Quintessence International, 10/2012

Objective: To compare the clinical performance of two different veneer preparation designs (overlap and nonoverlap) on anterior veneer restorations in vital teeth in a retrospective clinical study. Method and Materials: In this study, 292 anterior all-ceramic veneer restorations in vital teeth were clinically examined in 74 patients. The preparation designs were categorized by the amount of tooth reduction on the final casts, with 245 in the overlap and 47 nonoverlap group. Results: After a mean ± SD observation time of 124.25 ± 60.61 months, 20 failures occurred. All failures occurred in the overlap design. Restorations with nonoverlap preparation designs showed significantly fewer failures than restorations with overlap preparation design (P = .018, log-rank). Conclusion: Based on the findings of this study, whenever feasible, a preparation design without incisal overlap is recommended, especially in vital teeth. Parole chiave: incisal reduction, overlap, survival, veneer preparation design, vitality

Objective: The use of a coronally advanced flap (CAF) and connective tissue graft (CTG) is a well-established procedure to cover single and multiple recessions and improve soft tissue esthetics. However, until now, there are still limited data evaluating patient morbidity, the fear of imminent tooth loss, and modification of sensitivity in surgical areas. The aim of the present study was to evaluate the patient-centered outcomes associated with CAF + CTG. Method and Materials: Thirty-four patients (mean age, 30.76 ± 6.88 years) with single or multiple Class I and II gingival recessions were treated using a CAF + CTG. The following parameters were evaluated at 14 days and 1, 3, 6, and 12 months after surgery: esthetics, root hypersensitivity, fear of imminent tooth loss, daily activities or nutritional habits, and the levels of postsurgical morbidities. A visual analog scale was used to evaluate patient-centered outcomes. The percentage of patients belonging to each of the severity scales, the mean values associated with each parameter, and the statistical significance of the modification of the monitored parameters were calculated. The parametric F (Fisher) test and the least significant difference post hoc pair-wise comparisons were computed. Results: There were statistically significant differences between baseline and all follow-up time points in root hypersensitivity and in fear of tooth loss. Preoperative prevalence of fear of tooth loss was 99%. Esthetics were statistically significantly improved at the 1-, 3-, 6-, and 12-month visits compared with the evaluation at 14 days. No palatal bleeding was recorded. The pain perception in the donor area was mild: Only 3% of patients reported severe palatal pain, and the mean VAS score for palatal pain was 3.79 ± 1.49. Conclusion: Treatment of single and multiple gingival recessions with CAF + CTG resulted in predictable improvements of soft tissue esthetics and root hypersensitivity but was associated with a slight increase in patient morbidity, mainly related to the harvesting of CTG. This should be considered when treating patients with esthetic demands. Parole chiave: connective tissue graft, esthetics, gingival recession, patient-centered outcome, quality of life

In addition to providing functionality to patients, contemporary dentistry strives for esthetic excellence. Patients with anterior impairments, such as shape, size, and position alterations, have compromised smile harmony. A multidisciplinary orthodontic-operative dentistry approach has improved the treatment of these patients, since the use of orthodontic appliances in association with direct composite restorations can solve many esthetic problems. Although this treatment strategy is rather widespread, professional skills are necessary for the correct reproduction of the main features of teeth. Moreover, treatment success is directly related to its longevity. With the aid of a 9-year follow-up case report, a simple direct technique associated with an orthodontic treatment for restoring the esthetic appearance of an impaired smile, with good short- and long-term outcomes, based on minimal but essential esthetic repair interventions is discussed. Such coordinated treatment proved to be effective for the establishment and maintenance of an esthetic and pleasant smile. Parole chiave: diastemata, esthetics, follow-up, orthodontics, peg-shaped teeth, tooth recontouring

Nowadays, esthetic demand stimulates optimized optical features that offer satisfactory masking effects, particularly in anterior restorations. In cases in which only a single tooth is involved, the treatment is one of the most challenging of all esthetic restorations. The optical characteristics of the natural teeth are essential to masking the restoration and are determined by the interaction of light and dental substrates with varying degrees of translucency and opacity. Additionally, form and superficial texture are important in terms of ensuring the natural harmony of the dental restoration. Thus, technical approaches, such as mock-up and composite resin stratification, have led to favorable outcomes. This case report describes an easy and reliable restorative procedure of a maxillary central incisor that focuses on achieving a natural appearance by using an adequate direct composite resin restoration. Parole chiave: composite resin, fluorescence, mock-up

Objective: When a mandibular third molar is partially impacted in the soft tissue, it must be determined whether the extraction wound should be left partially open or completely closed. We hypothesize that a blood clot preserving a surgical wound with easily cleanable surfaces by primary closure and drain application would postoperatively minimize dry socket and/or alveolitis development. Method and Materials: Twenty patients requiring bilateral extraction of partially soft tissue-impacted mandibular third molars in a vertical position were included in the study. The existence of dry sockets, alveolitis, pain, facial swelling, and trismus were evaluated on the second, fifth, and seventh days of the postoperative period. Results: On the second day, pain, trismus, and swelling were higher in the drained group; however, pain reduced progressively in the drained group over time. There were no cases of dry sockets or alveolitis except for a single patient on the seventh day in the drained group over the 7-day study period. On the other hand, in the secondary closure group, the number of dry sockets was 8 (40%) on the second day. The number of alveolitis was 10 (50%) on the fifth day and 4 (20%) on the seventh day. Conclusion: Closed healing by drain insertion after removal of partially soft tissue-impacted third molars produces less frequent postoperative dry sockets and/ or alveolitis development than occurs with open healing of the surgical wound. In cases with a risk of alveolitis development (lack of oral hygiene, immunocompromised patients, etc), it can be avoided with the "kiddle effect" and related undesired complications by implementing closed healing with drain insertion. Parole chiave: alveolitis, closed healing, drain insertion, third molar

Objective: To systematically review the allergic reactions associated with metal alloys in porcelain-fused-to-metal (PFM) fixed prosthetic devices. Method and Materials: After reviewing the titles and abstracts of the articles as well as removing duplicates, 22 articles were considered relevant. PubMed, Web of Science, ScienceDirect, and Google Scholar from 1970 to 2012 were evaluated, and randomized studies, review articles, case reports, cross-sectional surveys, and abstracts were included. Conference papers and posters were excluded. Results: Although reported, allergic reactions to metallic alloys in the context of PFM devices are not well documented. Allergic reactions to high noble and noble metal alloy cores of palladium and gold and to base metal alloys nickel and cobalt in the context of PFM fixed partial dentures (FPDs) are reported. Each type of metal is associated with a different rate of allergic reactions, which may be attributed to the extent of corrosion of the alloy, population exposure, and the biologic environment. Because few studies document allergic reactions to metals that comprise PFM crowns and partial dentures, further research in this field is necessary to determine the frequency and type of reactions elicited. Conclusion: Though allergic reactions to metal alloys used in dentistry are well documented, only few articles focus on the correlation between FPDs and metal allergies. Thus, this paper surveys case reports of hypersensitivity reactions linked to FPDs and reviews the current literature on allergic reactions to the metallic elements comprising those devices. Parole chiave: dentistry, fixed partial denture, metal allergy, systematic review

Objective: To compare the current (t1) periodontal status of post-liver transplantation patients to their status 10 years earlier (t0). Method and Materials: Seventeen patients 45 to 71 years of age who were evaluated approximately 10 years previously were enrolled in the study. All subjects had undergone a liver transplantation 1 to 10 years prior to the initial examination (t0). Clinical and radiographic parameters were recorded for the Ramfjord Index teeth and compared between t0 and t1, including Plaque Index (PI), Gingival Index (GI), probing depth (PD), clinical attachment level (CAL), and gingival overgrowth (GO). Bone loss was measured on digitized images of panoramic radiographs. Results: Mean PI, GI, CAL, and GO were slightly lower at t1 than at t0; however, these differences were not statistically significant (P > .05, Student t test for paired observations). The mean PD was reduced at t1 (2.43 ± 0.18 mm) compared with t0 (3.35 ± 0.22 mm), which was statistically significant (P = .001, Student t test for paired observations). To the contrary, the mean radiographic bone loss at t1 was higher than at t0 (5.61 vs 4.48 mm, respectively), which was also statistically significant (P = .017). Tooth loss was observed in some of these patients, ranging from 0 to 4 during the 10 years of follow-up, which amounted to an annual rate of 0.24 teeth per patient. Conclusion: Post-liver transplantation patients maintained stable clinical periodontal parameters during a 10-year period; however, some radiographic bone loss occurred during this time. Parole chiave: bone loss, gingival overgrowth, liver transplant, longitudinal, periodontal medicine

This study assessed the viability of bone and soft tissue healing at the wound extraction site, when the wound was both covered and not covered with a mucoperiosteal flap. In total, 40 patients were enrolled in the clinical study and were randomly allocated to each treatment cohort group. Parole chiave: extraction, socket, tooth, wound

Objective: To investigate the influence of chlorhexidine in different concentrations when mixed with mineral trioxide aggregate gray (MTA-G) or white (MTA-W). The antibacterial effect on Enterococcus faecalis was used as the primary parameter. Method and Materials: Similar to the agar diffusion test, Mueller-Hinton agar plates were inoculated with E faecalis (ATCC 19433), and 14 groups (n = 21) were prepared. The specimens consisted of MTA-W and MTA-G, and these were enriched with chlorhexidine concentrations of 0.1%, 0.2%, 0.5%, 1.0%, 1.5%, and 2.0%. Pure MTA-W and MTA-G (each combined with distilled water) were used as controls. After incubation periods of 24 and 48 hours, the inhibiting areolae were measured. Results: Pure MTA-W, in contrast to pure MTA-G, had no bactericidal effects. With increasing chlorhexidine concentrations of up to 1.5%, a linear increase in bactericidal activity was observed. In contrast, MTA-G showed only a low self-bactericidal influence, and the antibacterial effects with increasing chlorhexidine concentrations were significantly lower than those of MTA-W (P .001). Conclusion: When mixed with distilled water, pure MTA-G revealed a low bactericidal effect against E faecalis. The use of chlorhexidine with MTA mixtures leads to an antibacterial effect against E faecalis, and within the first 48 hours, this effect is significantly higher in combination with MTA-W when compared with MTA-G. Parole chiave: chlorhexidine, Enterococcus faecalis, microbiology, mineral trioxide aggregate

Objective: Recent studies have shown that inflammatory diseases can be influenced by nutritional factors. For this reason, this study was designed to evaluate the food intake of patients with periodontal disease in comparison to healthy subjects using a 7-day food record (7-DFR). Method and Materials: The study population consisted of 42 patients with chronic periodontitis and 38 healthy subjects (controls). Periodontitis was diagnosed by using the Plaque Index, Sulcus Bleeding Index, and measurement of probing depth. All participants completed a 7-DFR, which was analyzed with DGE-PC Professional 2.7. To confirm the nutritional analysis, the vitamin C plasma level of each participant was measured. Additionally, the oral discomfort of patients with periodontal disease was ascertained by using an additional questionnaire. Results: Analysis of the 7-DFR revealed that patients with periodontitis had significantly lower intake rates of vitamin C, folic acid, magnesium, and fiber than those of healthy controls. The mean vitamin C plasma levels were significantly lower in patients with periodontitis (0.63 mg/dL) compared with healthy control subjects (1.13 mg/dL, P .05). Evaluation of the questionnaire showed that approximately 50% of patients experienced discomfort while eating. Conclusion: The present study shows that patients with periodontitis have a reduced intake of vitamin C, folic acid, magnesium, and fiber compared with healthy subjects. This is possibly an outcome of oral discomfort during mastication. To avoid an insufficient nutrient supply for a patient with periodontal disease, the patient's choice of foods should be closely monitored. Parole chiave: diet, folic acid, nutrients, oral discomfort, periodontitis, vitamin C

Objective: To evaluate the effect of diode laser irradiation on crystallographic and morphologic characteristics of root canal walls after final irrigation with either 17% EDTA or BioPure MTAD. Method and Materials: Root canals in 60 single-rooted teeth were instrumented using a rotary Ni-Ti system. The teeth were randomly divided into three groups (n = 20) based on the final irrigants: group 1, saline; group 2, 17% EDTA; and group 3, MTAD. Each group was further divided into two subgroups (n = 10). Subgroup A received diode laser irradiation at a wavelength of 810 nm and an output power of 2 W for 5 × 5 seconds, while subgroup B received no irradiation. A paired t test was used to compare mean dentinal erosion before and after irradiation in each group. Specimens were analyzed using SEM and x-ray diffractometery. One-way ANOVA and a post hoc Tukey test were used to evaluate dentinal erosion between groups. Kruskal-Wallis and Mann-Whitney U tests were used to evaluate any significant differences in the amount of dentin erosion between the groups. Results: SEM micrographs showed closed dentinal tubules in the control group, while in unlased BioPure MTAD and EDTA groups, clean root canal walls were evident. Erosion was mostly seen in EDTA-treated teeth, while an increase of erosion degree was noted on root canal walls after additional laser irradiations. After irrigation and laser irradiation, the XRD spectrums indicated sharper peaks of EDTA, which showed a slight crystallographic change compared with the other groups. EDTA made changes in the mineralization of dentin due to its higher accumulation on the dentinal wall surface and produced significant degrees of erosion in comparison with MTAD by changing the physical properties of the root canal wall surface. These undesirable changes can be enhanced by further laser irradiation. Conclusion: Results confirm that a diode laser in combination with BioPure MTAD have minimum effect on the chemical properties of root canal dentin while having good smear layer removal properties. The results of the present study indicated that a diode laser in combination with Biopure MTAD might be suggested as a final management of the root canal system prior to canal obturation. Parole chiave: diode laser, EDTA, MTAD, SEM, x-ray diffraction

Objective: Preparing the root surface by planing is an important procedure in the treatment and prevention of periodontal disease. The present study was designed to compare root surface characteristics following root planing with hand and power-driven instruments. Method and Materials: In the present study, 40 single-rooted teeth indicated for extraction were selected and divided into two groups according to whether hand or rotary instruments were used (group I or II, respectively). Teeth were randomly selected. Scaling was performed with ultrasonic instruments. A mucoperiosteal flap was raised to the level of the alveolar crest, and root planing was done with hand instruments for the teeth in group I and with a rotary bur for the teeth in group II. Subsequently, the instrumented teeth were extracted, and the resulting surfaces were evaluated under a scanning electron microscope. Results: In group I, deep scratches and striae were present. Considerable loss of tooth substance was observed, with a mean value of 1.57 ± 0.45. In group II, the root surface appeared flat and smooth, with fewer signs of gouging or scratching, with a mean value of 0.68 ± 0.49. The results were highly significant when both groups were compared (P = .001). Conclusion: In the present study, although both instruments used were found to be effective in removing deposits from the root surfaces, the results favored the use of rotary instruments over hand instruments for root planing to achieve a smooth, clean root surface. Parole chiave: instrumentation, periodontitis, root planing