Quintessence International, 03/2017

Pretreatment with occlusal splints is a crucial step in a structured treatment approach for a complex rehabilitation that changes the vertical dimension of occlusion. Meticulous patient compliance is one of the essential prerequisites for overall treatment success. However, patient compliance is all too often insufficient due to esthetic, phonetic, and functional limitations when using conventional occlusal splints in one arch. Modern production technologies now allow the use of tooth-colored occlusal splints made of polycarbonate, whose quality and material properties are quite distinct from those of conventionally manufactured splints made of transparent polymethyl methacrylate (PMMA). These materials, produced under standardized polymerization conditions, are extremely homogenous, which provides benefits such as a greater accuracy of fit by eliminating the polymerization shrinkage, greater long-term stability of shapes and shades, better biocompatibility, less wear, and a more favorable esthetic appearance. In addition, tooth-colored polycarbonate splints can be fabricated very thin without significantly increasing the fracture risk, thanks to the flexibility of the material. The improved wearing comfort combined with acceptable esthetics result in significantly improved patient compliance in terms of a "23-hour splint." Conclusion: By providing separate splints for the maxilla and mandible in the case of major alterations of the vertical dimension of occlusion, the esthetic and functional aspects defined by the wax-up can be completely transferred to the removable splints for a "test drive" by the patient, reversibly, and under realistic conditions. This dual-splint approach additionally facilitates segmental transfer into the definitive restoration. Keywords: altered vertical dimension of occlusion, CAD/CAM, complex rehabilitation, esthetic and functional evaluation, polycarbonate, pretreatment phase, tooth-colored splints, wax-up

Objective: Reducing the pain after root canal therapy is a key aspect in endodontic practice. The present systematic review aimed to identify the factors that influence postobturation pain (POP) in patients receiving single-visit nonsurgical root canal treatment. Data Sources: A literature search was performed manually and in Pubmed (Medline) database to identify relevant articles. A data extraction form was constructed and data were collected from the identified articles. Results: In total, 24 articles were identified for the systematic review, and factors associated with POP were tabulated. Conclusion: Specific preoperative factors (old age, sex, molar teeth, mandibular teeth, presence of preoperative pain, and absence of periapical radiolucency) and procedures (administration of prophylactic drug, bupivicaine anesthetic agent, radiograph or apex locator working length determination methods, instrumentation, irrigating system, laser, cold lateral compaction obturation technique, reducing the occlusion, and postoperative drugs) were associated with POP. Keywords: age, gender, postobturation pain, root canal treatment

Objective: To examine the correlation between the gingival biotype and the morphology of the alveolar bone in human subjects, assessing the clinical and the practical values of these findings. Method and Materials: Thirty-five subjects were enrolled. The labial plate thickness was measured by cone beam computed tomography (CBCT). The correlation between CBCT and probe transparency measurements was analyzed with regard to tooth type (canine or central incisor). Additional data analysis included possible correlation to gender and smoking status. Results: Of the patients, 57% (20/35) were female; 23% (8/35) were smokers; 78% (25/32) of maxillary teeth had thin biotype compared to 50% (19/38) of mandibular teeth; 63% (10/16) and 32% (6/19) of the patients had thin biotype in maxillary and mandibular teeth respectively. More than 30% of the subjects demonstrated different biotypes in the same jaw at different sites. The probe transparency through the soft tissue at the maxillary canine was positively correlated with the width of the facial bone plate at the alveolar crest (P = .026). Conclusion: Biotype can vary in the same subject at different sites. Only the maxillary canine's biotype correlated with the facial plate width. Keywords: alveolar bone loss, anatomy, cross-sectional, gingival recession, tissue biotype

Objective: Immediate implant placement and restoration following tooth extraction is desirable for shortening treatment times and maintaining oral structures. With a variety of bone-level implants available on the market, the goal of this in-vitro study was to compare different implant designs. Method and Materials: Using a polyurethane foam sandwich model with an intermediate cortical layer, a standardized extraction socket model was created. The following implant systems were assessed: OsseoSpeed EV (Astra), Straumann Bone Level Tapered (BLT), and Nobel Active (NA). Implant stability assessment included implant insertion torque (IT) and implant stability quotient (ISQ). The three implant systems were compared in a statistical analysis based on the two sample tests with the level of significance set at ? = .05 and Bonferroni correction for multiple comparisons. The relationship between IT and ISQ was assessed using the Pearson correlation coefficient. Results: IT values were highest for NA implants, with a mean of 36.52 Ncm, which was significantly greater than in BLT (P .001) and Astra (P .001). ISQ values were highest for NA, with a mean 53.9, which was significantly higher than for BLT (P .001) but not for Astra (P = .07). BLT showed significantly lower ISQ as compared to NA (P .001) and Astra (P .001). Overall, the IT and ISQ measurements did not correlate. Conclusion: The developed extraction model allowed for consistent measurements of implant stability parameters at a clinically relevant level. Implant design seems to play a relevant role for achieving primary stability in challenging situations. Next evaluation steps should involve testing under dynamic loading conditions. Keywords: extraction socket, immediate implant placement, implant design, implant stability, insertion torque

Numb chin syndrome (NCS) is a multifactorial neuropathic disorder associated with paresthesia to the chin, lip, and oral mucosa, particularly arising as a sequela to various dental-related procedures or infections in the mandible. Timely elucidation of the underlying etiology is of paramount importance as the presentation of NCS could serve as a harbinger of malignancy or metastatic disease. This report describes an unusual case of NCS developing synchronously with a vertical root fracture and odontogenic infection in a mandibular first molar. Clinicians should consider the inclusion of a vertical root fracture as plausible cofactor for the development of NCS. Keywords: cracked tooth, inferior alveolar nerve, odontogenic infection, paresthesia

Objective: The purpose of this systematic review was to assess the difference in the incidence of intraoperative and postoperative complications between the conventional and alternative surgical techniques, during sinus floor augmentation surgery. Data Sources: Electronic databases were searched for publications related to sinus floor augmentation surgery performed with different techniques (ie, conventional lateral window, piezosurgery, osteotome, trephine) and the incidence of complications. The articles were evaluated by independent reviewers, according to predetermined inclusion/exclusion criteria and processed for meta-analysis, following the PRISMA protocol. Initial search returned 3,940 articles, after inclusion/exclusion criteria, and quality assessment 11 articles were included in the meta-analysis: five randomized clinical trials and six retrospective studies. All the 11 included studies compared the incidence of complications in conventional lateral window sinus augmentation surgery versus alternative techniques, including: osteotome (five articles), piezosurgery (four articles), sonic surgery (one article), and trephine (one article). Meta-analysis of the incidence of intraoperative and postoperative complications during conventional lateral window sinus floor augmentation surgery versus alternative techniques, showed a significantly lower incidence of intraoperative complications for the retrospective studies. However, when data from the clinical trials alone were included in the meta-analysis, a statistically significant difference could not be detected for the incidence of intraoperative and postoperative complications. Conclusions: The use of alternative techniques for sinus floor augmentation surgery (ie, piezosurgery, sonic surgery, osteotome, and trephine) does not necessarily reduce the incidence of intraoperative and/or postoperative complications compared to the conventional technique. Keywords: dental implants, intraoperative complications, piezosurgery, postoperative complications, sinus floor augmentation, review

Objective: Dental students have high levels of anxiety that can affect not only academic performance but also increase the risk for other diseases. It is believed that the increase in the incidence of chronic orofacial pain in temporomandibular disorders (TMDs) may have an impact on the quality of life and general health of subjects. The aim of this study was to evaluate the prevalence of TMD in dental students and its association with general health, quality of life, and anxiety. Method and Materials: Ninety students were evaluated by four questionnaires to determine the prevalence and sever-ity of TMD (Fonseca's questionnaire) and to quantify general health (General Health Questionnaire - GHQ), quality of life (World Health Organization Quality of Life - Brief version - WHOQOL-brief) and anxiety levels (State-Trait Anxiety Index - STAI). Results: Approximately 58.9% of dental students presented TMD. Among the indicators of general health, psychologic stress (P = .010), distrust in their own performance (P = .012), and psychosomatic disorders (P = .020) showed a statistically significant difference with the presence of TMD. The four areas proposed in the questionnaire regarding quality of life, such as physical (P = .016), psychologic (P .001), social (P = .045), and environmental (P = .017) factors also showed significant differences with the presence of TMD. Conclusion: A high prevalence of TMD was observed in dental students. In addition, some psychologic domains are important psychosocial indicators associated with the presence of TMDs. Keywords: anxiety, epidemiology, general health, quality of life, temporomandibular joint disorders

Objective: There are no studies that have (a) compared self-perceived oral symptoms and clinical and radiographic periodontal parameters (plaque index [PI], bleeding on probing [BoP], clinical attachment loss [CAL], and marginal bone loss [MBL]) among shamma-chewers (SC) and gutka-chewers (GC); and (b) assessed periodontal parameters among SC. The aim of the present study was to compare the self-perceived oral symptoms and periodontal parameters among SC, GC, and controls. Method and Materials: Information regarding demographic characteristics and self-perceived oral symptoms was gathered using a structured questionnaire. Odds ratios were computed for self-perceived oral symptoms and periodontal parameters and compared between the groups. For multiple comparisons, the Bonferroni post-hoc test was used. Level of significance was set at P .05. Results: Forty-seven SC, 45 GC, and 41 control individuals were included. Group comparisons for pain in teeth, pain on chewing, bleeding gums, and burning sensation in the mouth showed no statistically significant difference among SC and GC. These symptoms were significantly higher in SC (P .01) and GC (P .01) than controls. PI, BoP, PD (4-6 mm and > 6 mm), and CAL were significantly higher in SC (P .05) and GC (P .05) than controls. There was no statistically significant difference in PI, BoP, PD (4-6 mm and > 6 mm), and CAL among SC and GC. There was no statistically significant influence of daily frequency of smokeless tobacco consumption and duration of placement in the mouth on the severity of periodontal parameters. Conclusion: Self-perceived oral symptoms and periodontal parameters were worse among SC and GC than controls, with no statistically significant difference when comparing these findings between SC and GC. Keywords: alveolar bone loss, gingival bleeding, periodontal disease, questionnaire, smokeless tobacco