Quintessence International, 06/2000

Intrusion injuries of the primary dentition are highly associated with developmental disturbances of their successor teeth. The age of the child at the time of injury, the direction and severity of the intrusion, and the presence of alveolar bone fracture are important variables influencing the effect of primary tooth intrusion on the developing permanent germ. The developmental defects of the permanent successor tooth range from mild alteration in enamel mineralization to severe sequestration of the developing germ. This article will review the developmental anomalies of the permanent incisors induced by intrusion injuries of their predecessors.

Trauma to anterior teeth is relatively common among children and teenagers; it has been estimated that approximately one quarter of the population under the age of 18 years sustain traumatic injury in the form of anterior crown fracture. Reattachment of a fractured fragment to the remaining tooth can provide esthetically pleasing results provided that the fragment is available. In this report, a systematic clinical approach through evaluation of periodontal, endodontic, coronal, and occlusal aspects is presented to help dentists analyze the factors affecting selection of techniques and materials. In addition, use of adhesive materials for tooth fragment reattachment is illustrated. Modifications of the reattachment process, including placement of veneer and radicular post, are also discussed.

The 'modified' indirect working die technique is introduced. The technique expands the capabilities of the indirect working die technique, which features flexible removable dies for fabricating provisional restorations. The modified technique is distinguished by its potential for restoring multiple teeth, up to and including the complete arch, by utilizing a complete-arch impression tray to which a simple modification is made. It is an accurate, timesaving, and laborsaving method for fabricating provisional restorations.

The treatment of patients with severe forms of amelogenesis imperfecta presents an interesting challenge to the dental team. A 16-year-old girl presented with a severely compromised occlusion and poor esthetics that had lowered her self-esteem. Preoperative investigations included the determination of completion of growth, an accurate diagnostic waxup, and an evaluation of clinical crown lengths. Periodontal full-flap surgery was planned to lengthen clinical crowns and create gingival harmony. This was to be followed by placement of 28 complete crowns to restore occlusal function and gain a pleasing esthetic result. All-porcelain crowns were placed from premolar to premolar in each arch (20 crowns), and porcelain-fused-to-metal crowns were placed on each molar tooth in each arch (8 crowns). The final treatment result provided this patient with a mutually protective occlusion and with esthetics that greatly enhanced her self-image.

A 16-year-old girl had a history of unilateral ankylosis of the temporomandibular joint, which was reconstructed with an autogenous costochondral graft. About 2.5 years after surgery, the patient presented with overgrowth of the costochondral graft, resulting in deviation of the jaw toward the unaffected side.

Objective: The main objective of this study was to investigate the frequency of oral manifestations in children with acquired immunodeficiency syndrome. It also attempted to correlate the presence of lesions with the patient's degree of immunosuppression, as measured by the T4/T8 ratio. Method and materials: Oral examinations were performed in 51 children with acquired immunodeficiency syndrome for a 2-year period. A questionnaire used in this investigation was based on the children's classification proposed by the Centers for Disease Control in 1987. The children's T4/T8 ratios were obtained from their medical files. Results: Pseudomembranous candidiasis was the most common lesion, found in 21.57% of the children. Salivary gland disease was present in 19.61% of patients. Erythematous candidiasis was observed in 5.88%, and linear gingival erythema and oral hairy leukoplakia were both observed in 1.96% of children. Children with a T4/T8 ratio < 0.5 were more prone to development of pseudomembranous candidiasis. Conclusion: Pseudomembranous candidiasis was the most common type of oral lesion in human immunodeficiency virus-positive children with acquired immunodeficiency syndrome. There was a relationship between the frequency of oral manifestations and the patient's T4/T8 ratio.

Objective: The goal of this investigation was to assess in vitro the quality of marginal sealing of composite-dentin adhesive systems and human dentin. Method and materials: Forty intact human premolars and third molars were extracted from subjects of both sexes and of different ages. After the enamel layer was removed, a Class V cavity was formed on the buccal surface, and a wedge cavity was formed on the lingual surface. These were restored with resin composite materials and their corresponding dentin adhesive systems. The quality of marginal sealing was evaluated by assessing the linear penetration of silver nitrate dye. Results: The best marginal sealing between composite materials and the cavity walls, in both wedge erosions and Class V cavities, was provided by Scotchbond Multi-Purpose/Valux and Syntac/Helioprogres systems. Dye penetration was slightly greater with the XR-Bond/Herculite, Gluma/Pekafill, and Superlux Universal Bond 2/Superlux Solar systems. The greatest microleakage was observed in Tripton/Opalux and Denthesive/Charisma specimens. Conclusion: The use of an adhesive system and the corresponding resin composite does not eliminate microleakage completely when the cavity margins are in dentin.

Objective: The purpose of this investigation was to evaluate microleakage in Class II cavities restored with the condensable resin composite SureFil, placed with or without a liner and 1 of 2 different dentin bonding agents. Method and materials: Extracted noncarious human teeth were randomly divided into 4 groups of 15 each and restored according to manufacturer's instructions: group 1, SureFil and Prime & Bond NT; group 2, SureFil and PQ1; group 3, SureFil, PermaFlow, and PQ1; group 4, Heliomolar and Syntac Single-Component (control). Specimens were stored in 37°C water for 24 hours. All specimens were thermocycled between 5°C and 55°C for 500 cycles. Each specimen was immersed in 0.2% basic fuchsin dye for 24 hours and then sectioned longitudinally and horizontally. Dye penetration at enamel and cementum margins were viewed at 330 magnification by 2 independent, calibrated evaluators. Specimens exhibiting dye penetration = 0.1 mm beyond the cavosurface margin were considered to have leakage. Results: Chi-square tests revealed no statistically significant differences in the presence of microleakage when all groups were analyzed together. However, 2 by 2 comparisons revealed that group 3 had significantly fewer specimens with microleakage than did groups 1, 2, or 4. Conclusion: To limit microleakage, a flowable composite should be used as a liner when a condensable composite material is used.