Quintessence International, 02/2003

The treatment of a 12-year-old girl with a Class I malocclusion, severe anterior crowding, and posterior crossbite is described. The patient, who had limited growth potential and exhibited a straight facial profile, was treated with rapid maxillary expansion and nonextraction edgewise mechanics.

A patient, diagnosed with a combination of level 3 endemic dental fluorosis and degree 1 tetracycline staining, was treated sequentially by macroabrasion techniques and nightguard vital bleaching. Various pairings of diamond and carbide burs, abrasive disks, rotary polishing points, and diamond polishing pastes were tested to obtain the optimal combination for macroabrasion. This conservative treatment regimen produced results that were termed "excellent" by the patient and met the goals of the dentists.

Objective: The goal of the present study was to evaluate the microleakage on the cementum/dentin and enamel surfaces in Class II restorations, using different kinds of resin composite (microhybrid, flowable, and compactable). Method and materials: Forty human caries-free molars were extracted and selected. Eighty Class II standardized cavities were made in the cervical wall at the cementoenamel junction (CEJ) and at the mesial and distal surfaces. The teeth were divided into four groups: G1 - adhesive system + microhybrid resin composite Z100; G2 - adhesive system + compactable resin composite Prodigy Condensable; G3 - adhesive system + flowable resin composite Revolution + Z100 resin composite; G4 - adhesive system + Revolution fluid resin + compactable resin composite Prodigy Condensable. The adhesive system used in this study was Scotchbond Multi-Purpose Plus. The specimens were thermocycled in baths of 5°C and 55°C for 1,000 cycles and immersed in 50% silver nitrate solution. The specimens then were sectioned and evaluated on degree of dye penetration. Results: The results were evaluated using the nonparametric Kruskall-Wallis test, which showed a statistically significant difference between groups G1 and G4, G2 and G4, and G3 and G4. Conclusions: None of the materials was able to eliminate the marginal microleakage at the cervical wall; the application of a low-viscosity resin composite combined with a compactable resin composite significantly decreased the microleakage.

Coronal fractures must be approached in a methodical and clinically indicated way to achieve successful restoration. One option for treatment is reattachment of the dental fragment. Reattachment creates a very positive emotional response in the patient and simplifies the maintenance of the patient's original occlusion. This article discusses dental fragment reattachment techniques and presents clinical cases of coronal fracture involving enamel, dentin, and pulpal exposure.

Objective: To assess the potential of DIAGNOdent (DD) readings for detecting secondary enamel and dentin carious lesions associated with resin composite restorations in a set of preserved extracted adult teeth. Method and materials: Thirty test sites adjacent to resin composite restorations in 15 extracted teeth were evaluated visually and with DD readings for enamel and dentin caries. The results were compared to gold standard diagnosis determined by sectioning through each site and subsequent microscopic observation. Sensitivity, specificity, accuracy, and likelihood ratios at optimum threshold values for enamel and dentin caries were determined. Receiver operator characteristic (ROC) analysis was performed to compare visual and DD diagnostic methods. Results: Histologic incidence of enamel caries was 20% and dentin caries was 36.67%. All composite restorations in the sample teeth fluoresced (range 5 to 22). For enamel caries detection with DD, the optimum threshold of >/= 26 produced a sensitivity of .67 and a specificity of .79. For dentin caries detection with DD, the optimum threshold of >/= 22 produced a sensitivity of .73 and a specificity of .84. ROC analysis showed that the DD readings do contain diagnostic information. DD readings for dentin caries diagnosis produced better diagnostic results compared to visual readings for the 30 test sites in the study, but these results were not significantly different. Conclusion: DIAGNOdent readings may have potential for resin composite secondary enamel and dentin carious lesion detection. DIAGNOdent instrument design factors and technique should be optimized to improve performance prior to clinical trial for this application.

Objective: The aim of this study was to develop an experimental model for the assessment of bone augmentation, and in doing so, compare the use of b-tricalcium phosphate (TCP) bone grafts in combination with Gore-Tex augmentation material (GTAM) and GTAM without TCP. Method and materials: Calvarial sites in eight Sprague Dawley rats were prepared for bone augmentation. Graft materials and Hermann stainless steel bone pins were used for localized bone augmentation. Specimens were subjected to macroscopic and histological evaluation at the sixth week. Results: Bone formation was significantly higher in the group with the graft support. Conclusion: TCP bone grafts used in conjunction with supporting pins may contribute to successful bone regeneration by osseoconduction and by maintaining the membrane-created space. At the sixth week, guided bone regeneration utilizing Gore-Tex augmentation material and TCP bone grafts resulted in the formation of viable new bone.

A 7-year-old female patient presented with a rare case of bilateral distal ectopic eruption of the mandibular permanent central incisors. Treatment instituted was extraction of the retained primary teeth and placement of a fixed appliance for alignment and repositioning of the mandibular permanent incisors.

This article reviews the clinical behavior, histologic features, differential diagnosis, and treatment of a benign osteoblastoma. Benign osteoblastoma is a rare tumor constituting 1% of all primary bone tumors. Only 15% of osteoblastomas occur in the skull and jaw bones. The most common clinical presentation is a painful or tender swelling. A case is presented of a 21-year-old female who had noted discomfort for approximately 2 years, and the pain was not relieved by any analgesic. The choice of treatment was local excision and curettage. In this case, root resorption of the adjacent tooth, which is not a characteristic behavior of osteoblastoma, is seen.

Invasive aspergillosis in healthy hosts is a very rare occurrence, but it may become pathogenic under certain circumstances. In the head and neck region, aspergillosis usually involves the maxillary sinus. This case report describes secondary Aspergillus infection of the mandible in a 35-year-old female patient in whom the maxillary sinus was primarily involved 5 years previously.

Objective: Surgical removal of impacted mandibular third molars with primary wound closure may result in postoperative edema, facial swelling, pain, and restriction of mouth opening. The type of closure may be a cause of these complications. The aim of this study was to compare the effects of placement of a surgical tube drain before primary closure with the effects of primary closure alone after removal of fully impacted mandibular third molars. Method and materials: The study group included 13 patients aged 15 to 39 years with bilateral fully impacted mandibular third molars. The insertion of a small surgical tube drain before primary closure (drain group) was compared to a simple primary closure procedure (no drain group) after removal of the impacted third molars in a randomized crossover design. The duration of the operation was recorded. Patients were evaluated 1, 2, 3, and 7 days postoperatively for facial swelling and trismus. Results: The facial swelling experienced by the drain group was significantly less than that experienced by the no drain group. The degree of trismus was greater in the no drain group than in the drain group, but the difference was not statistically significant. Conclusion: Use of a surgical drain, especially after removal of fully impacted third molars, will reduce postoperative facial swelling.

Objective: The amount of residual monomer is one of the principal factors affecting the properties of acrylic resin denture bases. In recent years, glass fibers have been used to strengthen denture base resins. The purpose of this study was to investigate the effect of glass fiber reinforcement on the amount of residual methyl methacrylate released from two different denture base resins (heat cured and autopolymerized). Method and materials: Continuous unidirectional and woven preimpregnated glass fiber reinforcements (Stick and Stick Net) were used to reinforce heat-curing and autopolymerizing denture base resins. Results: The release of residual methyl methacrylate from heat-cured and autopolymerized test specimens reinforced with glass fibers was significantly higher than that from unreinforced test specimens. Stick Net glass fiber reinforcement resulted in significantly higher residual monomer release than did Stick glass fiber reinforcement. Test specimens made from heat-cured denture polymethyl methacrylate released less residual methyl methacrylate than did specimens made from autopolymerized polymethyl methacrylate. Conclusion: Glass fiber reinforcement increases the residual monomer content of denture base resins. The level of residual monomer ranged from 0.11% to 0.37% in heat-cured resin and from 0.18% to 0.46% in autopolymerized denture base resin.