = .039). No contact of tooth apex and mandibular canal (Class III) was similarly often seen in both radiographic techniques (P = .59). Contact of tooth apex and the mandibular canal (Class II) was significantly more often verified by CBCT imaging than was assumed in panoramic tomography. Conclusions: Preoperative CBCT may be helpful in Class II cases for verification of the topographic relationship between the mandibular canal and mandibular third molars. Keywords: cone beam computed tomography, mandibular canal, mandibular third molar

Excessive cementum formation, referred to as hypercementosis (HC), is an uncommon nonneoplastic process that principally occurs with permanent teeth. Widespread tooth involvement has been confined mostly to Paget disease of bone. Only a limited number of reports of HC coincident with periodontitis has appeared in the literature. The aim of this article is to present the clinical, radiographic, and histopathologic findings of a 44-year-old female with moderate to severe periodontitis synchronous with 22 HC-affected teeth. A list of other etiologies associated with HC is provided. Keywords: etiology, florid, hypercementosis, periodontitis

The aim of this article is to introduce and illustrate the "Teflon tape technique," which provides good lucidity in combination with excellent isolation of the working field. It is intended to serve as a supplement to the gold standard rubber dam for the adhesive working dental practitioner. Primarily, the Teflon tape technique (Teflon is a registered trademark, and not affiliated with Teflon tape) is particularly suitable for the adhesive cementation of restorations with very thin margins. It allows free access to subgingival areas with variable gingival retraction. Furthermore, this principle can also be applied to other indications, such as Class V restorations or deep core buildups. The technique described is therefore flexible and easy to use. This combination allows a fast integration of the Teflon tape technique into the daily workflow of the dental practitioner. Keywords: adhesive dentistry, dental technology, isolation, prosthodontics, restorative dentistry, veneers

Invasive cervical resorption (ICR) is a dental lesion starting in the cervical region and involving the loss of dental hard tissue as a result of odontoclastic action. Due to its localization and invasive pattern, this process represents a challenging clinical situation. When feasible, the major aim of an ICR treatment is to completely remove the pathologic tissue (specifically at the entry point of the lesion) and to seal the resulting defect, without compromising tooth rehabilitation. In this context, choosing how to access the resorptive lacuna is essential. Two main options have been described in the literature: an external approach, requiring the surgical exposure of the resorptive lacuna, and an internal approach, taking advantage of the endodontic access cavity. However, there are no guidelines that indicate which approach to choose for the treatment of an ICR. This article is based on four clinical cases. It aims to provide specific clinical and radiologic features that should be considered in order to take the most appropriate decision, when choosing between the internal and the external approaches. It is proposed to base the therapeutic strategy on the accessibility and the size of the portal of entry of the lesion. When the entry point is wide, its extension along the root must also be taken into account. Other important parameters are the circumferential and vertical extents of the lesion in the radicular dentin. Although it is not a determining factor, the pulpal involvement of the lesion can also be considered. Keywords: case series, decision-making process, external approach, internal approach, invasive cervical resorption