Quintessence International, 02/2012

A new approach to fill tunnel preparations with composites of two different consistencies is presented. Removal of caries through a narrow access space and reliably filling this cavity are the two main problems with tunnel-prepared teeth. Caries removal can be supplemented by the use of hand instruments, especially curettes, but filling the lesion with composite of a single consistency is problematic. Flowable composite alone does not create enough pressure to place the filling material into shallow extensions of the lesion; packable composite does not flow well enough. A solution for this problem may be a dual-consistency technique: flowable composite is placed, followed by packable composite, with no light curing in between. The flowable composite is pressed into small details of the cavity by the pressure created by the packable composite. Keywords: dual-consistency technique, flowable composite, packable composite, Opallis, Syntac, tunnel preparation

We describe the management of BRONJ triggered by dental implants in a patient on oral bisphosphonates. The sequestrum in the body of the mandible was large and involved the inferior alveolar nerve, causing a painful neuropathy. A successful outcome was obtained by combining conservative and surgical interventions. Keywords: dental implants, neuropathic pain, osteoporosis

Objective: Due to global migration, clinicians often see patients with different ethnic backgrounds. Planning esthetic prosthodontic treatment for patients with different ethnicities can be a challenge. The aim of this study is to analyze the smile features of Chinese individuals. Method and Materials: Sixty-two Han-Chinese subjects with a mean age of 28.5 years were enrolled and photographed. Standardized digital photographs were made to measure the height of displayed maxillary gingivae, papillae, and teeth during an enjoyment smile. The data were then compared with the data acquired from Caucasians in a previous study. Statistical analysis was performed using the Mann-Whitney test and two-factorial nonparametric analysis. Results: The mean display of the central incisors was 10 mm, with no significant difference between sexes (P = .74). The mean amount of display of the molars and premolars was significantly lower in Chinese (P .001) than in Caucasians. The mean displayed gingiva in all subjects (n = 62) was 1.3 mm (0 to 8 mm). There was no significant difference between sexes (P > .05), but there was a significantly lower display of gingiva at the molars in Chinese (P .001). Of all the subjects, 16.1% (n = 10) displayed gingivae from the central incisor to the first molar with a mean gingival height of 2.8 mm. The subjects showed a mean papilla height of 3.4 mm (0 to 11.6 mm) with no significant difference between sexes (P > .05). Again, a significantly lower display of papilla at the molar (P .001) was found in Chinese. Of all subjects, 43.5% (n = 27) of all subjects showed papilla from the central incisor to the first molar. The mean papilla height of these subjects was 3.9 mm. All subjects displayed at least one papilla. Conclusion: The results indicate that pink esthetics is a prime factor for both Chinese men and women in the esthetic restoration from the central incisors to the premolars. Keywords: denture, esthetics, lip dynamic, smile

Objective: Neutrophils play a critical role in the innate immune response. There are no studies that have correlated the neutrophils in plaque, saliva, and gingival crevicular fluid (GCF) to probing pocket depth (PPD) and to each other in periodontally healthy and diseased subjects. The aim of the present investigation was to assess and correlate the neutrophil levels in dental plaque, saliva, and GCF in periodontally healthy and diseased subjects. Method and Materials: Forty-five subjects were recruited. They were divided into three groups based on the Gingival Index (GI) and the Russell Periodontal Index (PI) as clinically healthy (group 1), gingivitis (group 2), and chronic generalized periodontitis (group 3). Saliva and GCF samples were collected using a Durapore filter, and plaque samples were collected using an area-specific subgingival curette. Neutrophils were counted using an improved Neubauer chamber. Results: Neutrophils were present in the plaque, saliva, and GCF of all three samples. There was a statistically significant difference between the neutrophil numbers in all the samples with respect to the severity of periodontal disease. The strength of association was the strongest between PPD and plaque neutrophils. Conclusion: The neutrophils in dental plaque samples correlated positively with PPD in periodontally healthy and diseased subjects. Keywords: dental plaque, gingival crevicular fluid, Millipore filter, neutrophils, saliva

Objective: To reassess the accuracy of three impression techniques relative to the passive fit of the prosthesis. Method and Materials: An edentulous maxillary cast was fabricated in epoxy resin with four dental implants embedded and secured with heat-cured acrylic resin. Three techniques were tested: closed tray, open tray nonsplinted, and open tray splinted. One light-cured custom acrylic tray was fabricated for each impression technique, and transfer copings were attached to the implants. Fifteen impressions for each technique were prepared with medium-bodied consistency polyether. Subsequently, the impressions were poured in type IV die stone. The distances between the implants were measured using a digital micrometer. The statistical analysis of the data was performed with ANOVA and a one-sample t test at a 95% confidence interval. Results: The lowest mean difference in dimensional accuracy was found within the direct (open tray) splinted technique. Also, the one-sample t test showed that the direct splinted technique has the least statistical significant difference from direct nonsplinted and indirect (closed tray) techniques. All discrepancies were less than 100 µm. Conclusion: Within the limitations of this study, the best accuracy of the definitive prosthesis was achieved when the impression copings were splinted with autopolymerized acrylic resin, sectioned, and rejoined. However, the errors associated with all of these techniques were less than 100 µm, and based on the current definitions of passive fit, they all would be clinically acceptable. Keywords: dental implants, impression techniques, passive fit

The aim of this study was to evaluate the clinical and esthetic outcomes of 10 consecutive single-tooth implant restorations in the anterior maxilla. A specific treatment protocol consisting of (1) atraumatic extraction of the failing tooth, (2) placement of an SLActive bone-level implant with simultaneous guided bone regeneration at 6 to 8 weeks postextraction, (3) loading of a provisional restoration at 2 to 3 months following implant placement, (4) production of a customized impression coping, and (5) loading of the definitive all-ceramic abutment and crown 6 months after delivery of the provisional restoration was utilized in all cases. The outcomes were assessed 1 year after loading of the definitive restoration using standard clinical parameters: pink (PES) and white esthetic scores (WES). All implants were successfully integrated, accounting for a 100% survival and success rate. Besides clinical success, the application of the specific treatment protocol may be able to provide esthetically pleasing single-tooth implant restorations in the anterior maxilla, as was demonstrated by the results for PES (7.9 ± 1.7) and WES (7.0 ± 1.5). Keywords: dental implants, esthetics, general dental practitioner

Objective: To describe a case series of intraoral granular cell tumors in terms of clinical, histologic, and immunohistochemical features. Method and Materials: Nine cases of intraoral granular cell tumors were described in terms of clinical features (patient sex and age, anatomical location, size, type, time to clinical progression, and lesion treatment), histologic features (necrosis, spindling, vesicular nuclei with large nucleoli, increased mitotic activity, high nuclear to cytoplasmic ratio, and pleomorphism) and immunohistochemical features using S-100, CD68, neurofilament protein, desmin, and galectin-1. Results: Studied patients were mostly women with a mean age of 32 years. Lesions arose as solitary nodules on the tongue, with size ranging from 0.1 to 3.0 cm. Mean time to evolution was 21.83 months. All cases were treated by surgical excision. Two cases were classified as atypical and seven as benign. All cases presented immunoreactivity for S-100, CD68, and galectin-1, and there was no reactivity for desmin and neurofilament protein. Conclusion: General practitioners should consider granular cell tumors during the differential diagnosis of nodular lesions on the tongue. Results suggest that histologic criteria may be used to distinguish between benign and atypical intraoral granular cell tumors. Finally, analysis of the clinical profile and the use of immunohistochemical markers may facilitate diagnosis and clarify the histogenesis of these lesions. Keywords: Abrikossoff tumor, granular cell tumor, histopathology, immunohistochemistry

Maxillary antrolithiasis is characterized by masses of tissue of endogenous or exogenous origin that calcify within the maxillary sinuses. Aspergillosis is a fungal disease in which the maxillary sinus is a primary site of infection. Aspergillosis mycetoma, its noninvasive form, is the most prevalent modality of the disease in the maxillary sinuses. In approximately half of the cases reported in the literature, calcification of the fungal mycelia, which later became antroliths, was verified. This article reports a rare case of the accidental discovery of a maxillary antrolith associated with noninvasive aspergillosis in an immunocompetent and asymptomatic 56-year-old woman. The diagnosis and therapeutic procedures used in treating the patient are discussed as well as the probable iatrogenic origin of the fungal pathology. Keywords: aspergillosis, Aspergillus fumigatus, maxillary diseases, maxillary sinus

Objective: To evaluate the periodontal status of patients with oral lichen planus and compare it with that of healthy controls. The association between periodontal condition and the extent of disease in oral lichen planus patients was also examined. Method and Materials: A descriptive clinical study was made of the periodontal condition of 80 consecutive patients with clinically and histologically diagnosed oral lichen planus and 40 healthy controls. Measurements were made of the Gingival Index, Plaque Index, and Community Periodontal Index of Treatment Needs (CPITN). Results: Mean CPITN scores were significantly higher in oral lichen planus patients (2.8 ± 0.7) than in the healthy controls (1.1 ± 0.8) (P .001).The patients with oral lichen planus showed no statistically significant difference in CPITN scores according to the extent of the lesions or their clinical form of presentation. Conclusion: The periodontal condition of the oral lichen planus patients was significantly worse than in the control group. Keywords: desquamative gingivitis, group control, oral lichen planus, periodontal status

Objective: To evaluate the influence of air pressure, water flow rate, and pulse frequency on the removal speed of enamel and dentin as well as on their surface morphology. Method and Materials: Twenty-four bovine incisors were horizontally cut in slices. Each sample was mounted on an experimental assembly, allowing precise orientation. Eighteen cavities were prepared, nine in enamel and nine in dentin. Specific parameters for frequency, water flow rate, and air pressure were applied for each experimental group. Three groups were randomly formed according to the air pressure settings. Cavity depth was measured using a digital micrometer gauge, and surface morphology was checked by means of scanning electron microscopy. Data was analyzed with ANOVA and Duncan post hoc test. Results: Irradiation at 25 Hz for enamel and 30 Hz for dentin provided the best ablation rates within this study, but efficiency decreased if the frequency was raised further. Greater tissue ablation was found with water flow rate set to low and dropped with higher values. Air pressure was found to have an interaction with the other settings, since ablation rates varied with different air pressure values. Conclusion: Fine-tuning of all parameters to get a good ablation rate with minimum surface damage seems to be key in achieving optimal efficiency for cavity preparation with an Er:YAG laser. Keywords: air pressure, efficiency, Er:YAG laser, morphology, water spray

Objective: To investigate the effect of filler content on microtensile bond strength (µ-TBS) in Class I cavities. Method and Materials: Experimental composites with filler contents of 80%, 76%, 70%, 60%, and 50% by weight were used. Polymerization shrinkage was measured with Acuvol, and a three-point flexural test was performed to determine flexural properties. For evaluation of µ-TBS, 25 extracted human molars were randomly divided into five groups and Class I cavities were prepared. After filling with one of the experimental composites and curing for 40 seconds, teeth were serially sectioned perpendicular to the cavity floor. Stick-shaped samples were tested with a microtensile tester. Statistical analysis was conducted using ANOVA and Pearson correlation tests. Results: Significant correlations were found between filler content and polymerization shrinkage (r = -0.973, P .05) and the filler content and Young modulus (r = 0.891, P .05). Different filler contents in the experimental composites had no significant effect on µ-TBS or flexural strength. Conclusion: In a Class I cavity model, this in vitro study showed that the filler content did not influence the flexural strength of experimental composite resins and had no effect on the microtensile bond strength between composite resin and dentin. Keywords: composite resins, filler content, flexural modulus, flowable composites, microtensile bond strength, polymerization shrinkage

Objective: To define and compare the microbiologic profile of subgingival plaque in German patients with periodontitis (including aggressive and advanced chronic periodontitis) and healthy subjects and to determine significant association between isolates and clinical status. Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, and Tannerella forsythia are major periodontal pathogens, though it is recognized that other species may also contribute to the pathogenesis of periodontal disease. Method and Materials: Thirty-three patients with clinical and radiologic proof of aggressive and advanced chronic periodontitis and 20 healthy subjects were enrolled in this study. Clinical indices were recorded as six-point measurements on each tooth. Samples of the subgingival plaque were taken with paper points from four teeth of each individual. The samples were divided into two parts. One part was immediately cultivated, while the other one was stored at -20°C until analyzed by real-time polymerase chain reaction. Results: A total of 284 anaerobic isolates (224 isolates from patients and 60 isolates from healthy controls) were identified. Forty different anaerobic species were isolated, with a mean of 6.78 species per patient and 3 species per healthy control subject. Significant differences in prevalence (after adjusting for multiple comparisons, P .001) were found for Prevotella intermedia/nigrescens, Fusobacterium nucleatum, T forsythia, Treponema denticola, and Veillonella parvula. The first four species were associated with the aggressive periodontitis group and V parvula with healthy subjects. Conclusion: When compared with healthy controls, the microbial profile of subgingival plaque from periodontitis was found to contain known periodontal pathogens with a different prevalence to that described in earlier studies. P intermedia/nigrescens, F nucleatum, T forsythia, and T denticola have been found in lower proportions and small quantities in healthy subjects. Keywords: periodontal pathogens, periodontitis, subgingival plaque