Quintessence International, 06/2013

The available options for restoring multiple surface cavities are: amalgam, composite resin, or indirect restorations. Adhesive system and intradentinal pin-retained composite resin restorations should have a similar performance to pin-retained amalgam, regarding resistance to support occlusal forces. Polymerization shrinkage is a major concern when performing direct posterior composite resin restorations and the incremental insertion technique can provide less stress and outstanding margin behavior. Intradentinal pins can potentially enhance composite resin's retention, while reducing gaps caused by polymerization shrinkage. This article reports a clinical case involving an extensive restoration on a posterior tooth with cusp loss that was successfully treated using an intradentinal pin and direct nano-hybrid composite resin restoration. Schlagwörter: composite resins, dental restoration, dental pins

Objective: To evaluate the efficacy of systemic lycopene along with routine scaling and root planing in terms of changes in clinical parameters and levels of circulating tumor necrosis factor alpha (TNF-α), salivary interleukin 1beta (IL-1ß), and uric acid in chronic periodontitis. Method and Materials: Forty-two systemically healthy subjects with chronic periodontitis were included in a randomized, placebo-controlled, parallel design, double-blinded trial. The subjects were randomly distributed between the two treatment groups: test group (n = 21) 8 mg lycopene/day and placebo group (n = 21) along with adjunctive scaling and root planing. Patients were monitored at baseline and at 2 months after therapy. Periodontal parameters regarding plaque index (PI), modified gingival index (MGI), bleeding on probing (BOP), clinical attachment level (CAL) gain, and probing pocket depth (PPD) reduction were evaluated and peripheral blood samples and whole saliva were obtained at these points of time to measure the levels of IL-1ß, TNF-α, and uric acid using commercially available kits. Results: Test group (Lycopene) showed better results after therapy compared to the placebo group with reference to PI (P = .004), MGI (P =.002), BOP (P = .021), salivary IL-1ß (P = .05), and uric acid levels (P = .02). The CAL gain, PPD reduction and serum TNF-α value were not statistically significant but showed an improvement compared to the placebo group. Conclusion: Further longitudinal studies are required to establish the role of lycopene in the management of chronic periodontitis. Schlagwörter: antioxidants, clinical trial, chronic periodontitis, lycopene

Objective: The objective of this study was to quantify the potential effects of screw- and cement-retention on strain development of implant-supported fixed dental prostheses (FDPs). Method and Materials: A total of 20 single crowns and 70 three-unit FDPs were fabricated to fit an in vitro model situation with two implants. Using strain gauges attached to the model material adjacent to the implants, strain development of the restorations during fixation was recorded while the parameters cement type (provisional and definitive cement), cementation force (10 N and 100 N), and tightening torque (5 Ncm, 10 Ncm, and 15 Ncm) were varied. MANOVA with Pillai's trace was used for pairwise comparisons between groups (α = .05). Results: Mean absolute strain development ranged from 5.11 µm/m for to 27.26 µm/m for single crowns and from 16.46 µm/m to 689.04 µm/m for multi-unit restorations. Screw-retained single crowns exhibited significantly smaller strain development as compared to cement-retained single crowns (P = .009). The type of cement used seemed to have no effect on strain development of an FDP regardless of the cementation force applied (P = .064 and P = .605). An increase in tightening torque for screw-retained FDPs also had no effect on resulting strain development (P values ranging from .692 to .807). Nonuniform results were found when comparing screw- and cementretention as the retention mechanism for FDPs. Conclusion: Strain development seems to depend predominantly on the accuracy achieved during the fabrication process whereas the retention mechanisms themselves as well as their potential parameters only have a minor effect. Schlagwörter: cement-retention, implant-supported dental prosthesis, passive fit, screw-retention, stress development

Objective: To perform a literature review on the clinical and/or laboratory performance of the use of calcium hydroxide in deep cavities of primary teeth. Method and Materials: Literature in professional journals and summaries of BBO, LILACS, and MEDLINE databases (2000 to 2010) linked to the Virtual Health Library and PUBMED were searched. The search strategies used included the following descriptors: "dental caries" and "dental cavity lining" and "primary tooth", "dental cavity lining" and "primary tooth" and "calcium hydroxide", "dental caries" and "dental cavity lining" and "primary tooth" and "calcium hydroxide". The abstracts were selected according to the following inclusion criteria: published between 2000 and 2010, English language, trial and/or laboratory studies or literature review, regarding the use of calcium hydroxide in deep cavities of primary teeth. The abstracts analysis was performed by two reviewers separately. Potentially relevant studies available in full were analyzed based on criteria for quality assessment and displayed on an evidence-based table. Results: After reading the abstracts (N = 39), six were selected as a basis for developing the study. Conclusion: Analysis suggests that calcium hydroxide is an interesting alternative in the control of caries lesions of primary teeth with the possibility of significantly increasing the success of indirect pulp capping; however, it should not be considered a determining factor in the success of a restorative procedure. Schlagwörter: calcium hydroxide, dental cavity lining, dental caries, primary tooth

Odontomas, the most common odontogenic tumors, occur more frequently in the maxilla and are rarely larger than a tooth. They are usually found incidentally on routine dental radiographs during the second decade of life. The treatment of choice is surgical removal, and large tumors are challenging as damage may occur to surrounding anatomic structures. In this article we describe a "giant" compound odontoma occupying the entire body of the mandible and ramus in a 7-year-old girl. A conservative intraoral enucleation was used to avoid facial scarring and preserve mandibular continuity and function. The huge bony defect healed completely without a bone graft or further intervention. This case report emphasizes the importance of the early diagnosis of these lesions and a conservative surgical approach as well as the extraordinary healing potential of young patients. Schlagwörter: compound odontoma, intraoral enucleation, odontogenic tumor, odontoma

Objective: The purpose of this case report is to introduce a minimally invasive microsurgical technique for the treatment of the necrotic, immature apex tooth in adult patients and to provide treatment recommendations. Method and Materials: A 43-year-old male patient was diagnosed with chronic apical periodontitis associated with a necrotic, immature apex of the maxillary central incisor. A minimally invasive microsurgical approach was applied for the treatment of the periapical disease. The crown of the immature apex tooth was left intact. Results: The 1-year follow-up radiograph revealed uneventful healing of the periradicular lesion while soft tissue healing was optimal. Conclusion: The minimally invasive microsurgical technique may provide a viable solution for the survival of challenging necrotic, immature apex tooth cases in adults. Proper case selection is mandatory for the success of this technique. Schlagwörter: immature apex, microsurgery, minimally invasive

Arrested pneumatization of the sphenoid sinus is a normal anatomic variant which may be mistaken for pathology. Suspected cases of arrested pneumatization of the sphenoid sinus on cone beam CT and multidetector CT scans are presented. Pertinent imaging findings and differential diagnosis are discussed. Schlagwörter: arrested pneumatization, cone beam computed tomography, sphenoid sinus

Objective: This randomized, single-controlled study was performed to validate in vivo the efficacy of single Fluorinex treatment by examining fluoride incorporation into enamel using electron microscopy. Method and Materials: Twenty healthy participants referred for routine dental treatment which also required extractions of at least two teeth as part of their treatment plan were included in this study. For each participant, one randomly selected tooth was extracted and sent for blind electron microscopic fluoride assay (control, C). Next, following a single Fluorinex treatment, the second (test, T) tooth was extracted and sent for the same assay. Intra-individual and intergroup fluoride content comparisons were performed, between control and test teeth. Results: Highly significant intra-individual and intergroup differences were found between the treated and untreated teeth. Fluoride atomic percent (at%) and weight percent (wt%) estimated least squares means of untreated group were found to be 0.56 and 0.48, and in the treated group 17.35 and 14.35. This increase in fluoride at% [16.78 ± 2.3 (SE)], was also significant statistically (P < .0001); likewise, the increase in fluoride wt % [13.86 ± 1.97 (SE)] was similarly significant (P < .0001). The system was well tolerated by the participants with minimal transitional mild side effects. Conclusion: In vivo fluoride application using the active Fluorinex system resulted in a significant increase of fluoride content in the enamel of adult permanent teeth compared to untreated internal controls. Schlagwörter: caries prevention, fluoride, Fluorinex, fluoritray, third molars, topical fluoridation

Objective: Differentiated macrophages (MØ) are the resident tissue phagocytes and sentinel cells of the innate immune response. These cells are major constituents of periapical granulomas. Current studies indicate these activated cells as the source of bone-resorbing cytokines in the periapical granuloma. Periapical inflammation can be mediated by proinflammatory cytokines like interleukin 1ß (IL-1ß), tumor necrosis factor α (TNF-α), IL-6, and IL-8. Reducing the production of these cytokines may be beneficial for the treatment of periapical lesions. Oils rich in omega-3 fatty acids like docosahexaenoic acid (DHA) have been linked with anti-resorptive and bone-protective effects. The purpose of this investigation was to study the effect of DHA on the expression of these cytokines by normal and lipopolysaccharide (LPS)-treated MØ. We hypothesized that pretreatment of MØ with DHA decreases the expression of pro-inflammatory cytokines induced by LPS-treated MØ. Method and Materials: THP-1 monocytes were cultured and differentiated into MØ. DHA was added to MØ in a dose-dependent manner. MØ samples were added to the following groups: Group 1, ethanol alone as a solvent control; Group 2, 10 µg/ml of DHA (D1); Group 3, 20 µg/ml of DHA (D2); Group 4, 10 µg/ml of DHA + LPS (DL1); Group 5, 20 µg/ml of DHA + LPS (DL2); Group 6, LPS alone. Reverse transcriptase-PCR (RT-PCR) followed by ImageJ analysis was used to measure cytokine expression. Results: The results show that IL-1ß and TNF-α levels for DL and DHA (basal) were significantly lower than the levels in LPS alone. IL-6 was increased in the DL groups. There was no significant change for IL-8. Conclusion: DHA at higher concentrations may selectively decrease proinflammatory cytokine production of IL-1ß and TNF-α. More studies are needed to verify the anti-inflammatory therapeutic action of agents like DHA omega-3 fatty acids. Schlagwörter: cytokines, docosahexaenoic acid, endodontics, IL-1ß, IL-6, IL-8, inflammation, root canal, TNF-α

Objective: To investigate the effect of surface treatments on the surface properties of yttria-stabilized zirconia ceramics (Y-TZP) and the interfacial bond strength to self-adhesive resin cements. Method and Materials: Two types of Y-TZP (Vita In-Ceram YZ [VZ] and IPS e.max ZirCAD [IZ]) were used. The specimens were divided into four groups in each test according to the surface treatment used: Group A (control; no treatment), Group B (airborne-particle abrasion), Group C (CH2Cl2 for 60 minutes), and Group D (hot etching for 60 minutes). Scanning electron microscopy, atomic force microscopy, and X-ray diffractometry were carried out. Two types of self-adhesive resin cements (i CEM [IC] and Multilink Speed [MS]) were used for testing the adhesion. The G-value (J/m2) was measured with a four-point bending configuration. Following fracture testing, specimens were examined with a stereomicroscope. Data were analyzed using ANOVA and Tukey test. Results: IZ treated with hot etching showed the highest average surface roughness values (172.5 ± 15.43 nm) compared with the other groups (P < .05). The greatest amount of monoclinic phase was measured after airborne-particle abrasion for VZ (8.9%), followed by IZ (6.1%). Improvements in bond strength values were found in the following order: hot etching > CH2Cl2 > airborne-particle abrasion > no treatment. Most failure modes were adhesive type of failures between ceramics and cement material (68.76%). Conclusion: Adhesion between Y-TZP and self-adhesive resin cements can be improved by the use of CH2Cl2 or hot etching surface treatments prior to resin cement application as an alternative technique to airborne-particle abrasion treatment. Schlagwörter: adhesion, atomic force microscopy, self-adhesive resin cement, surface treatments, X-ray diffractometry, Y-TZP ceramic