Quintessence International, 09/2015

Objective: For decades, dental restorative treatment of large and deep cavities of posterior teeth has been adequately ensured by amalgam or by indirect gold restorations; with the continuing advancements in material technology and clinical techniques, alternative and more esthetic types of restorations have become feasible. Proximal box elevation (PBE) using composite resins has been advocated for relocating subgingival cavity outlines; treatment success and effects of PBE require documentation. Data Sources: An electronic search was performed on several literature databases to identify relevant articles published in indexed journals until April 2015. Method and Materials: The authors independently screened the relevant papers found (PBE with composite resins). Results: This paper compiles the current knowledge about PBE (which is predominantly based on laboratory research, in particular with a focus on microleakage and marginal adaptation), revealing that flowable composites allow for a stepwise elevation of proximal cavity floors, thus simplifying treatment of deep lesions, and broadening the restorative spectrum. A case report revealing an advanced caries lesion and demonstrating the clinical application of the PBE technique together with an indirect computer-aided design/computer-assisted manufacture (CAD/CAM) all-ceramic restoration is presented, assuring the practitioner's familiarity with effective placement techniques. Conclusion: PBE represents a promising two-step treatment regimen, simultaneously encompassing the benefits of immediate dentin sealing and facilitating direct or indirect adhesive restorations of cavities with margins located beneath the gingival tissues. However, high-quality randomized clinical trials are required to confirm the laboratory outcomes. Keywords: advanced caries lesion, caries diagnosis, CEREC, gingivitis, margin relocation, open-sandwich restoration, proximal box elevation, proximal margin elevation technique

Objective: To investigate if a comprehensive supragingival control can modify the periodontal risk and suggested recall interval over time, using an adaptation of an available model of periodontal risk assessment (PRA, Perio-Tools® website). Method and Materials: Single-arm clinical trial data (visible plaque and gingival bleeding indexes, periodontal probing depth, bleeding on probing, and clinical attachment level from baseline (day 0, T0), day 30 (T1), and day 180 (T2) from 50 moderate-to-severe periodontitis patients (25 never-smokers; 25 smokers) submitted to a comprehensive supragingival plaque control regimen for 180 days were subjected to a secondary analysis using an adaptation of the PRA. The periodontal risk (high, medium, or low) and suggested recall interval were calculated per patient and at each experimental time. General linear models and the Cochran test were used for statistical analysis, considering the dependence of the data. Results: All patients were at high risk at baseline. At T1, 20% migrated to medium-risk (P = .002). At T2, 38% and 8% exhibited medium- and low-risk, respectively (P ≤ .001). The reduction between T1 and T2 was significant (P = .001). The mean recall interval increased from 3.0 ± 0.0 (T0) to 3.6 ± 1.2 (T1), and 4.9 ± 2.6 months at T2 (P .003). The effect that smoking habit exerted on risk was limited to the first 30 days, and no effect on recall interval was observed. Conclusion: The oral hygiene condition is an important indicator that influences the risk and the recall interval over time, thus deserving attention when evaluating the individual periodontal prognosis. Keywords: biofilm, dental scaling, periodontitis, risk

Objective: The aim of this study was to evaluate the radiographic outcomes following regenerative surgery using enamel matrix derivative (EMD) + freeze-dried bone allograft (FDBA). Method and Materials: In total, 74 two- or three-wall intrabony defects were treated by a combination of EMD+FDBA followed by supportive periodontal therapy (SPT) for a minimum of 2 years. Radiographs were taken at baseline and after the follow-up period. The measurements taken were: baseline defect angle, CEJ to the coronal part of the alveolar bone crest (CEJ-BC), CEJ to the apical part of the intrabony defect (CEJ- BD), the intrabony component of the defect (DL), and the defect angle between the lines CEJ-BC and CEJ-BD. Results: Baseline defect angles were divided into three groups: first group defect angle ≤ 22 degrees; second group 22 degrees to 36 degrees; and third group ≥ 36 degrees. A significant difference in DL following treatment was found in all groups (6.930 mm, 4.202 mm, and 2.073 mm respectively; P .01). The largest difference in DL was measured for the first group. A positive linear correlation was found between baseline values of the defect angle, CEJ-BD, CEJ-BC, and the later change in DL (P .01). Conclusion: The use of EMD+FDBA results in radiographic bone gain. Narrow defect angle and the depth of the intrabony component have significant positive correlation to radiographic bone gain. Keywords: defect angle, depth of the intrabony component, enamel matrix derivative, freeze-dried bone allograft, radiographic bone gain, regeneration

Inlay-retained fixed dental prostheses (IRFDPs) represent a minimally invasive alternative to conventional fixed dental prostheses (FDPs) to replace single posterior missing teeth. The aim of the present review article is to assess the clinical outcome of different IRFDPs in order to derive recommendations regarding their clinical application. Hence, it is essential to highlight important factors that influence the longevity and success of IRFDPs, such as treatment plan, appropriate case selection with proper indications, as well as tooth preparation. Furthermore, a good understanding of bonding technologies and awareness of pretreatment procedures for different materials are indispensable for the long-term success of IRFDPs. Keywords: inlay-retained fixed dental prostheses, hybrid fixed dental prostheses, minimally invasive preparation, single missing tooth, zirconia ceramic

Objective: Poor bone density in the posterior maxilla often presents challenges in achieving implant stability. Insertional torque (IT) and resonance frequency analysis (RFA) have been used to objectively monitor the process of osseointegration. This study was designed to quantitatively assess the primary and secondary stability of fixtures placed using the osteotome or conventional drilling technique, in soft bone. The study also assessed if there was a correlation between IT and RFA measurements. Method and Materials: Sixteen implants of a standardized dimension were randomly assigned to two groups: osteotome or conventional drilling. IT was taken at the time of placement. RFA was recorded at baseline and 30, 60, and 90 days. Results: Average IT and RFA were 36 Ncm (range 25-45 Ncm) and 61.5 implant stability quotient (ISQ; range 44-72 ISQ), respectively. RFA in the osteotome group increased from day 0 to day 30 (63.5 to 68.0 ISQ) whereas it decreased in the conventional drilling group (65.9 to 56.6 ISQ). At 90 days, both groups showed similar results. No statistically significant difference between IT and RFA was found across all time intervals. Conclusion: IT and ISQ values were shown to fluctuate depending on various local anatomical factors such as density of the bone. Additional clinical and radiographic studies are needed in type 1 to 4 bone to determine the utilization of RFA and IT for routine implant surgery. Adequate stability measurements are critical for implant placement. Future guidelines and knowledge of stability and bone density values may help in establishing loading protocols and improving success rate. Keywords: dental implant, cone beam computed tomography, implant stability, insertional torque, osteotome, resonance frequency analysis

Objective: The purpose of the study was to compare the pain-related behavior and the pain perception associated with three anesthetic techniques in pulpotomies of primary mandibular second molars: traditional inferior alveolar nerve block (IANB), IANB with computer-controlled local anesthetic delivery (CCLAD), and intraligamental anesthesia with CCLAD. Method and Materials: The sample comprised 91 randomly selected healthy children aged 5 to 9 years, who were scheduled for pulpotomy in the mandibular second molar. Patients were divided into three groups according to the type of anesthesia received. Group A received traditional IANB, group B received IANB with CCLAD, and group C received intraligamental anesthesia with CCLAD. Pain-related behavior and pain perception levels were assessed using the established behavior code and the Wong-Baker FACES Pain Rating Scale respectively. Results: The mean of pain-related behavior was significantly lower (P .001) in the intraligamental anesthesia with CCLAD group than in the other two groups. The pain perception scores were significantly higher in the traditional IANB group than in the IANB with CCLAD group, and the intraligamental anesthesia with CCLAD group (P = .044 and P .001 respectively). The mean ± SD of the pain perception of IANB was 1.39 ± 0.200, IANB with CCLAD was 0.87 ± 0.133 and ILA with CCLAD was 0.13 ± 0.063. Conclusion: Intraligamental anaesthesia with CCLAD was clearly associated with less pain than the IANB with or without CCLAD. Keywords: computerized anesthesia, pain behavior, pain perception, primary molars, pulpotomy

Objective: The aim of this study was to evaluate the clinical relevance of three different bone collecting devices in a volumetric comparison. Method and Materials: Bone harvesting for the collection of bone particles was performed on bovine mandibles. Three different types of bone collecting devices (Tests 1, 2, and 3) were used. Ten drilling sites in each group were prepared and bone particles were collected. Bone particles were sieved twice in sieves with 500 μm and 1,000 μm openings. The bone particles were divided into three groups: 500 μm (SP), 500-1,000 μm (MP), and >1,000 μm (LP). Total wet volume, fractional wet volume, fractional dry volume, and weight were measured. The shape of the dried particles was examined using a microscope. Results: All particles in all three groups had a wood shaving-like appearance. With Test 1 and Test 2, LP were the most common (0.510 ± 0.064 mL, 0.430 ± 0.067 mL), and in Test 3, MP was the most common (0.112 ± 0.019 mL). Among the SP and MP, the wet volume of Test 3 was significantly greater than those of Tests 1 and 2 (P .001). However, among the LP, the wet volume sequentially increased from Test 1, to Test 2, and Test 3 (P .001). The proportion of dry volume was similar to that of wet volume. Conclusion: Three innovative bone collecting devices could collect comparable amounts of bone particles to commercially available bone graft materials. Keywords: autogenous bone graft, bone collector, oral implantology, particle size

Objective: The aim of this study was to determine the presence of periodontal disease among patients with rheumatoid arthritis (RA) in comparison with a control group. Method and Materials: The study included 44 patients diagnosed with RA according to American Rheumatism Association (ARA) criteria, who were attending the Morales Meseguer Hospital Rheumatology Service (Murcia, Spain), and 41 control subjects. Patients younger than 18 years or patients suffering systemic diseases that could affect the immune system were excluded. Age, sex, smoking habits, alcohol consumption, and body mass index were registered. Each patient underwent a full periodontal examination. Results: Bleeding on probing was significantly greater in the RA group (0.9 ± 0.36) than the control (P .001). The Plaque Index was significantly higher in the RA group (0.76 ± 0.34) versus the control group (0.55 ± 0.2) (P .001). RA patients showed a 0.13 increased risk of periodontal disease (95% confidence interval, 0.05-0.37). Conclusion: Patients with RA suffered a higher risk of periodontal disease and for this reason these patients must be instructed to intensify their oral hygiene regimes. Keywords: oral health, oral hygiene, periodontitis, rheumatoid arthritis