Quintessence International, 06/2011

Objective: The extraction of an impacted mandibular third molar may result in periodontal complications on the distal surface of the adjacent second molar. The purpose of this study was to compare the influence of three full-thickness flaps on the periodontal healing of the adjacent second molar after extraction of impacted mandibular third molars. Method and Materials: Forty-five volunteers with bilateral impaction of the mandibular third molars were selected. Each patient was randomly assigned to one of three groups: group A (envelope flap modified by Thibauld and Parant), group B (Laskin triangular flap), and group C (envelope flap modified by Laskin). The periodontal health of the second molars was evaluated at 3, 6, 12, and 24 months after surgery via clinical measurements. Results: After 21 days, there was no correlation between postoperative complications (such as edema and alveolitis) and flap design. However, there was a statistically significant reduction of pocket probing depth (PPD) and increase of clinical attachment level (CAL) in group B compared to the other groups (P .05) 24 months after surgery. Conclusion: The effect of the type of flap used for mandibular third molar surgery on the periodontal status of the second molars as well as the factors that influence this outcome remains uncertain. Regardless of the flap design, the periodontal conditions of the adjacent second molar deteriorated after 12 and 24 months. The decision to use a certain type of flap should be based on the surgeon's preference. Keywords: complications, flap design, impacted teeth, pocket probing depth, third molar surgery

General dentists should be aware that extraoral dental cutaneous lesions can be confused with dermatologic lesions. We report two cases of cutaneous lesions of dental origin that were initially misdiagnosed as being dermatologic in origin. Multiple treatments were performed, including plastic surgery, but the lesions did not resolve. Then, the lesions' dental etiology was identified. Endodontic intervention resulted in resolution of the problem, confirming the initial misdiagnosis. A dental etiology, as part of a differential diagnosis, should be kept in mind with orofacial skin lesions. Keywords: cutaneous, dental, etiology, misdiagnosis, odontogenic origin

Complete inversion and impaction of both permanent central incisors is uncommon and rarely reported in the literature. In this report, we describe the treatment of maxillary central incisors that were completely inverted and impacted and positioned high in the vestibule. The esthetic results achieved provide an alternative to extraction or surgical repositioning. Keywords: central incisors, esthetics, impaction, orthodontic traction, permanent dentition

Amelogenesis imperfecta is a hereditary disease that causes structural anomalies in dental enamel of both the primary and permanent dentition. The anomaly may present a variety of clinical forms and appearances, with its main characteristics being the loss of tooth structure, compromised esthetic appearance, and dental sensitivity. The aim of this study was to present the clinical report of a 16-year-old patient with severely compromised esthetics as a result of amelogenesis imperfecta of the hypocalcified type who was rehabilitated with composite resin and ceramic crowns. Keywords: amelogenesis imperfecta, diagnosis, treatment

Objective: Finite element analysis (FEA) has been frequently used to study the loading situation of dental implants and bone resulting from the fixation of nonpassively fitting restorations. The goal of the present investigation was to demonstrate the effect of geometric model parameters and mesh size on FEA results. Method and Materials: Five three-dimensional FEA models representing a three-unit fixed dental prosthesis (FDP) supported by two terminal implants were constructed. The models differed in terms of mesh size, bone geometry, implants, and restoration and were created either by joining virtual free-form objects or utilizing optical scans of existing components. By applying thermal changes in volume of specific elements in the area of the FDP pontic, a horizontal misfit of 10 µm between implants and the restoration was introduced. The resulting loading situation of the bone around the implants was recorded as von Mises equivalent stress. Results: Maximum stress magnitudes ranging from 13.1 to 24.9 MPa occurred in the cortical part of the implant site where the neck of the implant penetrates bone. In trabecular bone, loading magnitudes were lower by a factor of 20. Modeling implant threads did have a remarkable effect on the stress situation as well as different span lengths of the restorations modeled. All other parameters led only to small variations in maximum loading magnitudes. Conclusion: Simplistic FEA models based on virtual free-form objects with limited level of mesh refinement seem to allow for a basic evaluation of peri-implant bone loading resulting from the fixation of misfitting superstructures. Keywords: bone loading, finite element analysis, implant-supported restoration, model geometry, passive fit, von Mises equivalent stress

Cysts lined with gastrointestinal or respiratory epithelium are rarely found in the oral cavity. These lesions usually involve the ventral surface of the tongue or floor of the mouth. This article describes a new case of a lingual cyst lined by respiratory epithelium, discussing its clinical relevance, surgical management, and ideal time for intervention. Keywords: lingual cyst, management, respiratory epithelium

Objective: As the exact etiology of recurrent aphthous stomatitis remains unknown, its treatment has primarily been palliative to relieve the pain, associated inflammation, and duration of the lesions by using antibacterial mouthrinses, analgesics, and immunomodulators. Nevertheless, no treatment has been universally effective in management of recurrent aphthous stomatitis, which necessitates the search for novel therapeutic agents. The aim of this study was to assess the clinical efficacy of the aqueous extract of Rosa damascena, which has reported anti-inflammatory and antinociceptive properties, in the treatment of recurrent aphthous stomatitis. Method and Materials: This was a randomized, double-blind, placebo-controlled investigation. Fifty patients were enrolled in this 2-week study; the clinical efficacy of the mouthwash on pain, size, and number of ulcers in the test group was compared with that of the placebo group on days 4, 7, 11, and 14. Results: There were no statistically significant differences between baseline parameters. However, statistical analysis indicated a significant difference on days 4 and 7 between the placebo and test groups for all parameters. Conclusion: This study showed that mouthwash containing Rosa damascena extract was more effective than the placebo in the treatment of recurrent aphthous stomatitis. Keywords: clinical trial, placebo, recurrent aphthous stomatitis, Rosa damascena

Gingival enlargement is defined as an overgrowth or increase in size of the gingiva. Enlargement can be of many types depending on etiologic factors like inflammation, drug-induced effects, neoplasm, hormonal imbalance, and systemic involvement (leukemia, etc). Drugs and hormonal imbalance are the most common causes of gingival enlargement. Nonspecific conditioned enlargement, or pyogenic granuloma, is considered an exaggerated conditioned response to minor trauma or chronic irritation. Pyogenic granuloma occurring in the oral cavity is a common phenomenon. However, simultaneously occurring generalized pyogenic granuloma in the oral cavity is a rare entity. Generalized pyogenic granuloma on the back and skin have been reported. This is the first case report of generalized pyogenic granuloma in the oral cavity. A 19-year-old male patient reported with a complaint of difficulty in mastication and generalized swelling of the gingiva that developed within a span of 15 days. Family and systemic history were noncontributory. Based on the clinical findings, histopathology report, and immunohistochemistry result, the patient was diagnosed with generalized pyogenic granuloma. Scaling and root planing were performed as the first phase of therapy followed by external bevel gingivectomy. The patient was followed for 3 months. The patient was advised to visit the clinic for regular maintenance visits for 1 year, as pyogenic granuloma has a tendency to recur. Keywords: external bevel gingivectomy, generalized pyogenic granuloma, gingival enlargement, pyogenic granuloma, scaling and root planing

Objective: To evaluate the remineralizing effects of aqueous phosphate-buffered solutions using various saturations with respect to octacalcium phosphate or brushite (OCP/DCPD) on bovine enamel subsurface lesions. Method and Materials: Demineralized specimens (n = 18 per group) were exposed to one of six phosphate-buffered solutions with theoretical OCP saturations of S0.83, S1.17, S1.43, S1.64, S1.83, or S1.99 (pH, 6.3; calcium concentration, 0.53 to 3.18 mM). One aqueous solution without calcium was used as a negative control (S0; pH, 6.3); one without calcium and phosphate was a reference (S; pH, 4.3). HEPES-buffered Buskes solution served as a reference (B2.46; pH, 7.0); a pH-adjusted one was a positive control (B1.21; pH, 6.3). Mineral losses (whole lesion and surface area/inner part of the lesion) before and after storage (2 and 5 weeks, 37°C) were evaluated from microradiographs. Results: The pH values of all solutions remained stable. Compared to baseline, S0.83 to S1.99 and B2.46 to B1.21 showed significantly increased mineral gains after both storage periods (P .05, paired t test). S0 showed neutral effects (P = .190), whereas S demineralized the specimens (P .001). Storage in S1.64, S1.83, and S1.99 revealed no differences compared to B2.46 (P > .997, ANOVA and Tukey), but a mineral gain of S1.64 to S1.99 was significantly increased compared to B1.21 (P .012). Similar results could be observed for surface areas and inner lesion parts. Conclusion: The in vitro conditions chosen revealed that the used phosphate buffer system was suitable to maintain stable pH values. The higher saturated (OCP) solutions S1.64, S1.83, and S1.99 revealed mineral gains comparable to B2.46; thus, saturations of 1.64 (OCP) or 1 (DCPD) might be preferable for remineralization studies. Keywords: calcium phosphates, enamel subsurface lesion, HEPES, microradiography, phosphate buffer, remineralization, saturation

Objective: To assess the association between secondary trauma from occlusion and the severity of periodontitis. Method and Materials: A total of 288 subjects with chronic periodontitis of varying severity and 93 healthy subjects were included in the study. Premature and balance contacts were identified by manual palpation and visualization of occlusal contacts during clenching in habitual intercuspation and lateral or protrusive movements of the mandible. Statistical analysis was performed with Kruskal-Wallis, Mann-Whitney, and Spearman correlation tests. Results: Statistically significant differences (P .001) were found for all variables tested (ie, the total amount of trauma per patient and the number of premature and balance contacts increased significantly with the level of clinical attachment loss). The Spearman test showed a statistically significant correlation between the total amount of trauma per patient and the severity of periodontitis (P .001). Conclusion: The results of this study indicate that secondary trauma from occlusion (ie, premature and balance contacts) is frequently seen in periodontally compromised patients and is positively correlated with the severity of attachment loss. Keywords: occlusion, periodontitis, prevalence, trauma from occlusion

Folliculosebaceous cystic hamartoma is a rare cutaneous hamartoma consisting of dilated folliculosebaceous structures interspersed within mesenchymal elements. These lesions may present as 0.5- to 3.0-cm papules or exophytic nodules and are usually solitary, symmetric, asymptomatic, dome-shaped, or even umbilicated. The usual location is the midface and scalp of adults. We present a unique case of a mucocutaneous folliculosebaceous cystic hamartoma involving the upper lip and oral mucosa. General practitioners and oral health care providers should be sentient of this lesion and consider it in their differential diagnoses. Keywords: cystic, folliculosebaceous, hamartoma