Quintessence International, 04/2020

Objective: The objective of the present study was to assess the effect of monolithic and bilayer restorations considering heat-pressed and milled/CAD/CAM reinforced lithium disilicate ceramic veneers, on the flexural strength after cementation. Method and materials: Thirty-five specimens were divided into five groups (n = 7), according to the restorative solution: 2-mm thickness composite resin (CR2); heat-pressed monolithic ceramic 0.6 mm (HPM), CAD/CAM monolithic ceramics 0.6 mm (CCM); heat-pressed monolithic ceramic 0.4 mm + 0.2 mm glass-ceramic (HPB); CAD/CAM monolithic ceramic 0.4 mm + 0.2 glass-ceramic (CCB). Specimens were cemented on composite resin bars and submitted to a three-point bending test on a Universal Testing Machine, until fracture. Fractured samples were analyzed under stereomicroscope and SEM. Flexural strength data were analyzed by one-way ANOVA and Tukey test. Results: The control group showed the highest flexural strength results (119.57 ± 19.49 MPa), with values similar to groups HPM (98 ± 25.62 MPa) and CCM (96.14 ± 20.60 MPa). Groups HPB and CCB showed lower values when compared with the other groups. Fracture started from the base on monolithic groups and from ceramic on bilayer groups. Conclusion: Both ceramic systems (CAD/CAM and heat-pressed) have similar fracture strength, although bilayer restorations present lower strength when compared with monolithic ceramics. Keywords: CAD/CAM, ceramics, dental materials, esthetics, operative dentistry, prosthodontics, veneers

Objective: The aim of this study was to compare and evaluate the clinical results obtained in the maxilla and mandible by taking digital impressions following application of hyaluronic acid fillers for the reconstruction of multiple papillary losses. Method and materials: Evaluation was made of a total of 200 papilla spaces in 20 patients applied with hyaluronic acid filler injection to consecutive papillae regions in both arches symmetrically. The area of the interdental space and the percentage change in the area value over time was calculated separately for each papilla space by taking digital impressions before the application of hyaluronic acid and at 3, 12, and 24 months after the application. Results: A significant improvement was determined in the area values of both arches at 3, 12, and 24 months compared to the baseline values. In the percentage change at 24 months, irrespective of whether the mandible or maxilla, the highest filling percentage of all the spaces was between the canine and lateral incisors. When the 24-month filling percentages were compared between the maxillae and mandibles, the most significant difference was between the central teeth. Conclusion: The results showed that success was obtained in both arches with hyaluronic acid filler injection applied for reconstruction of multiple papilla losses; because the filling percentages in the maxilla at 3 months and 12 months were greater than those in the mandible, it can be suggested that results can be obtained more quickly and at a higher level in the maxilla. Keywords: digital impression, hyaluronic acid, interdental papilla, multiple papillary loss, papilla reconstruction

An alternative approach was used to increase the buccal vestibular depth of two edentulous patients, using free epithelialized palatal grafts. Two edentulous patients presented with shallow vestibules and inadequate keratinized tissue width in the mandibular anterior region. These sites were treated with vestibuloplasty followed by placement of an epithelialized palatal graft. In order to minimize graft movement and possible mechanical trauma to the area, the graft was covered with the buccal flap during the initial stages of healing. The patients maintained an increase in the vestibular depth as well as the keratinized tissue width at 14 months and 5 years postoperatively. Successful outcomes in terms of increase in vestibular depth can be achieved with the use of epithelialized palatal graft that is covered during the initial stage of healing. The dental practitioner fabricating the complete denture should be aware of the advantages offered by this alternative surgical technique. Keywords: epithelialized palatal graft, free gingival graft, keratinized tissue augmentation, periodontal surgery, vestibuloplasty

Objectives: To evaluate the influence of implant splinting on peri-implant marginal bone level and implant failures in completely edentulous patients who have been rehabilitated with mandibular implant overdentures. Method and materials: A literature search of electronic databases (PubMed and Cochrane Central Register of Controlled Trials [CENTRAL]) was performed, with the last search conducted in July 2019. Randomized controlled trials with at least a 12-month follow-up period were selected. The review and meta-analysis were performed in accordance with PRISMA guidelines. Two comparisons were included in the meta-analysis: (1) Two-implant supported ball versus two-implant supported bar mandibular overdenture; (2): Two- versus four-implant supported bar mandibular overdenture. Results: Six randomized controlled trials fulfilled the inclusion criteria and were included in a quality assessment and meta-analysis. Pooled data revealed a nonsignificant difference in marginal bone level (I2 = 0%; P = 1; mean difference = 0.00; 95% CI −0.37 to 0.37) and implant failures (P = .24; risk ratio = 6.07; 95% CI 0.30 to 121.33) when two-implant ball overdentures were compared to two-implant bar overdentures. Similarly, there was no significant difference in marginal bone level (I2 = 59%; P = .59; mean difference = −0.16; 95% CI −0.73 to 0.41) or implant failures (I2 = 0%; P = .36; risk ratio = 2.03; 95% CI 0.45 to 9.16) when two- versus four-implant bar overdentures were compared. Conclusion: Based on the findings of the meta-analysis, there is no influence of implant splinting on peri-implant marginal bone level and implant failures for completely edentulous patients rehabilitated with mandibular implant overdentures. However, this result should be interpreted with caution due to the limited number of analyzed studies, most of them considered at unclear risk of bias. Well-designed randomized controlled trials with follow-up periods of at least 5 years are highly recommended to establish evidence with regard to the influence of implant splinting on mandibular overdentures. Keywords: dental implants, implant failure, mandibular overdenture, marginal bone loss, splinting

This paper describes an alternative computer-aided design/computer-aided manufacturing (CAD/CAM) technique for the creation of a combined prosthetic restoration with orthodontic appliance (PROA). This concept allows the use of orthodontic appliances such as brackets, attachments, or any other type of appliance over different types of prosthetic restorations. The PROA concept aims to mitigate problems associated with performing restorative treatment when orthodontic treatment is necessary. This proposed concept provides the clinicians with proper control and planning of the interdisciplinary treatment that will lead to the final tooth shape, form, and proportions while performing orthodontic tooth movements. Keywords: 3D printing, aligners, attachment, bracket, CAD/CAM, digital, orthodontics, PROA, restorative, treatment plan

Objective: This study aimed to evaluate the effectiveness of DentalVibe in pain reduction during local anesthetic injection compared to traditional injection in pediatric patients. Method and materials: This cross-over randomized controlled clinical trial included a sample of 60 children, aged 5 to 7 years, who were selected based on the need for local anesthesia for bilateral mandibular pulpotomy treatment. They were randomly allocated into two groups. Each group received two mandibular nerve block injections, with a 2-week interval as the washing out period. At first appointment, mandibular nerve block injection was performed either with vibration using DentalVibe at the injection site or benzocaine gel 20% applied before local anesthetic injection; the alternative technique was used at the second appointment. In each visit subjective pain was evaluated using the Wong-Baker FACES Pain Rating Scale and objective pain was evaluated using the FLACC (Face, Legs, Activity, Cry, Consolability) scale. Results: Assessment using the Wong-Baker FACES Pain Rating Scale showed that the mean pain levels in DentalVibe and traditional injection groups were 0.80 ± 1.34 and 2.60 ± 3.22, respectively. The mean pain levels according to the FLACC scale were 2.20 ± 2.04 and 3.13 ± 2.30 in the DentalVibe and traditional injection groups, respectively. Both scales showed statistically significant differences between the two groups in favor of DentalVibe (P .001). A positive significant correlation between the two scales in the two interventions was recorded, where the Spearman rho was 0.41 for the DentalVibe group, and 0.52 for traditional injection group (P .001). Conclusion: Compared to the traditional approach, DentalVibe reduced pain sensation during mandibular nerve block injection in pediatric patients. Keywords: benzocaine, DentalVibe, FLACC (Face, Legs, Activity, Cry, Consolability) scale, mandibular nerve block, pain rating scale

Free mucous membrane grafts and connective soft tissue grafts have been considered the gold standard in oral soft tissue regeneration for a long period of time. Due to the morbidity while harvesting autogenous soft tissue grafts, xenogeneic collagen matrices of porcine origin were recently developed. Next to soft tissue regeneration, these collagen matrices have also been reported to be suitable for bone regeneration in the context of bone graft stabilization and shielding techniques. Collagen matrices are classed as medical devices, and are produced in a complex treatment and cleaning process. With respect to the individual area of indication, collagen matrices are produced from porcine dermis, pericardium, or peritoneum. The advantages and limitations of collagen matrices in comparison to autogenous soft tissue grafts in the different indication areas are controversially discussed. There might be evidence that these collagen matrices are able to reach similar outcomes to autogenous soft tissue grafts in certain indications. Currently, a final assessment of this relevant question is not possible cause of a lack of evidence-based data. Originally published (in German) in Quintessenz Zahnmedizin 2019;70:64–76) Keywords: acellular, barrier matrix, collagen matrix, collagen type I/III, guided bone regeneration, guided tissue regeneration, porcine scaffold, remodeling matrix, xenogeneic matrix

Background: The twin block Injection is a novel nerve block that has been shown previously to be efficacious in the management of masticatory myofascial pain. Little is known about its effectiveness for reducing pain from the temporomandibular joint (TMJ). Case report: A 19-year-old man presented with limited mouth opening with pain in the left side of his face. After a thorough history and examination was completed, the diagnosis was acute anterior disc displacement without reduction in the left TMJ and myalgia of the left side temporalis and masseter muscles. After receiving the twin block injection, the patient reported that the pain in his TMJ had reduced along with the concomitant myalgia. The twin block injection is efficacious for the management of both arthrogenous and myogenous sources of temporomandibular disorders. Keywords: myalgia, nerve blocks, temporomandibular disorder

Facial allotransplantation (FA) is an emerging alternative modality following severe loss of hard and soft tissues. Although there are vast numbers of publications on the surgical aspects of this technique, limited information is available in the literature with regard to the long-term dental care of affected patients following postoperative stabilization and return to their locally based clinical milieu. The objective of this report is to review patient demographics, etiologies, structural graft components, immunosuppressive strategies, donor tissue pathogenicity, neurologic recovery, potential complications, and present clinical guidelines for dental management. Additionally, a brief discussion of the preparation of the donor mask, and cutaneous and intraoral images of allograft rejection have been provided. Keywords: complications, dental, face transplantation, management, oral and maxillofacial, rejection, surgery