Quintessence International, 03/2002

Most dental trauma requires immediate action to preserve the affected teeth. Furthermore, the trauma has often a great impact on the appearance and well being of the patient. In this case trauma resulted in a very deep complicated crown-root fracture of one incisor and a complicated crown fracture in another incisor of a 47-year-old woman. A combination of surgical extrusion and adhesive restoration was chosen to provide good prognosis for the teeth as well as an instant esthetic result that was well accepted by the patient. Eleven months after trauma, the treated teeth exhibited good healing and normal function.

An 11-year-old patient that fractured her maxillary left central incisor is presented. The fracture involved two thirds of the crown, compromising the pulp, and extended subgingivally on the palatal aspect, invading the biologic width. The procedure used to repair the fracture included flap surgery with a slight ostectomy and endodontic treatment. The reattachment of the tooth fragment and the restoration were performed with a bonding system and a resin composite. Examination 6 months after treatment revealed periodontal health, good esthetics, and normal function.

Objective: The clinical performance of porcelain laminate veneers was evaluated at 5 years. Method and materials: One hundred eighty-six porcelain laminate veneers were placed in 61 patients, aged 18 to 70 years, by a single operator following the same clinical procedure. At the 5-year recall, esthetics, marginal integrity, marginal discoloration, fracture rate, and patient satisfaction were recorded. Results: At recall 98.4% of the veneers were satisfactory without intervention. The retention rate was excellent, the fracture rate was very low, and the maintenance of esthetics was superior. Patient satisfaction was very high. Conclusion: Porcelain laminate veneers offer a reliable and effective procedure for the conservative and esthetic treatment of anterior teeth.

Objective: A genetic polymorphism in the interleukin 1 gene has been implicated as a factor in determining the severity of adult periodontitis. Among white Europeans, the prevalence of genotype-positive subjects has been reported to be around 30%. The purpose of this study was to assess the prevalence of genotype-positive individuals in a Hispanic population. Method and materials: Fifty Mexicans were evaluated for their interleukin 1 genotype with a commercially available test. Subjects were divided into groups, as determined by their genotype (positive or negative), and were then analyzed according to age, sex, and smoking habits. Results: Thirteen of 50 subjects were genotype positive, a prevalence of 26%. The most common polymorphisms found in genotype-positive subjects were allele 1.2 for the IL1A gene and allele 1.2 for the IL1B gene. When only subjects older than 30 years were evaluated, the prevalence of genotype-positive individuals was 31%. Conclusion: The prevalence of genotype-positive subjects in a Hispanic population was 26%, similar to the prevalence found among ethnic populations from or descended from Northern, Central, and Southern Europe.

Objective: The aim of this study was to assess the relationship between socioeconomic status and oral hygiene, gingival condition, and dental caries among 12- to 15-year-old children. Method and materials: Poor children of low-to-moderate socioeconomic status (n = 674) attending 10 public schools were chosen randomly from each of the five geographic areas in Irbid, Jordan. Rich children of high socioeconomic status (n = 347) attending 10 private schools were also included. Schoolchildren were examined for oral hygiene, gingival condition, and dental caries. Results: Significantly higher proportions of children attending public schools had bleeding on brushing and calculus. Mean plaque and gingival scores were higher in public school children than in private school children, but the difference was not statistically significant. The public school children had higher overall scores for decayed, missing, or filled teeth and surfaces as well as higher scores for decayed teeth and surfaces, but there was no statistically significant difference between groups. However, children attending private schools had significantly more missing and filled teeth and surfaces. Conclusion: The findings for oral hygiene, gingival status, and dental caries were worse, but not significantly worse, among poor children than they were among rich children. Therefore, dental health education is recommended for both socioeconomic groups.

Amelogenesis Imperfecta is a hereditary disorder that affects enamel on primary and permanent teeth. It is a rare dental disease but represents a major restorative challenge for the dentist. A 14-year-old boy presented with sensitive, discolored, and mutilated teeth and a decreased vertical dimension of occlusion. The aim of treatment was to reduce dental sensitivity, to restore esthetics, and to correct the vertical dimension of occlusion. To modify the occlusion, and to protect the dentin from chemical and thermal attacks, nickel-chrome onlays were placed on the molars. To improve the esthetics of the incisors and premolars, resin composite restorations were applied. The patient was regularly recalled during the postoperative period. Radiographic and clinical examinations 10 months posttreatment revealed no evidence of disorders associated with the restored teeth or their supporting structures.

Objective: The aim of this study was to assess the effect on microleakage of cyclic lateral fatigue forces in different types of cervical resin composite restorations. Method and materials: V-notch cavities were prepared at the cementoenamel junction in 60 extracted human premolars and restored with a bonding system along with one of the following resin composites: hybrid resin composite, microfilled resin composite, and flowable resin composite (20 each). Ten specimens from each group of 20 were subjected to 8,400 cycles of lateral fatigue forces (44 N) at the occlusal half of the clinical crown in a machine specifically developed for this purpose. The other 10 specimens of each group served as controls, representing the microleakage that occurred without lateral fatigue forces. All specimens were stained with a 50% silver nitrate solution and sectioned sagittally. A scoring system of 0 to 6 was used to record the amount of die penetration along the restoration-tooth interface. Results: There was leakage in both the fatigued specimens and the nonfatigued control specimens. There were significant differences in the mean values of microleakage for the restorative materials studied. In the nonfatigued groups, hybrid resin specimens exhibited significantly more microleakage at the dentin-resin interface than did microfilled or flowable resin specimens. In the fatigued groups, hybrid resin specimens exhibited significantly more leakage at the dentin-resin interface than did microfilled resin specimens. Conclusion: The least elastic resin composite tested, the hybrid material, generally showed the most leakage. This suggests that the elasticity of these resin composite restorative materials may be a factor in the amount of microleakage in cervical restorations.

Enamel adhesion by means of acid etching has become an accepted technique in restorative dentistry. Adhesion to dentin, however, is still under investigation. At this time, two distinct adhesive techniques are prominent in the attempt to establish a strong bond to dentin: total-etch and self-etching primers. Total-etch bonding systems have been shown to be effective both in vitro and in clinical evaluations. The new total-etch one-bottle bonding systems, although exhibiting the same success on laboratory tests, still have to prove their clinical effectiveness. Self-etching primer systems are undergoing rapid evolution; their results are not yet sufficiently predictable overall, but some systems have achieved positive results in both enamel and dentin bonding. Further studies are necessary to confirm the long-term efficiency of these self-etching primers.

The stomatognathic system is a complicated structure, and patients usually adapt to their existing vertical dimension of occlusion. Therefore, prosthetic rehabilitation of decreased vertical dimension of occlusion should be considered only when dictated by esthetic or functional requirements. If the loss of vertical dimension is significant, provisional prostheses should be used before the final prosthesis to prevent tension or pain in the temporomandibular joints and the muscles as the patient adapts to the new dimensions. Acrylic resin provisional prostheses were used for three patients before the final prosthesis was fabricated with the restored vertical dimension of occlusion. The period of use varied, depending on the patient's individual adaptive ability. The important aspect is to find the most comfortable position for the patient.

An impacted third molar in the subcondylar region is extremely rare. This case report describes an impacted mandibular third molar in the subcondylar region associated with a dentigerous cyst.

Objective: To aid in differentiation of the two lesions, direct immunofluorescence was used to examine the fluorescence patterns