Quintessence International, 08/2016

Invasive cervical resorption is a pathologic process leading to progressive and usually destructive loss of tooth structure. The pathogenic mechanism is not completely understood and the diagnosis may be challenging. The aim of this article is to present an unusual case of bilateral presence of invasive cervical resorption lesions in maxillary central incisors and to discuss the treatment procedures using a novel repair material. The management of the present case was carried out in three phases. The first stage of the treatment aimed at curetting the active tissue from the resorption cavity and restoring the defect with the novel calcium silicate-based cement (Biodentine, Septodont). In the maxillary left central incisor it was not possible to remove the resorptive tissue without exposing the pulp, and therefore root canal treatment was performed. At the second phase, a full-thickness flap was raised in order to expose and repair the defect that was extending subgingivally. At the third phase teeth were restored with composite resin. The patient was kept under review and after a follow-up period of 2 years neither signs of periradicular lesion nor recurrence of resorption were observed. The teeth were asymptomatic, and restorations appeared to be in excellent condition. In conclusion, Biodentine seems to be a promising material for the treatment of invasive cervical resorption lesions. Keywords: calcium silicate cement, invasive cervical resorption

Objectives: The aims of this study were to determine the relationship between compliance in patients with chronic periodontitis and the efficacy of nonsurgical periodontal treatment as well as to investigate the factors that influence the compliance of patients with chronic periodontitis. These aims may be useful for determining the prognosis and improving the efficacy of treatment. Method and Materials: Four hundred patients with chronic periodontitis were classified into three groups: the complete compliance group (S1), the erratic compliance group (S2), and the failing compliance group (S3). The patients who were in group S1 received supportive periodontal therapy (SPT) on time: they presented for their appointments within 2 months of the scheduled date; the patients who missed their appointments by more than 2 months or who completely missed a return visit one or more times, were placed in group S2; and the patients who never returned to receive SPT were assigned to group S3. They completed a questionnaire about compliance and underwent a clinical periodontal examination. SPSS 13.0 was used for the statistical analysis. Results: Groups S2 (49.4%) and S3 (34.1%) were significantly different from group S1 (87.0%) (P .05) in their understanding that periodontal disease is always associated with other diseases. The analysis of severe pain during the treatment revealed significant differences (P .05) between group S1 (22.2%) and group S3 (39.9%). Awareness of chronic periodontitis and comfort during treatment are important factors influencing patient compliance. The distance of the patient's residence from the hospital, working hours, and attitudes of family members also affect patient compliance. Conclusion: Doctors should educate patients about oral health and manage their patients' comfort as much as possible during treatment, thereby enhancing patient compliance and achieving better treatment efficacy. Keywords: chronic periodontitis, compliance, factor analysis, supportive periodontal therapy

Objective: To clinically evaluate the healing of multiple adjacent maxillary Miller Class I, II, and III gingival recessions (MAGR) treated with the modified coronally advanced tunnel (MCAT) in conjunction with an enamel matrix derivative (EMD) and subepithelial connective tissue graft (SCTG). Method and Materials: Twelve systemically healthy patients (6 females) with a total of 54 adjacent maxillary Miller Class I, II, or III MAGR were consecutively treated with MCAT in conjunction with EMD and SCTG. Out of the 54 recessions, 44 were classified as Miller Class I, five as Miller Class II, and five as Miller Class III. Patients were included in the study if they presented at least two adjacent recessions with a depth of ≥ 3 mm. Measurements were made at baseline (immediately before reconstructive surgery) and at 12 months postoperatively. The primary outcome variable was complete root coverage (CRC) (ie, 100% root coverage). Results: Healing was uneventful in all cases without any complications such as postoperative bleeding, allergic reactions, abscesses, or loss of SCTG. At 12 months, statistically highly significant (P .0001) root coverage was obtained in all patients and recessions. CRC was obtained in 37 Miller Class I, three Miller Class II, and one Miller Class III recessions, respectively. Mean root coverage was 96%. Mean keratinized tissue width increased statistically highly significantly (P .004) from 2.04 ± 0.95 mm at baseline to 2.37 ± 0.89 mm at 12 months. Conclusion: The present findings indicate that the proposed treatment concept results in predictable coverage of multiple adjacent maxillary Miller Class I, II, and III MAGR. Keywords: enamel matrix derivative, modified coronally advanced tunnel, multiple adjacent maxillary Miller Class I/II/III recessions, root coverage, subepithelial connective tissue graft

Objective: The worldwide prevalence of obstructive sleep apnea (OSA) is increasing day by day and is estimated to be as prevalent as asthma and diabetes. Untreated sleep apnea can have dire health consequences and can increase risk of hypertension, diabetes, heart disease, and heart failure. Dentists are often the first professional to become aware of a potential problem since they are usually in contact with their patients more frequently than are physicians. The present study was aimed at evaluating the effect of four different mandibular advancement splints fabricated at different jaw positions on sleep parameters in patients with OSA. Method and Materials: 72 patients who fulfilled the study criteria were selected. All the patients were randomly divided into four groups of 18 patients each. All the patients in group 1 were given a mandibular advancement splint (MAS) fabricated at 60% of maximum protrusion and 4 mm of vertical opening. All the patients in group 2 were given a MAS fabricated at 60% of maximum protrusion and 6 mm of vertical opening. All the patients in group 3 were given a MAS fabricated at 70% of maximum protrusion and 4 mm of vertical opening. All the patients in group 4 were given a MAS fabricated at 70% of maximum protrusion and 6 mm of vertical opening. Results: The maximum change in all the sleep parameters was observed in group 3 when MAS was fabricated at 70% of maximum protrusion and 4 mm of vertical opening. Conclusion: The present study suggested that MAS was more effective with no patient discomfort when fabricated at 70% of maximum protrusion and 4 mm of vertical jaw separation. Keywords: Apnea/Hypopnea Index (AHI), jaw position, mandibular advancement splint, obstructive sleep apnea

Objective: The purpose of this article is to describe long-term results of the dynamic implant valve approach (DIVA) for the dental implant procedures when the implant system with internal ports was used. Method and Materials: During 2012 to 2015, 378 titanium-aluminum-vanadium implants (Ti₆Al₄V ELI; diameter 3.75 mm; length 11.5 and 13 mm) were implanted in 172 patients (one to nine implants per patient) using the DIVA technique. The DIVA implants were used in cases when sinus membrane and/or nasal floor elevation procedures were needed. The condition of the implants was assessed during the follow-up period up to 60 months. Results: Out of 378 inserted implants, 257 implants were inserted in the maxilla with the bone level 5 mm, and 121 implants were inserted in the maxilla with the bone level > 5 mm. In 357 cases (94.5%), the implantation was totally successful both from objective CBCT clinical and subjective patients' viewpoints. The comparison of complication rates between the cases with the bone level 5 mm and the cases with the bone level > 5 mm indicated no significant difference (P = .32). Conclusion: Preliminary results that the DIVA simplifies the dental implantation procedure and augmentation treatment were confirmed. The implant with an inner sealing screw can be used in cases with elevation of the maxillary sinus membrane, and simplifies the surgery and secures optimal dental implant placement. This new type of implant simplifies the maintenance phase of implant dentistry and helps to overcome possible complications. Keywords: dental implant, implant maintenance, maxillary sinus floor elevation

Objective: Abnormalities of the midface and maxilla are frequently corrected using Le Fort I surgery. This osteotomy passes near the apices of the maxillary teeth, severing the blood vessels and nerves supplying the teeth. The aim of this review was to determine the effect of Le Fort I osteotomy on pulpal vascularity and neurosensory response. Data Sources: A systematic search of the literature was performed in PubMed/ Medline, Google Scholar, EMBASE, and ISI Web of Knowledge from 1969 up to and including December 2015 using the following key words: Le Fort 1, tooth vitality, maxillary osteotomy, pulp, orthognathic. Reference lists of relevant articles were hand-searched for additional articles. Results: Sixty-two studies were located by initial screening; 38 did not meet the eligibility criteria; three were excluded after full-text review, 13 were excluded after quality assessment, leaving nine studies eligible that met all inclusion criteria for this systematic review. The postoperative follow-up period of the included studies ranged from 3 months to 28 months. Five studies assessed pulpal blood flow using laser Doppler flowmetry and eight studies assessed the pulpal neurosensory response using electric pulp testing. Conclusion: There is a decrease in pulpal vascularity and neurosensory response following a Le Fort I osteotomy in the early postoperative period (1 to 10 days) that is likely temporary. Further controlled clinical studies with standardized parameters are required to determine the long-term effects of Le Fort I osteotomy on the vascular and neural healing of the dental pulp. Keywords: Le Fort I osteotomy, pulpal neurosensory response, pulpal vascularity

Objective: Rivaroxaban, apixaban, edoxaban, and dabigatran are the first direct oral anticoagulants (DOACs) to be cleared by the Food and Drug Administration for prevention of thromboembolic disorders. Patients previously taking conventional anticoagulants are now being treated with DOACs, and as a result, more dentists will be treating patients on DOACs in the community. At present, there is no validated monitoring test that can estimate bleeding risk for patients on DOACs, and the available dental literature is based on case reports and expert opinions. It is unclear whether the dose of DOACs should be continued, partially interrupted for 1 day, or completely interrupted for longer than 2 days prior to dental treatment. The aim in this case series is to describe the dental treatment of patients on DOACs and the outcomes of dental treatment for these three clinical approaches. Method and Materials: We report on a series of patients on DOACs seen in a hospital dental clinic and the outcomes of dental treatment for three clinical approaches: continuation of DOACs throughout dental treatment, partial interruption of DOACs 1 day prior to dental treatment, or complete interruption of DOACs for longer than 2 days prior to dental treatment. Results: None of the patients exhibited significant postoperative bleeding regardless of approach. Clinically significant postoperative complications were managed without difficulty. Conclusion: Our experience suggests that dental treatment may be safely delivered following continuation, partial interruption, or complete interruption of the DOAC dose for dental treatment. Large-scale comparative studies are warranted to assess the preferred clinical approach. Keywords: anticoagulant, bleeding, dental, direct, management, oral

Pain is among the most common reasons for patient visits to healthcare providers, especially to dental practitioners. This case illustrates the obligation of the general dentist and specialist to recognize facial pain disorders of nonodontogenic origin, and outlines a paradigm for treatment of this unusual case. A 59-year-old man presented with chronic, progressive right periorbital pain since 2006, of 7 years duration. The initial diagnosis was a fracture of the right outer rim of the orbit secondary to trauma. The patient had undergone a variety of clinical and radiographic evaluations, pharmacologic therapies, and limited surgical procedures with no benefit. The description of his pain varied. Initially complaints were consistent with musculoskeletal pain, ie chronic, localized, aching, and evoked by pressure. It evolved into a neuropathic quality with increasing and spontaneous pain associated with sensory changes. Pain levels, which were initially mild, became moderate to severe. After a detailed review of the patient's history, radiographic records, and a comprehensive clinical evaluation, a CBCT of the maxilla was performed. While not considered a routine radiographic study, CBCT is readily available to the general dentist and specialist. CBCT was indicated in this case and revealed a rare interosseous hemangioma of the maxilla. The portion of the maxilla containing the lesion was surgically removed and a prosthetic replacement was placed. At 12 months after the procedure the patient remains pain free. Keywords: benign neoplasm, interosseous hemangioma, orofacial pain, otolaryngology, radiology, surgery

Osteoma cutis is a condition that generally presents with true bony deposits in the skin. Although the pathogenesis of osteoma cutis is not clear, it supposes that certain preexisting conditions like acne vulgaris may contribute to generating these ossifications. These osteomas are usually asymptomatic and do not require any treatment unless they cause cosmetic issues. Rarely, this dermatologic condition may be observed in dental practices and it may be difficult to understand and diagnose the clinical and radiographic findings of this disease. In the current case, the diagnosis of osteoma cutis and the special sub-type multiple miliary osteoma of the face was made after considering the patient's history and the clinical and radiographic examinations. In order to contribute to the understanding of the diagnosis, the etiology, imaging modalities, and treatment of this rare disease, we present a case report of a 60-year-old woman with incidentally recognized multiple radiopaque microspheres that presented on intraoral radiographs, a panoramic radiograph, and CT scan. General practitioners should have some knowledge regarding the clinical and radiographic findings of this disease. They may be the first person to identify the condition and may play an important role in explaining the findings or cosmetic problems of their patients. This knowledge is also required for the necessary consultations and treatment of the patient. Keywords: acne, dental radiography, osteoma cutis