Quintessence International

Subgingival crown-root fractures are major complications that jeopardize tooth survival and require the clinician to adopt a multidisciplinary approach combining different dental specialties to effectively treat the teeth and ensure long-term survival. Fragment reattachment is a conservative therapeutic option for uncomplicated crown-root fractures. However, biologic width involvement must be carefully evaluated and addressed. This article describes a case of restoration of a crown-root fracture by means of periodontal surgical exposure of the fracture, crown and root recontouring, and fragment reattachment. Keywords: adhesion, biologic width, crown-root fracture, reattachment

Objective: Growing evidence shows an association between periodontal and general health. This study was undertaken to compare the prevalence of hypertension, respiratory diseases, diabetes, arthritis, and allergies among patients with and without alveolar bone loss. Method and Materials: A total of 420 individuals aged 18 years and older were selected. Self-reported systemic diseases, age, gender, marital status, smoking, alveolar bone level, and number of teeth present were obtained from the subjects' dental records prior to treatment. Chi-square, Student t test, and logistic regression were used for data analysis. Results: Hypertension, respiratory diseases, diabetes, and arthritis were significantly more prevalent among subjects with moderate to severe alveolar bone loss. Hypertension and diabetes remained significantly more prevalent among subjects with more severe alveolar bone loss even after adjusting for confounders. Also, subjects with moderate to severe alveolar bone loss were 4 times more likely than their counterparts to have 3 or more systemic conditions. Conclusion: Subjects with moderate to severe alveolar bone loss have an increased prevalence of systemic diseases, especially hypertension and diabetes mellitus. Keywords: allergy, alveolar bone, arthritis, diabetes, hypertension, periodontitis, respiratory diseases

Objectives: The purpose of this study was to evaluate the correlation between central incisor form and face form in 4 racial groups and to investigate if there was agreement among experts in categorizing the central incisor forms. Method and Materials: A total of 160 subjects (40 whites, 40 mulattos, 40 blacks, and 40 Asians) ranging from 18 to 33 years of age were selected. Digital photographic records were made, 1 full-face and 1 intraoral view of the maxillary right central incisor. The outline tracings of the tooth and face images were obtained using Adobe Photoshop 5.0 software. The outline tracings were printed in distinct transparencies, and 3 prosthodontists determined if there was correspondence between the tooth and the face forms by superimposition of the transparencies. If there was disagreement among the prosthodontists' evaluations, the prevalent decision was considered. The experts also classified the central incisor forms into square, ovoid, tapering, or combination at 2 different sessions. At the first session, no instructions were given. At the second session, the prosthodontists were instructed to follow Williams' method of classification. Results: A correspondence between tooth and face forms was found in 23.75% of all cases. Agreement on the tooth form classifications among the prosthodontists occurred in 30.62% of all cases at the first session and 24.37% at the second session. Conclusion: There is not a highly defined correlation between central incisor form and face form in any racial group studied. In addition, the experts were not in fair agreement in categorizing tooth forms. Keywords: artificial teeth, complete denture, esthetics, facial morphology, race, tooth morphology

Impaction of mandibular second molars is relatively rare. A case of a deep impacted mandibular right permanent second molar in a 26-year-old woman is presented. This article describes the extraction of the tooth and reports the risks of the surgical procedure. Careful manipulation of tissues and correct application of mechanical principles involved in tooth extractions allowed surgical success. Keywords: impacted teeth, mandibular second molar, tooth extraction

Dental management of patients with autoimmune vesiculobullous disorders is compli-cated because of prominent involvement of oral mucosa, increased risk of oral disease, and difficulty in rendering dental care. Although these diseases are relatively uncommon, dental practitioners should be familiar with the oral sequelae of these conditions and their management. Pemphigus vulgaris, cicatricial pemphigoid, and epidermolysis bullosa represent the most common autoimmune oral vesiculobullous diseases. This case-illustrated review summarizes the pathogenesis, diagnostic features, and natural history of oral vesiculobullous disorders, placing an emphasis on the treatment and prevention of associated oral disease aimed at maintaining a healthy, functional dentition. Keywords: cicatricial pemphigoid, dental complications, epidermolysis bullosa, pemphigus vulgaris, vesiculobullous disorders

Objective: The purpose of this study was to determine whether anterior crowns fabricated using a computerized shade selection system (ShadeScan, Cynovad) (experimental procedure) match adjacent teeth better than anterior crowns fabricated using conventional shade prescription and clinical slides (control). Method and Materials: Five subjects who required a crown to restore a maxillary central incisor were selected. Two metal-ceramic crowns were fabricated for each incisor, 1 using the experimental procedure and 1 using the control method. The shade selection method to be used for the first and second crowns was randomly assigned. The duration of each procedure was recorded. Each restoration was tried-in in a double-blind manner and evaluated for its level of match to adjacent teeth using modified Ryge criteria. Data were analyzed within each subject using descriptive statistics and paired t test (alpha = .05). Results: In 40% of the cases, both procedures did equally well. In the remaining 60% of the cases the control procedure (two-thirds of the cases) performed better than the experimental procedure (one-third of the cases). Duration of the control procedure was 14.4 ± 5 minutes, and the experimental procedure was 5.2 ± 3.3 minutes. A paired t test showed the difference was significant (P = .0045). Conclusion: The level of matching of crowns fabricated with the ShadeScan system was not different from crowns fabricated using the control. However, it took significantly less time to record the shade with the ShadeScan system. Keywords: ceramics, clinical study, computers, crowns, ShadeScan, shade selection

Objective: The main objective was to compare the presence of interlayer gaps between 2 hybrid composites placed using a microlayer and a 2-layer technique. Method and Materials: Standardized Class 1 cavities were prepared in 40 extracted posterior teeth. Two resin composite materials were used. The control group, group A, consisted of samples of the materials extruded out of the manufacturers' syringes. Group B consisted of 10 teeth restored using 2 layers per restoration. Group C consisted of 30 teeth restored using 6 microlayers per restoration. A scanning electron microscope was used to detect voids in the samples. Results: Round, well-defined voids were found in 85% to 100% of the samples within the bulks of the resin composite materials only. A statistically significant relationship between the type of composite and presence of bubbles (Fisher exact test, P = .04) was found among the 2-layer technique group. No statistically significant difference (Fisher exact test, P = .48) was found among the microlayer technique group. Irregular interlayer gaps were found in 5% to 15% of specimens within areas between bulks of composite, as detected by an electron microscope based on the different densities of the bulks of composite and the interlayer areas. No such statistically significant relationship was found (Fisher exact, P = .62) among the study groups. Conclusions: Voids are routinely found in bulks of composite materials. Higher incidences of interlayer gaps in the 2-layer samples suggest that the use of a microlayering technique may result in fewer gaps. Keywords: comparison, gap, microlayer, posterior composite restoration, technique, void

Objectives: The objective of this study was to compare the step-down technique in simulated curved root canals using K hand files (VDW) and ProFiles 0.06/0.04 (Dentsply Maillefer). Method and Materials: A total of 72 canals were blindly prepared by instructed students: 1 block with K files and a second one with ProFiles 0.06/0.04 in connection with the EndoStepper (SET). Postoperative images of the canals were taken, and an independent dentist assessed preparations for amount and position of material removed during preparation. Efficacy of the instruments is described in terms of canal shape, instrument failure, canal blockages, and preparation time. Results: ProFile instrumentation provided well-centered and tapered preparations while maintaining the apical foramen; in contrast, the use of K files resulted in frequent alterations of the root canal. In the apical portion, both techniques showed unprepared areas. The coronal diameter in hand-instrumented canals was more irregular and wider than in those mechanically prepared. There was no separation of a ProFile instrument. Hand instrumentation was faster than mechanical, but the difference was not statistically significant. Conclusion: Under the conditions of the study, the ProFile rotary system was simple and safe to use and created better preparations than hand instrumentation. Keywords: hand instrumentation, mechanical preparation, nickel-titanium, rotary, simulated root canals

An abnormal upper labial frenum is capable of retracting the gingival margin, creating a diastema, limiting lip movement, and in cases of a high smile line, affecting esthetics also. When an abnormal frenum is present, frenectomy is advised. This technique has been modified in many ways. But in most of the techniques the zone of attached gingiva and esthetics are not considered. This case report highlights a new technique of frenectomy that results in good esthetics, excellent color match, gain in attached gingiva, and healing by primary intention at the site of the thick, extensive abnormal frenum. Keywords: attached gingiva, diastema, esthetics, frenectomy, frenum