Quintessence International, 06/2018

Objective: The aim of this in-vitro study was to investigate the marginal and internal fit of zirconia copings fabricated by five CAD/CAM (computer-aided design/computer-assisted manufacture) systems. Method and Materials: A typodont mandibular right first molar was prepared according to ideal parameters for a zirconia crown, scanned digitally, and 100 identical resin dies fabricated by 3D printing. Samples were randomly divided into five groups and sent to CAD/CAM systems for zirconia copings (A, Ceramill-Motion 2, Amann Girrbach; B, Weiland, Ivoclar Vivadent; C, Cerec, Ivoclar Vivadent; D, Prettau Zirconia, Zirkonzahn; E, Cad4dent). CAD of the copings included standardized cement space of 30 µm and CAM was carried out. Copings were tried/adjusted on the respective dies and embedded under a standardized load of 20 N in self-curing resin. Samples were sectioned mesiodistally into two halves. Marginal and internal gap values were measured with a digital microscope at 50 to 200 × magnification at nine sites. Results: The lowest and highest mean gap values of 46.93 ± 13.50 and 101.65 ± 35.56 μm were found for Group A and Group D, respectively. ANOVA showed a statistically significant difference between the mean values of all the groups (P = .000). Multiple comparisons with post hoc Tukey test indicated a statistically significant difference (P < .05) between: Group A and all groups except B; B with D; C with A; D with A; and B and E with A. Mean buccal/lingual gap value was found to be 51.54 ± 58.54 μm. Of the nine sites, the least gap resulted at the buccal axial wall and the greatest at the central groove. The overall mean gap recorded for the copings was 72.43 ± 57.56 μm. Conclusion: Marginal and internal adaptations of CAD/CAM zirconia copings is influenced by manufacturing technique, and variations exist for different systems. Measurement sites showed different levels. CAD/CAM systems investigated showed a clinically acceptable level of gap values (< 120 µm). Keywords: CAD/CAM, ceramic crown, dental crown, zirconia, zirconia crown

Gingival recessions have multifactorial etiology and are often associated with non-caries cervical lesions. Different surgical techniques have been proposed over the years for their treatment, according to the severity of the recession. A novel technique, called restoration guided creeping attachment (RGCA), for the treatment of combined gingival recession and non-caries cervical lesion is presented. RGCA aims at treating Miller class I and II recessions using a specifically designed composite restoration and a minimally invasive approach. A clinical case describing the technique and forming the basis for further studies is presented. Although the results obtained are encouraging, a wider number of patients and longer follow-ups are needed to assess the reliability of this technique. Keywords: composite, composite restoration, creeping attachment, gingival recession, non-caries cervical lesion

Objective: This systematic review analyzes existing literature on the clinical efficacy of air polishing devices (APDs), discussing the evidence-based data available for justifying their use as an alternative to conventional periodontal debridement in supportive periodontal therapy. The main objective of the review was to assess whether APD was as equally efficient or superior in obtaining successful treatment outcomes when compared with conventional methods. Data Sources: Following PRISMA guidelines, a systematic literature search of articles in English, up to December 2016, was conducted using PubMed, Cochrane, and Medline. Relevant articles were selected based on specific criteria. Seven studies were selected for the final assessment. One more study was added after a manual search of the literature. Due to considerable heterogeneity in study designs and outcome variables measured, only clinical parameters (probing depth, bleeding on probing, and clinical attachment level) were selected for meta-analysis. Conclusion: The studies selected for this systematic review provide some evidence that APDs as monotherapy could be an alternative to conventional debridement of single- and multi-rooted teeth with no furcation involvement, during supportive periodontal therapy. Comparing clinical and microbiologic outcomes, APDs seem to be as effective as conventional treatments. The primary advantage for the use of APDs in supportive periodontal therapy seems to be their ability to efficiently remove biofilm, without causing damage to the periodontal soft tissues or tooth and root structure. There may also be an advantage regarding patient comfort and time consumed. Keywords: dental air abrasion, dental/instrumentation, erythritol, glycine, periodontal pocket/therapy, sodium bicarbonate

Objective: This in-vivo study was performed to assess the interrater agreement and reliability of ICDAS (visual), transillumination, radiographic, and laser fluorescence proximal caries detection tools in between primary and adjacently erupted permanent molars. Method and Materials: This study was in accordance with Guidelines for Reporting Reliability and Agreement Studies. Two calibrated examiners assessed the nonobvious noncavitated apparently sound 100 interproximal sites using predefined criteria. Interrater agreement was analyzed as proportion of agreement. Interrater reliability assessment was performed using weighted kappa statistics and intraclass correlation coefficient. Results: The maximum interrater agreement was projected with conventional bitewing radiography (97%), and the minimum with DIAGNOdent pen (84%), with significant difference (P < .001) in the proportion of agreement. All methods showed substantial interrater reliability, except fiber-optic transillumination. Maximum interrater reliability was noticed for ICDAS (International Caries Detection and Assessment System) method with a weighted kappa value of 0.80 (96% CI, 0.58 - 0.93) followed by conventional and digital bitewing radiography, with values of 0.74 (95% CI, 0.51 - 0.96) and 0.73 (95% CI, 0.43 - 0.92) respectively. Conclusion: ICDAS and bitewing radiography seem to be the most reliable methods, with a higher proportion of agreement between the examiners compared to the other methods addressed in this study for proximal caries detection. Keywords: caries, diagnosis, interrater agreement, interrater reliability, permanent dentition, primary teeth

Objective: To report the outcome of simultaneous placement of dental implants with maxillary sinus elevation in the presence of antral pseudocysts. Method and Materials: This case series involved 14 patients with 28 implants placed simultaneously with maxillary sinus elevation. The psuedocysts were treated by cystic fluid extraction. Postoperative examinations were performed at 3, 6, and 12 months. Results: All restorations were finished 6 to 9 months after implant placement. Nine antral pseudocysts disappeared and five decreased in size. All implants were deemed successful at 1 year postoperatively, showing osseointegration and masticatory function. No mobility was found during the follow-up period. Conclusion: In the absence of maxillary sinus infection, the combination of cystic fluid extraction, maxillary sinus elevation, and immediate implantation showed an acceptable clinical outcome in this series of patients. Keywords: cyst, dental implant, maxillary sinus, sinus augmentation

Objectives: This systematic review aims to determine the impact of temporomandibular disorder (TMD) therapeutic interventions on patients' oral health related quality of life (OHRQoL) and to recommend approaches that improve QoL. Data Sources: A systematic search of the literature was performed between January 2007 and October 2017 to identify articles on TMD interventions and OHRQoL. Randomized controlled trials, and retrospective and prospective cohort studies that mentioned dedicated tools for measurement of OHRQoL changes in TMD patients after therapeutic interventions were included. Abstracts of studies that did not mention any form of measurement of OHRQoL in their treatment outcome were excluded. The initial screening yielded 171 articles. After evaluation of abstracts and full text articles, five articles fulfilled all selection criteria and were included. Most TMD treatment interventions seem to improve QoL to some extent, but no single treatment modality can be advocated as the sole approach to managing TMD. Conclusion: Psychotherapy, occlusal appliance therapy, arthrocentesis, and orthodontics/orthognathic surgery (in subjects with severe malocclusion) appear to improve OHRQoL of TMD patients. Recommendation on the best TMD intervention for improving QoL could not be made due to the diverse TMD subtypes and non-disease specific OHRQoL instruments employed. More studies incorporating TMD-specific OHRQoL measures and targeting explicit TMD subtypes based on internationally accepted diagnostic criteria are warranted in this area of research. Keywords: craniomandibular disorder (CMD) treatment, oral health related quality of life (OHRQoL), quality of life (QoL), temporomandibular disorder (TMD) therapy, TMD/CMD management

In chronic periodontitis and peri-implantitis, cells of the innate and adaptive immune systems are involved directly in the lesions within the tissues of the patient. Absence of a periodontal ligament around implants does not prevent a biologic process similar to that of periodontitis from affecting osseointegration. Our first focus is on factors in the biology of individuals that are responsible for the susceptibility of such individuals to chronic periodontitis and to peri-implantitis. Genetic factors are of significant importance in susceptibility to these diseases. Genetic factors of the host affect the composition of the oral microbiome in the same manner that they influence other microbiomes, such as those of the intestines and of the lungs. Our second focus is on the central role of stem cells in tissue regeneration, in the functioning of innate and adaptive immune systems, and in metabolism of bone. Epithelial cell rests of Malassez (ERM) are stem cells of epithelial origin that maintain the periodontal ligament as well as the cementum and alveolar bone associated with the ligament. The tissue niche within which ERM are found extends into the supracrestal areas of collagen fiber-containing tissues of the gingivae above the bony alveolar crest. Maintenance and regeneration of all periodontal tissues involves the activity of a variety of stem cells. The success of dental implants indicates that important groups of stem cells in the periodontium are active to enable that biologic success. Successful replantation of avulsed teeth and auto-transplantation of teeth is comparable to placing dental implants, and so must also involve periodontal stem cells. Biology of teeth and biology of implants represents the biology of the various stem cells that inhabit specialized niches within the periodontal tissues. Diverse biologic processes must function together successfully to maintain periodontal health. Osseointegration of dental implants does not involve formation of cementum or collagen fibers inserted into cementum - indicating that some stem cells are not active around dental implants or their niches are not available. Investigation of these similarities and differences between teeth and implants will help to develop a better understanding of the biology and physiologic functioning of the periodontium. Keywords: bone, bone loss, dental implants, gingival health, plaque, stem cells