Quintessence International, 09/2012

Foreign bodies are common findings in the maxillofacial region, most commonly the result of accidents and physical aggression. Among the objects frequently found in the orofacial tissues are fragments of metal, plastic, wood, and glass. Visualization and exact identification of the location of these objects can be challenging but is of major importance prior to surgical removal. The present case report describes the use of cone beam computed tomography to locate, visualize, and surgically remove glass particles in the oral cavity. Keywords: accident, cone beam computed tomography, foreign body, glass, radiopaque

Objective: To investigate via a split-mouth cross-sectional study the prevalence of gingival recessions associated with lateral lower lip piercing in a population obtained from a nondental setting. Method and Materials: A split-mouth study was performed in a sample of 47 patients with one lateral lower lip piercing. Teeth in direct contact with the intraoral closure of the stud were defined as test teeth; contralateral teeth were selected as controls. Clinical examination included full-mouth plaque and bleeding indices, probing depth, recession, clinical attachment level, periodontal biotype, evaluation of hard tissues, occlusal trauma, stud characteristics, and mucosal inspection and palpation. Results: Midbuccal recession was noted in four test teeth compared with one control tooth (8.5% and 2.1%, respectively; P = .250). The canine and first premolars were the most affected. Tooth chipping occurred in one test tooth and no control teeth. Plaque levels were significantly higher in test than control teeth (P .001). Conclusion: Lateral lower lip piercing is associated with significantly higher plaque accumulation on adjacent teeth. A small percentage of lateral lower lip piercings may cause tooth chipping or buccal recession in adjacent teeth. Keywords: body piercing, gingival recession, tooth injuries

The loss of an entire tooth in the anterior region is accompanied by impairment of esthetics, function, phonetics, and self-esteem. It is common knowledge that treatment with implants during childhood or early adolescence is not an option. Splinting of adjacent teeth during growth and development may interfere with the independent process of teeth realignment and repositioning during that phase of life. Other creative solutions must be offered, such as free-standing composite buildup restorations on compromised broken teeth or single wing/cantilevered restorations adhered to one neighboring tooth during the growth period. The positive effects of reinforced composite materials were researched and presented in the literature. Their use is clearly indicated for interim and economical restorations. Long-term follow-up on a mandibular incisor that experienced trauma, losing its clinical crown and vitality when the patient was 12 years of age, is discussed with all the various aspects of material selection, future considerations, and long-term follow-up to adulthood, when a conventional crown was prepared and delivered. Keywords: adolescence, core buildup, endodontically treated teeth, fiber-reinforced post, mandibular incisor, reinforced composite restoration, traumatic injuries

Objective: To compare the regenerative potential of bone graft used alone and in combination with barrier membrane in noncontained human periodontal infrabony defects. Method and Materials: Twelve patients (7 men and 5 women, 30 to 65 years of age) with moderate to severe chronic periodontitis were included in the study. A total of 16 one- or two-walled intraosseous defects were selected and randomly divided for decalcified freeze-dried bone allograft, alone (control group) or in combination with polylactic acid, polyglycolic acid barrier membrane (test group). Pocket probing depth (PPD), clinical attachment level (CAL), radiologic bone fill (RBF), and alveolar height reduction (AHR) were recorded immediately before surgery and after 3 and 6 months postoperatively. The ANOVA and Newman-Keuls post hoc tests were used for statistical analysis. A two-tailed probability value of P .05 was considered to be statistically significant. Results: For bone graft alone, PPD reduction was 2.00 ± 0.19 mm, CAL gain was 1.38 ± 0.18 mm, and RBF was 0.63 ± 0.26 mm: for the test group, PPD reduction was 2.75 ± 0.37 mm, CAL gain was 1.50 ± 0.27 mm, and RBF was 1.13 ± 0.23 mm. AHR for the control and test groups was 0.38 and 0.37 mm, respectively. Conclusion: These results confirmed nonsignificant clinical and radiologic differences in regenerative outcome with bone graft alone and with guided tissue regeneration in the treatment of noncontained human periodontal infrabony defects. Keywords: bone graft, combined periodontal regeneration technique, guided tissue regeneration, infrabony defect

A 66-year-old osteoporotic woman suffered from long-term mental paresthesia (numbness), facial swelling, and a nonhealing extraction site. Fulfilling the three clinical diagnostic criteria for bisphosphonate-related osteonecrosis of the jaw (BRONJ; exposed bone for at least 8 weeks, current bisphosphonate [risedronate] treatment, and no history of head and neck radiation therapy), she was diagnosed and treated accordingly. Nevertheless, a later histopathologic examination revealed malignant lymphoproliferative infiltration of large and intermediate cells. Based on immunostaining and positron-emission tomography, she was diagnosed as having primary diffuse large B-cell lymphoma. This case demonstrates the limitation of the current diagnostic method of BRONJ. Thus, the clinician should be particularly cautious and aware of the differential diagnosis, including malignancy, especially when lesions are accompanied by (mental nerve) neuropathy and long-standing swelling/expansion, and even when plain radiography is not a contributing factor. Keywords: bone, numb chin syndrome, paresthesia, trigeminal neuropathy, wound healing

Objective: Salivary enzymes may be used to diagnose periodontal conditions. Salivary arginase activity (SAA) is related to susceptibility to bacterial infection. Therefore, the aim of this controlled interventional study was to determine the SAA before and after nonsurgical periodontal therapy. Method and Materials: Eighty-nine subjects were selected: 31 periodontally healthy patients (controls), 27 gingivitis patients, and 31 chronic periodontitis patients. Plaque and Gingival Indices, probing depth, and clinical attachment level were monitored. The presence of Campylobacter rectus, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and Prevotella intermedia was evaluated by polymerase chain reaction. Salivary total protein level and SAA were also established by spectrophotometry. Clinical and arginase data were analyzed using the Wilcoxon, Mann-Withney, and Kruskal-Wallis tests (P .05). For microbial data, the chi-square test was used. The Pearson correlation test was also used between each parameter evaluated. Results: After therapy, due to a significant reduction in SAA, the values observed for the gingivitis and periodontitis groups were similar to those found in the healthy group. Interestingly, after therapy, SAA followed the same positive pattern showed by the overall improvement of clinical parameters (gingivitis and periodontitis groups mean values, pre- > posttherapy) and by the reduction of target pathogens (gingivitis group T forsythia, pre- > posttherapy; periodontitis group P gingivalis, T denticola, P intermedia, and T forsythia, pre- > posttherapy). Conclusion: Based on the reduction of SAA after therapy, in accordance with the expected reduction in clinical and microbiologic parameters, it was concluded that SAA has the potential to serve as a reliable method to access to the therapeutic response of chronic periodontitis subjects treated with nonsurgical periodontal therapy. Keywords: arginase, gingivitis, periodontitis, therapy

Prosthodontic treatment for edentulous patients with microstomia is a challenge because of the constricted opening of the oral cavity. This clinical report presents the prosthetic management of an edentulous maxilla in a patient with burn-induced microstomia. A sectional maxillary complete denture was fabricated. With the use of a custom-made inlay structure at the overlapping metal base along the palatal midline, the sectional prosthesis was successfully and easily inserted and provided adequate function in the patient's mouth. Keywords: microstomia, sectional maxillary complete denture

Objective: To determine the effectiveness of aloe vera gel in the treatment of oral lichen planus when compared with triamcinolone acetonide. Method and Materials: A randomized, double-blind, clinical trial was designed. The study sample constituted 40 patients (23 males and 17 females) who were randomly divided into two equal groups. Group A patients received aloe vera gel, while group B patients received triamcinolone acetonide. Results: Forty patients were included in the study. Most of the sample presented with erosive (n = 18) and atrophic (n = 14) variants of oral lichen planus. When clinical signs and symptoms were observed after 8 weeks of therapy, it was determined that aloe vera gel was more effective than triamcinolone acetonide in the treatment of oral lichen planus. Conclusion: Aloe vera gel can be considered a safe alternative treatment for oral lichen planus. Keywords: aloe vera gel, burning sensation, healing, oral lichen planus, triamcinolone acetonide

Objective: Techniques currently applied to determine the marginal accuracy of dental crown restorations yield inadequate information. This investigation aimed to test a new virtual approach for determining the precision of fit of single-crown copings. Method and Materials: Zirconia single crown copings were manufactured on 10 gypsum, single-tooth master casts with two different established computer-aided design/computer-assisted manufacture (CAD/CAM) systems (groups A and B). After cementation, the circumferential fit was assessed with an industrial noncontact scanner and virtual 3D analysis, following a triple-scan protocol. Marginal fit was determined by virtual sectioning; each abutmentcoping complex was digitally sliced in 360 vertical sections (1 degree per section). Standardized measurement distances for analyzing the marginal fit (z, xy, xyz) were selected, and a crosshair alignment was utilized to determine whether crowns were horizontally and/or vertically too large or small. The Mann-Whitney test was applied to test for differences between groups. Results: Significant differences in the xy direction (P = .008) were measured between groups. Group A showed a greater number of horizontally overextended margins and a higher frequency of xy distances greater than 150 µm, in addition to a tendency for excessive z distances (P = .095). Conclusion: The mean marginal gap values were clinically acceptable in the present investigation; however, a full circumferential analysis revealed significant differences in marginal coping quality. Keywords: CAD/CAM, fit, margin, virtual, zirconia

Objective: To compare the efficacy of ProFile File cleaner and a nanostructured foam in removing debris from two rotary nickel-titanium instruments during and after instrumentation. Method and Materials: Twenty mandibular premolars were decoronated and instrumented up to either #40.04 RaCe (#40.04) or K3 (#40.04) instruments (n = 10). Each group of files was randomly divided into two groups: ProFile File cleaner and Nano Foam cleaner. The instruments were examined under a scanning electron microscope (SEM) before and after placement into the canals. Subsequently, instruments were introduced into each cleaner and examined again under SEM. The amount of debris removal from the instruments was determined by ImageJ software. Data were subjected to Kruskal-Wallis and Mann-Whitney tests at a .05 level of significance. Results: The amount of debris removal was significantly different between the groups (P = .002). The amount of debris removed was significantly higher in K3 with Nano Foam cleaner than ProFile File cleaner (P = .009). Conclusion: Nanostructured foam can remove debris from endodontic files, especially from those with complex cross-section. This method is recommended to help optimize debris removal with the further possibility of instrument sterilization and reduced risk of cross-contamination. Keywords: debris removal, nanostructured foam, ProFile File cleaner, rotary nickel-titanium instrument, scanning electron microscope

Objective: To use finite element analysis to investigate the influence of insertion torque on the stress distribution around an immediately placed oral implant. Method and Materials: Finite element software was used to model a mandibular molar extraction socket. The properties of surrounding cancellous bone and thickness of cortical bone were modified to give four 3D finite element models (I, II, III, and IV). A wide-diameter tapered oral implant was modeled and inserted into the socket. Final insertion torques of 32, 50, and 70 Ncm were applied, and the stress profile in each model was evaluated. The maximum von Mises stresses along the buccal cortical bone adjacent to the implant neck were statistically analyzed to compare the three torque values and four bone models. Results: At the level of the cortical bone, the greatest von Mises stress levels were generated in model IV and diminished as the bone quality increased. Significant increase in stress values at the crestal bone level was observed in all models after using 70 Ncm compared with 32 Ncm. The maximum von Mises stresses at the cancellous bone were higher in model I and reduced with lower level of bone quality (model IV). Conclusion: The use of 70 Ncm or more insertion torque during placement of an immediately placed wide-diameter implant substantially increases stresses on the crestal bone. The development of a modified surgical protocol involving moderate insertion torque value (32 to 50 Ncm) may contribute to minimizing the risk of early implant failure in extraction sockets. Keywords: compression necrosis, finite element method, immediate placement, insertion torque wide-diameter implant