Quintessence International, 08/2003

Excessive alveolar bone atrophy often confounds a conventional therapy with complete dentures. Implant therapy has found a way to solve the problem through enhanced stability and retention, thus increasing its functionality, leading to improved patient satisfaction and a higher quality of life. This article describes an implant-supported restoration of a patient with reduced oral health and high Oral Health Impact Profile values (OHIP-14). Upon improvement of oral hygiene and the compliance of the patient, the residual dentition was extracted and four implants were inserted, both in the maxillary and the mandibular arches. After the healing period was completed, two implant-supported prostheses with rigid bars for retention were fabricated. The patient's esthetics, phonetics, and masticatory function were properly restored at the time of delivery. A significant improvement in the patient's quality of life was noticed. In comparison to conventional dentures, the implant-supported overdentures offer better function and comfort for many patients.

Desquamation of the gingiva is a sign that may be encountered in clinical practice. Various diseases can affect the gingival tissues. Mild desquamation that is localized may be associated with mechanical irritation or induced by trauma. Moderate to severe generalized desquamation associated with ulceration and erythema may be indicative of a more serious systemic condition. Although often overlooked, mucocutaneous diseases frequently present with gingival desquamation as an early presenting symptom. The most common mucocutaneous diseases that affect the oral cavity are lichen planus, pemphigus, and mucous membrane pemphigoid. This article reviews the etiology, signs and symptoms, and therapies for these disorders. Increased knowledge of mucocutaneous diseases can help the clinician recognize these disorders and enable the patient to receive appropriate therapy.

Burning mouth disorder (BMD) is a chronic, oral pain condition associated with burning sensations of the tongue, lips, and mucosal regions of the mouth. Diagnosis of the condition is complicated by the fact that a variety of systemic and local factors can be contributory. Treatment goals are to reduce symptoms by eliminating identifiable abnormalities. Secondary lines of therapy include pharmacotherapeutic approaches that target neuropathologic mechanisms that appear to be active.

Objective: Packable composites are a comparatively recent addition to the dentist's armamentarium, Solitaire-2 being an example of this type of material. This paper reports the performance of 100 restorations formed in Solitaire-2 in conjunction with the Gluma Solid Bond system and Gluma One Bond bonding systems, in Class I and II cavity restorations in permanent teeth, placed in the practices of five members of the Product Research and Evaluation by Practitioners (PREP) Panel, a group of United Kingdom-based dental practitioners who are prepared to undertake research projects in their practices. Method and materials: Five members of the PREP Panel were each requested to place 20 Solitaire-2 restorations. These restorations were reviewed at 1 year by a trained and calibrated evaluator, and the PREP panel member who had placed the restorations. Results: A total of 88 restorations (33 Class I, 55 Class II) in 49 patients (mean age 43 years) were reviewed at 1 year. One Class II restoration (a large mesio-occlusodistal restoration) had been replaced at 10 months after a fracture was detected across the distal box. The remaining 87 (99%) of the restorations were intact with no secondary caries detected. Conclusion: Ninety-nine percent of the Solitaire-2 restorations, placed in general dental practice conditions in conjunction with the Gluma Solid Bond system and Gluma One Bond bonding systems, were found to be performing satisfactorily at 1 year.

Objective: This in vitro study compared the microleakage of resin composite restorations placed in Class II cavity preparations using an incremental placement technique with and without the addition of precured resin composite inserts. Method and materials: Sixty standardized mesio-occlusal and disto-occlusal cavities were prepared in 30 recently extracted molar teeth. Twenty cavities were restored by employing the incremental placement technique (group I), and 40 cavities were restored using the incremental placement in the presence of precured composite inserts of two sizes: 1X 3 mm (group II) and 1.25 X 3 mm (group III). The restored teeth were thermocycled for 250 cycles in water baths set at temperatures of 5°C and 50°C using a 30-second dwell time, stained, and sectioned horizontally at the middle of the restoration. Following sectioning, each specimen was microscopically examined at X4 magnification. The extent of dye penetration at the tooth/restoration interface was scored for each test group, and the scores obtained were subjected to one-way analysis of variance (ANOVA) and Tukey's pairwise comparison at a 95% significance level. Results: The current investigation showed statistically significant differences in dye penetration between the three test groups. Conclusion: The use of precured resin composite inserts with the incremental placement technique in the restoration of Class II cavity preparations seems to improve the marginal seal of the proximal walls of finished restorations.

Objective: Two occlusal concepts exist for the setup of complete dentures: canine guidance and balanced occlusion. These two schemes were studied in a randomized clinical trial of 22 patients. Method and materials: Subjective data were collected using a visual analog scale that described the patients' satisfaction with the esthetic appearance, the ability to chew, the ability to speak, and denture retention. Objective data were collected on the number of denture ulcers, the number of occlusal contacts, and denture retention during eccentric movements. Statistic evaluation was performed with the Friedman test. Results: Patients assessed canine-guided dentures to be significantly more satisfying in esthetic appearance, mandibular denture retention, and chewing ability. The ability to speak and the retention of maxillary dentures were not influenced by the occlusal concept in the patients' opinion, whereas the examiners found that maxillary canine-guided dentures lost retention more frequently during eccentric movements than balanced dentures. The objective inspection of mandibular denture retention underscores the patients' assessment, showing that the mandibular canine-guided dentures are much more stable during laterotrusive and protrusive movements. Conclusion: Canine guidance can be used successfully in complete denture treatment as it provides better mandibular denture retention, esthetic appearance, and chewing ability.

During the last 15 years, we have started to understand tooth development at the gene level. The list of genes known to regulate the position, shape, or number of teeth is lengthening rapidly. Interestingly, so far all these genes have important functions in the mediation of cell communication, which is generally considered the most important mechanism driving embryonic development. The communication is mediated by small signal molecules that are sent to nearby cells, thereby affecting their behavior and advancing differentiation. There are dozens of different signals and their receptors and target genes, which together form complicated signaling networks. The defects in several human conditions affecting tooth development have been identified recently, and these genes have turned out to be necessary components of signaling networks. Experimental studies using transgenic mice as models for human syndromes such as ectodermal and cleidocranial dysplasia have pinpointed the exact roles of the disease genes and indicated ways for possible new therapies. It is also possible that by combining the knowledge of molecular regulation of tooth development with the recent breakthroughs in stem cell research, dreams of building new teeth in dental practice may come true in the future.

Dr Donna Rumberger graduated from New York University College of Dentistry in 1980 and has practiced dentistry in Manhattan ever since. Even before her graduation, she was active in organized dentistry, always viewing it as a conduit for helping other people. Working with the American Association of Women Dentists, she was cofounder of the Smiles for Success Foundation, a program started in New York City that helps women advance from welfare into the workforce with restored, healthy smiles. That program now has expanded to 14 other cities. Working with organized dentistry in New York City, she has been instrumental in initiating and running the Skate Safe program, which provides mouthguards and oral home care education for inner city children in Harlem. In addition, she has worked with the dentistry merit badge program for the Boy Scouts of America Jamborees, helped coalesce women's dental organizations in New York City, and led her dental society to collaborate with Columbia University in a program to improve access to dental care. As further evidence of her ability to get things done, she also has served as president of the American Association of Women Dentists, the Midtown Dental Society, and the New York County Dental Society-one of the largest dental societies in the country.