Quintessence International, 10/2015

Central dominance is an important element of an esthetic smile. Color, form, and size have been suggested as tools for assessing the dominance of maxillary teeth. A spectrophotometer can be used to determine the value, hue, and chroma. Correct sizing of restorations according to the central incisor dominance principle improves not only esthetics but also aspects of occlusion, such as anterior guidance. Refractory porcelain systems can effectively restore the color, shape, emergence profile, and incisal translucency. This report illustrates the esthetic and occlusal rehabilitation of the dominance of maxillary central incisors using fabricated minimal thickness refractory porcelain veneers. Keywords: color, dental ceramics, dental esthetics, dental occlusion, veneer

The complete dental rehabilitation of patients with a vertical dimension loss (VDL) caused by structural enamel deficits associated with amelogenesis imperfecta (AI) represents a difficult challenge for restorative teams. Accurate analysis and treatment planning that includes esthetic and functional evaluations and adequate material selection are important prerequisites for successful results. Long-term provisional restorations play an important role in exploring and elucidating the patients' esthetic demands and functional needs. Restorative treatment options can vary from requiring only oral hygiene instructions to extensive dental restorations that include composite fillings, ceramic veneers, metal-ceramic, or all-ceramic crowns. This case report describes a full-mouth rehabilitation of a patient with amelogenesis imperfecta including the case planning, bite replacement, preparation, and restoration setting steps with an experimental CAD/CAM polymer and porcelain veneers. Keywords: adhesive technique, amelogenesis imperfecta, CAD/CAM polymer, full-mouth rehabilitation, glassceramics, occlusal onlays, veneers

Objective: In this study the apical debris score regarding the rotary use of the CanalBrush (Coltène-Whaledent) with three different tip variations was compared to that of sole needle irrigation. Method and Materials: Sixty straight roots of human teeth with one canal were instrumented to size 45/.04. Roots were split into halves, reassembled, and embedded in model resin to form separable tooth models. Artificially manufactured dentin debris was packed into the apical 2 mm of the roots to form a relatively consistent debris challenge to be assessed. Then, the debris of each root half was evaluated apically using a modified Hülsmann-score under a light microscope. After remounting the models, root canals were irrigated with NaOCl 3% (2 mL): group 1 with sole needle irrigation, in groups 2 to 4 additionally agitated with different versions of the CanalBrush for 30 s at 600 rpm; group 2, one straight bristle ("old"); group 3, two additional diagonal bristles ("new"); group 4, central straight bristle of the new version removed ("experimental"). Following this, all root halves were reevaluated. Results: Irrigation reduced debris scores in all groups (Wilcoxon tests, P .001). Mean debris scores were reduced from a pre-irrigation score of about 4 for all groups to a score of around 2 to 3 in groups 1 and 2, and to scores around 1 in groups 3 and 4. Samples of groups 3 and 4 were significantly cleaner than of groups 1 and 2 (Mann-Whitney tests, P .05). Conclusion: CanalBrushes with diagonal bristles achieved an improved apical cleaning ability. Keywords: apical cleanliness, artificial dentin debris, CanalBrush, Hülsmann-score, rotary agitation, separable tooth model

Objective: The aim of this study was to compare the use of periodontal probing and cone beam computed tomography (CBCT) images in the diagnosis of furcation involvement (FI) in patients with chronic generalized severe periodontitis. Method and Materials: Fifteen patients with chronic generalized severe periodontitis were included in this study. In total, 174 furcation sites (all in molar teeth) were analyzed. FI was assessed at three sites (buccal, mesiopalatal, and distopalatal) of maxillary molars, and at two sites (buccal and oral) of mandibular molars. FI was assessed both clinically (periodontal probing) and on CBCT images, using a dichotomous scale (present/absent). The agreement between clinical and CBCTbased findings was calculated. Results: FI were more often detected by means of CBCT than by means of clinical examination. Agreement between the evaluation methods was present in 46.9% of cases (63.3% in maxilla, 45.0% in mandible). FI detected clinically was confirmed by means of CBCT in 24% of the evaluated sites. The largest agreement (73.7%) in FI detection was found in the distopalatal maxillary sites between CBCT and clinical probing. The smallest agreement (36.6%) was found in the buccal sites of the mandibular molars, in which 63.3% of FI were detected using CBCT only, but not clinically. Conclusion: The number of FI detected by means of CBCT was larger than by means of periodontal probing. In those cases in which chronic generalized severe periodontitis is clinically diagnosed, and surgical treatment is necessary, CBCT may be suggested as an adjunct tool for FI assessment. Keywords: cone beam computed tomography, furcation involvement, periodontal disease

Objective: The aim of this multicenter randomized controlled clinical trial was to test posterior zirconia-ceramic fixed dental prostheses (FDPs) veneered with a computer-aided design/computer- assisted manufacture (CAD/CAM) lithium disilicate veneering ceramic (CAD-on) and manually layered zirconia veneering ceramic with respect to survival of the FDPs, and technical and biologic outcomes. Method and Materials: Sixty patients in need of one posterior three-unit FDP were included. The zirconia frameworks were produced with a CAD/CAM system (Cerec inLab 3D/Cerec inEOS inLab). Thirty FDPs were veneered with a CAD/CAM lithium disilicate veneering ceramic (Cad-on) (test) and 30 were veneered with a layered zirconia veneering ceramic (control). For the clinical evaluation at baseline, 6, and 12 months, the United States Public Health Service (USPHS) criteria were used. The biologic outcome was judged by comparing the plaque control record (PCR), bleeding on probing (BOP), and probing pocket depth (PPD). Data were statistically analyzed. Results: Fifty-six patients were examined at a mean follow-up of 13.9 months. At the 1-year follow-up the survival rate was 100% in the test and in the control group. No significant differences of the technical outcomes occurred. Major chipping occurred in the control group (n = 3) and predominantly minor chipping in the test group (minor n = 2, major n = 1). No biologic problems or differences were found. Conclusions: Both types of zirconia-ceramic FDPs exhibited very good clinical outcomes without differences between groups. Chipping occurred in both types of FDPs at small amounts, yet the extension of the chippings differed. The test FDPs predominantly exhibited minor chipping, the control FDPs major chipping. Keywords: CAD/CAM, CAD-on, fixed dental prosthesis, lithium disilicate, zirconia

Objective: To review the current literature, and to evaluate the occurrence, severity, and duration of tooth sensitivity during and after vital tooth bleaching as well as to identify possible sources and risk factors of bleaching sensitivity (BS). The inclusive analysis should allow the clinician to get an overview about today's evidence based results concerning BS. Search Strategy: The search included Cochrane Central Register of Controlled Trials, Ebsco, Embase, PubMed, and Scopus from February 1991 to February 2015. Studies published in English and German were considered. Selection Criteria: Randomized controlled trials including placebo or control groups, with statistical analysis of BS interventions, and with a study sample size of at least 30 participants at baseline were selected. Data Collection and Analysis: Screening of titles and abstracts, data extraction, and quality assessment of full texts were undertaken. Results: A total of 136 articles were identified, with 18 papers meeting the inclusion criteria and presenting data that could be used in the analysis. Included trials provided some details on occurrence, severity, or duration of BS, but papers did not focus solely on BS. The majority of the studies were judged to be at a high risk of bias according to their study design. Investigation methods and outcomes concerning severity of BS and duration varied significantly. Evidence-based explanations for BS could not be found. Conclusion: BS still remains an unsolved phenomenon that needs further follow-up with high-quality studies following the well-accepted CONSORT guidelines. Keywords: bleaching sensitivity, carbamide peroxide, hydrogen peroxide, risk factors/predictors, therapeutic aspects, tooth sensitivity, vital tooth bleaching

Objective: Oral and periodontal infection load need to be treated in the predialysis stage among chronic kidney disease (CKD) patients in order to avoid later complications in dialysis or transplantation. Periodontal health was studied by specifically comparing diabetic nephropathy patients with those with other kidney disease. Method and Materials: This descriptive retrospective study comprised 144 predialysis patients (47 women), aged 23 to 83 years, examined at the Helsinki University Hospital, Finland. Of them, 52 (36%) had diabetic nephropathy. Oral and general health data, Periodontal Inflammatory Burden Index (PIBI), and Total Dental Index (TDI) were recorded from hospital records. Results were analyzed with cross tabulation, Pearson chi-square test, and binary logistic regression with Wald test. Results: Of the diabetic nephropathy patients 39%, and of those with high A1C values 36%, respectively, had two or more sites with probing depths ≥ 6 mm compared with 19% in the other CKD group, and 18% of those with lower A1C values. TDI scores were high among 55% of the diabetic nephropathy patients. A1C values ≥ 6.5% associated with moderate periodontitis in 67%, and elevated PIBI in 62%. Conclusion: High A1C values associated with high oral infection burden indices. Diabetic nephropathy patients had more often high TDI scores and deep periodontal pockets compared with the other CKD patients. Keywords: chronic kidney disease (CKD), diabetes, glycosylated hemoglobin, periodontal disease, predialysis