Quintessence International, 01/2013

Adhesive restorations have increasingly been used in dentistry, and the adhesive system application technique may determine the success of the restorative procedure. The aim of this study was to evaluate the influence of the application technique of two adhesive systems (Clearfil SE Bond and Adper Scotchbond MultiPurpose) on the bond strength and adhesive layer of composite resin restorations. Eight human third molars were selected and prepared with Class I occlusal cavities. The teeth were restored with composite using various application techniques for both adhesives, according to the following groups (n = 10): group 1 (control), systems were applied and adhesive was immediately light activated for 20 seconds without removing excesses; group 2, excess adhesive was removed with a gentle jet of air for 5 seconds; group 3, excess was removed with a dry microbrushtype device; and group 4, a gentle jet of air was applied after the microbrush and then light activation was performed. After this, the teeth were submitted to microtensile testing. For the two systems tested, no statistical differences were observed between groups 1 and 2. Groups 3 and 4 presented higher bond strength values compared with the other studied groups, allowing the conclusion that excess adhesive removal with a dry microbrush could improve bond strength in composite restorations. Predominance of adhesive fracture and thicker adhesive layer were observed via scanning electron microscopy (SEM) in groups 1 and 2. For groups 3 and 4, a mixed failure pattern and thinner adhesive layer were verified. Clinicians should be aware that excess adhesive may negatively affect bond strength, whereas a thin, uniform adhesive layer appears to be favorable. Keywords: adhesive system, bond strength, composite resin

Objective: To clinically evaluate the treatment of Miller Class I and II multiple adjacent gingival recessions using the modified coronally advanced tunnel technique combined with a newly developed bioresorbable collagen matrix of porcine origin. Method and Materials: Eight healthy patients exhibiting at least three multiple Miller Class I and II multiple adjacent gingival recessions (a total of 42 recessions) were consecutively treated by means of the modified coronally advanced tunnel technique and collagen matrix. The following clinical parameters were assessed at baseline and 12 months postoperatively: full mouth plaque score (FMPS), full mouth bleeding score (FMBS), probing depth (PD), recession depth (RD), recession width (RW), keratinized tissue thickness (KTT), and keratinized tissue width (KTW). The primary outcome variable was complete root coverage. Results: Neither allergic reactions nor soft tissue irritations or matrix exfoliations occurred. Postoperative pain and discomfort were reported to be low, and patient acceptance was generally high. At 12 months, complete root coverage was obtained in 2 out of the 8 patients and 30 of the 42 recessions (71%). Conclusion: Within their limits, the present results indicate that treatment of Miller Class I and II multiple adjacent gingival recessions by means of the modified coronally advanced tunnel technique and collagen matrix may result in statistically and clinically significant complete root coverage. Further studies are warranted to evaluate the performance of collagen matrix compared with connective tissue grafts and other soft tissue grafts. Keywords: collagen matrix, modified coronally advanced tunnel, multiple adjacent gingival recessions, root coverage

A new technique to cover recessions to take advantage of connective tissue grafts and coronally advanced flaps is proposed. A 34-year-old woman presented with a 2-mm Class I recession on the buccal aspect of her maxillary right canine. A full-thickness flap was placed coronally to cover the exposed root, and a partial thickness flap was positioned apically. Complete root coverage was obtained, and the width of keratinized tissue had increased from 2 to 4 mm at the 6-month postoperative visit. These clinical outcomes were maintained for 3 years. This single surgical approach benefits from obtaining not only complete root coverage but also increasing width of keratinized tissue, without requiring a second surgical site. Keywords: connective tissue graft, coronally advanced flap, Miller Class I recession

Dentistry has not been exempt from changes in this era of technology-driven revolution. Entire workflows are already digitalized, and restorations are designed and manufactured using computer-aided solutions. This case report describes the reconstruction of 24 teeth using digital techniques. Keywords: CAD/CAM, case report, ceramic, crown, digital, imaging, polyurethane, scanning, veneer

The edentulous maxilla is often affected by bone resorption, sometimes making it difficult to place standard diameter implants. Narrow diameter implants made of titanium-zirconium (Ti-Zr) alloy, which has superior mechanical properties compared with titanium, have been proposed for these difficult situations. This retrospective clinical observation reports the outcome of the use of reduced diameter implants made of Ti-Zr alloy supporting maxillary overdentures retained with locator abutments. The charts of all patients who received maxillary overdentures supported by four unsplinted implants from January 2009 to June 2010 at the Department of Periodontology and Prosthodontics, Eastman Dental Hospital, Rome, Italy, were reviewed. All patients treated with four narrow diameter Ti-Zr implants were selected for the present case series. Ten patients were found, six of whom received augmentation procedures. After 12 to 16 months of follow-up, no implants were lost, and only one implant showed bone resorption greater than 1.5 mm. Implants showed a success rate of 97.5% and a survival rate of 100%. All prostheses were successfully in function. The present case series showed promising results regarding the use of narrow diameter implants made of Ti-Zr supporting maxillary overdentures retained with locator abutments. Keywords: edentulous maxilla, narrow implants, overdenture, titanium-zirconium

Objective: To evaluate and compare marginal bone loss around mini-implants supporting maxillary overdentures with either partial or full palatal coverage. Method and Materials: Nineteen edentulous patients complaining of retention problems involving their maxillary dentures were randomly allocated in two groups. Group I (n = 10) received maxillary dentures with full palatal coverage, and group II (n = 9) received maxillary dentures with partial palatal coverage. In total, 114 mini-implants (6 per patient) were inserted using the nonsubmerged flapless surgical approach and loaded immediately with maxillary overdentures. Each implant was evaluated at the time of initial prosthetic loading and at 6, 12, and 24 months thereafter. Radiographic evaluation was performed in terms of vertical and horizontal bone loss. Implant mobility (via Periotest values) was measured using a Periotest device, and patient satisfaction was evaluated with a visual analog scale. The cumulative survival rate was calculated using Kaplan-Meier analysis. Results: After 2 years, the mean vertical bone loss in groups I and II was 5.38 and 6.29 mm, respectively, while the mean horizontal bone loss in groups I and II was 1.52 and 1.93 mm, respectively. Most bone resorption occurred within 6 months after overdenture insertion in both groups. Group II recorded significant higher vertical bone loss and Periotest values than group I at all observation times. The cumulative survival rates of the mini-implants were 78.4% and 53.8% for groups I and II, respectively. All patients were satisfied with their maxillary overdentures in terms of retention and chewing ability. Conclusion: Rehabilitation of edentulous maxillae with unsplinted mini-implants supporting overdentures and in particular with a combination of partial palatal coverage is not recommended because of excessive marginal bone resorption and the higher failure rate of mini-implants than was expected. Keywords: bone loss, immediate load, maxillary, mini-implants, overdenture

Objective: To evaluate the effect of patient- and tooth-related factors on the outcome of apical surgery in a multicenter study. Method and Materials: A total of 281 teeth in 255 patients undergoing periradicular surgery were investigated clinically and radiographically 6 to 12 months postoperatively. Results: The overall success rate was 88.0%. Sex was a significant (P = .024) predictor, with a success rate of 89.8% in females and 84.0% in males. The success rate was significantly higher in patients 31 to 40 years of age. The treatment of premolars resulted in a significantly higher success rate (91.9%) than the treatment of anterior teeth (86.1%, P = .042) and molars (86.4 %, P = .026). The loss of the buccal bone plate and the extension of apical osteolysis to the furcation area in molars resulted in a considerably lower success rate. Lesion size, preoperative pain, tenderness to percussion, fistula, and resurgery were significant factors. Conclusion: There are several factors influencing the success rate of apical surgery that must be taken into account when considering apical surgery as a treatment alternative. Keywords: clinical study, endodontic surgery, predictors, success rate

Objective: Heart failure affects large population groups. The understanding of the etiology, pathophysiology, and treatment of heart failure has changed considerably within the last few years. The changes have significant implications for the medical management of the disease, as well as on the ability to provide proper dental treatment for these patients. Method and Materials: A retrospective observational study of the outcome following dental treatment of 54 patients was performed: 32 with refractory heart failure stage D (study group) and 22 patients at risk for heart failure stages A to C (control group). Dental management of these patients concentrated on the prevention of iatrogenic, dental setting- induced, and precipitating factors of heart failure. To prevent deterioration of patients' medical condition, a comprehensive, tailored treatment including adequate anxiolysis, close monitoring, profound dental anesthesia, and close follow-up was used. A previously described three-step gradual level protocol (at home, waiting room, and dental chair) was adopted. Results: All the planned dental procedures were successfully completed. Six patients experienced respiratory distress during treatment, and five patients demonstrated arrhythmias during dental treatment. Only minute differences were found between the groups regarding blood pressure and heart rate. Conclusion: Use of the suggested protocol facilitated the completion of planned dental treatments for all patients. Thus, providing essential dental treatment for severe heart failure patients with special attention to their medical problems and the use of medications and supporting means to prevent health-compromising situations is recommended. Keywords: chronic heart failure, medically complex patient

Radicular cysts are the most common cystic lesions of the jaw. Most of these lesions involve the apex of the offending tooth and appear as well-defined periapical radiolucencies. This case presents an unusually large multilocular radicular cyst crossing the midline and involving almost the entire body of the mandible. The clinical and radiographic appearance mimicked an aggressive cyst or benign tumor. The lesion was surgically excised, and the teeth were endodontically treated without any postoperative complications. Keywords: multilocular radiolucency, periapical radiolucency, radicular cyst

In clinical practice, dentists are faced with the dilemma of whether to treat, maintain, or extract a tooth. Of primary importance are the patient's desires and the restorability and periodontal condition of the tooth/teeth in question. Too often, clinicians extract teeth when endodontic therapy, crown-lengthening surgery, forced orthodontic eruption, or regenerative therapy can be used with predictable results. In addition, many clinicians do not consider the use of questionable teeth as provisional or transitional abutments. The aim of this article is to present a novel decision tree approach that will address the clinical deductive reasoning, based on the scientific literature and exemplified by selective case presentations, that may help clinicians make the right decision. Innovative decision tree algorithms will be proposed that consider endodontic, restorative, and periodontal assessments to improve and possibly eliminate erroneous decision making. Decision-based algorithms are dynamic and must be continually updated in accordance with new evidence-based studies. Keywords: decision trees, periodontal prognosis, questionable teeth, treatment planning

Objective: The temporomandibular opening index (TOI) is endfeel distance divided by active and passive mouth opening. The asymmetry index (AI) is a measure of difference in left and right condylar heights. This study examined the relationship between AI and TOI in myogenous TMD and non-TMD patients. Method and Materials: Fourteen myogenous TMD patients diagnosed by the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) were recruited (1 man and 13 women) and 14 non-TMD patients (6 men and 8 women) were included as controls. Differences between the TMD patients and control group of non-TMD patients were determined by the two-tailed t test, while multiple linear regression analysis was used to examine the correlation between AI and TOI adjusting for sex and age. Results: AI and TOI were significantly higher (P = .001 and P = .045, respectively) among TMD patients. A significant positive correlation was found between TOI and AI for the TMD group (r = 0.84, P = .01) but not for the control group. Conclusion: A positive correlation was found between TOI and AI in the myogenous TMD group. Keywords: condylar asymmetry, myogenous, opening index, TMDs