Quintessence International, 01/2011

The combination of inadequate bone volume, poor bone quality, and elevated occlusal forces contributes to the posterior maxilla being the least predictable site for implant survival. Osteotomes are surgical instruments that have been designed in an attempt to improve bone quantity and quality. Conflicting reports in the literature compare the percentages of bone-to-implant surface contact between the implants placed using osteotomes and conventional drills. However, some studies use different osteotomes that may be harmful to the bone. Innovative pilot intermediary osteotomes used in conjunction with divergent sequential osteotomes to ensure parallelism, expand narrow ridges predictably, safely and significantly internally elevate the sinus, aid in future site development, and assist in immediate implant placement are introduced. The hypothesis is that the quality of bone is simultaneously enhanced, but controlled clinical studies are needed to prove this theory. Keywords: bone quality, implant sites, osteotomes, trephine-osteotome sinus lift

Objective: Transitional implants are indicated for cases in which immediate loading is counterindicated because a healing period is necessary for osseointegration of the definitive implants. These provisional implants were developed to support an implant-supported fixed prosthesis or overdenture to provide retention, stability, and support. The aim of this article was to conduct a literature review on transitional implants to highlight the characteristics of the transitional implants and their advantages, indications, and contraindications, including the level of osseointegration of such implants according to the functional period. Method and Materials: The present literature review was based on the OldMedline and Medline databases from 1999 to 2010 using the key words "transitional implants" and "temporary implants." Fourteen articles were found: 11 clinical studies or techniques and three histologic and histomorphometric studies. Results: The transitional immediate prostheses were worn by completely and partially edentulous patients. Advantages of transitional implants include complete denture retention, stability, and support; maintenance of chewing, phonetics, and patient comfort; protection of bone grafts; vertical stop during healing period; easy and fast surgical and prosthetic procedures; lower cost in comparison to the definitive implant; and reestablishment of esthetics. The success of transitional implants as conservative treatment for conventional immediate loading is a reality if correctly indicated. Conclusion: Transitional implants are a provisional treatment alternative for completely and partially edentulous patients. However, additional studies are required to evaluate the level of remodeling and repair of the transitional implants under loading. Keywords: bone remodeling, implants, osseointegration, prostheses

Surgical repositioning is a treatment option for an impacted tooth with root dilaceration in an inverted position. In this case report, surgical repositioning of an abnormally impacted and labially dilacerated maxillary right central incisor is described. The impacted and dilacerated maxillary incisor was surgically repositioned in the early root development period and erupted into proper position with normal root development during a 2-year follow-up period. Keywords: impacted tooth, open apex, repositioning

Objective: To evaluate the effect of a pomegranate-containing mouthrinse on plaque, determine whether it has any adverse effects, and evaluate its antibacterial properties against selected periodontopathogens in vitro. Method and Materials: Thirty periodontally healthy volunteers, randomly divided into three groups, refrained from all mechanical oral hygiene measures for 4 days and used one of the randomly assigned mouthrinses (A, pomegranate; B, chlorhexidine; or C, distilled water [placebo]) twice daily. The Plaque Index (PI) was assessed at days 0 and 5. Adverse effects were also evaluated. Pomegranate extract was tested against Aggregatibacter actinomycetemcomitans (A.a.), Porphyromonas gingivalis (P.g.), and Prevotella intermedia (P.i.). Results: In all groups, the PI significantly increased from the baseline to day 5 (P .1). The pomegranate mouthrinse created no adverse effects. There was a statistically significant difference (P .05) between the chlorhexidine and placebo rinse and the pomegranate and placebo rinse, but no statistically significant difference was found between the chlorhexidine and pomegranate rinse with respect to the PI. Pomegranate extract showed inhibition of all three strains of periodontopathogens at various concentrations. Conclusion: These results indicate that the pomegranate mouthrinse has an antiplaque effect. Pomegranate extract is efficacious against A.a., P.g., and P.i. strains in vitro. Pomegranate mouthrinse should be explored as a long-term antiplaque rinse with prophylactic benefits. Keywords: Aggregatibacter actinomycetemcomitans (A.a.), antiplaque agent, mouthrinse, pomegranate, Porphyromonas gingivalis (P.g.), Prevotella intermedia (P.i.)

Objective: To evaluate the efficiency of NitrAdine (MSI Laboratories) tablets in the reduction of oral Candida levels, biofilm formation, and appliance odor in maxillary removable orthodontic appliance wearers. Method and Materials: Seventy children between 11 and 15 years of age undergoing maxillary removable appliance treatment were assigned via a double-blind randomized method to the experimental or placebo arm of the study. One milliliter of unstimulated saliva was collected at the beginning of the experiment and 6 weeks later after treatment of the maxillary removable appliance with NitrAdine tablets. Samples were cultured on chromogenic Candida agar, and the number of colony-forming units per mL of saliva (CFU mL-1) was determined. Results: There was no significant difference in salivary Candida levels before or after treatment with NitrAdine tablets. There was a significant drop in plaque accumulation on the appliance and a significant amelioration in appliance odor. There was a small, nonsignificant drop in individuals exhibiting counts of 400 CFU mL-1 or more in the experimental group and a nonsignificant increase in the number of new species in the placebo group. Conclusions: NitrAdine tablets are effective in reducing plaque accumulation and appliance odor during maxillary removable appliance treatment. Further in vivo studies are required to determine the efficacy and exact protocol for NitrAdine tablets in appliance disinfection. Keywords: biofilm, Candida, disinfection, maxillary removable appliance, plaque

Objective: Optical magnifying devices such as magnification loupes are increasingly used in clinical practice and educational settings. However, scientific evidence to validate their benefits is limited. This study assessed the effect of dental magnification loupes on psychomotor skill acquisition during a preclinical operative dentistry course. Method and Materials: The performance of first-year dental students was assessed during an Advanced Simulation Course (AS) using virtual reality-based technology (VRBT) training. The test group consisted of 116 dental students using magnification loupes (+MAG), while students not using them (-MAG, n = 116) served as the control. The following parameters were evaluated: number of successfully passing preparation procedures per course rotation, amount of time per tooth preparation, number of times students needed computer assistance and evaluation, and amount of time spent in the computer assistance and evaluation mode per procedure. Data were collected on each student through VRBT during the preparation procedure and stored on a closed network server computer. Unpaired t tests were used to analyze mean differences between the groups. In addition, student acceptance of magnification loupes was measured and evaluated through survey interpretation. Results: +MAG students completed more preparations, worked faster per procedure, and used the computer-assisted evaluation less frequently and for shorter periods, therefore displaying greater overall performance. The survey revealed a high degree of student acceptance of using magnification. Conclusion: Dental magnification loupes significantly enhanced student performance during preclinical dental education and were considered an effective adjunct by the students who used them. Keywords: dental education, dental loupes, dental magnification, dental telescopes, virtual reality-based technology training

Objectives: To assess the prevalence and distribution of bleeding on probing (BoP) in a cohort of periodontally diseased patients, evaluate the influence of patient-related predictors on BoP variability, and characterize two subgroups of patients with a significantly different BoP score. Method and Materials: Six hundred and one patients were retrospectively included. The percentage of BoP-positive sites was calculated for the entire dentition (%BoPtotal) and within different areas of the dentition. The influence of patient-related predictors on intersubject variability in %BoPtotal was evaluated. Two subgroups of patients, belonging to the lowest (LB, low bleeding) and highest (high bleeding, HB) quartile of patient distribution according to %BoPtotal, were identified. Results: Median %BoPtotal was 26.4%, with 99% of the population showing at least one BoP-positive site. %BoPtotal was positively correlated with patient age and number of sites with pocket probing depth (PPD) >= 5 mm, and significantly more prevalent in mandibular vs maxillary sites, posterior vs anterior sites, interproximal vs oral/buccal sites, and sites with PPD >= 5 mm vs PPD = 4 mm. LB and HB patients were significantly different for %BoPtotal, as well as in sites with PPD = 4 mm and PPD >= 5 mm, but not for sex, age, smoking status, daily cigarette consumption, diabetic status, and number of sites with PPD >= 5 mm. Conclusions: BoP was highly prevalent and variable in both patients and different areas of the dentition; patient-related factors and site-specific characteristics (such as age, number of periodontal pockets, probing depth, tooth type, and aspects) seem to be partly responsible for the individual variation in BoP; and HB and LB were not significantly different with respect to the investigated predictors. Keywords: bleeding on probing, gingival inflammation, periodontal disease

Enamel pearls are enamel anomalies on primary and permanent teeth roots that usually appear at furcation areas, especially in maxillary second and third molars. Enamel pearls usually occur singularly, but as many as four have been observed on the same tooth. This report describes an unusual case of multiple enamel pearls associated with periodontal pockets localized on all maxillary first and second molars. Because the patient had an advanced stage of periodontitis, the maxillary right first and left second molars were extracted. The remaining two maxillary molars were included in a strict follow-up protocol. Enamel pearls were confirmed as the cause of localized periodontitis; therefore, it is very important to recognize their radiologic aspect to ensure proper treatment of the involved teeth. Keywords: enamel pearls, localized periodontitis, root enamel

Objective: To assess the prevalence of headaches and painful tempormandibular disorders (TMDs) and examine these via demographic and specific lifestyle parameters, as well as examine the relationship among TMDs, headaches, and depression rates. Method and Materials: A group of 359 medical and dental students completed a detailed questionnaire regarding demographic features and the presence of headaches and facial pain. The survey included a section on lifestyle (nutrition, alcohol and tobacco consumption, physical activity) and a Zung depression assessment. Results: About eleven percent of the subjects reported pain: 8.6% from the jaw joint, 1.7% from the muscles of mastication, and 0.8% had both (ie, painful TMD). Eighty-three percent reported a lifetime prevalence of any headache, most of which were episodic tension-type headaches (56.9%) or migraines (19.2%). There was no significant correlation between headache diagnosis and the presence of painful TMD. Patients with painful TMD had higher depression scores than patients without and smoked more tobacco. This was not observed in headache patients. Patients with headache complained of significantly more dizziness and fatigue, particularly in the migraine and frequent episodic tension-type headache groups. Conclusion: TMD patients should be carefully assessed for the presence of emotional problems and referred to a suitable care provider. Keywords: depression, orofacial pain

Objective: This study evaluated the effect of surface treatments (Nd:YAG laser, CO2 laser, Al203 airborne-particle abrasion, and silica-coating) on the zirconia-to-resin shear bond strength (SBS). Method and Materials: Eighty-one Lava (3M ESPE) blocks (13 × 4 × 2 mm) were embedded in acrylic resin, polished, and randomly divided into three groups, which received the following surface treatments: no abrasion, Al2O3 airborneparticle abrasion (50 µm), or silica-coating (Cojet, 3M ESPE). Each group was divided into three subgroups that were treated with Nd:YAG laser, CO2 laser, or no laser irradiation. Following application of a monomer phosphate-containing primer, cylinders of resin cement (Panavia F, Kuraray) (n = 18) were built on the surface. SBS testing was carried out after 24 hours of storage in water. Surface roughness and topography (SEM) after treatments were evaluated. Results: According to ANOVA and Tukey test (α = 0.05), mean SBS after Nd:YAG laser treatment ranged from 14.09 to 16.20 MPa and was statistically higher than CO2 laser (6.24 to 10.51 MPa) and no laser treatment (4.65 to 8.79 MPa). The Nd:YAG laser created more roughness on zirconia when compared to the CO2 laser and abrasion treatments. Silica-coating increased the SBS of lased and nonlased zirconia. Significant microcracks were found on specimens treated with CO2. Conclusion: Nd:YAG laser pretreatment, whether associated with abrasion methods or not, created consistent roughness on the zirconia surface and significantly increased zirconia SBS to Panavia F. Silica-coating could potentially increase the SBS of lased and nonlased zirconia. Significant microcracks were found on specimens treated with the CO2 laser. Keywords: adhesion, dental restorative material, laser, surface modification, surface treatment, zirconia

Recent research has shown that temporomandibular symptoms may be associated with or occur independently of whiplash-associated disorders related to motor-vehicle collisions. A PubMed/Medline search was conducted using the terms "temporomandibular disorders," "orofacial pain," "temporomandibular joint," "whiplash," and "whiplash-associated disorders and motor-vehicle accidents and motor-vehicle collisions" for the years 1995 to 2009. Systematic reviews, meta-analyses, and clinical studies were included if they addressed temporomandibular disorders, whiplash epidemiology, diagnosis, and prognosis. References in the selected articles were also reviewed (including those prior to 1995) if the articles specifically addressed the topic. An evidence base was established for general outcomes using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. Temporomandibular symptoms may develop following motor-vehicle collisions and be more complex, representing a component of a symptom cluster of potentially regional and widespread pain impacted by psychosocial factors. Oral health care providers must be aware of the relationship between temporomandibular symptoms, whiplash-associated disorders, and trauma and the more complex nature of the symptoms for appropriate diagnosis and management. Keywords: motor-vehicle collisions, temporomandibular symptoms and disorders, whiplash-associated disorders

Objective: The effectiveness of seals obtained after cementation of fiber posts into root canals is still unclear. The aim of this in vitro study was to evaluate the influence of ethanol treatment on the bond between root canal surfaces and fiber posts. Method and Materials: Forty sound extracted teeth were selected for this study. The specimens were endodontically treated, and a post space was prepared. In half of the teeth, the post space was etched and bonded (group 1); in the other half, it was etched, dried with ethanol, and bonded with the same adhesive system (group 2). A fiber post was placed in each root using the same adhesive and restorative protocol. Restored samples were perpendicularly sectioned at the coronal, middle, and apical third and prepared for SEM observation to evaluate the interfaces among root dentin, resin cement, and fiber posts, as well as the characteristics of the resulting hybrid layer. Results: SEM examination of interfaces among root dentin, resin cement, and fiber posts showed differences in adhesive interfaces between the groups. No significant differences (P > .05) were found at the cement-post interface. At the dentin-cement interface, group 1 showed significantly lower scores (P .05) than group 2. In both groups, the cementpost interface showed significantly (P .05) lower gap scores than the dentin-cement interface. Conclusion: Ethanol drying does not seem to be effective in improving the adhesion of fiber posts into root canals. Keywords: adhesive interfaces, ethanol, fiber post, resin cement, resin-dentin interdiffusion zone, scanning electron microscopy

Objective: There is a paucity of clinical evidence regarding the amount and frequency of repositioning of pathologically migrated teeth after conventional periodontal treatment. The present study was carried out to find and relate these two parameters of periodontal success with severity of migration. Method and Materials: A total of 45 subjects with a history of recently formed diastema or noticeable increase in already existing diastema were selected. Twenty-nine patients with 76 diastema sites participated in the study (16 patients were lost to follow-up). Repositioning was assessed by measuring the sites on study models obtained at baseline, reevaluation at 6 weeks after nonsurgical periodontal therapy, and 4 months after surgery. Results: After nonsurgical therapy, 65.78% of sites demonstrated some degree of repositioning, while 7.89% closed completely. Four months after surgical treatment, 32.30% of sites showed complete repositioning and 47.69% of sites showed an additional partial repositioning. This corresponds to a 79.99% rate of positive responses to therapy. When sites measuring = 1 mm were considered, 65.38% showed complete closure and 96.15% demonstrated positive response to therapy. Conclusion: The findings suggest that there is an inverse relationship between the severity of migration and amount (as well as frequency) of repositioning. The results emphasize the importance of early diagnosis in the successful treatment of pathologic migration to prevent more complex and time-consuming orthodontic and prosthodontic procedures. Keywords: complete closure, pathologic tooth migration, periodontal disease, periodontal therapy, repositioning, severity of migration