Quintessence International, 04/2003

The previously named localized juvenile periodontitis (LJP), recently reclassified as localized aggressive periodontitis (LAP) seen in young people, is a rare condition characterized by severe periodontal destruction around first molars and incisors in individuals with little or no accumulation of visible plaque and/or calculus. Treatment of this condition has traditionally included periodontal surgery and adjunctive antibiotic therapy. Even though several periodontal regeneration techniques in these patients have been reported, there have been no reports of the use of the enamel matrix proteins in the treatment of intrabony defects caused by this disease. This report describes the case of a 15-year-old patient who was diagnosed as having LAP and the resulting treatment and outcome. The treatment consisted of systemic antibiotic therapy and periodontal surgical procedures combined with enamel matrix protein application. The 6-month clinical probing and attachment level measurements and radiographic findings are reported.

Guided bone regeneration using an absorbable membrane combined with one-stage implants was used to treat a 45-year-old woman. Two months following tooth extraction, two implants were placed-one in the extraction site and one in a healed site. An absorbable membrane was applied to cover the bony defect in this recent extraction site. After a 24-month follow-up, probing depths were normal, increased radiopacity was seen in the extraction site, and the implant was still clinically stable.

Access to the pulp chamber for endodontic treatment is indicated inter alia as a result of extensive caries, trauma to the tooth causing fracture or loss of vitality, requiring restoration of the missing tooth structure. Different approaches and materials are described in the literature for foundation restorations, either with a cast post and core or immediately, with a chairside post-and-core system. This article briefly reviews the current data regarding the microbiologic, prosthetic, mechanical, and periodontal aspects while emphasizing the immediate approach using amalgam, resin composites, and glass ionomers. Factors affecting retention of the post are presented to guide the clinician in selecting a suitable post-and-core system to preserve optimal root structure and prevent root fracture. Three clinical cases are presented in which tooth structure was restored using different techniques: in the first two, provisional acrylic resin shells, one custom made and the other prefabricated, were used to house an amalgam coronal-radicular dowel core, where in the third case, a copper band was used for a composite post-and-core system. All cases emphasize the ease of production and short chairtime in the stages of crown fabrication.

Objective: Carisolv is a relatively new chemomechanical method for caries removal. The aim of this clinical study was to compare Carisolv with the conventional drilling technique. Method and materials: Forty-five volunteers, ages 18 to 55 years, each with two contralateral primary coronal mesio-occlusal or disto-occlusal carious lesions, similar in extent, participated in the study. Two calibrated operators treated all lesions. One operator treated both lesions in one visit (one lesion with Carisolv and the other with conventional drilling). Following the filling procedure, the opinion of each patient regarding each caries removal method was recorded. The need for drilling in addition to the Carisolv application, the time required for caries removal, the need for anesthesia, and the gingival reaction to the Carisolv gel were recorded by each operator for each case. Results: The patients found Carisolv treatment more pleasant (82%) and preferable (88%) to drilling. Of the patients treated with drilling, 40% required anesthesia compared to the 8% treated with Carisolv. Additional drilling for complete caries removal was needed in 10% of Carisolv-treated lesions. Carisolv induced no gingival reaction. Significantly longer times were required for caries removal with Carisolv (12.2 ± 4.1 minutes) compared to drilling (6.8 ± 2.8 minutes). Conclusions: The Carisolv technique was: (a) accepted by the majority of patients, (b) efficient for caries removal, (c) considered a time-consuming technique for the dentists, and (d) considered less dependent on local anesthesia.

The talon cusp, or dens evaginatus of anterior teeth, is a relatively rare dental developmental anomaly characterized by the presence of an accessory cusplike structure projecting from the cingulum area or cementoenamel junction. This occurs in either maxillary or mandibular anterior teeth in both the primary and permanent dentition. This article reports five cases of talon cusp, two of them bilateral, affecting permanent maxillary central and lateral incisors and canines that caused clinical problems related to caries or occlusal interferences.

This report describes the rare case of an impacted mandibular third molar that was displaced into the submandibular region. Upon locating the tooth, successful extraction was performed. Healing was unincidental.

The objective of this literature review is to discuss the various parameters related to clinical success of implant treatment in geriatric patients. Old age is not a contraindication for implant therapy; however, clinicians should be aware of potential risks, possible medical complications, and psychosocial issues that affect implant prognosis in geriatric patients.

The basic mechanism of dental amalgam corrosion has been thoroughly studied during the last 50 years by various experimental techniques, most often carried out in vitro. Electrochemical methods were extensively employed, and it was recognized that a gradual dealloying of the more electroactive components, Zn, Sn, and to a lesser extent Cu, contributed to change the surface composition. It is also well known that, in all circumstances, galvanic coupling threatens the longevity of the restoration. Among the patients examined at the hospital attached to the Department of Dental Surgery of the Paris 5 University, the authors observed, in a few exceptional circumstances of defective restorations, a release of liquid metal droplets in the surrounding tissue. These particles were identified as elemental mercury. This unexpected phenomenon was the result of the use of a low-silver-content alloy, combined with an enhanced corrosion process due to galvanic coupling with a silver alloy crown and brass screw-posts. In the described clinical case, the tooth, which had to be extracted, was axially sliced for observation by scanning electron microscopy coupled with elemental analysis by X-ray fluorescence energy dispersive spectroscopy. The observations showed a dramatic corrosion of the amalgam matrix with the formation of porosity even in the bulk of the material. Superposition of the element mappings proved (1) the electrochemical coupling of the amalgam with the silver-based crown, (2) the decalcification of the dentin, and (3) the formation of tin oxychloride precipitates in the matrix porosities and the interfacial gaps. These experimental results corroborate the corrosion mechanisms described hereupon. They support the current national and international recommendations for the dental amalgam formulation and for a rigorous professional practice.

Objective: This study investigated the cervical microleakage between a cobalt-chromium (Co-Cr) alloy and four indirect polymeric veneering materials using different adhesive systems. Method and materials: The Co-Cr-based alloy for fixed prosthesis used in this study (Biosil F, Degussa) was veneered with four different polymeric materials: Artglass, Chromasit, Solidex, and Superacryl. Results: Superacryl produced the highest microleakage score (4 ± 0.0). The least microleakage at the interface was produced by Artglass (1 ± 0.816), followed by Chromasit (2 ± 1.414) and Solidex (2.5 ± 1.0). Only the differences between Artglass and Superacryl were significant. Conclusion: Within the limitations of this in vitro study, cervical microleakage between the coping and the veneer depended on the particular polymeric material used for veneering. Leakage was significantly lower when resin materials were used together with a chemical conditioning system (ie, Artglass/Siloc).

Objective: The purpose of this in vitro study was to investigate fracture resistance in teeth restored with cast post and cores with and without ferrule and using two different luting cements. Method and materials: Forty intact maxillary premolars were endodontically treated after their crowns were removed at 2.00 mm from the cementoenamel junction. Specimens were embedded in acrylic resin blocks in aluminum cylinders, 4.00 mm apical to the cementoenamel junction. Twenty specimens were ferruled, and half of the posts and cores were cemented with zinc-phosphate cement, while the other half was cemented with resin cement. The same procedures were followed for the nonferruled group. Loads were applied at an angle of 45 degrees and measured with a universal testing machine. ANOVA and Tukey test were used for statistical analyses; a significance level was established at 5%. Results: Ferruled specimens showed greater resistance than nonferruled ones, regardless of the cement used. There was no statistical difference between the group of specimens cemented with resin cement and without ferrule and the ferruled groups. The nonferruled group with zinc-phosphate cement showed the poorest results. Conclusion: A 2.00-mm cervical ferrule is important for fracture resistance of restored teeth, and resin cement has a better performance.

Freeman-Sheldon syndrome, also called whistling-face syndrome, is a very rare genetic condition, occurring both sporadically and by transmission through autosomal dominant or recessive mode, which affects primarily the face and skeleton. Characteristics include microstomia of the mouth, which gives the person a whistling appearance, a flat face, club feet, contracted joint muscles of the fingers and hands, and underdeveloped nose cartilage.This article describes a case of Freeman-Sheldon syndrome in a 10-year-old male. The most apparent deformities are associated with orofacial and skeletal development.

The ameloblastoma is a benign odontogenic tumor of epithelial origin. Histopathologically, it occurs in six patterns: plexiform, follicular, acanthomatous, granular cell, basal cell, and desmoplastic type. This report presents a rare case of an ameloblastoma in the maxillary sinus that consists of three types: follicular, plexiform, and acanthomatous. The diagnostic procedure, surgical therapy, and follow-up findings are described and discussed.