Quintessence International, 01/2022

Objective: The opacity of the zirconia ceramic restoration may influence the degree of conversion (%DC) of dual-cured resin cements. The aim of this study was to evaluate the degree of conversion of resin luting agents photocured under different high translucency zirconia shades. The opacity of each ceramic shade was evaluated. Method and materials: The opacity percentage of Lava Frame and three Lava Plus High Translucency Zirconia ceramic shades (W1, A2, and B4) was determined. A spectrophotometer MiniScan was used to measure the opacity percentage of each specimen (0.7 mm thick) and then the opacity was calculated. Specimens from three different resin cements (Panavia F2.0, RelyX Unicem 2 Automix Self-Adhesive, and PermaFlo DC) were prepared with 100-µm thickness. The specimens were photocured according to the manufacturers’ instructions under a ceramic block (0.7 mm thick). Specimens photocured without the ceramic block were used as control. Fifteen groups (n = 3) were evaluated. Micro-ATR/FTIR (micro-attenuated total reflectance/Fourier-transformed infrared spectroscopy) spectrometry was used to evaluate the extent of polymerization of all specimens after 24 hours. The %DC was determined using experimentally polymerized versus maximally polymerized composite. Results: The opacity percentages (mean ± SD) of W1, Lava Frame, A2, and B4 ceramics were 72.41% ± 0.04%, 74.24% ± 0.09%, 77.63% ± 0.11%, and 78.17% ± 0.12%, respectively. There was a statistically significant difference in %DC among the different cements investigated (P = .003) and a statistical difference in %DC was also found among the different ceramic shades studied (P = .030). For the Lava Frame and A2 ceramic blocks, the resin cements tested presented the lowest %DC except for the RelyX Unicem resin cement. Conclusions: The %DC of RelyX Unicem 2 cement under low zirconia opacities (W1 and Lava Frame) was greater compared to high zirconia opacities (A2 and B4). For the Panavia F2.0 cement, no effect on the %DC under different high translucency shades was observed. The highest %DC of PermaFlo cement was exhibited when the ceramic shade W1 was used. Clinical implications: Dual-cured resin cements exhibited different degrees of conversion depending on the opacity of the zirconia restoration. However, different brands demonstrated higher or lower dependency of the light transmittance on their degree of conversion. Keywords: ceramic shade, degree of conversion, dual-cure resin cement, FTIR

Resolution of a periapical periodontal lesion as determined by radiographic examination may take a year or longer. Orthodontic movement is known to have a positive effect on the bone topography and morphology. The literature presents no information about the effect of orthodontic movement on the rate of periapical endodontic healing following a root canal treatment. The aim of this report was to present the use of orthodontic root extrusion in cases with a periapical lesion, where other options are ruled out. Three case reports involving endodontically treated teeth with a periapical lesion are presented. In each case, the performed orthodontic extrusion resulted with healing of the periapical environment towards a predictable crown fabrication or replacing a hopeless tooth more safely with an implant-supported crown. In all cases presented, signs of radiographic healing were demonstrated in a relatively shorter time than is considered acceptable, following the extrusive orthodontic movement, with no clinical sensitivity to percussion or periodontal pockets. In conclusion, orthodontic extrusion of endodontically treated teeth with periapical lesions presented positive radiographic healing signs along with no clinical symptoms of pain and mobility and a positive effect on marginal bone level and soft tissues, at a faster rate than was expected. This report may assist in supporting a clinical decision to apply vertical extrusive forces on compromised endodontically treated teeth presenting with a periapical lesion. Healing signs may be observed within a shorter time period, which may allow better prediction for the prosthetic phase. Keywords: dental implant, endodontically treated teeth, forced eruption, implant replacement, implant site, orthodontic extrusion, periapical lesion, radiographic healing, root resorption

Objectives: The aim of this retrospective case series was to report the performance up to 5 years of an innovative surgical design (the apically incised coronally advanced surgical technique [AICAST]) for the regenerative treatment of one- or two-walled intrabony periodontal lesions. Method and materials: After completion of standard step I to II periodontal therapy, nine isolated periodontal defects were treated through AICAST. The following clinical outcome measurements were collected before the surgical intervention and at the last available follow-up: probing pocket depth (PPD), recession depth (REC), and clinical attachment level (CAL). Periapical radiographs of the treated teeth were also taken at baseline and at the last available follow-up (18 months or 5 years postoperatively). Results: A mean (± standard deviation) PPD reduction of 6.05 ± 1.76 mm (P < .01), REC reduction of 1.15 ± 1.97 mm (P = .119), and CAL gain of 7.20 ± 2.13 mm (P < .01) were attained when comparing preoperative results with the last follow-up visit. CAL gain of 6 mm or more was reached in eight out of nine treated cases (88.9%), with a residual PPD of 2 to 3 mm in all the cases. Complete radiographic fill of the intrabony component was present in all the defects, while detectable suprabony radiographic filling was identified in two cases. Conclusion: AICAST represents an innovative surgical design for the treatment of deep intrabony defects and the eventual reduction of the associated gingival recessions. Preliminary results show good performance in terms of clinical attachment gains and maintenance of the marginal tissues. Keywords: coronally advanced flap, enamel matrix derivatives (EMD), papilla preservation flap, periodontal regeneration, periodontitis

Objectives: Candida adherence to the denture base is an important cause of denture stomatitis in elderly and handicapped patients where effective patient- and physician-based disinfection methods are required. The purpose of this study was to investigate the in vivo effectiveness of chemical and physicochemical methods and their combinations against common oral Candida species on denture base acrylic resin. Method and materials: Patients were divided into six groups according to disinfection methods. For chemical disinfection, chlorhexidine, sodium hypochlorite, and glutaraldehyde were used by the patients. Microwave and ozone therapy were applied by physicians for physicochemical disinfection. Fungal load count was performed. This procedure was repeated before applying any disinfection procedures, at 1 week and 1 month after the patient started to use the relevant chemical disinfectant and apply physicochemical methods. A multivariate analysis test was used to determine the change in fungal load over time and whether this change led to a difference among the groups (P < .05). Results: The most frequently isolated Candida strain was Candida albicans. The change in fungal load over time was significantly different (P < .001). However, the difference between the groups did not show any significant difference in the paired comparison analyses of the chemical disinfection groups (P >.05). No Candida strains were detected in either physicochemical method at any of the control time points. Conclusions: The study concluded that chemical disinfectants used by patients were effective for but total eradication of Candida adhesion requires the use of additional ozone or microwave therapy. Keywords: Candida albicans, chemical disinfection, complete dentures, microwave, ozone therapy

Objectives: This clinical trial evaluated the effects of red wine exposure on the effectiveness of at-home bleaching with 10% carbamide peroxide, degree of tooth sensitivity, and levels of periodontal inflammatory markers. Method and materials: Eighty participants were assigned to two groups, namely, those who drank red wine (experimental group), and those who did not drink red wine (control group). The experimental group participants rinsed their mouths with 25 mL of red wine four times a day during the bleaching period. Shade evaluation was assessed visually by using the Vita Classical and Vita Easyshade techniques. Tooth sensitivity was evaluated by the numeric and visual analog scales, and the salivary and gingival crevicular fluids were collected for assessment of nitric oxide (NO) levels, a marker of inflammation. Differences in color change were analyzed by one-way analysis of variance (ANOVA). The absolute risks of tooth sensitivity were compared by the Fisher exact test. Tooth sensitivity intensity data sets for both the visual analog scale and the numeric rating scale were compared using the Wilcoxon signed rank test (α = .05). Repeated measures and two-way ANOVA followed by the Bonferroni test were used to assess time-course and differences between groups in NO production. Results: The bleaching technique was effective regardless of wine consumption (P > .05). Tooth sensitivity was classified as mild, with no differences between groups (P > .05). Red wine reduced both the gingival crevicular fluid and salivary levels of NO (P < .05). Conclusion: Red wine does not interfere with the effectiveness and sensitivity of at-home teeth bleaching with 10% carbamide peroxide and protects against bleaching-induced inflammation. Keywords: at-home bleaching, carbamide peroxide, crevicular gingival fluid, nitric oxide, tooth sensitivity

Objectives: Healing of postextraction alveolus is a complex process that involves soft and hard tissue regeneration. Pain, swelling, difficulty in opening the mouth, delayed bone tissue healing, alveolitis, and horizontal or vertical resorption of bone tissue are the main problems that impact on consequent treatment. Blood concentrates PRGF (plasma rich in growth factors) and PRF (platelet-rich fibrin), which are rich in growth factors, create better conditions for postextraction alveolus healing, enhance quality of soft tissues and bone regeneration, and decrease pain. The study objective was to compare physiologic healing of the postextraction zone with PRF- and PRGF-induced changes. Method and materials: In total, 43 patients were randomly divided into three groups: control group (mandibular molar extraction and filling of postextraction alveolus with hemostatic sponge containing gentamicin), group 2 (postextraction alveolus filled with PRGF), and group 3 (postextraction alveolus filled with PRF). Bone regeneration was evaluated in CBCT scans after 1 month. Pain was evaluated using the visual analog scale (VAS). Results: After evaluating VAS results 1 day after surgery the lowest pain score was in the PRGF group. Tooth alveolus vertical and diagonal dimensions in the control group were significantly (P = .017) smaller than in the PRGF group. The vertical dimension of the alveolar ridge did not change significantly (P = .859) in the PRGF group; however, it was significantly reduced (P = .04) in the PRF group. One month after surgery the age of the control group was inversely proportionally correlated with the height and diagonal dimension of callus. Conclusion: Both blood concentrates had great anti-inflammatory properties, but PRGF had better osteoblastic properties and resulted in lower postoperative pain. Keywords: alveolar process, bone regeneration, plasma-rich in growth factors, platelet-rich fibrin, postoperative pain, tooth socket

Objective: Occlusal stabilization splints (OSSs) are first-line therapy for temporomandibular disorder (TMD) and sleep-related-bruxism (SRB). The main goal of this study was to quantify adherence rates to OSS therapy in TMD patients and among non-painful conditions such as clenching and bruxism. It was hypothesized that adherence rates would be similar to those for other chronic conditions. Method and materials: Medical records of 99 patients seen in the Orofacial Pain Clinic between 2006 and 2014 were reviewed. Patients meeting the inclusion criteria were interviewed over the telephone regarding OSS adherence. Results: Of the 99 patients interviewed, 80 had chronic orofacial pain related to TMD and 19 received OSS due to (non-painful) SRB. Patients were divided according to usage; the USER group (58 patients, 58.6%) used their OSS for more than 1 year; the NUSE group was the remaining 41 (41.4%) patients who used their device for less than 1 year. Of the patients with pain as the reason for OSS use, 50 (62.5%) were in the USER group and 30 (37.5%) were in the NUSE group. The most common diagnosis was masticatory muscle disorders (MMD) with a 71.4% adherence rate, representing 60.3% of the USER group, which was significantly higher than those with SRB and other facial pain (P = .039). The most common reasons for non-adherence were sleep difficulties with OSS (31.6%) and resolution of the problem (25%). Conclusions: Patients reporting mild to major pain reduction had higher adherence rates than those with complete pain relief or none at all. Patients with MMD exhibited higher adherence rates than those with other facial pain types and SRB. Keywords: adherence, masticatory muscle disorders, occlusal stabilization splint, temporomandibular disorders

Objectives: The literature review aimed to compile and summarize the results of research relating to the recordings of condylar displacements obtained with extraoral devices, to guide clinicians to set dental (virtual) articulator parameters. The meta-analysis was undertaken to assess the sagittal condylar inclination (SCI) and transversal condylar inclination (TCI, also known as Bennett angle) values according to horizontal reference planes, movement studied, and patient characteristics: dental status, interocclusal relationship, skeletal pattern, and signs and symptoms of temporomandibular disorders (TMD). Data sources: A bibliographic search was conducted in the three following electronic databases: MEDLINE, EMBASE, and Cochrane Library and Best Evidence. The review was restricted to trials involving participants meeting the following criteria: (1) adult, (2) no previous surgery in the temporomandibular region, and (3) no serious comorbidity conditions. Descriptive statistics were calculated for all study groups and were compared by applying a one-way ANOVA. Conclusion: All 20 articles selected corresponded to a total of 933 subjects evaluated. The recording devices and horizontal reference planes had a significant impact on the SCI values. Age, dental status, and the presence of symptoms and signs of TMD in subjects had no influence on SCI values, unlike Angle class II, division 2, the class II sagittal pattern, or the increased vertical skeletal pattern SCI parameters (P < .05). The mean TCI value was 8 degrees and was independent of individual patient characteristics and the extraoral recording device used. For accurate kinematic simulation, the patient’s personal plane of reference must be transferred to the system. Keywords: Bennett angle, condylar inclination, condylar kinematic, dental articulator, literature review, temporomandibular joint

Objectives: To review the dynamic analytical elements used in the functional assessment of the stomatognathic system, summarize the available scientific evidence, and consider interrelations with body posture and cognition. Method and materials: A thorough literature search was conducted using PubMed, the Cochrane Library database, and Google Scholar. Peer-reviewed articles and literature reviews provided up-to-date information addressing three topics: (a) the available knowledge and recent evidence on the relationship between the morphologic aspects of dental/craniofacial anatomy and oral function/dysfunction, (b) mandibular dynamics, considering mobility, functional activity, and existing methodologies of analysis, and (c) a possible correlation between the stomatognathic system, body posture, and cognition. Results: Modern dentistry may be regarded as a human adaptation strategy, helping to conserve healthy teeth for much longer without risking overall health. It is futile to treat patients using a mechanistic, sectorial approach that misrepresents patient behavior and requests, just as it is to affirm the absence of any structure-function relationships. However, it is also evident that there is a lack of general consensus on the precise functional assessment of the stomatognathic system, mostly due to the methodologic heterogeneity employed and the high risk of bias. Despite the abundant evidence produced with the aim of providing solid arguments to define dynamic models of functional assessment of the stomatognathic system, it is yet to become highly empirical, based as it is on operator experience in daily clinical practice. Conclusions: Further efforts from the scientific and clinical community, with the help of progress in technology, remain should this gap be filled and should substantial data on differences between pathologic and physiologic dynamic models of function be provided. Dentistry needs to employ – on a larger scale – objective, dynamic methods of analysis for the functional evaluation of the stomatognathic system, embracing concepts of “personalized medicine” and “interprofessional collaborations.” Keywords: cognition, kinesiography, mastication, neuroplasticity, oral function, posture