Quintessence International

Objective: This study evaluated the wear of computer-aided design/computer-assisted manufacture (CAD/CAM) burs and the morphologic changes after a number of millings. Method and Materials: Diamond burs (cylinder and step-bur) were divided into four milling groups: zero millings (G0); 15 millings (G1); 25 millings (G2); and 35 millings (G3). Seventy-five premolar crowns were milled using the Cerec Compact Milling unit and VitaBlock Mark II. Surface roughness, three-dimensional profile, and SEM were used for wear and surface damage evaluation. Results: Two-way ANOVA and Tukey test (α = .05) showed that G3 produced statistically different values compared to G0 and G2, but not G1. The cylinder burs showed higher roughness values than step-burs for all groups. SEM showed similar diamond particle damage for cylinder burs and step-burs, and signs of surface damage, cracks, and particle losses for G3. Conclusion: Both cylinder burs and step-burs were able to sustain a larger number of milling procedures than indicated by the manufacturer. Keywords: CAD/CAM, dental technology, diamond burs, prosthodontics, roughness

This article describes single-retainer resin-bonded fixed dental prostheses (RBFDPs) as an excellent alternative to orthodontic space closure or tooth replacement with implants or conventional fixed dental prostheses for congenitally and traumatically missing anterior teeth. Although the treatment with RBFDPs is technique sensitive, it is extremely reliable given a correct indication and adequate adhesive procedures. Keywords: children, resin-bonded fixed dental prostheses (RBFDPs), single tooth replacement

Objective: The mere osseointegration of an implant should no longer be considered a satisfactory criterion for success. Tooth extraction itself and, more importantly, possible local comorbidities such as periodontal or endodontic diseases, cause a reduction in the gingival volume of the edentulous site due to bone atrophy. This reduced volume must be treated and resolved to obtain a satisfactory esthetic result, which is an essential factor for successful implant rehabilitation. The classic approach to this problem relies on bone augmentation procedures. However, the present clinical study is aimed at showing that insufficient gingival volume may be corrected simply by resorting to soft tissue augmentation, provided that sufficient bone is present to allow implant placement. Clinical Considerations: The treatment is described of three cases characterized by considerable ridge atrophy that was caused by a simple extraction in the first case, periodontal breakdown in the second case, and radicular cyst removal in the third case. After healing, all cases presented with sufficient bone to allow implant placement, and insufficient volume was treated via soft tissue grafts during implant surgery. Esthetic results and patient satisfaction were monitored for 2 to 4 years and were very encouraging. Conclusion: Although the approach described in this report requires further investigation, it will likely lead to good results when used to treat a lack of pink volume in the most important esthetic area. Keywords: connective tissue graft, esthetic treatment, implant, implant treatment, ridge atrophy

Tooth-colored resin-based bracket bonding agents are used to fix orthodontic brackets to teeth as inconspicuously as possible. However, after debonding the brackets, these tooth-colored bonding remnants remain on the tooth surface and must be removed to prevent adverse sequelae. Various techniques can be used, all of which cause varying damage to the tooth structure, as the transition between composite and enamel is visually difficult to detect. With the fluorescence-aided identification technique (FIT) presented here, the fluorescent properties of new orthodontic composites are used for visualization, thereby allowing the tooth-colored but fluorescent resin-based bracket bonding remnants to be removed under direct view quickly and without damaging the tooth. Keywords: bracket, debonding, fluorescence-aided identification technique (FIT), orthodontics

Objectives: Dental anxiety may play a central role in the oral health status and treatment outcomes of oral surgical procedures. The study aimed to investigate the effect that brief written information has over patients undergoing oral surgical procedures and to evaluate factors that may cause anxiety. Method and Materials: A prospective study was performed on 38 mandibular third molar surgery patients (mean age 26.74 ± 6.44 years) and 56 implant surgery patients (mean age 49.13 ± 15.11 years). Each group was divided into two subgroups, and written information, explaining what they could expect and details about the procedure, was provided to study groups. The Spielberger State-Trait Anxiety Inventory was used to measure state (STAI-S) and trait anxiety (STAI-T). The visual analog scale (VAS) was used for pain scores preoperatively and on days 1, 3, 5, and 7. Demographic data and intraoperative behaviors of patients were recorded. Results: All groups had similar anxiety scores at baseline. Preoperative STAI-S and VAS scores were similar between study and control groups (P > .05). Study groups showed significantly lower mean intraoperative anxiety levels (P .05). The implant group had a significantly lower VAS score (P .05). STAI-T and preoperative STAI-S were not related to VAS. Postoperative STAI-S and VAS and recuperation were correlated (P .05). Women showed significantly higher anxiety and VAS scores. Conclusion: The patients who received written information did not report lower anxiety scores. However, improved patient cooperation could be achieved with this method. Different surgical procedures may cause anxiety for different reasons. Keywords: brief information, dental anxiety, dental implant, Spielberger State-Trait Anxiety Inventory, third molar surgery

Objective: The study aimed to assess the effect of topical applications of an amino acid and sodium hyaluronate gel after mandibular third molar extraction. Method and Materials: 136 patients requiring mandibular third molar extraction were enrolled. An amino acid and sodium hyaluronate gel was applied to the sockets of patients in the test group immediately following the extraction. The sockets of controls were simply flushed with a sterile saline solution. Patients' outcomes and postoperative complications were assessed 7 and 14 days after surgery. The cumulative incidence of dehiscence and secondary outcome measures were analyzed using a chi-square test. Results: Concerning the primary outcome, the incidence of dehiscence was 27.4% after 7 days in the treatment group and 36.4% in the controls (P = .28), and at 14 days it was 21.4% and 36.0%, respectively (P = .10). No statistically significant differences emerged in other variables (mouth opening range, appearance of soft tissue, presence of pus, pain on palpation of the alveolar socket, alveolitis, local lymphadenopathy, and adverse reactions). Pain perception was always lower in the treatment group during the first 7 days after surgery. Conclusion: Topical applications of an amino acid and sodium hyaluronate gel after mandibular third molar extraction made no statistically significant difference to the variables examined in the test and control groups. Clinical Relevance: This trial focused on postoperative complications after surgical third molar extraction. The use of a gel containing amino acid and sodium hyaluronate was investigated for the management of postoperative pain, edema, alveolitis, wound dehiscence and swelling. Keywords: extraction, hyaluronic acid, oral surgery, oral surgical procedures, pain, wound healing

Objective: The aim of this retrospective study was to measure the sinus membrane's dimensional changes following maxillary sinus augmentation via a lateral approach, and to examine the variables affecting changes in the membrane's thickness. Method and Materials: Sixty-six sinuses corresponding to 50 patients (15 males and 35 females) who underwent lateral wall maxillary sinus augmentation (34 unilateral and 16 bilateral) were retrospectively evaluated. The sinus membrane thickness was measured on cross-sectional cone beam computed tomography (CBCT) scans which were performed prior to and 9 to 11 months' post maxillary sinus augmentation. The Wilcoxon signed-rank test and the Mann Whitney U test were both used to compare between baseline and postoperative sinus membrane thickness. Pearson correlation tests were used to analyze correlations between graft height and sinus membrane thickness changes. Results: The mean age was 53 ± 4 years (45 to 71 years). A total of 132 CBCT scans were analyzed pre- and postoperatively (n = 66). The mean thickness of the sinus membrane before the procedure was 2.61 ± 3.61 mm, while the mean thickness of the membrane after the procedure was 2.94 ± 3.51 (P > .20). Thin membranes at baseline ( 1.56 mm) thickened by a mean of 2.21 ± 2.34 mm, range −0.413 to 10.62 mm, (P .0001); thicker membranes (≥ 1.56 mm) lost 1.46 ± 3.96 mm thickness, range −7.8 to 9.31 mm (P .0001). A moderate negative correlation between the baseline membrane thickness and change in thickness was observed (P .0001, r = −.52). No correlation was found between the graft height and changes in the sinus membrane thickness. Conclusion: Lateral wall maxillary sinus augmentation seems to affect the sinus membrane thickness. These changes are associated with the preoperative thickness of the membrane. Keywords: CBCT, maxillary sinus augmentation, mucosal thickness, sinus membrane

Background: Numerous publications have reported on migraines misdiagnosed as endodontic pathologies. However, reports on the effect that concurrent migraine and endodontic pathology can have on each other and how their respective treatments can also affect each other are limited. Clinical Presentation: Two cases are reported that presented with both migraine and periapical pathology. Patient 1 underwent root canal treatment, which partially alleviated both the migraine and odontalgia. Subsequent treatment with sumatriptan provided additional relief. Patient 2 underwent sumatriptan treatment, with no effect. Subsequent root canal treatment provided significant relief. Patients in both cases have shown continued improvement. Conclusion: Further research is necessary, but the two cases presented suggest that endodontic pathology and migraine symptoms may be associated and endodontic therapy may have an effect on migraine pain. Keywords: case report/series, diagnostic procedure, endodontic diagnosis, headache, pain

A growing patient population is adolescents and young adults who have had one or more serious medical problems and are aging into adulthood. This group of patients has unique medical needs, which has resulted in the development of a specialized area of medicine: transitional care medicine. The case reviews of two of these patients are described. Patient 1 was a 23-year-old man with hereditary pancreatitis. His genetic condition resulted in the need for pancreatic splenectomy and removal of part of his small bowel, resulting in insulin-dependent diabetes and malnutrition. These complex clinical issues and the challenges of chronic pain were further complicated by severe anxiety disorder and substance abuse. He presented to the University of Rochester Medical Center's Complex Care Center (CCC), an interdisciplinary clinic that provides care for adults with pediatric onset conditions, staffed with both dentists and physicians, with acute pain from a grossly decayed premolar tooth. His blood glucose measured > 500 mg/dL and he was experiencing an acute episode of anxiety. With the expertise and experience of center staff his care needs could be met. Patient 2 was a 32-year-old woman with chronic juvenile rheumatoid arthritis, drug-associated lupus, and mental health problems including depression. This condition requires her to be managed with broad spectrum immunosuppression to prevent joint inflammation that results in significant joint destruction and bone loss. She presented to the CCC with an abscessed molar tooth, which prevented her from receiving her required immunotherapy, IV tocilizamab. While monitored by on-site physicians, a center dentist could safely proceed with the extraction. These cases illustrate that, as the population of transitional care patients grows, general dentists can learn to work on-site with physicians and allied health per-sonnel to meet the need. Keywords: case report/series, complex diseases, interdisciplinary team, special health care needs, transitional care