Quintessence International, 08/2002

Prosthetic dental restorations alone do not produce esthetics. They must be in harmony with the surrounding gingiva, especially the gingival papilla. This case report describes the enhancement of the gingival papilla between an implant replacing the maxillary left central incisor and a provisional crown on the maxillary left lateral incisor. Esthetic harmony was disrupted by the absence of an interproximal papilla. First, provisional crowns on the implant and adjacent tooth were used in an attempt to remodel the interproximal gingival tissue, but the esthetic result was not satisfactory. The second attempt involved orthodontic extrusion of the lateral incisor in an incisal direction. The gingival tissue migrated incisally, thus restoring the deficient papilla and establishing restorative and gingival harmony. Both the implant and the lateral incisor were restored with ceramic crowns.

This case report describes the comprehensive treatment of generalized, advanced periodontal disease in a young patient. In view of the necessary reconstruction, the extensive destruction of the periodontal tissues required a systematic approach to determine the possibilities and the expectations of the patient. The subsequent oral rehabilitation was accomplished with fixed prosthodontics. In the mandible, strategically important anchor teeth were replaced with implants, allowing smaller units to be inserted. The long-term treatment result, however, can only be ensured with the full cooperation of the patient and consistent periodontal maintenance care.

Objective: The reliability of posttreatment canine-to-canine retention with resin composite retainers reinforced with plasma-treated woven polyethylene ribbons was compared to the reliability of directly bonded, multistranded wire retainers. Method and materials: This prospective study was based on an assessment of 20 consecutive patients (eight women and 12 men with a mean age of 22.4 years) who required a fixed canine-to-canine retainer after undergoing orthodontic treatment. The type of retainer used was randomized for each patient. A follow-up examination was carried out once every 3 months. The length of time the retainers stayed in place without resin fracture or loosening from the teeth at one or more points was evaluated. The study's endpoint was 24 months after the retainer had been bonded. Results: The ribbon-reinforced retainer remained in place for an average of 11.5 months, and the multistranded wire for a mean of 23.6 months. The difference was statistically significant. Conclusion: In terms of reliability for permanently fixed orthodontic retention from canine to canine, the direct-bonded multistranded wire is superior to the plasma-treated polyethylene woven ribbon and resin retainer.

Treatment of juvenile patients with a missing maxillary incisor is difficult, because an implant cannot be placed until growth is completed. The other minimally invasive alternatives are also problematic: Removable dentures are rarely accepted by juvenile patients, and the conventional resin-bonded fixed partial denture often provides a poor esthetic result because the metal retainer causes the abutment teeth to lose their natural translucency and to become grayish. Moreover, the alveolar ridge defect makes it easy to identify the prosthesis in the pontic area. The present case report describes the prosthetic treatment of a juvenile patient who had lost a maxillary incisor to trauma. To avoid the disadvantages of conventional therapies, subepithelial connective tissue was grafted to reshape the alveolar ridge. The space was closed with an all-ceramic resin-bonded fixed partial denture.

Objective: The aim of this study was to evaluate the resistance to fracture of intact and restored human maxillary premolars. Method and materials: Thirty noncarious human maxillary premolars, divided into three groups of 10, were submitted to mechanical tests to evaluate their resistance to fracture. Group 1 consisted of intact teeth. Teeth in group 2 received mesio-occlusodistal cavity preparations and were restored with direct resin composite restorations. Teeth in group 3 received mesio-occlusodistal cavity preparations and were restored with ceromer inlays placed with the indirect technique. After restoration, teeth were stored at 37°C for 24 hours and then thermocycled for 500 cycles at temperatures of 5°C and 55°C. Results: Statistical analysis revealed that group 3 (178.765 kgf) had a significantly greater maximum rupture load than did group 1 (120.040 kgf). There was no statistically significant difference between groups 1 and 2 or between groups 2 and 3. Conclusion: Class II cavity preparations restored with indirect ceromer inlays offered greater resistance to fracture than did intact teeth. The fracture resistance of teeth restored with resin composite was not significantly different from that of either the ceromer or intact teeth.

Objective: The purpose of this in vitro study was to evaluate the bond strength of porcelain veneer to base metal alloy using different adhesive systems. Method and materials: Eighty cylindrical models were cast in a nickel-chromium-beryllium base metal alloy. After they were mounted in self-cured acrylic resin, the surfaces of the specimens were air abraded. Specimens were divided into four groups of 20. Control porcelain disks were baked on the base metal. For the experimental groups, 60 porcelain disks were made. After 50-µm aluminum oxide sandblasting, a silane coupling agent was applied to the surface of the porcelain. The experimental groups were based on the type of adhesive used to bond porcelain to metal: Scotchbond Multipurpose and Duo Cement; One Coat Bond and Duo Cement; or Panavia 21 Ex. After 500 thermal cycles, the bonded porcelain specimens were placed under a continuous shear load of 2 mm/min until fracture occurred. Results: Mean values for bond strength were 25.39 (control), 19.10 (Panavia 21 Ex), 15.81 (Scotchbond Multipurpose), and 13.69 MPa (One Coat Bond). Statistically significant differences in bond strength were noted between the control group and all the experimental groups. A statistically significant difference was observed between Panavia 21 Ex specimens and One Coat Bond specimens. Conclusion: Panavia 21 Ex provided an effective bond strength between a porcelain veneer and a base metal alloy, the closest of all the experimental groups to that of the control group.

Objective: The purpose of this study was to evaluate pulpal responses to the use of four resin composite materials as direct pulp capping agents. The importance and effects of individual pulp capping variables are not well understood; consequently histomorphometric analysis was used to analyze these variables. Method and materials: Two hundred fifty standardized pulp-exposed cavities were prepared in nonhuman primate teeth. Exposed pulps were capped with calcium hydroxide and multistep and self-etching primer resin composites. Teeth were collected from 3 to 60 days to observe pulpal reactions. Following perfusion fixation, tissues were demineralized, sectioned, stained, and histomorphometrically measured. Bridge area, diameter of pulpal exposure, and cavity floor width were measured. Tunnel defects, operative debris, and pulpal inflammation were graded according to defined criteria. Results: The variables correlated to dentinal bridge area were, in decreasing order of significance, time elapsed since exposure, diameter of pulpal exposure, pulp capping material, and tunnel defects. The variables correlated to pulpal inflammation were the type and curing of pulp capping material. Other variables were not statistically significant. Conclusion: Pulp capping with resin composite materials provided acceptable pulpal inflammatory and dentinal bridge repair responses, comparable with those of calcium hydroxide. Although resin composites are promising as direct pulp capping agents, further investigations are required to optimize their application protocols to reduce the penetration of potentially cytotoxic monomers into pulpal tissue.

A 12-year-old boy presented with a fractured sewing needle within the palatal root canal of a nonvital permanent maxillary first molar. The patient admitted that he had often placed a sewing needle in the tooth to relieve discomfort associated with it. A minimal amount of tooth structure was removed around the foreign object to facilitate access for K-type files. Under copious irrigation, the files were worked around the object to loosen it. The fractured needle was removed with a tweezers that had long, narrow beaks. Use of this simple technique allowed the object to be removed from the root canal with minimal damage to internal tooth structure.

Objective: The aim of this study was to investigate and analyze the angulation of and the various indications for removal of mandibular third molars in Jordanians as a representative Arab sample. Method and materials: The data included in this retrospective study were obtained from the clinical and radiographic records of 1,282 patients undergoing mandibular third molar surgery during a 5-year period from 1994 to 1999. The indications for removal of the mandibular third molars were classified in accordance with age and gender. The angular position of mandibular third molars was registered. Results: A total of 2,252 mandibular third molars were removed from 740 male patients (57.7%) and 542 female patients (42.3%) aged 14 to 67 years. Pericoronitis was the most common indication for surgery, affecting 1,055 teeth (46.8%). Caries was observed in 519 third molars (23.0%). The vertical angular position was most commonly found (1,383 teeth; 61.4%) followed by the mesioangular position (407 teeth; 18.1%). Conclusion: The results obtained in this study are similar to those reported in earlier studies carried out elsewhere, although the incidence of periodontitis among Jordanians was significantly higher and occurred in older patients, and prophylactic removal was performed less frequently than has been reported in other countries.

A young adult who complained of extreme dentin sensitivity to tactile and thermal stimuli exhibited severe, generalized tooth erosion and an associated parafunctional habit. The diagnosis of the underlying general disease and treatment of its dental sequelae are presented, together with a 2-year follow up. Patients who are suspected of having gastroesophageal reflux should be referred to a gastroenterologist or other health professionals to ensure early diagnosis and treatment of the underlying disorder, thus minimizing the destruction of the patient's dentition and improving the patient's general health. Dental treatment should be adjusted to fit the characteristics of each case.