Quintessence International, 10/2003

Maintenance of gingival health is one of the keys for the longevity of teeth, as well as for the longevity of restorations. In this context, the biologic width functions as a barrier against the entrance of microorganisms into the internal medium of the periodontal ligament and into the gingival and osseous connective tissue. This clinical case describes a technique to reestablish the biologic width of a central incisor using forced extrusion and done without post-treatment corrective surgery.

Pulp exposure due to traumatic injuries in the anterior permanent teeth of adolescents is a common occurrence. A vital permanent maxillary incisor with complex crown fracture and pulp exposure was treated by partial pulpotomy and assessed clinically through pulpal sensitivity tests and radiographically for periapical healing. Partial pulpotomy consisted of pulp tissue removal to a depth of only 1 to 2 mm, then capping the pulpal wound with calcium hydroxide, lining with resin-modified glass-ionomer cement, and restoration with resin composite. At each recall (7, 15, 21, 50, 90, 150, and 250 days), no spontaneous pain was observed; the pulp showed signs of vitality and absence of periapical radiolucency after 90 days. For long-term success, partial pulpotomy is recommended as an option for cases of traumatic pulp exposure in permanent incisors with crown fractures.

Objective: Resin-embedded transparent teeth are devoid of the original crown morphology, because enamel is lost by demineralization. This study was designed to reproduce artificial enamel and to reconstruct the original crown morphology for resin-embedded transparent teeth. Method and materials: The impression of the coronal portion of human permanent teeth was taken with a silicone impression material. After demineralization, drawing ink was injected into the pulp cavities. The ink-infiltrated teeth were made transparent with methyl salicylate and embedded with polyester resin. Urethane prepolymer was injected into the impression, and the resin-embedded teeth were reinserted into the impression. After polymerization of the urethane resin, the specimens and the urethane resin were removed from the impression. Results: The original crown morphology of the resin-embedded transparent teeth could be precisely reconstructed with artificial and removable enamel. The resin-embedded teeth showed morphologic details of the black-stained pulp cavities through the transparent dentin and cementum. Conclusion: This study established a crown reconstructing method for resin-embedded transparent teeth. The specimens will be useful for demonstration of morphology of teeth and pulp cavities.

The primary advantage of using all-ceramic restorations is to reproduce a color and translucency close to those of the natural tooth. Additionally, it is anticipated that the use of an adhesion technique will allow a ceramic restoration without removing tooth structure in some patients. This case report describes the use of proximally bonded ceramic restorations for the closure of an anterior diastema without proximal tooth reduction. A silane coupling agent and a resin cement were used for bonding. The diastema was closed with the ceramic restorations, which provided a natural appearance of the teeth. It was concluded that ceramic restorations without proximal tooth reduction was effective in improving esthetics, if the case was properly selected.

Objective: The purpose of this prospective study was to analyze postoperative pain and swelling of patients undergoing surgical endodontic treatment using a strict protocol incorporating measures to control postoperative symptoms. Method and materials: The study consisted of 82 patients referred for surgical endodontic treatment. All surgical procedures were performed using a microsurgical technique employing strict protocol. All patients were premedicated with a single dose of oral dexamethasone (8 mg) preoperatively and two single doses (4 mg) 1 and 2 days postoperatively. Antibiotics were prescribed selectively only when severe symptoms were present due to infection. Patients were administered chlorhexidine mouthwash twice daily starting 3 days before the operation and an additional 7 days postoperatively starting the day after surgery. Cold compresses were applied on the skin at the site of surgery intermittently every 15 minutes during the operative day. Pain and swelling were recorded pre- and postoperatively, and the influence of different variables on postoperative sequelae were analyzed. Results: One day postoperatively, 76.4% of the patients were completely pain free, less than 4% had moderate pain, and 64.7% did not report any swelling. The preoperative symptoms significantly influenced the pain experience postsurgery. Conclusion: There was a low incidence of postoperative pain and swelling following endodontic surgical treatment according to protocol with measures to control postoperative signs and symptoms. Patients with preoperative pain were more likely to have postoperative pain.

Objective: A posterior composite should be able to maintain its shape when packed against a matrix band. The objective of this study was to develop an in vitro methodology to determine composite packability by measuring the displacement of a matrix band. Method and materials: The experimental setup consisted of a sectional matrix system secured for the restoration of an occlusodistal cavity preparation. The distance the band was displaced was measured from superimposed digital images. First, band displacements were measured under applied forces of 25, 50, and 75 g for different loading orders. Different forces resulted in different band displacements. Loading order significantly affected band displacements. Thus, the reproducibility of the experimental setup is ensured provided the band is replaced after each test. The cavity was filled with a universal composite (Z100, 3M ESPE) or a posterior composite (Filtek P60, 3M) at 37°C. Results: The band displacements were 32 ± 28 µm vs 107 ± 38 µm for ZI00 and Filtek P60, respectively. Conclusion: The present study proposed measuring band displacement as an in vitro methodology to determine the packability of dental composite. Based on the result, the posterior composite should help in forming contact better than the universal composite tested.

Objective: This study evaluated the resistance of various post and core materials against torsional forces on differently conditioned titanium posts. Method and materials: One hundred fifty pure titanium posts (DIN 17850-Ti4/3.7065) were conditioned utilizing Silicoater Classical, Silicoater MD, Rocatec, Kevloc, and Siloc. Subsequently, three post and core materials (Adaptic, Coradent, Ti-Core) were applied to titanium posts that were previously coated with a light-cured opaquer (Dentacolor). Thirty sandblasted titanium posts were used as reference for each core material. Following thermocycling (5°C to 55°C, for 30 seconds or 5,000 cycles), maximum torsional forces were determined with an electronic torque movement key. Results: Kruskal-Wallis, Mann-Whitney U-tests indicated significant differences between Adaptic, Coradent, Ti-Core (20.9 dNm, 18.84 dNm, and 18.62 dNm, respectively). There were no significant differences between Silicoater Classical (18.56 dNm), Silicoater MD (18.18 dNm), and Rocatec (16.95 dNm), while Siloc exhibited the highest results (20.44 dNm). Kevloc demonstrated significantly lower results (10.43 dNm) than those of other systems and the control group (14.49 dNm). Conclusion: Resistance of core materials against torsional forces on titanium posts increased with the use of chemical surface conditioning techniques, while the system using only acrylization did not improve the resistance in comparison to the unconditioned posts.

Objective: The aim of this study was to evaluate associations among the dental status, socioeconomic factors, and general health of 1,877 subjects between the ages of 55 and 79. Method and materials: Socioeconomic information (age, sex, education level) and questions on smoking and alcohol abuse were taken from an interview; income and medical information (number of diseases) were taken from a self-administered questionnaire; and HbA1C and CDT (diabetes and alcoholism markers) were taken from blood analyses. Results: Of the subjects, 73% had a low education level, and 27% of the subjects had a monthly income of 1,000 Euros and 13% of > 2,000 Euros. Twenty-six percent of the subjects were edentulous, and 29% had 20 or more teeth. The odds ratio of edentulism increased to 9.0 (95% confidence interval = 7.0-11.5) at the ages of 75 to 79 years compared to ages 55 to 79. Logistic regression analyses showed that edentulism was significantly associated with age, low education level, low income, smoking, and alcohol abuse. However, the retention of more than 20 teeth was associated with age. Conclusions: Age, low income, low education level, smoking, and alcohol abuse seemed to be risk markers for edentulism; whereas, the number of diseases, diabetes, and gender were not.

Aspiration of foreign bodies is a serious complication that may occur during the course of dental treatment. A case report of a 60-year-old man with recurrent pneumonia is presented. One year after the onset of his initial symptoms, a hard substance that made a complete mold of the bronchial tree at the inferior right lobe was extracted with a rigid bronchoscopy. This green material of elastic consistency was dental impression material (polyvinylsiloxane). On careful questioning, the patient indicated that he had dental impressions taken 2 months before the onset of the symptoms. Surgery was indicated and lobectomy of the inferior right lobe was performed without incident. To avoid this complication, some preventive precautions such as identifying high-risk patients; using rubber dam; tethering any small instrument with a ligature; placing a gauze screen to protect the oropharynx in sedated patients; and using custom impression trays to minimize the amount of impression material required have been suggested. In case of a suspected aspiration, the patient must be referred to appropriate medical care.