Quintessence International, 04/2013

Objectives: The physical properties of dental restorative materials have a crucial effect on the longevity of restorations and moreover on the esthetic demands of patients, but they may be compromised by bleaching treatments. The purpose of this study was to evaluate the effects of in-office bleaching agents on the physical properties of three composite resin restorative materials. Method and Materials: The bleaching agents used were hydrogen peroxide and carbamide peroxide at high concentrations. Specimens of each material were prepared, cured, and polished. Measurements of color difference, microhardness, and surface roughness were recorded before and after bleaching and data were examined statistically by analysis of variance (ANOVA) and Tukey HSD post-hoc test at P .05. Results: The measurements showed that hue and chroma of silorane-based composite resin altered after the bleaching procedure (P .05). No statistically significant differences were found when testing the microhardness and surface roughness of composite resins tested (P > .05). Conclusion: The silorane-based composite resin tested showed some color alteration after bleaching procedures. The bleaching procedure did not alter the microhardness and the surface roughness of all composite resins tested. Keywords: bleaching, color, composite resin, microhardness, roughness, silorane

Amelogenesis imperfecta is a hereditary disease affecting the quality and quantity of enamel with a prevalence of 1:700 to 1:14,000. Patients suffer from dental sensitivity and compromised esthetics. The conservative treatment of choice is based on ceramic crowns, but preparation design is unnecessarily destructive to tooth tissue. This case report describes a noninvasive technique with adhesively inserted occlusal composite resin crowns. Keywords: adhesive insertion, amelogenesis imperfecta, CAD/CAM, luting composite resins, noninvasive treatment, occlusal composite resin crowns

Objective: The aim of this clinical study was to evaluate whether a correlation exists between three-dimensional tooth mobility (TM) and Periotest values for maxillary anterior periodontally involved teeth (pocket depth > 3 mm) before and after periodontal therapy. Method and Materials: Force-related TM was measured in 3 N intervals in 19 participants as they bit down on a load cell. Periotest values were evaluated at reproducible measurement points. Both measurement techniques were performed on maxillary central and lateral incisors and canine teeth before periodontal treatment and after a healing period of 3 months. The Pearson product-moment correlation coefficient was calculated to determine exploratory associations. Results: The comparison between TM and Periotest values indicated "high" and "optimum" correlations for maxillary central incisors before and after periodontal therapy. Lateral incisors exhibited "moderate" and "high" correlations, whereas canines exhibited "weak" and "moderate" correlations before and after periodontal therapy. Conclusion: Periotest values may provide valuable information about quantitative metric tooth mobility in periodontally involved teeth. In future investigations, the study design can expand on various dental fields, such as implantology and traumatology. Keywords: correlation study, diagnosis, Periotest, photogrammetry, tooth mobility

Background: Periodontitis is associated with glycemic control in patients with diabetes. The purpose of this study was to determine if glycosylated hemoglobin is elevated in patients with severe periodontitis who are nondiabetic adults. Methods: A total of 60 patients were selected and were divided into test and control groups. The test group included 30 adults without diabetes but with severe periodontitis (more than 30% of the sites showing clinical attachment loss [CAL] >= 5 mm and bleeding on probing [BOP]), and the control group included 30 healthy adults (probing depth = 4 mm, BOP = 15%, and no CAL). Glycosylated hemoglobin (HbA1c) was assessed in the laboratory for these patients. Groups were compared using the t test, Mann-Whitney U test, chi-square test, and Pearson's correlation. Results: There was a slight increase in mean HbA1c scores in the test group (cases 5.76%, controls 5.63%, P = .071). Mean body mass index [BMI] among cases and controls were similar. On intragroup comparison among BMI subgroups of the test group, HbA1c levels in the overweight subgroup were significantly higher compared to the normal BMI subgroup (overweight 5.89%, normal 5.68%, P = .017). Among controls, values were similar. Intergroup comparison showed that among overweight patients, the test group showed a significant increase in the mean HbA1c value compared to controls (cases 5.89%, controls 5.65%, P = .016). Pearson's correlation comparing plaque scores and HbA1c values of the entire sample was positive and revealed significance at the level of 0.01. Conclusion: There was no clear-cut link between severe periodontitis and glycemic control in nondiabetic individuals. Severe periodontitis patients who were also overweight showed significantly higher HbA1c values compared to their normal counterparts. Keywords: glycosylated hemoglobin, nondiabetics, severe periodontitis

Objective: Assessment of the risk for tooth extraction in general and due to periodontal reasons in relation to patient factors. Method and Materials: All patients' charts of three German practices were screened for extractions until 300 patients with extractions (cases) had been collected. All patients without extractions that were screened served as controls. Cases and controls were compared regarding parameters at the patient level. Stepwise logistic regression analyses identified factors influencing the risk for extraction. Results: 2,174 patients were analyzed (300 cases/1,874 controls): aged 52.4/45.7 years (P .001), women 52%/57%, calcium channel blocker medication 15%/8% (P .001), mean Periodontal Screening Index (PSI) 2.5/1.8 (P .001). In the case group, 459 teeth were extracted. The risk for tooth extraction in general and due to periodontal reasons was associated with calcium channel blocker medication (OR 1.49/1.66), active smoking (1.35/1.59), age (10 years) (1.13/1.36), practice 1 (1.48/2.19), and number of sextants with PSI code 4 (1.33/1.78). A continuous dentition with >= 20 teeth left was protective against extractions in general. Conclusion: Calcium channel blocker medication, active smoking, age, individual dentists, and number of sextants with PSI code 4 are risk indicators for tooth extraction. Keywords: calcium channel blocker medication, periodontal disease, smoking, tooth extraction

Implant-supported prosthetic restorations with veneered crowns and fixed dental prostheses are a proven, scientifically accepted treatment concept in fixed prosthodontics. However, in this area of indication there is a comparatively high technical complication rate, which occurs mainly in the area of the superstructure in the form of minor or major chipping of the veneering material. Various studies have shown that purely implant-supported restorations are subjected to higher loading than those on natural abutment teeth due to the special biomechanical conditions. A possible approach to prevent technical complications is to create higher stability for the implant superstructure through the use of high-strength materials. This would, however, result in undiminished overloading being transmitted to the implant components and could cause increased technical and biological complications. This article describes a new procedure for the use of replaceable veneers made from high-performance polymer material on modified implant abutments. By storing digital datasets for the veneer section, it can be replaced easily and quickly if it becomes worn or is fractured. A reduction in the stresses for the implant components and biological structures under the polymer is also to be expected due the material properties of polymers. Keywords: CAD/CAM abutments, macro-retentive element, overload protection for implants, PMMA-based high-performance polymer, replaceable veneer, titanium adhesive bases, zirconium dioxide

Objective: To provide an empirical description of the relationship between the spread of head and neck infections, and the causal tooth. Method and Materials: The hospital records of 155 patients presenting with odontogenic head and neck infections due to a single identifiable tooth from January 2000 to August 2011 were reviewed. The following data were collected: age, sex, clinical presentation, etiology, location, and spread of infection. The causal tooth and location of infection were subsequently compared to the literature. Results: In the present study population, the causal tooth most frequently (47.1%) consisted of the third mandibular molar. Infection of maxillary teeth most commonly spread to the buccal space, whereas infection originating in the mandible mostly spread to the submandibular, pterygomandibular, and buccal spaces. The literature search provided 18 usable articles. Fourteen studies discriminated between mandibular and maxillary origin of infection, and three articles elaborated on the direct relationship between causal tooth and location of infection. Spaces most frequently affected in the literature are the submandibular, masticator, lateral pharyngeal, buccal, and sublingual spaces. A large amount of discrepancy was found between studies. Conclusion: When describing the location of infection, most studies do not discriminate between maxillary and mandibular origin. Although the literature seems to be unambiguous about the predetermined spread, this article demonstrates that it is more difficult to predict the spread of an infected tooth than previously expected. Large studies with clearly noted causal teeth in relation to location of spread should shed more light on the discrepancies found in this review. Keywords: causal tooth, dental infection, head and neck infection, location of infection, odontogenic spread

Objectives: Dental phobia is a psychological disease and a possible contraindication for implant therapy. The study aimed to show that implant therapy in dental-phobic patients (DP, test group) after adequate psychological and dental pretreatment (PDPT) is successfully possible and results in a similar implant prognosis as in nonfearful patients (NF, control group). Method and Materials: 15 DP with PDPT and 15 NF were treated with dental implants and were re-evaluated 2 to 4 years after denture-mounting regarding: alteration of dental anxiety (Hierarchical Anxiety Questionnaire [HAQ], Visual Analog Scale [VAS]), patient satisfaction and compliance, implant success, and peri-implant health. Statistical tests of non-inferiority DP versus NF were performed with Hodges-Lehmann estimators and respective one-sided 97.5% confidence intervals of Moses, and pairwise testings with Mann-Whitney test. Results: The DP test group rated its anxiety significantly lower at follow- up than at baseline (PHAQ .001). However, at follow-up, anxiety was still higher in DP than in NF (PHAQ = .046; PVAS .001). Implant success at follow-up was 100%. Oral health was equally good in DP and NF patients. At follow-up, all patients were satisfied with implant therapy, but compliance was better for NF (100%) than for DP (73% dental checkup; 67% dental hygienist). Conclusion: Implant therapy can be successfully performed in DP patients with PDPT as phobia is not negatively influenced by the invasive implant therapy. However, motivation for professional maintenance programs remains challenging. Keywords: contraindication, dental anxiety, dental phobia, implantology, implant success, psychological trauma