Quintessence International, 09/2008

Esthetic complications due to nonharmonious peri-implant soft tissue profiles are common in the anterior maxilla, especially when 2 adjacent implants are found. This article suggests the use of a single implant to replace 2 lost adjacent teeth in this region and demonstrates the treatment with 2 clinical cases. The main advantage is preservation of the interdental papilla and gingival contours, compensating for the alveolar bone crest resorption at the platform of a second implant. Keywords: cantilever, dental papilla, esthetic zone, gingival tissue, implant-supported prosthesis, titanium implants

Objective: To evaluate 4 interocclusal recording materials for their ability to reproduce accurately interocclusal relationships after a storage time of 1 or 48 hours. Method and Materials: A custom-made metal apparatus was used to simulate the maxilla and mandible. The vertical discrepancies were measured by a precision dial gauge. Eight interocclusal records were made in each of the following groups: (G1) Futar D (polyvinyl siloxane; Kettenbach), (G2) Ramitec (polyether; 3M ESPE), (G3) LuxaBite (composite resin based on bisacryl; DMG), (G4) Aluwax (aluminum wax; Aluwax Dental Products), (G5) LuxaBite corrected with LuxaBite, and (G6) LuxaBite corrected with Aluwax. The vertical discrepancies were measured after storage of the records for 1 and 48 hours at room temperature and repositioning of the records in the metal apparatus. Data were statistically analyzed using 1-way analysis of variance followed by the Games-Howell test (P = .05). Results: After storage times of 1 and 48 hours, respectively, the mean vertical discrepancies (µm) for G1 (23/33) and G2 (25/30) were statistically significantly lower than for G3 (431/745) and G4 (110/151) (P .05) but higher than for G5 (8/16) and G6 (7/17). There was no statistically significant difference between G1 and G2 or between G5 and G6 for either measurement. Conclusion: These vertical discrepancies increased after a storage time of 48 hours. However, correction of the LuxaBite records with LuxaBite or Aluwax showed significantly lower vertical discrepancies than all other materials. Clinically, the vertical discrepancies the corrected records caused could be insignificant. Keywords: aluminum wax, composite resin based on bisacryl, corrected record, dental material, interocclusal record, polyether, polyvinyl siloxane

Objectives: To determine the hardness versus depth profile of several polyacid-modified composite resins (PAM-Cs) as a function of shade (A2, A4) and compare the depth of cure (DoC) based on these profiles with that previously obtained with the scraping and penetrometer methods. Method and Materials: Samples of 6 PAM-Cs (Hytac, 3M ESPE; F2000, 3M ESPE; Glasiosite, Voco; Dyract, Dentsply DeTrey; Dyract AP, Dentsply DeTrey; Compoglass F, Vivadent) and 3 composite resins (Herculite Enamel XRV, Kerr; Z100, 3M ESPE; Durafill VS, Heraeus Kulzer) with shades A2 and A4 were light-cured in bulk in split stainless steel molds (thickness ranging from 0.5 to 3.5 mm in steps of 0.5 mm). The Knoop hardness of the irradiated top (KHNsurface) and nonirradiated bottom (KHNbottom) surfaces was determined as a function of sample thickness using a microhardness tester. Results: Regression analysis demonstrated that for a given material, KHNbottom equals KHNsurface up to a specific depth (= DoC) depending on the material and shade and then decreases linearly with increasing depth. The decrease of the KHN per unit depth differs significantly among materials and shades. According to a regression analysis, the scraping and penetrometer methods overestimate the DoC of PAM-Cs compared to the method based on the change of the hardness indentation with depth. Conclusions: Shade A2 results in greater values of DoC than shade A4, the effect depending quantitatively on the formulation of the material. Some formulations of PAM-Cs do not reach a DoC of 2 mm, a layer recommended to be applied in the incremental technique. The DoC as determined according to ISO 4049:2000 apparently is based on a lower degree of polymerization corresponding to a KHN of 80% of the irradiated surface. Keywords: compomer, composite resin, curing depth, Knoop hardness

An unusual case is reported of accidental extrusion of sodium hypochlorite solution into the maxillary sinus during instrumentation in the course of root canal treatment of a maxillary premolar. This caused a burning sensation accompanied by nasal bleeding, swallowing of blood, and interrupted breathing. The case was managed by irrigating with sterile saline, arresting nasal bleeding, and administering antibiotics, anti-inflammatory drugs, and decongestants. Keywords: endodontic irrigating solution, maxillary sinus, sodium hypochlorite

Objective: To investigate the distribution of several types of clefts among adolescents and adults receiving treatment at the Center for Rehabilitation of Craniofacial Anomalies, Unifenas, Minas Gerais State, Brazil. Methods and Materials: A total 154 untreated patients of low socioeconomic means with cleft lips and/or palates, without additional malformations, who came to the Center for Rehabilitation of Craniofacial Anomalies for treatment were analyzed, and clinical and socioeconomic variables were detailed. Results: A predominance of complete cleft lip and palate, either unilateral or bilateral, was observed (52.60%), followed by isolated cleft lip (33.12%) and isolated cleft palate (14.28%). A discrete relationship between cleft palate and the female gender was noticed, and males were more affected by other types of clefts. Conclusions: Non-Caucasian males with unilateral complete cleft lip and palate constituted the main profile of affected individuals. Keywords: cleft lip and palate, epidemiology, population study

A 24-year-old female was admitted to an infectious diseases unit with complaints of dyspnea and fever. She had suffered from multiple episodes of fever for 1 year. The diagnostic workup revealed multiple pulmonary nodules on the chest CT scan, suggesting septic pulmonary embolism, and a periapical abscess around the maxillary right central incisor. Because no other infectious source was found and resolution of the fever and the pulmonary lesions occurred only after extraction of the affected tooth and antibiotic therapy, the condition was diagnosed as a periapical abscess complicated by septic pulmonary embolism. Keywords: dental infection, dental infectious source, odontogenic infection, periapical abscess, pulmonary embolism, pulmonary lesions

Objective: This longitudinal randomized controlled clinical trial evaluated direct composite restorations for clinical acceptability of posterior restoratives in single- or multisurface cavities and provided a preliminary survey of the 3-, 6-, and 18-month results. Method and Materials: Three clinicians placed 46 QuiXfil (Xeno III; Dentsply DeTrey) and 50 Tetric Ceram (Syntac Classic; Vivadent) composite restorations in stress-bearing Class 1 and 2 cavities in first or second molars (43 adult patients). Clinical evaluation was performed at baseline and after 3, 6, and 18 months by 2 other clinicians using modified US Public Health Service criteria. At the final recall period, 45 QuiXfil and 49 Tetric Ceram restorations were assessed. Results: A total of 97.8% of QuiXfil and 100% of Tetric Ceram posterior composites were assessed to be clinically excellent or acceptable with predominating Alpha scores. At the 18-month recall, 1 QuiXfil restoration had failed because of bulk fracture. No significant differences between either composite could be detected at 18 months for all evaluated clinical criteria (P > .05). Small QuiXfil restorations exhibited significantly less marginal discoloration (P = .003) and better restoration integrity (P = .008) than large restorations. The comparison of restoration performance with time within both groups yielded a significant increase in marginal discoloration for QuiXfil (P = .011) and significant deterioration for anatomic form at the marginal step for Tetric Ceram (P = .011). However, both changes were only effects of scoring shifts from Alpha to Bravo. Conclusion: Clinical assessment of stress-bearing QuiXfil and Tetric Ceram posterior composite restorations exhibited for both materials good clinical results with predominating Alpha scores. Keywords: clinical study, composite, longevity, molars, USPHS

Although the maxillary permanent canine is frequently misplaced, misplacement of the mandibular canine is a comparatively rare event. Pre-eruptive migration of a tooth across the midline is called transmigration. This condition has not been reported for teeth other than canines. Dentigerous cysts can involve any tooth, but mandibular canines are rarely affected like premolars and molars. Odontogenic cysts associated with impacted teeth are usually removed through an intraoral approach. However, on rare occasion, an extraoral approach is required to remove these lesions. A case of transmigrant mandibular canine associated with a dentigerous cyst that required an extraoral submental approach for removal is presented. Keywords: dentigerous cyst, extraoral approach, transmigrant canine

Objective: To evaluate the effect of temperature on external tooth bleaching. Method and Materials: Human molars and premolars were internally stained and assessed using a standardized tea solution. The mesial aspects of the teeth were assigned to the treatment group (bleaching at 45°C), and the distal aspects of the teeth were assigned to the control group (bleaching at 37°C). An electronic chromometer with a tristimulus color analyzer was used to measure color change. The mean changes in the values of L*, a*, and b* from baseline to posttreatment were recorded, as were the overall color differences of the specimens in each group (ΔE*). Results: Increasing the temperature to 45°C significantly (P .05) increased the bleaching efficacy and reduced the time needed to gain a lighter tooth shade. Conclusion: A controlled increase in the temperature of the bleaching agent might be useful in achieving better tooth bleaching in a shorter period of time. Keywords: at-home tray vital bleaching, bleaching, carbamide peroxide, chromometer, hydrogen peroxide, power bleach, thermocatalytic bleach, tooth whitening, vital bleach

The occurrence of areas exhibiting cribriform morphology in odontogenic tumors is not a very frequent finding. This report describes the case of a 22-year-old man who presented with swelling in the left anterior maxilla. An excisional biopsy was performed under local anesthesia. Histopathologically, the lesion consisted of a cystic wall exhibiting an odontogenic epithelium lining composed of oval, angular, and elongated cells forming a cribriform pattern. No recurrence has been detected after 2 years. Keywords: cribriform, cystic wall, maxilla, morphology, odontogenic epithelium, odontogenic tumors