Quintessence International, 10/2011

This case report is an 8-year follow-up of a malpositioned single implant, which was treated with segmental osteotomy, to confirm the treatment's characteristics, indications, and advantages. Deep buccal positioning of an endosseous implant placed in the maxillary left central incisor area did not permit acceptable prosthetic rehabilitation, despite its favorable bone insertion with no significant marginal bone loss. The surgical procedure included osteotomy and block movement performed toward the lingual and cervical position, fixed with a provisional prosthesis and miniplates and mini-implants. A connective tissue graft was necessary for esthetics optimization and was performed in a second stage. Advantages including the prevention of alveolar ridge damage, the improvement of gingival contour, and the use of an already integrated implant are presented. Clinically satisfactory hard and soft tissue stability permitted us to consider segmental surgery as a reliable alternative for malpositioned osseointegrated implants. Schlagwörter: dental implants, malpositioned implant, prosthetic rehabilitation, segmental osteotomy

Composite resin restorations have been shown to be functionally reliable and esthetically acceptable to patients, primarily due to improvements in their chemicophysical characteristics. Nevertheless, clinical limitations, such as marginal discoloration, disadaptation, and microleakage, are observed in some patients with these restorations. The choice of treatment pursued to repair such restorations depends primarily on the analysis of the compromised restoration with regard to these aforementioned imperfections. The most common procedures invoked to treat compromised restorations include resurfacing, repairing the restoration with or without the use of surface sealants, and completely replacing the compromised restoration. This case report describes the proper implementation of a simple technique, known as composite resin posterior restoration, that yields a satisfactory outcome for patients who have been characterized with these clinical limitations. Schlagwörter: composite resin, conservative approach, posterior teeth

Preservation of primary teeth until their normal exfoliation plays a crucial role in preventive and interceptive dentistry. Premature loss of the primary second molar prior to the eruption of the permanent first molar in the absence of the primary second molar can lead to mesial movement and migration of the permanent molar before and during its eruption. In such cases, an intra-alveolar type of space maintainer to guide the eruption of the permanent first molar is indicated. In certain cases, however, the conventional design is not practical. This paper describes a new design for distal shoe appliances in cases of primary second molar loss prior to the eruption of the permanent mandibular first molar. Schlagwörter: distal shoe appliance, permanent first molar, primary molars, space maintainer

Objective: To evaluate the efficacy of oily calcium hydroxide suspension (OCHS) in the of treatment of infrabony defects. Method and Materials: Thirty patients with advanced chronic periodontitis, with one deep infrabony defect, were randomly treated with open flap debridement (OFD) (control) or OFD + OCHS (test). Clinical measurements were performed at baseline and 9 months after treatment. Surgical reentry was performed after 9 months. The primary outcome variables were reduction in probing pocket depth (PPD) and gain in relative attachment level (RAL). The secondary outcome was the reduction in depth of defect (DOD) measured intrasurgically. Results: A statistically significant reduction in PPD was observed at the end of 9 months, with the control group showing a mean reduction of 2.06 ± 0.59 mm from baseline to 9 months and the test 1.06 ± 1.22 mm (P >= .05). There was no statistically significant gain in RAL at the end of 9 months, with a mean of 0.60 ± 0.50 mm in the control group and 0.60 ± 0.91 mm in the test (P >= .05). No statistically significant difference was observed in DOD at 9 months, with a mean difference of 0.80 ± 0.77 mm in the control group and 0.66 ± 0.97 mm in the test (P >= .05). Conclusion: Within the limitations of the study, OCHS failed to demonstrate any superior clinical outcomes in comparison with OFD. Schlagwörter: infrabony defects, oily calcium hydroxide suspension, open flap debridement

Objective: To assess the survival rate of two different post systems after 5 years of service with a prospective randomized controlled trial. Method and Materials: One hundred patients in need of a post were studied. Half of the patients received long glass fiber- reinforced posts, while the other half received long metal screw posts. The posts were assigned randomly. After at least 5 years (mean, 61.37 months), follow-ups were established. When a complication occurred prior to this recall, the type and time of the complication was documented. Statistical analysis was performed using the log-rank test and Kaplan-Meier analysis. Additionally, a Cox regression was performed to analyze risk factors. Results: The survival rate of fiber-reinforced posts was 71.8%. In the metal screw post group, the survival rate was significantly lower, 50.0% (log-rank test, P = .026). Metal posts resulted more often in more unfavorable complications (eg, root fractures); consequently, more teeth (n = 17) had to be extracted. The Cox regression identified the following risk factors: position of the tooth (anterior vs posterior teeth), degree of coronal tooth destruction, and the post system (fiber-reinforced post vs metal screw post). Fiberreinforced restorations loosened in several patients; in some of these cases (n = 6), patients did not notice this, leading to the extraction of teeth. Conclusion: Long metal screw posts should be used with great care in endodontically treated teeth. Besides the selection of the post system, other factors influence the survival of the restoration. Schlagwörter: fiber post, metal screw post

Objective: To retrospectively analyze 14 consecutively treated cases of dental implants placed along with sinus lift procedures in patients with severe bone atrophy (residual bone height of 2 to 5 mm). Method and Materials: Thirty-one implants were placed with a lateral window sinus lift in 14 patients using deproteinized bovine bone alone (no membrane) for the graft. The implants were monitored for a mean 43.20 ± 9.30 months (minimum, 25.00 months; maximum, 53.00 months) after placement and 32.40 ± 11.10 months (minimum, 11.40 months; maximum, 41.60 months) after fitting of the prostheses. The outcome measures evaluated were implant success, radiographic measurements (original alveolar bone height, peri-implant marginal bone loss, and relationship of implant apex to graft), implant-related probing pocket depth (PPD), Bleeding Index (BI), and prosthesis sucess. Results: The implant success rate was 93.3%. The mean real alveolar bone height was 3.05 ± 0.87 mm, and there was evidence of peri-implant marginal bone loss (mean, 1.02 ± 1.40 mm). The relationship of implant apex to graft remained stable during follow-up. PPD was 5 mm in 91.6% of implants. The BI was 11.6%. The prosthetic success rate was 100%. Discussion: These findings indicate that dental implants can be employed successfully, even in conditions of severe bone atrophy, using only heterologous bone, provided suitable methods and materials are used (eg, site preparation, rough implant surfaces, and self-tapping screw implants). Conclusion: The treatment described appears to afford acceptable results, with lower overall costs and treatment time. Schlagwörter: bovine bone, simultaneous dental implant, sinus augmentation

The development of sinus augmentation procedures has diminished the problem of proper implant placement in the posterior maxilla in patients that have a pneumatized maxillary sinus and reduced alveolar bone. The gold standard approach to augmentation-the external sinus augmentation-was developed years ago and is still touted as the best approach for creating maxillary posterior bone. However, external sinus augmentation procedures are often quite traumatic, time-consuming, and costly, and they have anatomical limitations and considerable documented morbidity. This article discusses the external procedure and contrasts it with an internal sinus augmentation with osteotomes that is as effective in promoting sinus augmentation, is localized and relatively atraumatic, can be performed rapidly, is reasonable in cost, and has negligible morbidity. In addition, a modification of future site development augmentation, in preparation for secondary implant placement, is described, as are three cases, to demonstrate the impressive augmentation that can be achieved with osteotome sinus elevation. Schlagwörter: dental implant, external sinus augmentation, internal sinus augmentation, osteotomes, sinus elevation

Ramsay Hunt syndrome is a rare complication of the varicella zoster virus, defined as a peripheral facial palsy that typically results from involvement of the facial and auditory nerves. Ramsay Hunt syndrome can be associated with cranial nerves V, VI, IX, and X but rarely with XII. We describe an atypical case of Ramsay Hunt syndrome with multiple cranial nerve involvement of nerves V, VII, VIII, and XII. Antiviral drugs, antibiotics, insulin, and traditional Chinese drugs were administered immediately after admission. After 3 months of combination therapy, the patient had recovered satisfactorily. Herpes zoster can cause severe infections in diabetic patients and should be treated as soon after detection as possible. Ramsay Hunt syndrome should be recognized as a polycranial neuritis characterized by damage to sensory and motor nerves. In addition to facial and vestibular nerve paralysis, Ramsay Hunt syndrome may also involve cranial nerves V and XII. Schlagwörter: diabetes, peripheral facial paralysis, Ramsay Hunt syndrome, varicella zoster virus

Ectopic salivary gland tumors are rare in children. When salivary gland tumors do develop, they preferentially affect major salivary glands and then minor salivary glands. Pleomorphic adenoma, also referred to as a benign mixed tumor, is the most common tumor of the salivary glands. Approximately 90% of these tumors occur in the parotid gland, while the remaining 10% affect the minor salivary glands. However, it is uncommon to find them elsewhere in the head and neck region. We report a rare case of pleomorphic adenoma in the upper neck, an unusual site in an 8-year-old boy. Schlagwörter: cheek, ectopic mixed salivary gland tumors, heterotopic salivary gland tissue, palate, pleomorphic adenoma

Syphilis is among the oldest recognized sexually transmitted diseases. In the past decade, its incidence has risen significantly in the developed world. Oral syphilitic lesions, the most common extragenital sign of infection, are a diagnostic challenge to dentists, who are usually the first to examine the oral lesions. Biopsies are occasionally the first examination performed, but histologic findings are considered nonspecific. We present two new cases as well as an additional 25 published cases, suggesting that plasma cell arteritis and plasma cell neuritis is a combination that has not been reported in any other pathologic condition of the oral cavity and may be specific enough to direct the clinician toward a diagnosis of syphilis prior to clinical confirmation. Schlagwörter: diagnosis, endarteritis, neuritis, oral, plasma cell, syphilis

Objective: Dentists are required to institute infectious control procedures. Dental impression materials possessing antimicrobial properties may aid in reducing the risk of cross contamination since impression materials might play a role as carriers. The purpose of this study was to evaluate the antimicrobial properties of four impression materials. Method and Materials: Four impression materials-Orthoprint, Impregum Penta, Aquasil Ultra Monophase, and Permlastic-were evaluated by the direct contact test. The materials were tested in contact with Enterococcus faecalis, Staphylococcus aureus, Staphylococcus epidermidis, and Candida albicans. The materials were mixed; allowed to set; and examined immediately and after aging for 24, 48, and 72 hours and 1 week. Two-way ANOVA, one-way ANOVA, and Tukey multiple comparison procedures were applied to the results. Results: Impregum Penta presented the broadest antibacterial spectrum of all the materials tested. There was a complete growth inhibition of S aureus and S epidermidis, and it sustained this ability for at least 7 days. It also showed an antifungal effect by partially inhibiting the growth of C albicans, a quality that was seen only immediately after setting. Aquasil Ultra showed an antifungal effect only immediately after setting. Permlastic showed a complete growth inhibition when in contact with C albicans and sustained this ability for at least 7 days. No significant antimicrobial properties were recorded for Orthoprint. When in contact with E faecalis, no significant antibacterial properties were recorded for any of the materials. Conclusion: None of the tested materials exhibited a long-lasting or complete antibacterial and antifungal property. Therefore, disinfection of impressions is essential. Schlagwörter: antibacterial, cross contamination, impression materials

Objective: To assess the marginal adaptation of ormocer-, silorane-, and methacrylate-based composite restorative systems bonded to dentin cavities after water storage. Method and Materials: Cylindric dentin cavities were prepared on the buccal surfaces of 45 extracted human molars after their enamel was removed. The cavities were assigned to one of three groups (each n = 15). Each group was restored with one of three composite/adhesive systems: an ormocer-based (Admira/Admira Bond), a silorane-based (Filtek P90/P90 System Adhesive), and a methacrylate-based (Tetric Ceram/Excite). Marginal adaptation was evaluated immediately after polymerization and after 1 month and 1 year of water aging and thermocycling. Evaluation was performed under a metallographic microscope by recording frequency of gap-free restorations, width of maximum marginal gap (MG), percentage length of debonded margins relative to cavity periphery (DM), and marginal index (MI = MG × DM/100). The results were statistically analyzed with two-way ANOVA and the Tukey test at α = .05. Results: None of the composite/adhesive systems examined exhibited gap-free restorations at any aging time. Marginal adaptation was significantly affected by the type of restorative/adhesive system, while water aging time had no significant effect. Silorane composite restorations exhibited the lowest MG, DM, and MI values, while methacrylate composite restorations revealed the highest values. Ormocer restorations showed intermediate values. Conclusion: Although all examined composite systems failed to achieve gap-free margins with dentin cavities, the silorane-based system revealed the best marginal adaptation at all aging times. Schlagwörter: composite resin, dentin bonding, marginal adaptation, ormocer, silorane