Quintessence International, 05/2015

Current treatment protocols and recent developments in composite resin technology allow for extended indication of direct composite resin restorations. This article presents clinical longterm observations of direct composite resin restorations indicated for primary and replacement therapy, repair restorations, direct crowns, and composite buildups for the correction of tooth form. Keywords: direct composite buildups, direct composite resin restorations, esthetic correction, long-term results, posterior dentition

Objective: The hypothesis to be tested was that the clinical performance of nano-filled resin-modified glass ionomers (RMGIs) in Class I primary molars will differ from that of its preceding conventional RMGI. Method and Materials: The shear bond strengths of each material to primary molar dentin were measured (n = 10) using a notched-edge crosshead. Independent sample t test was used for statistical analysis. A split-mouth designed clinical trial was performed in which nano-filled RMGI (Ketac Nano; KN) and conventional RMGI (Vitremer; VR) were used to restore Class I cavities of primary molars. Each material group (n = 30) was evaluated according to United States Public Health Service (USPHS), regarding marginal discoloration, marginal adaptation, color match, anatomic form, and recurrent caries, at baseline, after 1 year, and after 2 years. Wilcoxon signed-rank test and chi-square test were used for statistical analysis. Results: Shear bond strength (mean ± SD) of KN (6.3 ± 3.9 MPa) was significantly lower (P .05) than that of VR (9.5 ± 2.7 MPa). After 2 years, KN restorations showed significantly increased wear (92% Alpha and 8% Charlie) and marginal discoloration (23% Bravo and 8% Charlie) with secondary caries (8%). Color match was significantly decreased for both KN and VR (69% and 73% Bravo, respectively). When parameters were compared for materials at each recall, there was no statistically significant difference between KN and VR. Conclusion: Nano-filled RMGI may not be better than conventional RMGI; its wear resistance deteriorates with time, and it has low bond strength to dentin. Keywords: bond strength, Class I, clinical trial, nano-filled resin-modified glass ionomer, primary teeth

Objective: The aim of this randomized controlled pilot study was to evaluate the effects of indocyanine green (ICG) as an adjunct to nonsurgical periodontal therapy in terms of reduction in percentage of viable bacteria and host tissue injury. Method and Materials: The study included a small cohort of 30 subjects diagnosed with chronic periodontitis. Three sites from three different quadrants were selected and were randomly treated by (1) scaling and root planing (SRP), (2) SRP with application of 810 nm diode laser, or (3) SRP with application of 810 nm diode laser and ICG at a concentration of 5 mg/ mL. Primary parameters included estimation of viable bacteria percentage and lactate dehydrogenase (LDH) levels. Secondary parameters included site-specific measures of plaque, gingivitis, pocket depth (PD), and clinical attachment loss (CAL) at specific time intervals. Results: Sites receiving laser and ICG resulted in a significant decrease in the percentage of viable bacteria at the end of 1 week when compared to the other groups. ICG application does not seem to cause tissue damage as evident by the LDH levels. Comparison of CAL and PD revealed nonsignificant differences in sites treated with laser and ICG at the end of the study period. Conclusion: Laseractivated ICG dye may enhance the potential benefits of SRP and can be used as an adjunct to nonsurgical periodontal therapy. Keywords: antimicrobial photodynamic therapy, bacterial viability, indocyanine green, lactate dehydrogenase, periodontitis, scaling and root planing

Objective: This study addresses common errors that may occur during digital impression procedures using the CEREC AC and in-office CAD/CAM systems. Error types and frequencies resulting from digital impressions of the oral cavity were investigated and their origins identified to facilitate the acquisition of more accurate digital impressions. Method and Materials: A total of 1,251 digital impression cases, including 163 onlays and 1,088 inlays, were constructed as restorations using the CEREC AC system. Two evaluators determined five categories of digital errors as a basis for evaluation over two sessions. The five categories were as follows: inappropriate scanner positioning (ISP), improper handling of the scanner (IHS), irregular powder arrangement (IPA), improper cavity preparation (ICP), and insufficient scanned data (ISD). Results: The most frequently encountered errors were non-linear powder application (IPA), inappropriate oral cavity scanner placement (ISP), and insufficient data (ISD). ISP showed that inlays had a slightly higher frequency of errors, but this observation was not statistically significant (P > .05). Conclusion: Most errors are caused by incorrect operation of intraoral scanners or uneven application of powder in acquiring digital impressions. To provide optimal digital impression results, careful chairside technique procedures and operation of intraoral scanners are required. Keywords: common error, digital impression, in-office CAD/CAM, intraoral scanner

Objective: After the recent decline in caries, caries development has become harder to predict. The aim of this 10-year cohort study was to monitor long-term caries development with special regard to educational status in schoolchildren. Method and Materials: For 521 five- to six-year-olds (mean 5.8 ± 0.5 years) participating in the compulsory pre-school examination, the oral status and the parental educational status was recorded. In the 10-year follow-up, 170 children (5.9 ± 0.3 years at baseline, 16.5 ± 0.4 years at 10 years) could be re-examined. Associations between the children's and parental educational background with the caries increment were analyzed. Drop-outs (n = 351; 5.8 ± 0.6 years) and drop-in 10th-graders (n = 364; 16.9 ± 0.6 years) were used for comparative analyses. Results: Mean caries scores increased from 0.1 DMFS (± 0.5) to 5.0 DMFS (± 6.6), while the other 10th-graders exhibited a significantly higher DMFS (6.6 ± 8.8; P .001). In children who later attended higher education, caries levels were already significantly lower at school entry (6.1 ± 7.4 dmfs) compared to the other children (11.1 ± 11.4 dmfs; P .005). Similarly to the baseline dmft (OR 3.6), the 10-year caries increment in the permanent dentition was significantly lower when the father had a university degree (2.7 ± 3.2 ΔDMFS compared with 5.1 ± 6.6; P = .02; OR 4.6). Conclusion: The parental educational status and caries levels in the primary dentition determined strongly the long-term oral health of their children, which means that effective preventive strategies have not been implemented to compensate inequalities in health and education. Keywords: dental caries, educational status, oral health, prediction, public health, risk

Hereditary angioedema (HAE) is a rare disease, little known to medical and dental practitioners, but with an increasing hospitalization rate over the years. HAE is due to a C1 esterase inhibitor deficiency/dysfunction that leads to an increased vascular permeability. The airways are the most affected, and life-threatening laryngeal swelling may occur. Episodes of HAE have no clear cause, but they can be triggered by anxiety, invasive procedures, and trauma. HAE is an important issue in oral and maxillofacial surgery, otorhinolaryngology, endoscopy, emergency medicine, and anesthesiology because even simple procedures may cause laryngeal edema. Recommendations on the management of HAE include long- and short-term prophylaxis, and treatment for acute attacks, but the importance of controlling anxiety is underestimated. Here, we report on the perioperative management of nine HAE patients scheduled for oral surgery, with a brief review of the literature on this topic. Keywords: anxiety, conscious sedation, dentistry, hereditary angioedema, oral surgery

Osteonecrosis of jaws (ONJ) is a chronic disease characterized by necrotic bone from any number of causes. ONJ can also occur due to several systemic and local factors which compromise blood flow within the bone. Among anti-resorptive medications, a very low risk of ONJ development is associated with oral bisphosphonates used for the management of osteopenia, osteoporosis, and Paget's disease. Raloxifene is a nonsteroidal benzothiophene which is classified as a selective estrogen receptor modulator (SERM). It is commonly used for the prevention and the treatment of osteoporosis in postmenopausal women and was recently approved to reduce the risk of breast cancer. Raloxifene is regarded as a safe alternative in the management of osteoporosis in terms of ONJ development. This report presents a case of ONJ in a patient receiving raloxifene, who presented with existing comorbidities and a history of discontinued oral bisphosphonates use. The clinical report is followed by a discussion aimed to clarify how the general practitioner should consider similar cases. Keywords: jaw, mandible, osteonecrosis, raloxifene

Metastatic involvement of oral osseous and soft tissues constitutes nearly 1% of all oral malignancies. However, maxillary involvement is uncommon and this phenomenon is even less likely when the primary source is thyroid. A rare case of papillary thyroid carcinoma metastatic to maxillary right posterior alveolar process and sinus in a 43-year-old woman is described and the spectrum of metastatic oral disease is reviewed. The importance of including metastasis in the differential diagnosis of jaw lesions is also emphasized. Keywords: metastatic, oral, papillary thyroid carcinoma

Objective: This randomized double-blind in vivo pilot study has evaluated the effects of a toothpaste containing fluoride (control) versus toothpaste containing fluoride, triclosan, cetylpyridinium chloride and essential oils (experimental) in controlling supragingival dental plaque and bleeding on probing in a sample of healthy schoolchildren. Method and Materials: In total, 48 children (8 to 10 years) were selected and randomly divided into two groups (experimental and control), using the two different toothpastes twice a day for 2 minutes each for a 4-week period. The investigation included an evaluation of plaque quantity, using the Turesky modified Quigley-Hein method, and bleeding on probing that was recorded dichotomously. The unit of analysis was set at the gingival site level. Plaque Index and bleeding on probing were analyzed using distribution tables and chi-square test. A generalized estimating equation was used to estimate the parameters of a generalized linear model with a possible unknown correlation between outcomes. Results: In total, 40 schoolchildren completed the trial. Considering each group separately, a statistically significant difference in plaque scores was recorded for both treatments (z-test = 9.23, P .01 for the experimental toothpaste; and z-test = 7.47, P .01 for the control toothpaste). Nevertheless, the effect over time was higher for the experimental toothpaste than for the control one (3.38 vs 1.96). No statistically significant results were observed regarding bleeding on probing. Conclusion: The 4-week use of the experimental toothpaste seems to produce higher plaque reduction compared to fluoridated toothpaste without other antibacterial ingredients. This finding has to be confirmed in a larger study. Keywords: cetylpyridinium chloride, dental plaque, essential oils, gingival bleeding, toothpaste, triclosan