Quintessence International, 04/2014

Objectives: Polyvinylpyrrolidone-iodine (PVP-iodine or povidone- iodine) enhances the treatment outcomes of initial periodontal treatment but the degree of benefit varies in the literature. A main reason might be the concentration of the dosage form and its contact time with the periodontal tissues. In this randomized pilot study the effect of repeated subgingival application of PVP-iodine during scaling and root planing (SRP) was assessed. Changes of clinical parameters and microbiotic taxa after 3 months were analyzed. Method and Materials: In a split-mouth design 12 patients with generalized, severe periodontitis were treated with SRP combined with subgingival application of either PVP-iodine or water. Test and control sides were isolated with a special rubber dam technique. Irrigations were reapplied during SRP. Periodontal probing depth (PD) and recessions were documented before treatment and after 3 months. Samples of subgingival bacteria before SRP and after 1 week, 1 month, and 3 months were analyzed. Results: Three months after SRP, changes for PD and recession in deep pockets were significantly higher in the PVP-iodine group (P = .012 and .044 respectively). The number of these pockets was reduced from 73 at baseline to 8 in the test and 19 in the control group. In both groups, bacterial taxa were reduced after 1 week. One month after SRP only taxa of Porphyromonas gingivalis in the PVP-iodine group were lower than at baseline. After 3 months, all taxa regained baseline values. Conclusion: PVP-iodine reapplied frequently during SRP might enhance pocket depth reduction in initially deep pockets. Keywords: microbiology, nonsurgical periodontal therapy, periodontitis, povidone-iodine

Single-retainer resin-bonded fixed dental prostheses (RBFDPs) present a minimally invasive treatment option as an alternative to implant-retained restorations in the esthetic zone. Advantages such as applicability to juvenile patients who do not come into consideration for implant therapy, and highly predictable and esthetic results make them a valuable treatment modality. This article outlines the treatment procedures with an all-ceramic RBFDP and reviews the existing data on the clinical outcome of this prosthetic therapy. The materials used for fabrication and insertion of the RBFDPs as well as the current scientific data are discussed. Keywords: all-ceramic, outcome, resin bonding, single retainer, zirconia ceramic

Objective: This short-term prospective study evaluated the clinical outcome of unsplinted implants retaining a mandibular overdenture with magnetic attachments in controlled type 2 diabetic patients. Method and Materials: Twenty-eight completely edentulous patients (18 men and 10 women) with controlled type 2 diabetes mellitus received a total of 56 implants (two per patient) in the canine region of the mandible using the standardized two-stage surgical protocol. All patients complained of insufficient retention of their mandibular denture. New maxillary complete dentures and mandibular overdentures were fabricated. Overdentures were connected to the implants with magnetic attachments. Each implant was evaluated at the time of prosthetic loading, and 6, 12, and 24 months thereafter. Clinical evaluation was performed using Gingival Index (GI), Plaque Index (PI), probing depth (PD), implant stability (ISQ), and vertical bone loss (VBLO). Cumulative success and survival rates were calculated using life table analysis. Results: After 2 years of overdenture insertion, there was a significant increase in PI, GI, PD, and VBLO. ISQ decreased significantly after 6 months of loading then increased again after 2 years. The cumulative survival and success rates of the implants were 91% and 87.5% respectively. Conclusion: Within the limitations of this study, the clinical outcome of unsplinted implants retaining a mandibular overdenture with magnetic attachments in controlled type 2 diabetic patients was favorable after 2 years. However, long-term randomized controlled trials are needed to compare the clinical outcome of unsplinted implants in diabetic and nondiabetic patients. Keywords: diabetes, implant, magnetic attachments, overdenture

The aim of this report is to present and discuss the clinical procedure of an implant-supported removable partial denture for a partially edentulous patient who exhibited a severely resorbed ridge and a collapsed vertical stop. The 67-year-old partially edentulous patient presented with a lack of vertical stop and an advanced transverse arch discrepancy. For the maxilla, an implant-supported removable partial denture was fabricated on bilateral distal implant abutments. The mandibular arch was restored with an implant-supported fixed partial denture, since it was expected to function more properly than a removable partial denture. This clinical report demonstrates a successful treatment approach to restore oral function and appearance for the patient. Keywords: customized titanium abutment, implant-supported removable partial denture, transverse arch discrepancy, zirconia crown

Impaction of both mandibular canine and lateral incisor is a rare clinical finding which is often treated by way of surgical extraction. This decision is often taken because of the anatomical limitations presented by the mandible, and the horizontal position of the impacted teeth, which have occasionally transmigrated, placing them in close proximity to the roots of neighboring teeth and with a high risk for causing their resorption. In addition, this condition significantly increases the likelihood that the area involved will undergo gingival recession and loss of crestal bone if an unsophisticated ortho-surgical approach is undertaken. The present report describes a novel ortho-surgical technique which maintains the alveolar crestal bone and utilizes a lingual arch attached to the first molars with traction through tunneling with super-elastic springs. This combined approach eliminated the need for extraction of the impacted teeth, and accomplished their full alignment without any of the aforementioned side effects. Every dentist (general practitioners as well as specialists) should be aware of this procedure and refer patients to a specialist. Keywords: impaction, mandibular canine, mandibular incisor, orthodontic traction, ortho-surgery, supernumerary, surgical exposure, transmigration

Objective: The surgical extraction of an impacted third molar involves a wide range of consequences such as trismus, swelling, and pain, as well as more significant complications, temporary or permanent, that can manifest altered sensitivity of the tongue or lips. The purpose of this prospective study was to evaluate the effects of three different flaps on postoperative discomfort considering trismus, edema, and pain, after the extraction of impacted third molars. The data derived from the analysis of the surgical trials performed at the Oral Surgery Unit, Department of Surgical, Reconstructive and Diagnostic Sciences, IRCCS Policlinico, University of Milan, directed by Professor F. Santoro, MD. Method and Materials: This study, developed over 2 years, involved 238 patients for a total of 238 extractions of impacted mandibular third molars. The 238 surgeries were performed on 114 men and 124 women: 54 avulsions were performed with the elevation of an envelope flap (Group 1), 48 avulsions through the elevation of a triangular flap (Group 2), and the remaining 136 avulsions were performed using a trapezoidal flap (Group 3). Results: Trismus was significantly reduced (P .05) in patients treated with envelope flap, as was the swelling perceived by the patient (P .05). Pain was closely related to the elevation of a mucoperiosteal flap and osteotomy. Our study does not reveal statistically significant differences between the three types of flap used; however, the number of analgesic tablets taken was lower in cases of elevation of a less traumatic flap (envelope and triangular flaps). Conclusion: The data collected in this study indicate the envelope flap as the most suitable for the reduction of the expression of postoperative complications such as swelling and trismus. Keywords: discomfort, flap, impacted third molar, surgery

Objective: The aim of this randomized two-center study was to compare quantic molecular resonance scalpel (QMRS) with traditional scalpel (TS) for the surgical treatment of labial mucoceles, in terms of impact on quality of life and postoperative pain (primary outcomes) and postsurgical lip paresthesia and recurrence of the lesion (secondary outcomes). Method and Materials: Eighty-five consecutive patients with labial mucoceles were randomized to receive traditional (46) or QMRS surgery (39) in two Italian University Hospital Centers. Patients were asked to complete three different forms during the first week after surgery to evaluate quality of life and postoperative pain. Periodic follow-up examinations were conducted at 1 week, 1 month, and 3 months after surgery, in order to detect recurrence of lesion and/or lip paresthesia. Results: Regarding the symptoms reported during the first week after surgery, questionnaires given to the patients and the mean painkiller consumption did not demonstrate any statistically significant differences within the two groups. Women treated with QMRS reported a worse experience than women treated with TS (P .05). Among all the mucoceles treated, during the follow-up period of 3 months, one that had been eliminated with the cold scalpel was seen to relapse, versus none of those treated with the QMRS (P = 1.0). We reported a localized and terminal paresthesia of the labial mucosa close to the surgical site in 10.58% of the total patients. Comparing the QMRS with TS, we observed a greater incidence of neurologic complications with the latter technique (P = .035). Conclusion: This is the first prospective randomized study to report outcome data and 3-month follow-up of a cohort of patients suffering from labial mucoceles. QMRS for surgical removal of labial mucoceles seems to be comparable to traditional scalpel in terms of postoperative quality of life, pain, and postsurgical lip paresthesia. Keywords: labial mucoceles, outcome, quantic molecular resonance scalpel, surgery

Odontomas are the most common odontogenic tumors, representing 70% of all odontogenic tumors. They may present in two specific forms; compound odontoma forms multiple small tooth-like structures, while complex odontoma forms an amorphous calcified mass. In this report, we present a 27-year-old male patient with multiple compound odontoma occupied regions at his jaws. The odontomas involve both alveolar and basal processes of the maxilla and mandible as well as both maxillary sinuses. Converse to conventional recommended treatment, which is surgical excision of the lesion, the management was removal of the lesion and clinical-radiologic followup. The first year's follow-up findings are presented in this case report. Keywords: compound odontoma, maxilla, mandible, odontoma

Objectives: Snoring and obstructive sleep apnea syndrome (OSA) can affect both esthetics and health. In this review article, we describe the role of the dentist in evaluation and treatment of snoring and OSA in children and adults, with an emphasis on oral appliances as a means to treat the adult population. Data Sources: A comprehensive literature search of publications from 1934 to 2013 in the PubMed/Medline/ Science Direct databases was performed to collect information about snoring, OSA, and oral or dental appliances using these terms as key words. The search was limited to peer-reviewed articles written in English, with a few exceptions in other languages. The literature search was endorsed by manual searching through peer-reviewed journals and reference lists of the selected articles. Conclusion: The dentist's role in the diagnosis of OSA in children and in diagnosis and treatment in the adult population with the help of oral appliances is vital. Diagnosis and treatment by the aware dentist can reduce major health risk outcomes. Keywords: obstructive sleep apnea, oral appliances, snoring

Objective: Nativity status is a major determinant of health and healthcare access in the United States. This study compared oral squamous cell carcinoma (OSCC) survival between US-born and foreign-born patients. Method and Materials: Data were obtained from the 1988-2008 Surveillance, Epidemiology and End Results database. A Cox proportional hazards multivariate model was used to assess the eff ect of birthplace on OSCC survival, adjusting for other sociodemographic and clinical covariates. Results: US-born patients had a higher median survival time (19.3 years; 95% confi dence interval [CI]: 18.6-19.7) compared to foreign-born patients (10.7 years; 95% CI: 10.1-11.3). After adjusting for other factors, being born in the US conferred a modest protective eff ect from OSCC mortality (hazard ratio [HR] = 0.93, 95% CI: 0.87- 0.99). Other factors that conferred better survival included involvement of paired structures (HR = 0.65; 95% CI: 0.58- 0.74), lip involvement rather than tongue lesions (HR = 0.76; 95% CI: 0.71-0.82), and receipt of either surgery (HR = 0.89; 95% CI: 0.84-0.94) or radiation therapy (HR = 0.92; 95% CI: 0.87-0.97). Conclusion: US-born patients had signifi cantly better OSCC survival compared to their foreign-born counterparts. This underscores the need for enhanced and sustained eff orts to improve access to healthcare among immigrant populations. In addition, oral health professionals such as general dentists, oral pathologists, and oral surgeons providing care to immigrant patients should ensure that reasonable eff orts are made to communicate eff ectively with patients with language barriers, especially in high-stake conditions such as cancer. This may help increase such patients' awareness of treatment provided and the critical issues regarding cancer care, resulting in enhanced treatment outcome. Keywords: foreign-born, immigrants, malignancy, nativity, oral cancer, survival