Quintessence International, 03/2011

The unusual treatment of a microstomia patient who was edentulous in the mandible is described. Impressions and registrations were taken with the help of sectional trays, and the treatment of choice for the final prosthesis was a two-piece, four-implant (BioHorizons)- supported bar overdenture with a connecting middle segment. Keywords: implant-supported overdenture, microstomia, sectional denture, sectional impression

A multidisciplinary treatment of a case of subgingival fracture in a maxillary anterior tooth is presented. This case report describes a simple method involving an interocclusal appliance and an elastic band for rapid orthodontic extrusion to reestablish biologic width. In addition, a simple technique for surgical recontouring following the coronal displacement of the gingival margin prior to restoration of fractured tooth is explained. Keywords: biologic width, forced eruption, orthodontic extrusion

Composite resins can be used to improve the esthetics of the smile at a low cost and with relatively high clinical performance. The aim of this article was to describe an approach to restore and enhance the esthetic appearance of the anterior dentition through vital tooth whitening and the direct layering of composite resin during predictable esthetic procedures. Keywords: composite restoration, dental esthetics, layering technique

Objective: To investigate the persistence of staining after the use of chlorhexidine gluconate mouthrinse. Method and Materials: Twenty-four subjects (nine women and 15 men) who underwent periodontal therapy and were prescribed the use of 0.2% chlorhexidine gluconate mouthrinse participated in this study. Color values of maxillary central incisors, canines, and first molars were recorded at baseline; 3 days; and 1, 2, and 3 weeks of twice-daily chlorhexidine gluconate use with a digital intraoral colorimeter according to the CIE L*a*b* coordinates. Results: While color-change (ΔE) values showed significant differences (P = .020) at different time points (10.1, 8.9, 8.9, 9.4, after 3 days and 1, 2, and 3 weeks, respectively), the duration of chlorhexidine gluconate use did not significantly affect the results (P = .873) (two-way ANOVA, Tukey test). No significant difference was found among ΔL* (P = .070), Δa* (P = .169), and Δb* (P = .691) values at any time point (one-way ANOVA). Measurements of baseline to day 3 differences showed significantly higher ΔE values than those at other time points (P .05), but this change remained nonsignificant after 1, 2, and 3 weeks of chlorhexidine gluconate use (P > .05) (Tukey test). The highest visible staining occurred on the first molars at all time points (83%, 79%, 79%, and 96% after 3 days and 1, 2, and 3 weeks, respectively) compared to the other teeth evaluated. Conclusion: The staining effect of chlorhexidine gluconate mouthrinse on natural dentition should be expected to be the highest in the first few days of use. Keywords: chlorhexidine, color, dental staining

Objective: To assess the distribution pattern of Langerhans cells in oral lichen planus using adenosine triphosphatase (ATPase) histochemistry and to correlate this with the duration of symptoms. Method and Materials: Included were fresh unfixed tissues from previously untreated cases that were clinically and histologically diagnosed as oral lichen planus (n = 18). Healthy oral mucosal tissues were used as controls (n = 5). ATPase activity in the Langerhans cells from the tissue samples was assessed by enzyme histochemistry. Results: The difference in the distribution pattern of Langerhans cells in the superficial and basal half of the epithelium in both the lesional and control tissue was significant (P .001, Mann-Whitney U test). With an increase in duration of symptoms, the median migration of cells from superficial position to the basal half was significant (P = .001, Kruskal-Wallis test). A negative correlation (Pearson correlation coefficient) was seen between duration of symptoms and migration of cells. Conclusion: The initial increase in the number of Langerhans cells in the lesional tissues compared to controls suggests that these cells are critically required for both the initiation and progression of the mucosal immune response in oral lichen planus. Variation in their number and distribution bear clinical importance as objective assessment of long-standing lesions could be made with reference to treatment planning. Keywords: ATPase, enzyme histochemistry, immunopathogenesis, Langerhans cells, oral lichen planus, special stains

Ectodermal dysplasia is a hereditary disorder of ectodermal origin. A 12-year-old boy was referred for management of the oral manifestations of his ectodermal dysplasia. An overdenture retained by natural teeth for the maxilla and a double-crown-retained denture for the mandible were made. Double-crown-retained dentures may be modified into complete dentures if the abutment teeth are lost. The patient was instructed to maintain oral hygiene and return periodically for follow-up visits. This report describes a potential routine approach to restoring the appearance, function, and psyche of a growing boy with ectodermal dysplasia. Keywords: ectodermal dysplasia, double-crown-retained denture, growing patient, overdenture, prosthetic treatment

The aim of this case report was to present a treatment strategy for severely injured teeth in children and adolescents by using periodontal surgery and adhesive techniques. A 16-year-old boy presented after a severe bicycle accident. A radiograph revealed a root fracture with connective tissue healing and displacement. Clinically, a crown-root fracture as well as an uncomplicated crown fracture of the same fragment was obvious. The root canal was prepared and filled with gutta-percha to the fracture line. A full periodontal flap was performed, and the crown-root fragment was adhesively fixed. The flap was tightly apposed, and the missing mesial edge of the tooth was restored with composite resin. A control radiograph showed a neatly fixed coronal fragment and sufficient root canal filling. The amount of work required proved to be acceptable for both patient and clinician-even if an implantation might have to be considered when the patient is full-grown-because of the longevity of the procedure. Keywords: crown-root fracture, periodontal flap, reattachment, root fracture

Objective: To evaluate the acceptance rate of the 2007 American Heart Association (AHA) prophylactic protocol by the patients for whom the need for prophylaxis for infective endocarditis was downgraded. Method and Materials: A survey among patients was conducted. Patients were included if they had to receive antibiotic prophylaxis prior to dental treatment according to the 1997 AHA protocol and did not require antibiotic prophylaxis prior to dental treatment according to the 2007 AHA guidelines. The perception of the patients and their physicians to the change was analyzed. Possible contributing parameters were assessed. Results: The slight decrease in the rate of acceptance with an increase in time since the AHA publication demonstrated by the logistic regression (odds ratio, 0.93; 95% CI, 0.79 to 1.10) was not statistically significant (P = .41). Parameters related to lower patient acceptance rates were invasiveness of dental treatment and the type of dental setting (P = .046 and .001, respectively). Parameters that were found not to affect the patient acceptance rate were the severity of cardiac condition and a durable history of dental treatments in the same institute (P = .06 and .26, respectively). Conclusions: Sixteen months after publication of the 2007 AHA guidelines, the acceptance rate of the protocol is moderate to high. Reasons for this partial acceptance are discussed. Keywords: acceptance, American Heart Association, endocarditis, prophylaxis

Oral melanoacanthoma is an uncommon reactive condition that appears as a solitary pigmented lesion and is most often found on the buccal mucosa. For it to appear in the gingiva is extremely rare-only 11 cases are reported in the literature. This article presents a case of gingival melanoacanthoma and reviews the previously published cases. Because gingival melanoacanthoma shares clinical features with other pigmented lesions with diverse genesis, the differential diagnosis of a solitary pigmented lesion on the gingiva is also discussed. Keywords: amalgam tattoo, gingiva, melanoacanthoma, melanoma, pigmented lesion, smoking- or drug-induced pigmentation

Objective: To investigate the prevalence of persistent pain of neuropathic origin after nonsurgical root canal treatment and to determine its characteristics, location, and severity utilizing a self-reported validated postal survey. Method and Materials: A modified version of the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) survey was mailed to 2,338 adult subjects who received a single-tooth nonsurgical root canal treatment at the University of Illinois at Chicago College of Dentistry Postgraduate Endodontics Clinic over a 4-year period. Two-hundred and fifty (10.7%) completed surveys were returned. Descriptive analysis, Pearson correlation to determine correlations between the S-LANSS scores and variables of interest, and t tests for group comparisons of the S-LANSS score were performed. Statistical significance was determined at P .05. Results: The prevalence of persistent pain of neuropathic origin among respondents after receiving single-tooth nonsurgical root canal treatment was 7% with the average pain reported as 7.2 on a visual analogue scale (where 0 is no pain and 10 is pain as severe as it could be). Neuropathic pain was more common in middle-aged (mean 50.6 years of age) individuals with no sex predilection and occurred more frequently in the mandibular arch without any differences attributable to the number of canals treated. Also, the majority of subjects most frequently endorsed their pain experiences as abnormal sensitivity to touch and pain when the area is pressed or rubbed. Conclusion: Dental providers need to recognize and understand the differences between nociceptive and neuropathic pain. Understanding these concepts will assist in preventing inappropriate, irreversible, and unnecessary interventions. Keywords: neuropathic pain, nonsurgical root canal treatment, Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS)

Objective: To evaluate whether the type of cola drink (regular or diet) could influence the wear of enamel subjected to erosion followed by brushing abrasion. Method and Materials: Ten volunteers wore intraoral devices that each had eight bovine enamel blocks divided into four groups: ER, erosion with regular cola; EAR, erosion with regular cola plus abrasion; EL, erosion with light cola; and EAL, erosion with light cola plus abrasion. Each day for 1 week, half of each device was immersed in regular cola for 5 minutes. Then, two blocks were brushed using a fluoridated toothpaste and electric toothbrush for 30 seconds four times daily. Immediately after, the other half of the device was subjected to the same procedure using a light cola. The pH, calcium, phosphorus, and fluoride concentrations of the colas were analyzed using standard procedures. Enamel alterations were measured by profilometry. Data were tested using two-way ANOVA and Bonferroni test (P .05). Results: Regarding chemical characteristics, light cola presented pH 3.0, 13.7 mg Ca/L, 15.5 mg P/L, and 0.31 mg F/L, while regular cola had pH 2.6, 32.1 mg Ca/L, 18.1 mg P/L, and 0.26 mg F/L. The light cola promoted less enamel loss (EL, 0.36 µm; EAL, 0.39 µm) than its regular counterpart (ER, 0.72 µm; EAR, 0.95 µm) for both conditions. There was not a significant difference (P > .05) between erosion and erosion plus abrasion for light cola. However, for regular cola, erosion plus abrasion resulted in higher enamel loss than erosion alone. Conclusion: The data suggest that light cola promoted less enamel wear even when erosion was followed by brushing abrasion. Keywords: abrasion, enamel, erosion, in situ, soft drinks

Objective: To evaluate the effect of composite preheating and light-curing duration on hardness and postgel shrinkage. Method and Materials: A hybrid composite (Filtek Z250, 3M ESPE) and a nanofilled composite (Filtek Supreme Plus, 3M ESPE) were preheated in a Calset (AdDent) heating device at its highest setting (68°C) before being light cured for 5, 10, 20, or 40 seconds. Vickers hardness of the top (0 mm) and bottom (2 mm) surface of the samples was measured 5 minutes after polymerization. The development of postgel shrinkage during polymerization was measured with a strain gauge. The results were compared to those of samples cured at room temperature. The sample size was five for each composite/temperature/light-curing duration combination. The results were statistically analyzed with two-way ANOVA and least squares means. Results: Preheating composites before light curing did not affect the bottom hardness or postgel shrinkage (P > .05) but significantly increased the top hardness of the Supreme Plus composite at all light-curing durations (P .05). Shorter light-curing durations than recommended by the manufacturer significantly reduced top and bottom hardness of both composites, regardless of preheating (P .05). Conclusion: Under the experimental conditions in this study, preheating of the composites only slightly increased hardness values and did not negatively affect postgel shrinkage. Reducing the light-curing durations, however, significantly reduced the hardness at both the top (0 mm) and bottom (2 mm) surfaces. Clinicians should ensure sufficient light-curing duration to obtain good mechanical properties rather than depending on composite preheating. Keywords: Calset, composite, hardness, light-curing duration, preheating, shrinkage