Quintessence International, 05/2011

This report describes the prosthodontic rehabilitation of a partially edentulous patient by means of a maxillary implant-supported removable dental prosthesis and mandibular telescopic crown prosthesis. Due to the patient's contributory medical history for epilepsy and deep vein thrombosis, clinical management considerations are outlined along with an evidence-based, medically oriented treatment sequence concerning the surgical and prosthodontic stages of the case. Keywords: antiepileptics, implant-supported removable dental prosthesis, medical history, oral anticoagulants, oral implant, telescopic crown prosthesis

Objectives: Hydroxyapatite, tricalcium phosphate, and bioactive glass are the most commonly studied alloplastic materials in periodontal regeneration. These materials have been tested alone and in combination with one another, but evaluation using all three materials in one defect has not yet been attempted. Although posttreatment histologic evaluation or reentry procedures are ideal for objectively assessing regeneration, computed tomography (CT) has become one more technique in clinicians' armories to judge the effectiveness of any such interventions. Hence, the present study was undertaken to clinically ascertain the healing of intrabony defects following treatment with a composite alloplast and complement the study with volumetric assessment using CT. Method and Materials: Twenty defects in 10 patients were treated either with open flap debridement or open flap debridement and bone graft implantation in a split-mouth study design. Clinical parameters including probing depth, clinical attachment level (CAL), and gingival margin level were recorded at baseline and at 6 months postsurgery. Plaque Index and Gingival Index were measured at baseline, 3 months, and 6 months. Hard tissue measurements were recorded using a high-resolution spiral CT scan. Results: A statistically significant (P .05) improvement in all parameters (namely probing depth, CAL, percentage defect fill, and linear bone growth) was observed in both groups of patients. However, the test group showed better clinical and radiographic outcomes when compared to the control group (P .05). Conclusion: The new composite alloplast resulted in better treatment outcomes than open flap debridement alone. Moreover, the use of CT scan in ascertaining the various defect parameters in periodontal treatment of intrabony defects appears promising. Keywords: aggressive periodontitis, composite alloplast, intrabony defect, periodontal regeneration, spiral CT, volumetric analysis

Amelogenesis imperfecta is a genetic disorder that causes defective enamel development in both the primary and permanent dentitions. Significant tooth structure damage often results in various pulpal symptoms, occlusal disharmony, impaired function, and esthetic disfigurement. These problems pose great challenges to the clinician when rehabilitating patients with amelogenesis imperfecta. This case report describes an uncomplicated and logical way to reorganize, temporize, and completely restore an extensively damaged dentition caused by amelogenesis imperfecta. Keywords: amelogenesis imperfecta, dental anomalies, esthetics, full-mouth rehabilitation, tooth wear

It is reported that peri-implantitis does not heal favorably following nonsurgical therapy. In this case study, three consecutive peri-implantitis patients with concomitant history of periodontitis were treated with nonsurgical therapy and reassessed up to 12 months following treatment. All treated peri-implantitis sites showed a considerable reduction in probing pocket depth, attachment loss, and bleeding on probing. This was also associated with bone fill of the vertical bony defects around the previously exposed implant threads. This case report shows that a degree of clinical resolution and radiographic bone fill can occur without the use of adjunctive antibiotics in peri-implantitis lesions of patients with periodontitis. Keywords: nonsurgical treatment, peri-implantitis, periodontitis, radiographic bone fill

Objectives: Dental procedures with high-speed instruments produce large amounts of aerosols. The present study aimed to clarify whether blood-contaminated aerosols were existent and floating in air during dental procedures and to evaluate the effect of an extraoral evacuator system. Method and Materials: An extraoral evacuator system with a test filter was used for sample collection at distances from 50 cm (n = 102) and 100 cm (n =124) behind the patient. A leucomalachite green presumptive test was performed on the test filter. One or more positive reactions on the test filter was considered a positive result, and the positive ratio in each procedure was compared. To assess the effect of the extraoral evacuator, an additional extraoral evacuator was introduced, and the positive ratio during third molar extractions at 100 cm behind the patient was compared (n = 55). Results: At 50 cm from the mouth of the patient during third molar surgery, full-crown preparation, inlay cavity (Black Class II) preparation, and scaling with an ultrasonic scaler, positive results were obtained in 92% (12/13), 70% (21/30), 35% (9/26), and 33% (11/33) of cases, respectively. At a distance of 100 cm, positive ratios sustained 90% (35/39), 48% (15/31), 29% (6/21), and 12% (4/33), respectively. When the second extraoral evacuator was utilized, the positive ratio, at a distance of 100 cm, decreased significantly from 90% (35/39) to 60% (33/55) (P = .0015, chi-square test). Conclusion: This study showed that blood-contaminated aerosols can be suspended in air, even in general dental settings, and that extraoral evacuators are useful for reducing contaminated aerosols. Keywords: aerosol, blood, infection control, leucomalachite green, occupational infection, splatter

Objectives: To evaluate the morphologic, mechanical, and chemical effects of carbamide peroxide bleaching agents on human enamel in situ. Method and Materials: Enamel slabs from extracted human teeth were divided in two and mounted on contralateral sides of removable maxillary appliances fabricated for three participants. Soft vinyl trays were adapted intraorally over the arch; one side contained a bleaching agent, and the other served as a control. Vital bleaching was conducted in vivo three times with three different bleaching agents and with new enamel specimens each time. Tests of Knoop microhardness, scanning electronic microscopy (SEM), and energy dispersive x-ray (EDX) were performed and analyzed by ANOVA. Results: No statistically significant differences were found between matched test and control specimens concerning microhardness values, morphology, or elemental content. Conclusions: Enamel surface showed no mechanical, morphologic, or chemical changes following bleaching in situ with three different carbamide peroxide agents. Keywords: EDX, microhardness, vital bleaching

Objectives: To evaluate the clinical long-term success of prefabricated precision attachments in retaining uni- or bilateral removable dental prostheses. Method and Materials: Twenty-three patients with uni- or bilateral shortened dental arches received removable dental prostheses attached to the residual dentition with two types of precision attachments. Results: After 5 years, 70% of bilateral and 25% of unilateral removable dental prostheses remained clinically functional. The most frequent cause of clinical failure was fracture of the abutment teeth for bilateral partial dentures and irreversible wear of the precision attachment for unilateral prostheses. Oral hygiene status significantly improved, and the mean pocket depth of the abutment teeth did not increase after 5 years. Conclusion: Removable partial denture prostheses, retained bilaterally with precision attachments, are a reliable treatment modality without negative long-term effects on periodontal health, whereas unilateral removable dental prostheses cannot be recommended because of high clinical failure rates. Keywords: distal free end, precision attachment, removable dental prosthesis, unilateral

Petrositis is a rare and severe complication of acute otitis media and mastoiditis. Although the extension of the inflammatory process from the petrous apex to the adjacent Meckel cave can lead to trigeminal pain, an irritation of the trigeminal nerve roots resulting in acute or chronic hyperactivity of masticatory muscles has never been reported. We report here the unusual case of an 86-year-old man who presented with a handicapping myofascial pain and dysfunction syndrome of the right temporal muscle as a heralding manifestation of an unusual form of petrositis. The patient progressively developed a retropharyngeal abscess, a right sphenoid sinusitis, and fatal meningitis. This case demonstrated that (1) myofascial pain and dysfunction syndrome that does not respond to conventional treatments may suggest an unusual etiology and warrant further medical investigations and a detailed medical history and that (2) petrositis can manifest itself with atypical clinical symptoms and radiologic signs. Keywords: myofascial pain and dysfunction syndrome, nasopharyngeal abscess, petrositis, sphenoid sinusitis

Enamel white spot lesions in anterior teeth that compromise esthetics are common. Microabrasion is indicated, since it affects enamel superficially. An acid-abrasive slurry with 37% phosphoric acid with pumice was used on the enamel for a controlled time period. Home bleaching with hydrogen peroxide was then used, further improving the final result. The method is safe, easy, and conservative and provides good esthetic results. Keywords: bleaching, enamel conservative procedure, microabrasion, white spot lesions

Objective: Temporomandibular joint (TMJ) disorders have been investigated for years due to their probable association with the neuromasticatory apparatus and the myoskeletal framework of the head and neck. In this study, we explored hard tissue structural changes within the TMJ (condyle, glenoid fossa, articular eminence, and joint space) using complex motion tomography. A correlation between these morphologic changes and clinical symptoms of disc-related TMJ disorders was attempted. Method and Materials: Submentovertex and complex motion tomograms were taken on 114 TMJs from 57 patients who were referred for preorthodontic TMJ imaging. The TMJs were categorized into joints that were symtomatic (S) and asymptomatic (AS). The tomograms were evaluated independently by a board-certified oral and maxillofacial radiologist, and the data were recorded. Results: In the majority of the patients with or without joint symptoms, the glenoid fossa, anterior slope, and posterior slope of the articular eminence were morphologically normal in appearance. The condylar position of the joints without symptoms was more posterior compared to those with symptoms within the glenoid fossa. Condylar heads were abnormal in the majority of the patients, both in coronal view and sagittal view, regardless of their symptomatology. Both groups of joints exhibited abnormal joint space and range of motion. The Fisher exact test was used to determine the significance of the difference between the morphology of symptomatic and asymptomatic joints. Of the results obtained, only the condylar head in coronal view (P = .0001) and joint space (P = .0007) demonstrated any statistical significance in terms of deviation from the norm between the two groups. Conclusion: Examination of hard tissue structures alone is insufficient to support the joint association in the presence of TMJ-related clinical symptoms. Simultaneous MR imaging may significantly increase the predictability of any clinical correlation. Keywords: complex motion tomography, condylar morphology, coronal images, sagittal images, temporomandibular joint

Cowden syndrome, also known as multiple hamartoma syndrome, is a rare autosomal dominant disorder characterized by multiple hamartomas and a high risk of development of malignancy. Oral findings, such as papillomatous lesions and fibromas, are common features; however, a periodontal phenotype has not been reported previously. Therefore, this report presents a case of gingival overgrowth associated with Cowden syndrome, its successful surgical management, and the 12-month follow-up results. Additionally, we discuss the implications for clinicians. A 23-year-old woman was referred to the Department of Periodontics, Piracicaba Dental School, presenting with generalized gingival overgrowth. A detailed dental and medical history and clinical examination confirmed the systemic diagnosis of Cowden syndrome. Histology, radiographs, and clinical data document the entire clinical approach and follow-up. Clinically, there were minor signs of recurrence of gingival overgrowth in a 12-month period after gingivectomy; however, papular lesions reappeared in keratinized gingiva immediately after healing. No signs of bone loss related to the systemic condition were observed radiographically. Histologically, a dense connective tissue with a moderate chronic inflammatory infiltrate and epithelial acanthosis, which is characteristic of gingival hyperplasia, were demonstrated. Gingival overgrowth may occur as an oral phenotype related to Cowden syndrome and can be successfully treated by means of external bevel gingivectomy, followed by regular maintenance therapy, contributing to the patient's well-being, both functionally and esthetically. Keywords: Cowden syndrome, gingival hyperplasia, gingival overgrowth, gingivectomy, multiple hamartoma syndrome, oral manifestations

Objective: To study the sealing ability of a self-adhesive sealant. Method and Materials: Thirty-five extracted molars were assigned to seven groups: group 1, 35% phosphoric acid (PA) followed by Clinpro Sealant (CL) as the control group; group 2, Enamel Loc (EL), a self-adhesive sealant; group 3, PA followed by EL; group 4, Adper Prompt L-Pop (AP) followed by CL; group 5, AP followed by EL; group 6, PA followed by Adper Single Bond Plus (SB) and CL; and group 7, PA followed by SB and EL. Specimens were thermocycled and immersed in 50 wt% ammoniac silver nitrate. Silver leakage was measured in ranks from 0 to 4 and analyzed with Kruskal-Wallis and Mann-Whitney tests at P .05. One additional tooth per group was used to study the enamel etching pattern. Specimens were observed under a field-emission SEM. Results: The least silver infiltration was measured for group 1 (control group), which was significantly different from all other six groups. Etching enamel prior to the application of EL resulted in significantly less leakage than all other groups, except for the control group. EL alone resulted in similar leakage to EL with either AP or SB. None of the groups resulted in perfectly sealed interfaces. Under SEM, EL was unable to etch enamel. The self-etch adhesive AP resulted in a less defined etching pattern than the etch-and-rinse adhesive SB. Conclusion: Etching enamel with phosphoric acid is still essential for sealing the enamel-sealant interface. The self-adhesive sealant tested in this study may not be indicated for clinical use. Keywords: dental bonding, dental leakage, electron microscopy, enamel etching, pit and fissure sealant