Quintessence International, 06/2012

Objective: To assess clinical survival and success rates of one-piece implants placed at the time of tooth extraction with immediate provisionalization and to evaluate radiographic peri-implant bone loss around one-piece implants 1 year after functional loading. Method and Materials: Forty-six patients (20 men and 26 women) with a mean age of 45.5 years (range, 24 to 74 years) were recruited from four centers for this case series report. Immediately following the extraction of untreatable teeth, all patients received one-piece implants. The implants were immediately restored and placed into function with no occlusal contact. Outcome assessments included clinical and radiographic evaluations. Results: Of the one-piece implants placed after extraction in the maxilla and mandible, 95.7% integrated successfully. The mean marginal bone loss after 1 year was 0.80 mm (SD, 0.53 mm). Overall peri-implant bone loss at maxillary sites was compared with overall bone loss at mandibular sites. At the 1-year follow-up, no statistically significant difference was found. The deeper the implants were placed below the crest, the more marginal bone loss was observed. However, no difference in marginal bone loss was observed as a consequence of the following three variables: implant length (10, 11.5, or 13 mm), implant diameter (3, 3.7, or 4.7 mm); and 3- and 6-month time periods after implant prosthesis placement. Conclusion: Based on data obtained from this sample size study, it can be concluded that one-piece implants can be successfully placed immediately after extraction with minimal peri-implant bone loss. Palabras clave: bone loss, extraction socket, immediate loading, one-piece dental implant, radiographic evaluation, survival rate

Complex rehabilitations represent a particular challenge for the restorative team, especially if the vertical dimension of occlusion (VDO) needs to be reconstructed or redefined. The use of provisional acrylic or composite materials allows clinicians to evaluate the treatment objective over a certain period of time and therefore generates a high predictability of the definitive rehabilitation in terms of esthetics and function. CAD/CAM technology enables the use of prefabricated polymer materials, which are fabricated under industrial conditions to form a highly homogeneous structure compared with those of direct fabrication. This increases long-term stability, biocompatibility, and resistance to wear. Furthermore, they offer more suitable CAD/CAM processing characteristics and can be used in thinner thicknesses than ceramic restorative materials. Also, based on the improved long-term stability, the transfer into the definitive restoration can be divided into multiple treatment steps. This article presents different clinical cases with minimally invasive indications for CAD/CAM-fabricated temporary restorations for the pretreatment of complex cases. Palabras clave: CAD/CAM manufacturing, complex rehabilitations, esthetic evaluation, functional evaluation, high-density polymers, provisional restorations, vertical dimension of occlusion

Objective: To report the long-term outcome of sinus augmentation with intra- vs extraorally harvested autogenous bone grafts. Method and Materials: Between January 1993 and August 2009, 146 patients (86 women and 60 men) were consecutively treated with sinus elevation procedures. In February 2010, 127 patients were re-evaluated. Bone grafts were harvested from the iliac crest (54 patients, group 1) and from the mandibular symphysis (73 patients, group 2). A total of 179 sinus augmentation procedures were performed (105 in group 1 and 74 in group 2). All patients received fixed prostheses. Results: A total of 456 Frialit II implants were placed in the 127 patients: 244 implants in extraorally harvested bone (group 1) and 212 in intraorally harvested bone (group 2). Patients had a mean bone graft consolidation period of 5.8 months in group 1 and of 5.2 months in group 2. During a minimum 3-month healing phase following implant placement, 35 of 456 implants failed (12.0% of group 1 and 4.5% of group 2) to become integrated in grafted bone. A total of 421 implants proceeded to occlusal loading with a fixed prosthesis. After a mean followup period of 110.2 months (range, 6 to 204 months), 34 implants were lost (25 in group 1 and 9 in group 2, for a total of 387 implants (91.9%) still functioning. Conclusion: Sinus augmentation procedures using intra- and extraorally harvested bone grafts can provide implant stability in the long term. However, major preoperative discomfort and more bone loss was seen when bone was harvested from the iliac crest. If autogenous bone is mandatory in sinus elevation procedures, extraorally harvested bone grafts can still be recommended, especially when bilateral procedures are indicated. Palabras clave: bone graft, bone resorption, dental implant, sinus augmentation

Hereditary gingival fibromatosis (HGF) and amelogenesis imperfecta (AI) are two rare oral conditions with genetic etiologies. The case of a 17-year-old boy affected by HGF, AI, anterior open bite, and pyramidal impaction of the maxillary molars is reported. Internal bevel gingivectomies were carried out to reduce gingival overgrowth. Clinical examination of the family revealed the presence of HGF and AI in his 12-year-old sister (both in milder forms) and of HGF in his older half brother. Genetic sequencing analyses were performed to detect any of the known mutations leading to HGF and AI. Histologic analysis revealed the presence of fibroepithelial hyperplasia, consistent with a diagnosis of GF. Sequencing genetic analysis failed to identify any of the common mutations leading to HGF (SOS-1) or AI (enamelin and amelogenin genes). This phenotype, similar to what has been described in other families, may represent a new syndrome caused by an as-yet unknown genotype. Palabras clave: amelogenesis, fibromatosis, genetic, gingival, mutation, syndrome

Objective: To assess the pattern of early bacterial colonization at implants and teeth in patients with a history of chronic periodontitis compared with a group of healthy subjects. Furthermore, the presence of host-derived markers at teeth and implants in the two subject groups was determined. Method and Materials: Subgingival and submucosal plaque and gingival crevicular fluid samples from 37 nonsubmerged healing dental implants and the deepest tooth sites per quadrant were analyzed 2 to 5 months after implant insertion. The presence of periodontal pathogens was assessed by means of real-time polymerase chain reaction. Further, the levels of interleukin (IL)-1ß, IL-8, and IL-10; secretory leukocyte protease inhibitor; and the neutrophil elastase activity were determined. Results: Eleven patients with chronic periodontitis and 13 subjects without periodontitis were recruited for this study. Bacterial species associated with periodontitis were detectable at both the teeth and implants. The presence was always higher in the chronic periodontitis group; the difference was significant for Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans at both the implants and teeth. The levels of IL-1ß were higher at teeth than at implants; in contrast, more IL-10 was measured at the implants. Conclusion: The present results indicate that (1) dental implants inserted in periodontally compromised patients are colonized with periodontal pathogens within the first weeks of healing; (2) inflammatory markers (IL-1ß) are present in higher levels at teeth as compared with implants, whereas at implants, anti-inflammatory cytokines (IL-10) might play the important role; and (3) the importance of periodontal treatment prior to implant insertion to reduce bacterial load and inflammation should be emphasized. Palabras clave: bacteria, early healing, implants, inflammation, periodontitis

Objective: To determine the prevalence and severity of early childhood caries (ECC) and its relation to feeding practices in Syria. Method and Materials: A total of 400 children aged 3 to 5 years (mean age ± SD, 4.2 ± 0.5) were screened from 20 randomly selected kindergartens in Latakia, Syria. Dental examinations were carried out by a specialist in pediatric dentistry using dmft and dmfs indices and an ECC scoring system. Information regarding feeding practices during early childhood was also collected. Results: Caries was seen in 70% of the children, with a total mean dmft value of 4.25 ± 4.2 per child. The mean values increased from 2.4 ± 3.2 dmft at age 3 to 5.6 ± 4.9 at age 5 (4.1 ± 6.3 and 12.8 ± 12.0 dmfs, respectively). Age and feeding practices showed statistically significant associations with caries (P .001). The mean dmft in the bottlefed children was 5.33 ± 4.6 compared with only 3.27 ± 3.5 in predominantly breastfed children. Fortyeight percent of the children had ECC, and 24% showed a severe degree with carious defects and open caries lesions. A significantly higher prevalence and severity of ECC was observed in children who were bottlefed (z-statistic, -2.1; P = .036) compared with breastfed children. Conclusion: In addition to a high prevalence of caries and ECC in preschool children, bottlefeeding led to even higher caries rates in Syria. Since the caries was largely untreated, preventive and restorative dental programs should be implemented. Palabras clave: breastfeeding, caries prevalence, early childhood caries, feeding practices, Syria

Objective: Systemic lupus erythematosus (SLE) is a serious multisystem disease with a variety of cutaneous and oral manifestations. It is an autoimmune disorder whereby patients develop autoantibodies to many of their cells, cell components, and tissue. The microvascular changes in SLE play a role in the pathogenesis of this disease. The aim of this study was to investigate the gingival microcirculation in SLE patients. Method and Materials: Fifteen SLE patients and 15 healthy subjects were recruited for this study. Gingival microcirculation was investigated using videocapillaroscopy, a noninvasive technique that permits the in vivo evaluation of microvascular patterns. Results: Significant differences between patients and controls for the capillary density were seen. An increase of mean capillary density was observed in SLE patients (105.5 ± 3.41) (P .05). Conclusion: This study showed significant modifications of gingival microcirculation in SLE patients. Palabras clave: capillaroscopy, gingival disease, microcirculation, systemic lupus erythematosus

Objective: To compare the effect of the pulpotomy medicaments glutaraldehyde, ferric sulfate, and formocresol on the structure and shear bond strength of a self-etch adhesive to the dentin of primary teeth. Method and Materials: Forty human primary molars were sectioned mesiodistally and divided into four groups: group I (control group), dentin specimens were soaked in distilled water for 48 hours; group II, dentin specimens were soaked in 2% glutaraldehyde; group III, dentin specimens were soaked in formocresol; and group IV, dentin specimens were soaked in 15.5% ferric sulfate. All specimens were rinsed with tap water and dried with air. AdheSE One (a self-etch adhesive) and Valux Plus composite resin were applied to the dentin surfaces. The molecular structure of the adhesive itself and adhesive with composite resin were tested using an FTIR spectrometer. Shear bond strength was tested with a universal testing machine. Failure modes analyses were performed with a scanning electron microscope (SEM). Results: Glutaraldehyde showed little changes in the molecular structure of the adhesive itself and adhesive with composite. However, ferric sulfate and formocresol affected the molecular structure of the adhesive alone and the adhesive with composite. The highest mean value of shear bond strength was for the glutaraldehyde group (11.17 ± 4.87 MPa). Ferric sulfate and formocresol significantly reduced shear bond strength after the application of pulpotomy medicaments (7.45 ± 3.73 and 5.31 ± 3.30 MPa, respectively). SEM analysis revealed that most of the specimens failed in cohesive and mixed modes. Conclusion: This study revealed that formocresol and ferric sulfate adversely affect the shear bond strength and molecular structure of the adhesive system to primary dentin. Palabras clave: bond strength, ferric sulfate, formocresol, glutaraldehyde, infrared, pulpotomy medicaments

Objective: To evaluate the effect of toothbrush design on brushing skills and plaque removal among young healthy adults. Method and Materials: A population of 200 healthy young adults was approached. Patients were randomly assigned to one of two research groups: one used a manual single-headed toothbrush, while the other used a manual triple-headed toothbrush. At the start of the study, participants were asked to brush their teeth using the provided toothbrush with no prior guidance or instructions. Plaque Index (PI) was measured. Immediately afterward, participants were personally instructed on how to brush their teeth using the provided toothbrush. Toothbrushing performance skill was evaluated and scored using the toothbrushing performance skill index (TB-PS-I/Ashkenazi index) following the first brushing, as well as on a recall visit 1 week later. Results: Following the first, uninstructed brushing, PI values ranged from 0.41 to 1.33, with higher plaque scores for the single-headed toothbrush group. One week after receiving brushing instructions, PI decreased in the both toothbrush groups and ranged between 0.12 and 0.81, with higher PI scores for the single-headed toothbrush group. Following the first, uninstructed brushing, total TB-PS-I scores, as well as component scores ("reaching" and "staying") showed no difference between the two toothbrush groups. One week after receiving brushing instructions, the TB-PS-I in the triple-headed toothbrush group was significantly higher than that in the single-headed toothbrush group. Conclusion: The tripleheaded toothbrush was found to promote easier toothbrushing and plaque removal both before and after receiving toothbrushing instructions. Palabras clave: gingivitis, manual toothbrush, oral hygiene, periodontitis, plaque, prevention

Objective: CAD/CAM is based on optical or mechanical scanning of tooth surfaces. The aim of this in vitro study was to investigate the influence of three different scan sprays on the proliferation, viability, and adenylate kinase (ADK) release of human fibroblasts. Method and Materials: Three different scan sprays (ScanDry, ScanSpray Luer Classic, and CEREC Optispray) were tested in vitro to determine their effects on proliferation, viability, and ADK release of human periodontal fibroblasts. A defined amount of the test material was sprayed into 96 multiwell plates, dried, and incubated with fibroblasts. The LIVE/DEAD Viability Assay, a two-color fluorescence-based method, was used to determine the cytotoxic potential (the AlamarBlue Assay for the proliferation rate and the ToxiLight BioAssay for the release of ADK). Results: There were differences between the scan sprays concerning inhibition of the proliferation and viability of fibroblasts. All materials inhibited the fibroblast proliferation and viability compared with the control group (P .001), and there were also significant differences among the scan spray groups. The scan sprays led to a greater release of ADK, but a significant difference could be found only between ScanSpray Luer Classic and CEREC Optispray (P .009). Conclusion: The results of this study proved that the scan sprays do not induce a significantly higher ADK release than the control group. The inhibiting effect on the fibroblast proliferation can be attributed to a material-independent phenomenon. Further experiments are necessary to validate the present data. Palabras clave: CAD/CAM, CEREC, cytocompatibility, in vitro, optical scanning, scan spray

Objective: To evaluate the influence of different conditioning methods of prepared teeth on the retention of cast metal copings bonded with two self-adhesive resin cements. Method and Materials: Mandibular first molars (n = 80) were prepared to receive metal copings. Sixteen molars were stored in water without interim copings as a control group (CG), while 64 molars were covered with interim copings. Eighty cast copings were laboratory fabricated from Ni-Cr alloy. Interim copings were removed, and 64 molars were cleaned and divided into four groups (n = 16) according to pretreatment methods of prepared molars: no pretreatment (T-NT) and conditioning with self-etching adhesive (T-SE), polyacrylic acid (T-PA), or ethylenediaminetetraacetic acid (EDTA) (T-ED). Each group was further subdivided into two subgroups (n = 8) according to luting cements. RelyX Unicem and seT self-adhesive resin cements were used for cementation of copings. Specimens were stored in water at 37°C for 6 months and then cyclically loaded and thermal cycled. Retentive stress in N was recorded for each specimen. Statistical analyses were conducted with two- and one-way ANOVA and Tukey HSD test. Results: Retentive stress ranged from 526.7 to 692.9 N for RelyX Unicem and 339.8 to 492.3 N for seT. There were no statistically significant differences between the mean retentive stress of the CG, T-SE, and T-PA groups (P > .05). The mean retentive stress of group CG was significantly higher than mean retentive stress of groups T-NT and T-ED (P .05). The mean retentive stress of the control and test groups bonded with RelyX Unicem was significantly higher than the mean retentive stress of the same groups bonded with seT. Conclusion: Conditioning of prepared teeth using polyacrylic acid or self-etching adhesive significantly increased the retentive stress of cast metal copings. Palabras clave: conditioning method, crowns, luting cements, retention