Quintessence International, 02/2005

A predictable esthetic restoration is not limited to the restored teeth; it has to include the gingival unit and its interface with the teeth involved. Failure to deliver restorations that maintain gingival health jeopardizes the success of any restorative procedure and creates potential for periodontal problems. Perforations, fractures, root resorption, or caries in the cervical area of the tooth, especially in the anterior part of the mouth, present many challenges to the clinician. Failure to place the crown margins on sound tooth material may violate the biologic width and should be considered a restorative failure. Orthodontic root extrusion or forced eruption is a well-documented clinical method for altering the relation between a nonrestorable tooth and its attachment apparatus, elevating sound tooth material from within the alveolar socket. It has some advantages over surgical crown lengthening, which is less conservative considering the sacrifice of supporting bone and the negative change in the length of the clinical crowns of both the tooth and its neighbors. This article presents a case of a maxillary right lateral incisor, extensively broken down following trauma, treated with orthodontic extrusion combined with gingival fiberotomy, without a need for a corrective surgical procedure. Keywords: biologic width, crown-lengthening procedure, ferrule effect, forced eruption, gingival fiberotomy, orthodontic root extrusion, sound tooth material, traumatic root fracture

Objectives: This study evaluated the ability of a new polyvinyl siloxane impression material (Affinis, Coltène/Whaledent, material A) to obtain final impressions free of bubbles and voids for indirect fixed cuspal-coverage restorations. The results were compared to a control polyvinyl siloxane impression material (material B). Both materials were handled by inexperienced clinicians (undergraduate dental students) in student clinics. Method and Materials: One-hundred and thirty patients who were treated in the Louisiana State University School of Dentistry Junior Student Clinic for indirect fixed cuspal-coverage restorations and who met the inclusion criteria were randomly assigned to either one of two treatment groups, group A (n = 65) or group B (n = 65). Two calibrated examiners evaluated the first impression of prepared posterior teeth at a magnification of 10 for acceptability (no voids or bubbles). Position of tooth, type of preparation, preparation finish line (Class I-V), and gingival bleeding scores were recorded. All statistical tests were performed with the level of significance set at .05. Results: The Fisher-Freeman-Halton test did not reveal significant associations between material and gingival bleeding score (P = .492). Significant differences in the location of the preparation finish line between materials were observed (P = .0096); material A was more frequently used in cases where the preparation finish line was located at least 2 mm subgingivally. Logistic regression was used to assess the effect of the material on the success of the impression (acceptable/ unacceptable). Material was highly significant in the logistic model (P .001) with an odds in favor of an acceptable impression being eight times higher with material A than with material B (odds ratio = 8.00; 95% confidence index for odds ration: 2.832, 22.601). The 60/65 (92.3%) impressions made with material A and 39/65 (60%) impressions made with material B were rated "acceptable." Conclusion: The new polyvinyl siloxane impression material provided a significantly higher proportion of impressions free of bubbles and voids than the control polyvinyl siloxane material. Keywords: accuracy, final impression, fixed restoration, impression material, randomized clinical trial

Objective: The purpose of this study was to evaluate the clinical performance of Procera AllCeram crowns placed over a 5-year period at three different private dental practices. Method and materials: Two hundred five Procera AllCeram crowns (50 anterior and 155 posterior) were evaluated in a prospective study from a minimum of 6 months to a maximum of 60 months, with a mean of 23.52 months. Results: A restoration was considered to be a failure when it impaired esthetic quality or function, thus necessitating remake of the crown. The survival rate was determined with the use of the Kaplan-Meier survival rate, which gave an overall survival rate of 96.7% (100% for the anterior crowns and 95.15% for the posterior crowns). Conclusion: The Procera AllCeram system seems to have a good prognosis for the posterior teeth and an excellent one for the anterior teeth. Keywords: all-ceramic crown, fracture resistance, longevity, Procera crown, randomized clinical study, survival rate

The heart pumps blood through a system of blood vessels under the control of an electric conduction system to deliver oxygen to all cells of the body. When the blood volume becomes greater than the limited volume capacity of the vascular system, the patient develops hypertension. When the myocardium does not get enough oxygen because of coronary artery disease, the patient will experience angina pectoris. If oxygen deprivation to the myocardium persists, the patient may develop myocardial infarction. When the conduction system malfunctions, arrhythmias occur and the heart is unable to pump blood through the vascular system at a regular rate and rhythm. When the heart is no longer able to pump enough blood to meet the metabolic demands of the body for oxygen, the patient is said to have developed heart failure. In addition, many of the above conditions can lead to thromboembolic complications. These cardiovascular diseases are the leading cause of death in the United States and most other Western countries. In the United States alone, more than 1 million annual deaths and as many as three times that number of serious consequences can be attributed to these conditions. To provide care to patients with cardiovascular disease, oral health care providers must understand the disease, its treatment, and its impact on the patient's ability to undergo and respond to dental care. Keywords: cardiac arrhythmia, cardiovascular disease, coronary artery disease, dental treatment, heart failure, hypertension, medical management, thromboembolic disorders

Objectives: All-ceramic resin-bonded fixed partial dentures (RBFPDs) were introduced as a conservative treatment approach 15 years ago. The purpose of this prospective study was to evaluate the long-term clinical survival of RBFPDs made with a conventional tworetainer design or a cantilever single-retainer design. Method and materials: A total of 37 anterior RBFPDs were made from the glass-infiltrated alumina ceramic In-Ceram. Sixteen RBFPDs with a conventional two-retainer design were inserted in 14 patients, and 21 RBFPDs with a cantilever single-retainer design were inserted in 16 patients. Panavia or Panavia 21 were used as luting agents either after silica-coating and silanation or after airabrasion only. Patients were recalled every year for a clinical examination to evaluate the restorations with regard to function and possible failures. The mean observation time in the two-retainer group was 75.8 months, and in the single-retainer group it was 51.7 months. Results: No restoration debonded. In the two-retainer group, one restoration was lost because it fractured after 3 months at both connectors and one restoration was removed alio loco accidentally. Also in this group, four RBFPDs fractured within 15 months after insertion at one connector, but the pontic remained in situ as a cantilever RBFPD for several years. In the single-retainer group, only one FPD fractured and was lost 48 months after insertion. The 5-year survival rate was 73.9% in the two-retainer group and 92.3% in the single-retainer group. When unilateral fracture of a FPD was taken as criterion for failure, the five-year survival rate decreased to 67.3% in the two-retainer group. Conclusions: Cantilever all-ceramic resin-bonded fixed partial dentures made from highstrength oxide ceramics present a promising treatment alternative to two-retainer RBFPDs in the anterior region. Keywords: adhesive, all-ceramic restoration, alumina ceramic, cantilever fixed partial denture, ceramic bonding, ceramic fracture, resin-bonded fixed partial denture, success rate

Actinomycosis has increasingly been recognized as a cause of persistent or recurrent periapical disease associated with endodontically treated teeth. This case report shows the classic clinical picture of periapical actinomycosis: persistent periapical disease with recurrent sinus tracts. Although there was no pain or swelling after clinically acceptable initial endodontic treatment, a periapical lesion developed. After retreatment, the periapical lesion persisted, and a sinus tract developed. The sinus tract healed with antibiotic therapy but recurred within a few months. This cycle of sinus tract to antibiotic therapy to recurrence of the sinus tract repeated several times over a period of 5 years. Upon biopsy, periapical actinomycosis was diagnosed, where classic "sulfur granules" were demonstrated in the histologic examination of the periapical lesion. Antibiotic therapy for a period of 6 weeks was prescribed subsequent to the histologic diagnosis because of the possibility of spread of the actinomycotic infection into the maxillary sinus. Considerable healing was evident within 5 months of surgical and antibiotic treatment. Keywords: antibiotic therapy, endodontic retreatment, endodontic treatment, periapical actinomycosis, periapical healing, periapical surgery