Quintessence International, 09/2014

Selection of the appropriate material for dental restoration has become more and more difficult owing to the increasing variety of restoration materials. A decision flow chart is presented to guide the treatment team (dentist and dental technician) in the selection of the restoration material. This material selection is based on the available interocclusal space, esthetic aspects (eg, brightness value or translucency of the neighboring teeth), as well as clinical evidence extracted from survival rates. Keywords: abutment color, brightness value, glass-ceramic, metal-ceramic, porcelain-fused-to-metal, translucency, zirconia

Objective: Pathologic migration is defined as a change in tooth position, resulting from a disruption of forces that maintain the teeth in the normal position with reference to the skull. Clinical evidence is limited that pathologically migrated teeth may reposition themselves after periodontal therapy. The current study was carried out to determine the frequency of spontaneous repositioning of pathologically migrated teeth after periodontal therapy, and to study the relation between the severity of migration and the degree of repositioning following treatment. Method and Materials: Twenty-five patients aged 20 to 45 years with moderate to severe form of periodontitis presenting 52 diastema sites secondary to pathologic migration involving maxillary anterior teeth participated in the study. After conventional periodontal treatment had been performed, reactive repositioning was assessed by measuring the space between pathologically migrated teeth and adjacent teeth on study models and radiographs obtained at baseline, reevaluation at 4 weeks after scaling and root planing (SRP), 3 months after periodontal surgery, and 6 months from baseline. Results: No changes were noted after SRP. On study models, 88.46% of all sites (46 of 52 sites) demonstrated various degrees of repositioning (both partial closure and complete closure) after periodontal therapy 6 months after baseline. Of these 46 sites, all exhibited improvement after surgical therapy. Labiopalatal repositioning was seen in 32 out of 51 teeth (62.74%). On radiographs, 77.27% of all sites (34 of 44 sites) demonstrated various degrees of repositioning (both partial closure and complete closure) after periodontal therapy 6 months after baseline. Of these 34 sites, all exhibited improvement after surgical therapy. Complete repositioning occurred in 34.61% and partial closure was seen in 53.80%. Conclusion: The findings suggest that spontaneous repositioning after periodontal therapy is likely, particularly when light to moderate degrees of pathologic migration are considered. Keywords: pathologic tooth migration, periodontal therapy, spontaneous repositioning, tooth movement, wound healing

Objective: The aim of this study was to compare the periodontal status in patients with Familial Mediterranean Fever (FMF) and in those without this disease. Method and Materials: 84 subjects clinically diagnosed with FMF and 75 systemically healthy controls, matched by age and gender, were recruited. All FMF patients were on a regular daily colchicine treatment and during attack-free periods. Gingival Index (GI), Plaque Index (PI), probing pocket depth (PD), and clinical attachment level (CAL) were measured in all subjects. To evaluate periodontal disease further, patients were stratified into five groups. Education information and smoking habits were recorded. Results: The FMF patients and healthy controls were comparable for age, gender, and smoking status (P > .05). The FMF patients had significantly higher PI and GI values and lower PD and CAL values than those of the control group (P .05). However, there was no significant difference among all groups in terms of periodontal disease severity (P > .05). In the FMF-severe periodontitis group, higher PI and GI values were seen (P .05). However, there was no significant difference between the FMF-severe periodontitis group and the controls with severe periodontitis regarding the PD and CAL values (P > .05). Conclusion: Patients with FMF using colchicine did not manifest higher attachment loss compared to age- and sex-matched systemically healthy controls. Keywords: colchicine, Familial Mediterranean Fever, periodontitis

Loss of tooth substance has become a common pathology in modern society. It is of multifactorial origin, may be induced by a chemical process or by excessive attrition, and frequently has a combined etiology. Particular care should be taken when diagnosing the cause of dental tissue loss, in order to minimize its impact. Several publications have proposed the use of minimally invasive procedures to treat such patients in preference to traditional full-crown rehabilitation. The use of composite resins, in combination with improvements in dental adhesion, allows a more conservative approach. In this paper, we describe the step-by-step procedure of full-mouth composite rehabilitation with v-shaped veneers and ultra-thin computeraided design/computer-assisted manufacture (CAD/CAM)- generated composite overlays in a young patient with a combination of erosion and attrition disorder. Keywords: attrition, CAD/CAM composite overlays, erosion, minimally invasive rehabilitation, v-shaped veneers

Objective: To describe the successful use of biphasic calcium sulfate for improving the buccal plate thickness in an immediate postextraction implant, and its final restoration with custom lithium disilicate abutment and veneer. Summary: A hopeless lateral incisor was replaced with an immediate postextraction implant in conjunction with a buccal plate augmentation based on biphasic calcium sulfate. Satisfactory soft tissue height and quality were maintained following healing. The final restoration managed the severely reduced prosthetic space due to deep bite, and allowed an adhesive luting procedure. Keywords: adhesion, buccal augmentation, calcium sulfate, dental implant, lithium disilicate, postextraction implant, veneer

Osteopetrosis (OP) is a rare genetic metabolic bone disorder characterized by osteoclast dysfunction impairing bone resorption. Together with normal osteoblastic activity this dysfunction promotes intense bone sclerosis with reduction of marrow spaces as well as bone turnover. Maxillofacial complications are common after tooth extraction. Osteomyelitis (OM) of the mandible occurs in around 10% of the cases with OP. The purpose of this paper is to report the first case of OP treated with dental implants, and to describe the protocol used to treat OM that developed after failure of one implant. The treatment of OM included long-term use of antibiotics and marginal bone resection with a piezoelectric device. Similar cases to confirm the efficacy of this treatment are required. Keywords: bone resorption, dental implants, osteomyelitis, osteopetrosis

Objective: A study was designed to measure of the incidence of bisphosphonate-related osteonecrosis of the jaws (BRONJ) following tooth extraction in patients receiving or who have received intravenous bisphosphonates (Zometa, zoledronic acid). Method and Materials: A prospective cohort study was made of 36 patients subjected to 62 tooth extractions. All these 36 patients had been treated or were receiving treatment with zoledronic acid. Results: The incidence of BRONJ following 62 tooth extractions in patients treated with zoledronic acid 4 months after extraction was 14.5%. Conclusion: No statistically significant associations were found with patient age, sex, hygiene index, total treatment time, surgical difficulty, or extraction site. However, the factors that significantly influenced the final presence of osteonecrosis were related to tooth extractions in the absence of periodontal disease, and if sockets remained unhealed at the month of extraction. Keywords: bisphosphonates, BRONJ, osteonecrosis, zolendronic acid, Zometa

Objective: Patients' perceptions of recovery following sinus augmentation procedures have scarcely been documented. The aim of the present prospective pilot clinical study was to evaluate the patient's perception of immediate postoperative recovery after sinus augmentation, using a minimally invasive implant device. Method and Materials: Eighteen patients (8 men, 10 women), average age 52 (median 48, range 38 to 72), who had been scheduled for sinus augmentation procedures, were asked to enroll in a prospective clinical study. A health-related quality-of-life questionnaire was given to the patient. The questionnaire was designed to assess patient's perception of recovery in four main areas: pain, oral function, general activity, and other symptoms. The questionnaire was compared to the surgical chart that described the surgical details and to the outcome. Results: Patients' perceptions of postoperative symptoms in the four tested areas: pain, oral function, general activity, and other symptoms were mostly scored "not at all" or "very little" from postoperative day (POD) 1. Most patients returned to work on POD 1. Conclusion: The current results offer a preliminary indication that patients undergoing sinus augmentation using a minimally invasive implant device can expect to experience minimum discomfort and immediate return to everyday activity. Keywords: bone augmentation, minimally invasive, quality of life, sinus floor elevation procedure, sinus lift

Objective: The dentist has a fundamental role in the early diagnosis of lesions of the oral cavity. The aim of this study was to establish the rate of erroneous clinical diagnoses and whether a clinical diagnosis is enough. The study was conducted to ascertain the overall accuracy of clinical diagnoses established by dentists. Study design: The biopsy reports of 1,566 samples taken from 1,406 patients and examined at the Dental Outpatients Department of the University of Padua from 1 January 2006 to 30 June 2012 were analyzed in order to compare the presumptive clinical diagnosis with the final diagnosis based on histology. Results: Overall, the dentists' clinical diagnoses were erroneous in 31.5% of cases. These diagnostic errors pertained to 23.8% of the benign neoplasms, 78.9% of the malignant neoplasms, and 17% of precancerous lesions. Conclusion: The present report should not be interpreted as a criticism of the clinicians making diagnostic errors but rather a confirmation of the policy to submit excised tissues for histologic examination. Keywords: clinical misdiagnosis, leukoplakia, oral cancer, oral examination, oral pathology, precancerous condition

Objective: To investigate the efficacy of conservative dental treatment (occlusal splint and pharmacologic therapy) and invasive therapy (prosthetic restorations) in the treatment of tension-type headache (TTH). Method and Materials: The study sample was composed of 70 patients who presented with symptomatic TTH and were assigned to three treatment groups according to their treatment needs. Group A (30 patients): a conservative treatment protocol with a combination of an occlusal splint and analgesic and muscle relaxant medication. Group B (10 patients): invasive prosthodontic procedures. Group C (30 patients): patients who refused any type of treatment but consented to the study served as a control group. Pain quality was measured with the Headache Impact Test (HIT-6). The statistical analysis was performed with the Wilcoxon rank test (P ≤ .05). Results: Conservative treatment with splints and analgesic medication and invasive treatment by prosthetic rehabilitation relieved the TTH symptoms. The patients who received treatment experienced a significant reduction in their discomfort after 6 months (P ≤ .01), whereas the patients who refused therapy remained, on average, at the same pain level (P ≤ .117). In group A, the HIT-6 score was reduced for 26 patients, and in group B for 8 patients. In group C a reduction of HIT-6 scores was observed in 10 patients. Conclusion: Conservative or invasive occlusal adjustments may serve as a useful tool in the treatment of TTH. Keywords: headache relief, occlusal adjustment, tension-type headache