Quintessence International, 10/2013

There has been an increase in the incidence of tooth structures altered through abrasion and erosion. Such patients need to be offered adequate treatment. This case report shows that consistent treatment planning leads to functional and esthetic rehabilitation, even in cases with severe tooth wear. Keywords: abrasion, attrition, erosion, esthetics, treatment planning, vertical relation

Objective: The aim of this study was to evaluate bovine enamel wear opposed to four different ceramic substrates (CEREC) in the glazed and polished conditions. Method and Materials: Sixty-three ceramic (IPS Empress CAD, Paradigm C, Vitablocs Mark II) and fourteen composite resin (MZ100) styli were prepared. Ceramics were subdivided into three surface conditions (n = 7), unpolished, polished, and glazed, and the composite resin (n = 7) into unpolished and polished. All styli were used as wear antagonists opposing bovine enamel blocks (8 mm × 9 mm) in an oral wear simulator. Wear tests were conducted at 30 N abrasion and 70 N attrition forces applied at 1.7 Hz for 5,000 simulated mastication cycles. Abrasion and attrition wear were evaluated using an automatic profilometer. Statistical analyses were conducted using Tukey's B rank order test, P = .05. Results: For bovine enamel opposing glazed Vitablocs, abrasion and attrition wear showed a volume loss significantly higher than bovine enamel opposing polished Vitablocs (P < .05). For attrition wear, bovine enamel opposing glazed Vitablocs and untreated Paradigm C showed a volume loss higher than bovine enamel opposing the other ceramic conditions. Conclusion: Abrasion and attrition wear of bovine enamel opposing antagonist ceramic was affected according to the ceramic surface condition and the ceramic material. Antagonistic wear against the studied ceramic materials and conditions exhibited wear rates within the range of normal enamel. In addition, the glaze layer presented as a protection, exhibiting fewer cracks and less loss of material on the ceramic surface. Keywords: abrasion wear, attrition wear, bovine enamel, ceramic antagonist, composite resin antagonist

Objectives: The aim of this prospective, randomized, controlled clinical study was to compare the clinical outcomes of the subgingival treatment with erythritol powder by means of an air-polishing (EPAP) device and of scaling and root planing (SRP) during supportive periodontal therapy (SPT). Method and Materials: 40 patients enrolled in SPT were randomly assigned to two groups of equal size. Sites had to show signs of inflammation (bleeding on probing [BOP]-positive) and a probing pocket depth (PPD) of ≥ 4 mm, however, without presence of detectable subgingival calculus. During SPT, these sites were treated with EPAP or SRP, respectively. Full mouth and site-specific plaque indices, BOP, PPD, and clinical attachment level (CAL) were recorded at baseline (BL) and at 3 months, whereas the percentage of study sites positive for BOP (BOP+) was considered as primary outcome variable. Additionally, patient comfort using a visual analog scale (VAS) and the time needed to treat per site was evaluated. Results: At 3 months, mean BOP level measured 45.1% at test sites and 50.6% at control sites, respectively, without a statistically significant difference between the groups (P > .05). PPD and CAL slightly improved for both groups with comparable mean values at 3 months. Evaluation of patient tolerance showed statistically significantly better values among patients receiving the test treatment (mean VAS [0-10], 1.51) compared to SRP (mean VAS [0-10], 3.66; P = .0012). The treatment of test sites was set to 5 seconds per site. The treatment of control sites, on the other hand, lasted 85 seconds on average. Conclusion: The new erythritol powder applied with an air-polishing device can be considered a promising modality for repeated instrumentation of residual pockets during SPT. Clinical Relevance: With regard to clinical outcomes during SPT, similar results can be expected irrespective of the two treatment approaches of hand instrumentation or subgingival application of erythritol powder with an air-polishing device in sites where only biofilm removal is required. Keywords: air polishing, biofilm removal, bleeding on probing, erythritol, supportive periodontal therapy

Prosthetic guided implant surgery requires adequate ridge dimensions for proper implant placement. Various surgical procedures can be used to augment deficient alveolar ridges. Studies have examined new bone formation on deficient ridges, utilizing numerous surgical techniques and biomaterials. The goal is to develop time efficient techniques, which have low morbidity. A crucial factor for successful bone grafting procedures is space maintenance. The article discusses space maintenance tenting screws, used in conjunction with bone allografts and resorbable barrier membranes, to ensure uneventful guided bone regeneration (GBR) enabling optimal implant positioning. The technique utilized has been described in the literature to treat severely resorbed alveolar ridges and additionally can be considered in restoring the vertical and horizontal component of deficient extraction sites. Three cases are presented to illustrate the utilization and effectiveness of tenting screw technology in the treatment of atrophic extraction sockets and for deficient ridges. Keywords: alveolar ridge deficiency, augmentation, GBR, site development, tenting screw technology

Objectives: Common complications associated with dental implant surgery are well recognized and are usually explained to patients during the process of informed consent. For the general dental practitioner, the periodontist, and the oral and maxillofacial surgeon, it is relevant to also be familiar with less frequent complications. This review gathers unusual complications of this surgical procedure and presents unique complications from single case reports. Method and Materials: Studies were located using systematic searches in Medline and the Cochrane Library electronic databases. Key words included the terms "implant", "dental", "oral", "complication", "unusual", and "rare". References from the relevant articles were also double-checked. The review was limited to English and German language articles, published within the last 15 years. Results: 17 different unusual complications were identified. The majority of studies report five different complications: permanent nerve injury, damage to teeth adjacent to the implant, excessive bleeding resulting in hematoma of the floor of the mouth, mandibular fracture, and displacement of implants into the maxillary sinus. Benign paroxysmal positional vertigo and a plunging ranula were reported sporadically. Another 10 complications were only described once in our literature search. Conclusion: Unusual complications are challenging. It is important for the dental practitioner to be aware of all the possible complications and to recognize them early so that adequate therapy can immediately be ensured. Keywords: complications, dental implants, rare

Oral metastases from osteosarcoma are rare, particularly in the soft tissues of the oral cavity. The aim of the current case is to present a patient with labial mucosa metastasis from a long bone osteosarcoma and review the literature. A 55-year-old man who had a recent leg amputation because of a giant cell tumor presented a lesion in the lower labial mucosa. After histopathologic and immunohistochemical analysis the diagnosis was of an undifferentiated sarcoma. The patient quickly developed other lesions on the scalp and on the hand, and biopsy of one of these lesions rendered the diagnosis of a giant cell-rich osteosarcoma. Reviewing all information, it was concluded that the leg tumor was the primary giant cell-rich osteosarcoma misdiagnosed as a giant cell tumor. This case emphasizes the importance of the general clinicians' multidisciplinary approach and association of information to arrive at the proper diagnosis, particularly in rare and difficult situations. Keywords: giant cells, labial mucosa, mouth, oral metastasis, osteosarcoma

Objectives: Evaluation of postoperative sensitivity in posterior teeth restored with etchand- rinse adhesive and composite resin after application of 2% chlorhexidine solution. Method and Materials: Thirty participants with similar dental caries on both sides of the jaws were selected. After cavity preparation, each tooth was randomized to one of the following restoration methods. Teeth in the control group were restored using etch-and-rinse resin adhesive (Single Bond, 3M ESPE) and universal microhybrid composite resin (Filtek Z250, 3M ESPE). Restoration of teeth in the experimental group was similar to the control group except that 2% chlorhexidine solution (Concepsis, Ultradent) was applied on the etched dentin for 60 seconds. Subjects were recalled for evaluation of postoperative sensitivity at 1 day, 1 week, 1 month, and 6 months. Data were analyzed by Fisher exact test (α = .05). Results: The experimental group showed significantly less postoperative sensitivity (8 teeth) compared with the control group (20 teeth) at the 1-day recall (P < .05; Fisher exact test). Conventional restorations were comparable to teeth treated with chlorhexidine at other recall times (P > .05). Conclusion: Chlorhexidine significantly decreased immediate postoperative sensitivity of posterior teeth restored by composite resin. Keywords: chlorhexidine, dentin conditioning, posterior composite resin restoration, postoperative sensitivity, randomized clinical trial

Objective: This study evaluated the effects of different post diameter and oversized post spaces on the push-out bond strength of a fiber post to dentin. Method and Materials: Fifty extracted human maxillary central incisors and canines were divided into five groups and submitted to the push-out test (0.5 mm min-1). Groups 1, 2, and 3 were restored using a fiber post size that was identical to the drill size (sizes 1, 2, and 3, respectively), and groups 4 and 5 were both prepared with drill size 3, and restored using the size 2 and 1 fiber post, respectively. The fiber posts were cemented using self-adhesive dual-polymerized resin cement (RelyX Unicem). The data were analyzed using a one-way analysis of variance (ANOVA) and the Tukey test. Results: There were no significant differences in the mean values for push-out bond strength between groups with different post diameters (P > .05). However, the push-out bond strengths were significantly different between groups with different cement thicknesses, and group 4 yielded the highest bond strength (11.7 ± 0.4 MPa). For all groups, the apical third had the lowest bond strength value (P < .05). Conclusion: The highest push-out bond strength values were obtained when one incremental oversized post space was used. Clinically, fiber post space has to provide an optimum cement thickness (around 120 µm) for adequate cementation. Keywords: bond strength, cement thickness, fiber post, push-out, self-adhesive cement