International Poster Journal of Dentistry and Oral Medicine, 01/2012

Deviations from the norm in root canal morphology are not uncommon. Dental clinicians should keep this possibility in mind whenever they perform root canal treatment. The root canal treatment of a mandibular molar with aberrant canal configuration can be diagnostically and technically challenging. The astute clinician must be aware of recent literature that states that the mandibular first molar has a 1-15% chance of a fifth canal. This poster reveals clinical management of a mandibular first molar with multiple mesial canals and also demonstrates a clinical case that contained a fifth canal i.e. the middle mesial canal. A good knowledge of possible variations in root canal morphology and a little extra effort to search for additional canals can go a long way in improving the long-term prognosis of the tooth in question. Keywords: mandibular first molar, multiple mesial canals, middle mesial canal, root canal morphology

A 54 years old partially edentulous female patient came to the office complaining of both esthetic and functional problems. The clinical examination showed the abnormal labiolingual relationship between the maxillary and mandibulary incisors and canines (anterior crossbite) and the generalized mobility. The X-ray exam exposed dramatically periodontal loss partly due to the traumatic occlusion. This patient refused both orthognathic and implant options. The patient needed a full mouth oral reconstruction. She accepted the prosthetic solution which was correcting the underbite - class 3 occlusion using porcelain metal dental bridges and removable partial dentures. The occlusion has been functionally restored as a part of the prosthetic treatment. Photos, X-rays and mounted study models were used to document the case in the beginning. The occlusal vertical dimension was evaluated and it was decided to remain the same. The acrylic temporary bridges were constructed in order to keep the occlusal vertical dimension and to test the esthetic results. The final prosthetic restoration implied two removable partial dentures with snap and magnets attachments. The patient wanted a better esthetic appearance so, accordingly, the color of the porcelain fused to metal crowns and bridges was brighter. Changing the anterior occlusion enabled her to change the smile habit from labial to a dental one, exposing the teeth without caring of the appearance. Due to the fact that the upper lip was better sustained, the facial and profile aspect improved. The anterior crossbite occlusion was transformed using prosthetic methods in edge to edge occlusion in order to obtain space for the lingual bar, a better esthetic appearance and a more favorable transmission of the occlusal load to the roots. This procedure is an effective method for treating anterior dental crossbite. Keywords: anterior crossbite, traumatic occlusion, prosthetic methods, esthetics

Objective: Recent literature has indicated that patients with rheumatoid arthritis (RA) are at higher risk of developing moderate to severe periodontitis than non-RA patients. In both diseases, genetic variants influence inflammatory immune responses, and polymorphisms of the interleukin18 (IL-18) and toll-like receptor4 (TLR4) genes, e.g., could play a role. We therefore evaluated known polymorphisms of these two genes in RA patients and healthy individuals with or without periodontitis. Methods: 68 RA patients and 203 non-RA control subjects were genotyped for c.896A>G and c.1196C>T polymorphisms in the TLR4 gene as well as for c. 368G>C and c.-838C>A IL-18 variants. Allele frequencies and genotype distribution were compared between the study groups. Clinical periodontal examination included probing depth (PD) and clinical attachment level (CAL). The presence of periodontitis was defined as proposed by the CDC Periodontal Disease Surveillance Workgroup (Page and Eke, 2007). Results: The genotype and allele frequencies of the two IL-18 promoter variants were not statistically different between the RA patients and healthy individuals. In contrast, TLR4 variants occurred in complete linkage disequilibrium, and were associated with RA, with an increased carrier rate of the c.896G and c.1196T allele in the RA patients (25% versus 9.9% in controls, p=0.004, Fisher's exact test; adjusted odds ratio [OR] for age and gender: 2.29; 95% confidence interval [CI]: 1.07-4.92). There was no significant association between any of the analyzed gene variants and periodontal status in univariate analysis. However, in a multiple logistic regression model, carriage of a TLR4 c.896G/c.1196T allele increased the risk of the occurrence of both RA and severe periodontitis together (adjusted OR: 3.67; 95% CI: 1.5-8.9). Conclusion: TLR4 gene variants could contribute to the susceptibility to developing RA and to developing severe periodontitis in RA patients. These findings support the hypothesis of a shared genetic background between RA and periodontitis. Keywords: rheumatoide arthritis, periodontitis, TLR4 gene polymorphism

Most encountered reasons of implant restoration failure are related to the fixation mode- cemented or screwed. Usually, a small vertical prosthetic space imposes a screwed restoration but there are many authors which use screwed fixed prosthetics in almost every case. The main disadvantage of this type of fixation is the improper implant-restoration connection. On the other hand is difficult to remove a cemented implant supported prosthetic piece without any restoration damages. We propose a solution, which permits us to use an industrial made titanium abutment, and in the same time, it makes possible the access to the abutment screw any time we need it. Keywords: cemented restorations, screwed, implant abutment, definitive cement, implant-supported restoration

Every one of us has a general sense of beauty. However our own individual expression, interpretation and experience make it unique. Webster's third new international dictionary defines "esthetics'' as "appreciative of, responsive to, or zealous about the beautiful; having the sense of beauty or fine culture." A desire to look attractive is no longer taken as a sign of vanity. In an economically, socially and sexually competitive world, a pleasing appearance is a necessity. Creating illusion is one of the most important objectives of esthetic dentistry. The ability to make a tooth look wider or thinner, smaller or larger is an invaluable aid when solving difficult esthetic problems. Illusion enhances realism using three techniques: 1. Shaping and Contouring. 2. Arrangement of Teeth. 3. Staining. As stated by Dawson "Esthetics and function go hand in hand. The better the esthetics, the better the function is likely to be and vice versa". Thus by this poster we are trying to show how esthetics can be enhanced by conservative illusionary effects. Keywords: esthetics, illusion, reality

A 62-years old partially edentulous male patient presented advanced tooth wear and a lowered occlusal vertical dimension. The patient hid his dental condition for many years by never smiling. Esthetic, masticatory and phonation functions needed significative improvments. The decreased vertical dimension was restored during a six weeks period using provisional crowns. The final oral rehabilitation was done using porcelain fused to metal crowns and two removable partial dentures attached with snap systems. Number of abutment teeth has to be increased in tooth wear cases. Occlusal nightguard is mandatory. Keywords: vertical dimension, bruxism, nightguard

Side stream dark field (SDF) imaging technology is a latest invention in the filed of medicine where in it measures the micro circulation at submucosal level. Its use has been observed in oral mucositis secondary to melphalan treatment. It has been used to monitor the post treatment mucositis in individuals subjected to chemotherapy. So could it be used in oral submucous fibrosis patients who have blanching of buccal mucosa secondary to constricted blood vessels and hence compromised micro vasculature. Nowadays vasodialators are more commonly used in the treatment of OSMF which has yielded favorable results. Hence this particular imaging modality SDF could be used to monitor the management of OSMF and also determine the exact amount of improvement. Herewith this paper highlights the detailed use of SDF and its possible use in OSMF patients. Keywords: side stream dark field, oral submucous fibrosis, microcirculation, perfusion

Objective: The aim of the present study was to evaluate the influence of desensitizer application (Hyposen, Lege Artis and Gluma Desensitizer, Heraeus Kulzer) on shear bond strength of ceramics to dentin. Material and methods: 72 freshly extracted third molars were included. Standardized cervical dentin specimens were prepared allowing the simulation of dentin perfusion. The specimens were divided at random into six experimental groups: Group VC: no desensitizer/ Variolink II; Group VH: Hyposen/ Variolink II; Group VG: Gluma/ Variolink II; Group BC: no desensitizer/ Bifix SE; Group BH: Hyposen/ Bifix SE; Group BG: Gluma/ Bifix SE. The desensitizers and adhesive cements were applied as recommended by the manufacturer. Shear bond strength of the above mentioned adhesive cements with or without desensitizer application to ceramic (IPS Empress, Ivoclar Vivadent) was measured using a special device in a universal testing machine. Results: The following shear bond strengths were obtained (mean values and standard deviations in MPa): Group VC: 5.56 ± 0.61, Group VH: 5.28 ± 0.96, Group VG: 3.04 ± 0.18, Group BC: 3.60 ± 1.38, Group BH: 3.60 ± 1.36, Group BG: 2.06 ± 0.16. Statistical analysis showed a significant influence of the used desensitizer and adhesive cement on shear bond strength (ANOVA). Treatment with Gluma (VG, BG) resulted in significantly lower bond strength values (p0.001; Tukey's Test). Pairwise comparison between the adhesive cements showed significantly higher values for Variolink II (p0.001; Tukey's Test). Within the limitations of an in vitro investigation it can be concluded that the application of desensitizers reduce the shear bond strength of all tested adhesive systems. Keywords: adhesives, ceramics, desensitizer, resin cements, shear bond strength

Objective: Periodontitis and rheumatoid arthritis (RA) show pathopysiological similarities. Thus, in the last years, possible associations between both diseases have been in the focus of scientific interest. Several studies have investigated the strength of this association, but with inconsistent results. Therefore, we evaluated the prevalence and severity of periodontitis in patients with RA as compared to healthy individuals in a German population. Methods: The study included 68 RA patients and 126 healthy individuals, for a total of 186 subjects. A comprehensive clinical periodontal examination included probing depth (PD), clinical attachment level (CAL), plaque index (PI) and bleeding index (BOP). Patients were asked to answer questions on smoking status and systemic diseases related to periodontitis in a written questionnaire. Results: Higher levels of mean interproximal PD (2.7±0.6vs 2.4±0.7 mm, p0.01) and CAL (3.2±1.0 vs 2.8±0.8, p0.01) were observed in the RA group as compared to healthy individuals, whereas the level of PI and BOP were similar. When the presence of periodontitis was defined as proposed by the CDC Periodontal Disease Surveillance Workgroup (Page and Eke, 2007), RA patients shifted significantly towards severe periodontitis (44.1% versus 29.4% in healthy individuals, Chi square p = 0.013). Patients with RA had a 3.24-fold risk (95% confidence interval of OR: 1.24 to 8.45) of severe periodontitis when compared to controls. In a multivariate analysis, after adjustment for age and smoking, this association became even stronger: OR: 6.55 (95% CI: 1.64 to 26.19). Conclusion: In this German cohort of RA patients, periodontitis was more common and significantly more severe than in healthy individuals. These results are in line with several former studies detecting an increased periodontitis risk in RA patients. Keywords: periodontitis, rheumatoid arthritis

Aromatherapy is a complementary therapy that uses plant extract essential oils for therapeutic purposes. It is based on the healing properties of the essential oils. It can be used to alleviate specific symptoms or as a relaxant. Aromatherapy is currently used worldwide in the management of psychiatric disorders like chronic pain, depression, anxiety and, some cognitive disorders, bipolar disorders, stress-related disorders and sleep disorders. This poster reviews about 'psycho-aromatherapy' in relation to psychiatric disorders, along with mechanistic, neuropharmacological effects. Keywords: psycho-aromatherapy, essential oils, psychatric disorders

Epidemiological studies on the dental status of schoolchildren from Danube Romanian cities are limited. Dental status of schoolchildren from the first and sixth grade from Fetesti, a town with low pollution on the Danube River, was evaluated. The investigated population consisted of 276 children (160 boys) from two schools from Fetesti: 121 children (61 boys) aged 6-7 years from the first grade (mean age 7y3mo) and 155 children (79 boys) aged 11-12 years from the sixth grade (mean age 11y7mo). The percentage of caries-free children in both samples is very low. 30% of the first grades have 9 primary teeth and 1.5 permanent teeth affected. For the sixth grade, 30% of the children have approximately 5 affected permanent teeth (SiC 30%) and 10% have 6 affected permanent teeth (SiC 10%). Regarding the status of the FPM, about 28% of the first grades and 63% of the sixth grades have caries on the FPM. Prevention programs are needed in order to achieve the WHO Global Goals for Oral Health for 2015 (SiC3 for 12 years olds). Early local preventive strategies, addressing schoolchildren from the first grade, can have better efficiency in helping decrease caries prevalence on FPM. Keywords: epidemiological data, schoolchildren, Danube town

Nasopalatal cyst (NPC) is rare but most common among the developmental, non-odontogenic cysts of the jaws. NPC also called as incisive canal cyst, Nasopalatal canal/duct cyst. It is unique in that it develops in only a single location, in the midline anterior maxilla. . NPC was first described by Mayer in 1914. It arises from the embryonic ducts of scrapa and stenson. It accounts for about 5-10% of the jaw cysts and 1% of the population. Majority of the cases occur between fourth to sixth decades of life. Males are more commonly affected than the females. Most of NPCs are asymptomatic. Usually patient complains of palatal swelling, upper anterior teeth displacement, sub-labial swelling, and low grade pain. Various combinations of swelling, discharge and pain may occur. Histopathologically, the type of cystic lining varies according to the location involved (palatine, nasal or intermediate). The cuboidal cystic epithelial lining is very rarely seen. NPCs are usually treated by enucleation, in case of large cysts, marsupialization may be considered before definitive enucleation. Recurrence rate ranges from 0% to 11%. we report a case of nasopalatal cyst in 38year old lady. Keywords: incisive canal cyst, developmental cyst, cysts of oral cavity

Caries detector dyes are used to help you distinguish between affected and infected dentin. Affected dentin is not infused with bacteria, and even though it might be softer than what we usually consider to be good, sound, hard dentin, should not be removed, while infected dentin must be removed before restoring the cavity. The dye evidently works by bonding to denatured collagen in the dentin, which is a byproduct of the decay process. They also help identify cracks and the location of even partially calcified pulpal tissue as an aid in canal identification for endodontic treatment. Keywords: caries detection, dyes, tooth conservation

Romanian Cantacuzino Institute produces Staphylococcus vaccine kit D (in dilutions) for the treatment of gingivitis and periodontitis since 1997. The vaccine is 1st generation type and contains 15 strains of staphylococcus. The premise of the method was the presence of the Staphylococcus in the periodontal pocket and its morphophysiological characteristics. D Staphylococcus vaccine kit consists of four boxes of vaccine in different dilutions as follows: 1. Five ampoules of 1 ml of staphylococcus vaccine in the dilution of 106 bacterial parts / 1 ml 2. Five ampoules of 1 ml staphylococcus vaccine in the dilution of 107 bacterial parts / 1ml 3. Five ampoules of 1 ml staphylococcus vaccine in the dilution of 108 bacterial parts / 1ml 4. 10 ampoules of 1ml of concentrated staphylococcus vaccine 109 bacterial parts / 1 ml Administration of the vaccine is 15-18 subcutaneous injections every 1-3 days after the original scheme, combined with a polivaccin (Polidin, product of Cantacuzino Institute) and antibiotics (ampicillin and metronidazole), along with traditional conventional treatment for gingivitis or periodontitis. Reimmunization: at 6 months, 1 year and 2 years time. IDR with dilution of 107 will be performed in patients suspected of allergic reactions. Results: positive evaluation of treatment is assessed by the following signs: - Decrease till absence of gingival inflammation, bleeding and pocket abscess, - Consistency, color and texture of gum is normalized, - Decrease of mobility and loss of sensation of unstable occlusion, - The histological decrease of leucocitary infiltrate and recovery of the depolimerized collagen network. In conclusion, immunotherapy with staphylococcus vaccine by modulating the immune response is an effective mean of treatment of periodontal diseases with predictable and immediate results for the patient. Keywords: periodontal disease, pathogenic agent, microflora of pockets, immunotherapy, modelation of immunity, Staphylococal polyvaccine

Bioesthetics is a conservative interdisciplinary approach to the restoration of dentition in its natural form and function. Principles of bioesthetics suggest that proper form by following proper graduation effect, smile line, midline, incisal edge position , principle of proportion and good crown morphology of restorations and teeth lead to good occlusion (Harmonized anterior guidance, proper overjet and overbite, stable centric relation contact) which is necessary for proper functioning and longevity of restoration . The proprioceptors in the periodontal ligaments, mucosa, lips, tongue, cheeks, muscles and TMJ send afferent stimuli to brain and brain in the presence of good occlusion send efferent stimuli to muscles of mastication for proper function. The purpose of this poster is to highlight the principles of bioesthetics. Keywords: form, occlusion, function, graduation effect, bioesthetics

Introduction: After completion of chemotherapy, the invent of prerequisites allow fabrication of denture and rehabilitation of occlusion and oro-facial system's function. Case report: The patient NL, aged 64 yrs.,was inspected at the University Clinic of dental prosthetic in Belgrade. She submitted the confirmation on completion of chemotherapy, after tumorous tissue removal. The fabrication of partial casted denture was indicated in her upper jaw. The denture was initially designed respecting remaining teeth in the upper jaw, with particularly designed base of the denture respecting shapes and forms of palatal tissues. Mastication, speech and swallowing were rehabilitated in this patient. There were not pathologic changes in her mouth, at recall. Conclusion: Partial casted denture for upper jaw, when designed in accordance with shape of supporting tissues after chemotherapy, is successful mode of treatment of partially edentulous patients after surgery and removal of tumor. Keywords: maxilla, denture, cast denture, cancer

Nanodentistry ... the word nano was derived from the greek word for dwarf. The late nobel prize winning physicist Richard P Feynman in 1959 proposed using machine tools to make smaller machine tools, which in turn, would be used to make still smaller machine tools, and so on, all the way down to the molecular level. Such nanomachines, nanorobots and nanodevices ultimately could be used to develop a wide range of atomically precise microscopic instrumentation and manufacturing tools. Feynman argued that these tools could be applied to produce vast quantities of ultra-small computers and various microscale and nanoscale robots. He concluded that this is "a development which i think cannot be avoided" and hence the vision of nanotechnology was born. Attempts are going on at present to produce molecular computer components using molecular parts at the nanometer scale (10-9 meter or 1 billionth of a meter). Tiny particles enter through the microscopic structures called atoms, and do miracles. Nanodentistry will make it possible to maintain a near perfect oral health through the use of nanomaterials, biotechnology, including tissue engineering and nanorobotics. Applications in dentistry include inducing anesthesia, major tooth repair, renaturalization procedures, dentin hypersensitivity, tooth repositioning, durability and appearance. Trends in oral health and disease also may change the focus on specific diagnostic and treatment modalities. Increasingly preventive approaches will reduce the need for curative or restorative interventions, as has already happened with dental caries. Nanodentistry will lead dentistry to its new horizon with painless experience, exertion free treatments, within minimum time. Through this poster we are trying to show the future of dentistry, how this, in modern era will affect both patients and clinicians. Keywords: nano, micro, atom, molecule, nanorobots, nanodentistry, nanodevices

Periodontal therapy is still based on elimination of plaque and calculus by mechanical means. Phase I therapy and periodontal surgical methods remain the main stay for elimination and control of periodontal disease. Antimicrobial therapy is also used in cases of aggressive periodontitis, necrotizing ulcerative periodontitis and in cases of pericoronitis. However, many patients always hope to gain control over their periodontal disease with non-surgical means itself. One of the innovative and novel way of periodontal therapy is the use of photodynamic therapy (PDT). Photodynamic therapy (PDT) can be defined as eradication of target cells by reactive oxygen species produced by means of a photosensitizing compound and light of an appropriate wavelength. The application of photosensitizing dyes and their excitation by visible light enables effective killing of periodontopathogens. PDT application has an adjunctive benefit besides mechanical treatment at sites with difficult access. Necessity for flap operations may be reduced, patient comfort may increase and treatment time would decrease. Keywords: photodynamic therapy, periodontitis, photosensitizing dyes

Stem cells are the class of undifferentiated cells that are able to differentiate into any specialized cell type. Teeth contain a rich source of highly potent stem cells which can be easily collected & stored for future medical & dental use. Tooth loss or absence is a common & frequent situation that can result from numerous pathologies such as periodontal diseases, dental caries, fractures, injuries and genetic alterations. For aesthetical, psychological & medical reasons, replacement of missing teeth is important. Modern dentistry for replacing missing teeth utilizes advances in stem cell biology. Emerging concepts in tissue engineering i.e. biological teeth may become an alternative for replacing missing teeth. This poster presents the idea to cultivate stem cells with odontogenic induction through epithelial - mesenchymal interaction, to adopt dental lineages with the help of scaffold /extracellular matrix to become a part of the tooth. Keywords: stem cell, tissue engineering, tooth regeneration