Quintessence International, 01/2003

Objective: There has been great interest in the treatment of gingival recession defects, especially with subepithelial connective tissue grafting. Recent advances have focused on subepithelial connective tissue grafting by the tunnel technique. In this clinical study, a modified periodontal plastic surgery technique for coverage of adjacent gingival recessions was performed. This surgical modification was based on the tunnel technique without vertical incisions, where the partial dissection was converted to a full-thickness dissection at the mucogingival area to supply more blood vessels. Method and materials: Patients, each contributing at least two adjacent buccal gingival recessions, were treated. Subepithelial connective tissue grafting was used to cover the defects. Gingival recession, probing depth, and attachment level were measured at baseline and 8 months posttreatment. Results: There were statistically significant improvements in attachment level and gingival recession after 8 months; the mean gain in attachment was 3.67 mm and the mean root coverage was 3.28 mm, which translated to mean root coverage of 95%. Conclusion: These findings suggest that subepithelial connective tissue grafting with a modified tunnel approach, in which the partial-thickness flap is converted to a full-thickness flap in a coronoapical direction, results in adequate early healing and highly predictable root coverage in adjacent gingival recessions.

Gingival recessions are of concern both esthetically and functionally for the dental patient. Bioabsorbable barriers were used to simultaneously treat six mucogingival recessions affecting six teeth in both maxillary quadrants of a 34-year-old woman. Root exposures ranging from 4 to 6 mm were successfully treated; complete root coverage was obtained at all treated sites. Follow-up visits up to 18 months revealed the stability of the clinical outcome, confirming the efficacy of the procedure.

The efficacy of a modified cast-metal resin-bonded splint was evaluated after 14 years in service. The splint was used to immobilize the root-compromised maxillary central and lateral incisors of a teenage male following relapsed orthodontic treatment. The affected teeth were indirectly traumatized, before their eruption, in a bicycle accident that resulted in avulsion of their primary predecessors. The rationale for selecting this treatment modality rather than the alternatives is discussed. The clinical protocol employed during the treatment and subsequent follow-up is described.

Objective: The purpose of this in vitro study was to evaluate the change in cavity volume after removal of amalgam and resin composite restorations, based on the dental skills of the operators. Method and materials: A high-speed turbine and diamond burs were used to prepare Class II cavities in 60 acrylic resin mandibular first molar teeth. After the teeth were weighed with precision scales, the cavities were restored with amalgam or posterior resin composite. The restored teeth were then stored in distilled water at room temperature for 48 hours. Three undergraduate students with 2 years' practical experience on patients, and three postgraduate students with an additional 4 years' practical experience in the Department of Operative Dentistry, removed the restorations from the cavities with a high-speed turbine, and the teeth were all weighed again. After cavities were rerestored with the same materials, each restoration was removed once more by the same operator. The weighing procedure was repeated before and after the removal of the restorations. The data were subjected to paired and unpaired t tests. Results: Every time a restoration was removed from a tooth, the cavity preparation became significantly larger, but the postgraduate students caused significantly smaller increases in cavity volume. Conclusion: Increases in cavity volume are not based on the nature of the restorative material; however, the individual experience levels and dental skills of the operators lead to significant differences in the cavity volume increase.

Objective: The purpose of this study was to evaluate two glass-ionomer cements placed in the occlusal surfaces of permanent molar teeth, using two cavity preparation methods. Method and materials: Three dentists placed 149 restorations for 68 patients in a hospital clinic. Atraumatic restorative treatment or conventional cavity preparation methods were used for two encapsulated, high-strength conventional glass-ionomer cements: Fuji IX GP and Ketac-Molar. Non-gamma 2 amalgam alloy was used in conventional preparations for comparison. Results: The restorative procedures were uneventful, but cavity preparations made with atraumatic restorative treatment hand instruments took approximately twice as long as did conventional rotary instrumentation. After 30 months, only one glass-ionomer cement restoration had failed. Both glass-ionomer cements showed high early losses of sealant material, but caries was not detected in the exposed fissures. Both glass-ionomer cements also showed relatively high restoration wear. At 30 months, the mean cumulative net occlusal wear was 119 ± 12 mm for Fuji IX GP and 96 ± 13 mm for Ketac-Molar; the difference was not statistically significant. Color matching improved significantly by 6 months; there was no significant difference in color match between the two glass-ionomer cements by 12 months. Minor surface tarnishing and marginal discrepancies were present in the amalgam restorations and increased with time. Conclusion: The occlusal restorations performed satisfactorily over periods of up to 30 months. However, the continued deterioration of the cements requires longer-term studies to be undertaken.

This review article discusses dental practice implications of prion diseases, including Creutzfeldt-Jakob disease. The current universal precautions used for infection control in dentistry do not inactivate infectious prions. There is a theoretical, yet real risk of prion disease transmission through dental treatment, although the magnitude of that risk has not yet been determined. Medical, family, and travel histories can demonstrate the need for implementing improved levels of infection control. Best practices include the following: For certain cases, single-use disposable dental instruments should be used. Those instruments that are not disposable, should have a thorough physical cleaning, be soaked in hot 1N sodium hydroxide solution for 1 hour, and then autoclaved in a vacuum or porous-load autoclave at 134°C to 138°C for 18 to 20 minutes. Dental and other health care professionals need to understand prion diseases, and for best practice, consider implementing recommended changes to infection-control measures, since current practices do not destroy infectious prions.

Objective: This retrospective study presents the type of osteosynthesis used for the fixation of condylar fractures and the postoperative results and complications observed. Method and materials: Forty-five patients with fractures of the mandibular condyle underwent open reduction and osteosynthesis with plates and screws. The surgical approach was, in most cases, via a submandibular incision. Stabilization was achieved in the majority of the cases with a 2.0-mm single or double miniplate, but 2.0-mm mini dynamic compression plates were also used. Results: The complications were mainly inadequate reduction, screw loosening, and limitation of mouth opening. No plate fractures or infections were observed. Conclusion: The use of a single plate (miniplate or dynamic compression plate) often produces inadequate stability and reduction postoperatively. The placement of two 2.0-mm zygomatic dynamic compression plates demands great tissue dissection and detachment and can lead to limitation of mouth opening. The use of two 2.0-mm miniplates seems to produce better stability and fewer complications.

Impaction of the permanent maxillary central incisor is rare. Trauma to the primary maxillary anterior teeth is the most common cause. Two case reports of impacted permanent maxillary central incisors with a history of trauma to the primary maxillary anterior teeth are presented. In one case there was radiographic evidence of complete arrest of root formation, and in the other case the root was dilacerated from the cervical third and the enamel surface was rough.

Objective: The aim of this research was to investigate the incidence of fully impacted teeth and their complications and to recommend suitable removal times for these teeth. Method and materials: One thousand patients who were referred to the Oral Surgery Clinic, Faculty of Dentistry, at Atatürk University were intraorally examined, and fully impacted teeth were determined from radiographs. The locations of fully impacted teeth and the complications they caused were recorded. A total of 110 patients with fully impacted teeth were divided into three age groups: 16 to 19 years, 20 to 35 years, and older than 35 years. Results: The incidence of fully impacted teeth was found to be 11.00%. The maxillary left third molars in females and the mandibular left third molars in males were the most frequently impacted teeth. Complications, such as pain, cysts, resorption of the impacted or adjacent teeth, infection, crowding, and axial changes in the position of the adjacent teeth, were associated with 28.42% of impacted teeth. Impaction was most frequent in the 20- to 35-year-old group. Conclusion: Extraction of fully impacted wisdom teeth before they cause complication is the ideal approach. However, in economically developing countries, such as Turkey, extraction of these teeth after complications occur is the most suitable approach because of restrictions in governmental budgets and the patients' poor socioeconomic conditions and fear of dentistry and oral surgery.

Objective: Clinicians have few quantitative studies that rank the in vivo pulp capping effects of commonly used restorative materials. These factors were investigated to provide guidance to clinicians. Method and materials: One hundred sixty-one standardized pulp-exposed cavities were prepared in nonhuman primate teeth. Exposed pulps were capped with calcium hydroxide, resin-modified glass-ionomer cements, and resin composites. Teeth were collected from 7 to 720 days to observe a full range of responses. Pulpal reactions were categorized according to the standards set by the International Standards Organization. Bacteria were detected with McKay's stain. Results: The incidence of bacterial microleakage was 19.7% with resin composite, 21.1% with resin-modified glass-ionomer cement, and 47.0% with calcium hydroxide. The severity of pulpal inflammation increased with the presence of bacteria or tunnel defects. The severity of pulpal inflammation prevented dentinal bridge formation at varying levels: slight for resin composite and resin-modified glass-ionomer cement, and severe with calcium hydroxide. The incidence of severe inflammation or pulpal necrosis was 7.9% with resin composite, 10.6% with calcium hydroxide, and 10.5% with resin-modified glass-ionomer cement. Other variables, such as pulpal exposure width and tertiary dentin formation, were not highly correlated to pulpal inflammation. Conclusion: Pulp capping with resin composite provided the lowest incidence of bacterial microleakage, the lowest levels of pulpal inflammation, and the lowest incidence of necrosis.

Objective: Two recently marketed light-emitting diode polymerization units were compared with a conventional halogen curing unit. Selected properties of resin composites polymerized with the three curing units were determined. Method and materials: Three different brands of resin composite were used in the investigation. The properties that were determined were flexural strength and modulus, determined in three-point bending tests; depth of polymerization, assessed by removal of uncured material after irradiation; polymerization contraction, evaluated with the bonded-disk method; and degree of conversion, measured by Fourier transform infrared spectroscopy. Results: The properties of resin composites polymerized with light-emitting diode curing units were equal or inferior to properties obtained after halogen light curing. Conclusion: Although several properties with some combinations of resin composite and light-emitting diode curing unit were inferior to properties obtained with the halogen curing unit, both the flexural strength and the depth of polymerization fulfilled the requirements set by the International Standards Organization.