Quintessence International, 06/2014

The restoration of endodontically treated teeth involves a difficult decision-making process, especially when it comes to more complex prosthetic rehabilitations. Regarding singletooth restoration, there are high-level requirements for the restorative components and the application of all necessary treatment steps to achieve the final restoration. So when is there a need for a single-crown restoration or when might a composite resin restoration also be sufficient? For the assessment of endodontically treated teeth as abutment teeth for prosthetic restorations, there are no clear guidelines beyond single-tooth restorations. The aim of this article is to compile important aspects of the restoration of endodontically treated single teeth, including more complex prosthetic reconstructions, based on the scientific literature. Keywords: core build-up, crown, postendodontic restoration, prosthodontic restoration, survival

Objective: Sodium hypochlorite (NaOCl) is an important tool in root canal disinfection although it is well known that the shelf-life of NaOCl is limited. In this study, NaOCl solutions that were collected from dental practices and were intended for endodontic irrigation were investigated to see whether they contained the expected concentration of free available chlorine. Method and Materials: NaOCl solutions were collected from dental practices. The concentration of available chlorine per sample was determined with iodometric titration and the pH was measured. Each participating dentist completed a questionnaire that requested data on a range of issues relating to the assumed concentration of NaOCl and handling of the sample. Results: Eighty-four samples with questionnaires were received. NaOCl was purchased from supermarkets and drugstores (36%), dental suppliers (48%), or pharmacies (16%). The median expected concentration was 2% (n = 36). On average, 27% less available chlorine was measured than the dentist assumed was in the sample (P .001). Fifteen percent of samples contained less than 1% available chlorine, which is needed for tissue dissolution and disinfection. The average pH was 11.5. Conclusion: The greatest differences in concentrations were found in NaOCl sourced from supermarkets or drugstores. Future studies should elucidate the cause of this discrepancy. Clinical relevance: In the meantime it is recommended to purchase NaOCl from professional suppliers, because this group showed the most reliable content of free available chlorine. Keywords: bleach, endodontic irrigation, pH, sodium hypochlorite

Objective: Over 15 years have passed since an enamel matrix derivative (EMD) was introduced as a biologic agent capable of periodontal regeneration. Histologic and controlled clinical studies have provided evidence for periodontal regeneration and substantial clinical improvements following its use. The purpose of this review article was to perform a systematic review comparing the eff ect of EMD when used alone or in combination with various types of bone grafting material. Data Sources: A literature search was conducted on several medical databases including Medline, EMBASE, LILACS, and CENTRAL. For study inclusion, all studies that used EMD in combination with a bone graft were included. In the initial search, a total of 820 articles were found, 71 of which were selected for this review article. Studies were divided into in vitro, in vivo, and clinical studies. The clinical studies were subdivided into four subgroups to determine the eff ect of EMD in combination with autogenous bone, allografts, xenografts, and alloplasts. Results: The analysis from the present study demonstrates that while EMD in combination with certain bone grafts is able to improve the regeneration of periodontal intrabony and furcation defects, direct evidence supporting the combination approach is still missing. Conclusion: Further controlled clinical trials are required to explain the large variability that exists amongst the conducted studies. Keywords: animals, bone grafts, Emdogain, enamel matrix derivative, intrabony periodontal defects, osteoinduction, preclinical studies, systematic review

Objective: The purpose of this study was to evaluate the bactericidal effectiveness of using a fiber-less Er:YAG laser in the first stage of therapy for moderate chronic periodontitis and to compare it with conventional treatment. Method and Materials: Two quadrants from 20 patients with moderate chronic periodontitis were treated with Gracey curettes (control), and the contralateral two quadrants in each patient were treated using an Er:YAG laser with total power of 1.5W (test). Subgingival plaque samples from the four deepest pockets in each quadrant were taken immediately before and 1 month after treatment, and the presence of nine marker bacteria was studied using real-time polymerase chain reaction technology. Results: A significant reduction of total pathogens and bacteria from the red complex was observed 1 month after treatment with both procedures. The results were more significant for the test group (P = .003) than for the control group (P = .005). Qualitative analysis of sites that had a therapeutically significant number and proportion of marker bacteria also showed significant reduction after treatment. Conclusion: The results of the present study suggest that the Er:YAG laser possesses comparable with conventional treatment bactericidal effectiveness against periodontal pathogens in vivo in the initial treatment of moderate chronic periodontitis. More evaluations should be performed to prove these results for a longterm successful clinical outcome. Keywords: antibacterial, curette, Er:YAG laser, periodontal disease

Objective: Short implants have been advocated as a treatment option in many clinical situations where the use of conventional implants is limited. This review outlines the eff ectiveness and clinical outcomes of using short implants as a valid treatment option in the rehabilitation of edentulous atrophic alveolar ridges. Data Sources: Initially, an electronic search was performed on the following databases: Medline, PubMed, Embase, Cochrane Database of Systematic Reviews, and DARE using key words from January 1990 until May 2012. An additional hand search was included for the relevant articles in the following journals: International Journal of Oral and Maxillofacial Implants, Clinical Oral Implants Research, Journal of Clinical Periodontology, International Journal of Periodontics, Journal of Periodontology, and Clinical Implant Dentistry and Related Research. Any relevant papers from the journals' references were hand searched. Articles were included if they provided detailed data on implant length, reported survival rates, mentioned measures for implant failure, were in the English language, involved human subjects, and researched implants inserted in healed atrophic ridges with a follow-up period of at least 1 year after implant-prosthesis loading. Conclusion: Short implants demonstrated a high rate of success in the replacement of missing teeth in especially atrophic alveolar ridges. The advanced technology and improvement of the implant surfaces have encouraged the success of short implants to a comparable level to that of standard implants. However, further randomized controlled clinical trials and prospective studies with longer follow-up periods are needed. Keywords: implant-supported prostheses, posterior edentulous jaws, short dental implant, success rate, surface topography

The objective was to present a way of using cone-beam computed tomographic (CBCT) images to classify alveolar bone tissue. CBCT images were acquired from PreXion3D tomography. Sagittal images of right and left maxillary and mandibular central incisors were obtained. A new grading scale was created based on the presence or absence of bone in each third of the tooth in buccal and lingual surfaces. The tooth was classifi ed into nine alveolar bone conditions: B1L1, B1L2, B1L3, B2L1, B2L2, B2L3, B3L1, B3L2, B3L3. This classifi cation is an additional tool to provide orthodontic and periodontic professionals the precise information needed in order to prevent periodontal problems or to avoid exacerbating them, both situations that might arise during orthodontic therapy. Furthermore, the grading will assist and enhance eff ective communication between professionals in dentistry. Keywords: bone tissue, classification, orthodontics, periodontics, tomography

Therapeutic decision making and successful treatment of furcation- involved molars has been a challenge for many clinicians. Over recent decades, several techniques have been advocated in the treatment of furcated molar teeth, including nonsurgical periodontal therapy, regenerative therapy, and resective surgical procedures. Today, root resection is considered a relevant treatment modality in the management of furcation- involved multirooted molars. However, root resective procedures are very technique-sensitive and require a high level of periodontal, endodontic, and restorative expertise. Given the high documented success rates of implant treatment, the clinician is increasingly confronted with the dilemma of whether to treat a furcated molar by traditional root resective techniques or to extract the tooth and replace it with a dental implant. This article reviews the outcomes of root resective therapy for the management of furcation-involved multirooted teeth and discusses treatment alternatives including implant therapy. Treatment guidelines for root resective therapy, along with advantages and limitations, are presented to help the clinician in the decision-making process. Keywords: furcation involvement, furcations, molar, periodontal disease, root resection

Objective: The aim of this paper was to present the function and potential of diagnosing caries lesions using a recently introduced near-infrared (NIR) transillumination technique (DIAGNOcam, KaVo). Method and Materials: The study included 130 adolescents and adults with complete permanent dentition (age > 12). All patients underwent visual examination and, if necessary, bitewing radiographs. Proximal and occlusal surfaces, which had not yet been restored, were photographed by a NIR transillumination camera system using light with a wavelength of 780 nm rather than ionizing radiation. Of the study patients, 85 showed 127 proximal dentin caries lesions that were treated operatively. Results: A cross table shows the correlation of radiography and NIR transillumination. Based on our practical clinical experiences to date, a possible classifi cation of diagnosis is introduced. The main result of our study was that NIR light was able to visualize caries lesions on proximal and occlusal surfaces. Conclusion: The study suggests that NIR transillumination is a method that may help to avoid bitewing radiographs for diagnosis of caries in everyday clinical practice. Keywords: caries detection, caries diagnostics, DIAGNOcam, near-infrared light, photo-optics, proximal caries