Quintessence International, 02/2020

Objective: The purpose of the present study was to assess the influence of type 2 diabetes mellitus (DM) on the evolution of pulpal and periapical pathology. Method and materials: Two reviewers independently conducted a systematic search for articles published between 1 January 2001 and 31 December 2018 on MEDLINE/PubMed, ISI Web of Science, and Scopus databases. An additional manual search was also carried out. Results: Ten studies fulfilling the inclusion criteria were included in the review (two longitudinal studies with 1-year follow-up comparing the success of primary root canal treatment between type 2 diabetic patients and non-diabetic patients, and eight cross-sectional studies). Analysis of the ten studies showed that inadequate control of type 2 DM may predispose and influence the inflammatory pulpal and periapical disease evolution. Conclusions: The present systematic review suggests that there are biologic bases to suggest that type 2 DM may act as a risk factor for developing an endodontic pathology, affecting the course of the disease in terms of susceptibility, prevalence, progression, and tissue healing capacity as a consequence of a disrupted immune response. However, more well-designed clinical investigations carrying out suitable research methodologies are needed to elucidate the influence of type 2 DM on the pulpal and periapical disease evolution. Keywords: dental pulp, diabetes, endodontics, periapical pathology, systematic review

Objectives: This laboratory study compared the effects of various post systems on the fracture resistance of endodontically treated mandibular premolars. Method and materials: Thirty-two extracted mandibular first premolars were collected, endodontically treated, and assigned into four test groups (n = 8). The classification was based on the post material as follows: traditional glass-fiber posts (TFP), traditional titanium posts (TTP), coated glass-fiber posts (CFP), and coated titanium posts (CTP). The posts were cemented with a dual-curing luting composite resin. Each specimen, which was prepared with a 2-mm ferrule height, received a composite resin core. All specimens were restored with cast CoCr crowns, which were cemented with glass-ionomer cement. All specimens were submitted to dynamic loading in a dual-axis chewing simulator for 1,200,000 cycles with a nominal load of 5 kg and simultaneous thermal cycling (5 to 55°C). Each specimen was secured in place and loaded at 30 degrees using a universal testing machine until fracture occurred. The results obtained were analyzed using one-way ANOVA and the fracture modes were investigated under stereomagnification (25×). Results: Fracture loads were as follows: 858 ± 216 N for CTP, 953 ±134 N for TFP, 979 ± 219 N for CFP, and 1,130 ± 286 N for TTP group. One-way ANOVA revealed no statistically significant differences among the test groups (P = .112). Conclusions: Under the conditions of the current study, no significant fracture resistance differences were found between teeth with the different prefabricated post systems. Keywords: endodontically treated teeth, fracture resistance, glass-fiber post, resin cement, titanium post

Objective: Marginal bone loss (MBL), a prognostic parameter for implant success, is associated with implant- and patient-related variables. The purpose of this study was to analyze the effects of the crown-to-implant ratio and independent factors of implant diameter, implant length, implant type, location, and platform switching on distal and mesial MBLs at the 6-, 12-, 24-, and 36-month recall sessions of single crown implant-supported restorations. Method and materials: Radiographic and clinical data of patients treated with single crown implants were collected. MBL was measured at the baseline and recall sessions on panoramic radiographs. The crown-to-implant ratio was calculated by dividing the length of the crown by that of the dental implant. Results: The crown-to-implant ratio had a moderately positive correlation with distal MBL at the 6-month recall session (P .05, r = 0.469) and a weakly positive correlation at the 12- (P .05, r = 0.220), 24- (P .05, r = 0.214), and 36- (P .05, r = 0.250) month recall sessions. Distal and mesial MBL did not significantly differ among the four implant types at any recall session (P > .05). The crown-to-implant ratio had no significant correlation with mesial MBL at the 12-, 24-, or 36-month recall session (P > .05), and a moderately positive correlation at the 6-month recall session (P .001, r = 0.434). Conclusions: MBL was similar among different implant types in the short and medium terms. There was a positive correlation between distal MBL and the crown-to-implant ratio. Keywords: alveolar bone loss, bone resorption, dental implants, implant-supported dental prosthesis, single-tooth dental implants

Objectives: The aim of this study was to determine the influence of patient-related systemic factors, local bone and intraoral factors, and implant-related factors on peri-implant marginal bone loss (MBL). Method and materials: The following data were collected from patients who received dental implants and were recalled for examinations at least 3 years after treatment completion: medical history, age, sex, habits, periodontal health, implant size and surface, surgical procedure, prosthesis type, implant failure, Plaque Index, and oral hygiene. MBL was investigated using both baseline and follow-up panoramic radiographs. Results: The study included 1,126 dental implants placed in 304 patients (185 [60.9%] women and 119 [39.1%] men). The mean age was 54.30 ± 13.52 years (range 22 to 83 years). The mean follow-up period was 58.8 ± 11.2 months. The MBL was observed in 271 (24.1%) implants, of which 160 (14.2%) were ≤ 2 mm and 111 (9.9%) were > 2 mm. Respective mean MBL values on mesial and distal sides were 0.42 ± 1.03 mm and 0.42 ± 1.02 mm. Of the implants, 19 (1.7%) were lost, leading to an implant success rate of 98.3%. Age, history of hysterectomy, history of periodontitis, oral hygiene, abrasions, smoking, implant location, implant surface, implant length, surgical procedure type, and prosthesis type were all found to be statistically significant for MBL (P .05). Certain combinations of these factors resulted in increased MBL. Conclusion: In the present study, local factors had more significant effects on MBL than did systemic factors, and combinations of these factors had greater effects on MBL. Keywords: clinical evaluation, dental implants, local and systemic factors, marginal bone loss, radiologic evaluation

Objective: High levels of primary implant stability have been advocated particularly for immediate loading protocols. Current implant systems and drill protocols are intended not to cause excessive stress on bone during implant insertion as resorptive processes might compromise esthetics and function. The goal of this narrative review was to summarize current data on the effect of mechanical stress on alveolar bone. Method and materials: PubMed was searched (final search conducted on 30 September 2019) applying the user query "(dental implant insertion) AND (mechanical stress) AND (bone)." The papers identified were grouped according to the research methodology applied (in vitro studies and finite element analysis, animal studies, and clinical trials). Results: In total, 176 articles were identified, of which 58 were included. A clear tendency towards increased stress in bone resulting from the use of undersized osteotomies was shown. Depending on the degree of undersizing, the inner parts of implant threads create healing chambers in which bone formation seems to progress very well, while areas of direct contact between implant body and alveolar bone experience resorption during healing. More resorption seems to occur when implants have been placed with higher insertion torque, although these implants maintain greater total bone-to-implant contact during initial healing. Clinically, mobile implants seem to have a compromised prognosis and high insertion torques seem not to guarantee successful osseointegration. Marginal bone level changes obviously have a tendency of being greater in implants inserted with high levels of torque. Conclusion: Clinicians should be cautious during implant surgery not to overstress bone. Future implant systems should focus on optimized drill protocols and apply macrodesigns that also derive stability from trabecular bone as well, instead of merely compressing the cortical layer. Keywords: alveolar bone, compression, implant insertion, marginal bone level change, mechanical stress

The health risks associated with aspiration and ingestion of foreign bodies in children are well known. The increased availability of magnetic toys have added to these risks. A 7-year-old girl presented at the Department of Maxillofacial and Oral Surgery at the University of Pretoria Oral and Dental Hospital with a complaint of pain under the tongue. Examination revealed that magnetic balls had been lodged on either side of the lingual frenum. The patient experienced pain and was unable to dislodge the magnets. This case report documents patient presentation and management and concludes with a brief discussion of potential complications associated with the oral intake of magnets. Though multiple cases documenting the complications associated with ingestion of magnets have been reported, reports of primary oral complications are scant. This case contributes to existing evidence for the dangers associated with high strength magnets used as toys by children. Keywords: foreign body, frenum, magnets, neodymium magnets, tongue

In recent years, a large number of studies have been published evaluating the therapy of oral lichen planus. In addition to standard medication such as topical glucocorticoid therapy, substances such as Aloe vera, hyaluronic acid, and treatments from traditional Chinese medicine have also been investigated. It is not always easy for dental practitioners to find an adequate therapy according to the clinical picture. This article presents therapies for dental practitioners who do not focus on treating patients with oral mucosa diseases. Oral lichenoid lesions, which are clinically and histologically similar, must be distinguished from oral lichen planus. Before starting therapy, it is necessary to differentiate between drug- and contact-related variants. Both clinical features have in common that according to the World Health Organization (2017) they belong to the class of potentially malignant disorders. Accordingly, these patients must be referred to a regular, and in oral lichen planus patients, lifelong, recall. Keywords: oral lichenoid lesion, oral lichen planus, topical glucocorticoids

Objective: Intranasal midazolam (INM) is an increasingly popular agent for sedation in the emergency department and outside the hospital in physician, imaging, and dental offices, to facilitate diagnostic and minor surgical procedures and avoid the need for an operating room and general anesthesia. The use of INM has been commonly associated with a burning sensation of the nasal mucosa. Despite its significance, this subject has received little adequate research focus. The objective of the current study was to evaluate the effectiveness of topical lidocaine in relieving pain related to INM administration. Method and materials: This was a blinded, randomized placebo-controlled trial. Sixty-three uncooperative children undergoing dental treatment, aged 4 to 11 years, were randomly assigned to one of three groups to receive the drug nasally via a precalibrated spray as per the following assignments: group A received 0.5 mg/kg midazolam, group B received lidocaine 2% prior to 0.5 mg/kg midazolam, and group C received saline 0.9% (placebo), 0.5 mg/kg. Children were asked to record the degree of pain using the Wong-Baker faces scale. Parental acceptance was also rated. Results: Topical lidocaine prior to INM administration reduced the burning sensation in the nasal mucosa and improved the drug acceptance. The median score of pain was 8, 1, and 4 in groups A, B, and C, respectively. The differences among the three groups were statistically significant (P > .05). The children's acceptance and parents' future acceptance regarding the intranasal drug administration was significantly higher in group B. Conclusion: INM administration results in burning sensation in the nasal mucosa with high levels of pain. Using topical lidocaine 2% counteracted the burning sensation and achieved a higher acceptance rate and lower pain scores. Keywords: burning sensation, children, intranasal, lidocaine, midazolam

Objective: Some patients with Down syndrome experience premature edentulism, which can lead to severe alveolar atrophy. This may cause retention problems with purely mucosa-supported dentures and ill-fitting total dentures. The intellectual disability associated with Down syndrome, with an (implied) inadequate ability for compliance, may pose a further challenge to dental treatment. The aim of this case report was to demonstrate that a combined implant-prosthetic denture with bar constructions can, nevertheless, be implemented in elderly Down syndrome patients with limited cooperation ability. Method and materials: This report is the first to describe the procedure for an implant-supported total prosthetic restoration with bar joint in a 52-year-old edentulous patient with Down syndrome and limited ability to cooperate. Previous dental solutions had severely curtailed the patient's quality of life. By combining various forms of treatment, including behavior management, the course of therapy could be adapted to the patient's cooperation capability. Results: The implant-supported total prosthetic restoration with bar joint was well accepted by the patient. Moreover, the patient's relatives reported that his life quality had improved distinctly (eg, considerable weight-gain, more positive mood). No impairments of the prostheses were observed during the 24-month follow-up period, and both implants remained clinically inconspicuous. Conclusion: The lack, or inadequacy, of dental prostheses can impair the life quality of individuals in need of such restorations. Implant-supported dentures in combination with a bar construction improve the retention of prostheses in atrophied jaws. This form of restoration is also proving to be a successful therapy option for elderly persons with Down syndrome. Keywords: behavior management, Down syndrome, edentulism, implant-supported prosthesis, intellectual disability, oral rehabilitation