Quintessence International, 04/2012

Placement of a dental implant and an interim restoration in the esthetic zone immediately following tooth extraction is now a common procedure. However, in such clinical situations, the fabrication of an appropriate interim restoration may be challenging. The aim of this article is to present a technique for modifying the extracted tooth so it can be used as an implant-supported interim restoration. Schlagwörter: dental implant, esthetic zone, immediate implant, immediate interim restoration

Objective: The aim of this prospective, double-blind, randomized long-term study was to evaluate the clinical performance of the self-etch adhesive AdheSE One in combination with the nanohybrid composite resin Tetric Evo Ceram for Class 1 and 2 restorations. The improvement of the clinical performance with the additional use of a flowable composite resin for cavity lining was tested. Method and Materials: In accordance with a split-mouth design, 50 patients received 100 restorations in premolars and molars. One restoration of each patient was chosen at random to be restored with an intermediary layer of a flowable composite resin. Each restoration was scored according to the modified Ryge criteria at baseline and after 6, 12, and 24 months. Results: After 24 months (recall rate 88%), the results of the Ryge evaluation for groups without (group T) and with application (group TF) of Tetric Flow were as follows: marginal adaptation, Alpha 40/40 and Bravo 3/4; marginal discoloration, Alpha 39/41 and Bravo 4/3; and filling integrity, Alpha 42/42 and Bravo 1/2. All restored teeth remained vital. The parameters hypersensitivity, recurrent caries, surface, color match, and proximal contact were scored Alpha for all teeth. Between groups, no statistically significant differences could be detected (Mann-Whitney U test, P > .05). Conclusion: In consideration of the short observation period, the clinical use of AdheSE One in stress-bearing posterior cavities reached acceptable clinical results with a 1.1% cumulative failure rate after 2 years. The use of a flowable composite resin did not show an improved clinical performance. Schlagwörter: clinical study, composite resin, flowable composite, Ryge criteria, self-etch adhesive

Objective: Human retrieved implants with an intact bone-implant interface play a pivotal role in validating data obtained from in vitro studies and animal experiments. This study presents a histologic and histomorphometric analysis of peri-implant tissue reactions and of the bone-titanium interface in three machined and sandblasted dental implants retrieved after a 5-year loading period. Method and Materials: Three implants, with an intact bone-implant interface, were found in the Archives of the Implant Retrieval Center of the Dental School of the University of Chieti-Pescara, Chieti, Italy. The three implants had been used in a two-stage submerged procedure and loaded as part of a small prosthetic restoration. One implant had been retrieved because of an abutment fracture, while there was a fracture of the connecting screw in the other two. One implant was in the maxilla (sandblasted surface), and two were in the mandible (one with a machined surface and the other with a sandblasted surface). All implants had been processed for histology. Results: All three implants presented mature, compact, lamellar bone at the interface. Many remodeling areas were present in the peri-implant bone, especially inside the implant threads. The bone was always in close contact with the implant surface. The bone-implant contact percentage of the machined implant was 92.7%, while the two sandblasted implants showed bone-implant contact percentages of 85.9% and 76.6%. Conclusion: The present histologic results confirmed that these implants with different surfaces maintained a good level of osseointegration over a 5-year loading period, with continuous remodeling at the interface, and showed high bone-implant contact percentages. Schlagwörter: bone remodeling, human histology, implant surfaces, retrieved dental implants

Objective: Sites in which bone is reduced in quality or height create challenges in esthetic reconstruction and loading support, which leads to a higher risk of failure. The Mk IV system with a TiUnite surface was designed specifically for placement in soft bone. This paper describes postloading outcomes of 103 Mk IV implants, with a focus on bone preservation in compromised bone sites during early remodeling, stability after abutment connection, and a 3- to 7-year follow-up from implant placement. Method and Materials: A series of 103 4-mm (diameter), >= 10-mm (length) Mk IV implants were placed in the maxillae of 25 females and 14 males. Twenty-three patients also received staged bone grafts, and two underwent socket augmentation as well as grafts. Areas of previous infection were prepared mechanically and chemically. To ensure primary implant stability, the size of the osteotomy and the number of entries were minimized. Following a delayed loading protocol, all patients were restored with fixed partial dentures. For analysis of bone stability, the marginal levels on the mesial and distal aspects of the implants were measured at 7× magnification by a radiologist not involved in the treatment. Results: Three implants were lost, 1 implant was never loaded although it integrated, 14 implants were not available for follow-up after abutment correction, and 5 had poor-quality radiographs. The mean marginal bone loss between implant insertion and loading was 1.21 ± 0.86 mm (n = 80). The differences in bone-remodeling levels in grafted and nongrafted sites were not significant. Data are reported on 103 implants in 39 consecutive patients through abutment connection, with radiographic follow-up from 3 to 7 years postimplant placement on 27 patients. Conclusion: It is critical to ensure optimal three-dimensional orientation and minimize site preparation, particularly when placing implants in compromised bone. With bone of poor preoperative density using a customized site preparation technique, excellent short-term implant survival and long-term bone stability have been demonstrated. Further follow-up will determine whether the Mk IV implant is the optimal design for compromised bone, including associated soft tissue stability. Schlagwörter: bone augmentation, bone loss, compromised, dental implants, follow-up studies, surface

Management of children and adolescents with qualitative or quantitative defects of enamel or dentin are often impeded by patient compliance, rare prevalence of disease, lack of evidence, and cost. The aim for all patients in this case series was to develop a suitable treatment strategy that required little chair time and was applicable to several conditions. Thirty-four laboratory-made composite resin restorations were placed in differently affected permanent posterior teeth of eight young patients. The ages of the patients ranged from 6 to 15 years. All restorations were adhesively inserted with the etch-andrinse technique and are still in situ. The longevity of the restorations at present is 2 to 48 months. This treatment method allowed relatively comfortable treatment for children and adolescents who required extensive dental treatment. The outcome has been favorable with good patient compliance, brief chair time, and functional and esthetic restorations. Schlagwörter: adolescents, children, hypomineralization, hypoplasia, indirect composite resin restorations

Halitosis (bad breath) is a common condition that is socially crippling for vast parts of the population and results from malodorous volatile sulfur compounds, which are by-products of oral bacteria. In this doubled-blind, randomized study, 75 subjects with halitosis were evaluated. The participants were treated with or without abrasive microcapsules (candy) containing zinc gluconate 0.5%, propolis 2%, and a combination of both (zinc 0.25% and propolis 1%). The halitosis was assessed by a Halimeter, a portable instrument that measures the emission of volatile sulfur compounds at different time exposures to the treatments. Breezy candy (which is sugar-free) was found effective in the treatment of halitosis for up to 4 hours. While treatment with regular candy (group 1, traditional candy without abrasive particles) showed reduction in malodor of 10%, Breezy candy showed reduction of up to 60% in malodor (P .0001). Since this was not a longitudinal study, the total duration of the effect was not assessed. Breezy candy in the abrasive form with zinc additive had the best potential to positively affect malodor when treating patients with halitosis. The combined effect of abrasion by microcapsules with zinc supplement represents a novel and successful approach for the treatment of halitosis. Schlagwörter: halitosis, propolis, zinc

White sponge nevus is a rare, inherited disorder that usually presents as nonpainful white plaque primarily involving the buccal mucosa, gingiva, and palate. Extraoral lesions most often occur in the esophagus or anogenital area, but almost invariably follow the development of typical buccal lesions. This article presents a familial case of white sponge nevus in which oral lesions were found in patients in three generations of the same family. Histologic findings include hyperkeratosis, acanthosis, and perinuclear eosinophilic condensation of epithelial cell cytoplasm, which serve to confirm white sponge nevus as the diagnosis. Clinical presentation and histopathology of white sponge nevus are discussed in relation to the differential diagnosis of other oral leukokeratoses. Schlagwörter: hereditary, hyperkeratosis, white lesion

Objective: To evaluate the effect of corrosion products on the microleakage of composite placed adjacent to nondiscolored dentin after amalgam removal. Method and Materials: Sixty Class 2 cavities were prepared on extracted premolars, which were divided into four equal groups according to the manner in which they were restored: group 1, light-cured packable composite (Elite LS) to establish a microleakage baseline; group 2, a high-copper amalgam (World Work) previously stored in 37°C normal saline for 6 months to create amalgam corrosion products; group 3, identical to group 2, but the amalgam was later replaced with composite, leaving the cavity walls intact; and group 4, identical to group 3 except the cavity walls were extended 0.5 mm after amalgam removal prior to insertion of the composite. Groups 1, 3, and 4 were kept in a 37°C normal saline for 1 week. Ten specimens from each of these three groups were randomly selected for dye-extraction testing, while dentin elemental microanalysis of five specimens from all four experimental groups was also conducted. Data were analyzed using ANOVA and the Tukey tests (α = .05). Results: Corrosion products were not detected in group 4, and no statistically significant difference (P > .05) in microleakage was found between this group and group 1. The highest dye absorbance was associated with group 3 (P .05). Conclusion: After amalgam removal, a 0.5-mm extension of the cavity walls could improve the dentinal marginal seal to replicate that of an initial composite restoration. Schlagwörter: amalgam, composite, corrosion products, dentin, dye extraction, energy dispersive x-ray analysis

Sporadic Burkitt lymphoma of the jaw is a rare neoplasm with an exceedingly fast doubling rate. This article presents a case of sporadic Burkitt lymphoma initially managed as an odontogenic infection. The early radiographic features and histologic criteria are discussed. Burkitt lymphoma should be considered in the differential diagnosis of any rapidly expanding or swelling jaw masses in young patients. Schlagwörter: Burkitt lymphoma, Epstein-Barr, jaw, sporadic

Objective: Biliary atresia is a congenital disease treated by liver transplantation. Adults may have oral consequences of the medical therapy. Green teeth are oral manifestations of the induced hyperbilirubinemia. Gingival enlargement is associated with the immunosuppressive drug. This case report describes the successful treatment of an 18-year-old patient displaying severe green teeth and gingival enlargement. Method and Materials: The gingival enlargement was treated by reducing the pathogenic oral microflora through scaling and root planing of the teeth, gingival excision surgeries, and conversion from cyclosporin to tacrolimus. Results: Gingival enlargement and inflammation had completely disappeared after nonsurgical treatment for the maxilla and after surgical treatment for the mandible. The green coloration of the teeth was masked using composite restorations. Conclusion: This case report indicates that a patient's quality of life can be improved by a team approach combining pharmacologic and dental therapies. Schlagwörter: cyclosporin, gingival enlargement, green teeth, hyperbilirubinemia, liver transplantation

Objective: To evaluate the morphologies of D.T. Light-Post (LP), JFP-II quartz (JQ), and JFP-II glass (JG) fiber posts and their microtensile bond strengths to light- or dual-cured resin core materials. Method and Materials: The resin core materials that were used for the core buildup included three dual-cure core materials (Clearfil DC, Rebilda DC, and Luxacore Z) and a light-cured core material (Z100). The microtensile bond strength of each group was tested, and the morphology of each post and fractured surface was evaluated using scanning electron microscopy. Two-way ANOVA and Tukey or Dunnett T3 tests were used for statistical analyses. Results: LP exhibited wider fibers and less matrix than the JFP-II posts, and JQ exhibited a similar surface texture to JG. The bond strength of the JQ group was significantly less than that of the other groups, but for each of the resin core materials that were used in this study, there were no statistical differences between JQ and JG. The results also showed that the microtensile bond strengths of the Luxacore Z/LP and Z100/JG groups were significantly higher than those of the other groups. Cohesive failure was the exclusive mode of failure in the Z100 group, and the other fractured surfaces exhibited adhesive failure. Conclusion: The bonding between fiber posts and resin core materials is affected by the fiber type, but the type of dual-cure resin has no effect on the post and core bonds for any of the three posts used in this study. Schlagwörter: bond strength, fiber post, microtensile test, resin material