Quintessence International, 03/2004

The occurrence of dental traumas in adult patients is on the rise, according to the literature, and require correct and adequate treatment specific to each fracture in order to preserve the remaining tooth. In this article, two different fracture cases are reported. Based upon these cases, it may be concluded that there are situations that require the clinician to have a multidisciplinary vision of the different dental specializations in order to effectively treat the patient.

The esthetic demands of patients have increased considerably during recent years. Due to this increasing interest in esthetics, as well as concerns about toxic and allergic reactions, the use of all-ceramic restorations has increased. One of the systems introduced for all-ceramic restorations is the IPS Empress system. This article examines one all-ceramic restoration system, IPS Empress, and presents patient cases in which all-ceramic crowns and fixed partial dentures have been utilized.

Objective: Restorative materials that possess antibacterial properties are considered advantageous. The aim of this study was to test the antibacterial properties of packable resin composite materials using a direct contact test (DCT) and an agar diffusion test (ADT). Methods and materials: Quadruple samples of SureFil, Alert, P-60, Synergy Compact, Pyramid, and Solitair were placed on the sidewalls of wells in a 96-microtiter plate, and polymerized. A suspension of 10-µL growth medium containing ca. 1 × 10⁶ viable mutans streptococci cells were placed on the surface of each sample for 1 hour at 37°C. Fresh medium was then added to each well, and the microtiter plates were placed in a temperature-controlled spectrophotometer which also served as an incubator. Bacterial growth was followed by recording the changes in optical density every 30 minutes for 16 hours. The ADT was performed by placing samples in punched wells of inoculated agar plates, and measurement of the inhibition zone was performed after 72 hours. Results: In both tests, none of the materials inhibited growth of S mutans. In the DCT, three materials enhanced bacterial growth. Composite samples, aged in phosphate buffered saline for 7 and 30 days, showed no differences when on tested material and controls. Conclusions: Packable composite materials revealed no antibacterial properties. Furthermore, freshly polymerized composites supported bacterial growth.

Objectives: To see if dentures contaminated with Staphylococcus aureus, Pseudomas aeruginosa, Bacillus cereus, Candida albicans, and herpes simplex virus 1 could be effectively decontaminated by using Medical Tabs for Dentures. Method and materials: Ten methylmethacrylate dentures with processed soft liners (soft-liner dentures) and 10 methylmethacrylate dentures without processed soft liners (hard dentures) were aseptically fragmented and individually incubated with a target microorganism. Test denture fragments were immersed in Medical for 5 minutes, vortexed for 5 minutes, and serially diluted onto media. The control denture fragments were similarly treated in sterile water. For virus contamination, denture fragments were contaminated with 1.2 × 10⁹ tissue culture infective dose (TCID)₅₀/mL. They were treated with either Medical for 5 minutes (test fragments) or water (controls) for 5 minutes. Serial dilutions were performed and viral (TCID)₅₀/mL titers were calculated using the Reed-Muench method. Results: Medical treatments effectively eliminated C albicans, S aureus, and P aeruginosa from soft-liner dentures. Treatment of hard dentures eradicated C albicans and reduced the numbers of S aureus and P aeruginosa to < 10. B cereus showed a reduction of 10 microorganisms in hard dentures while the soft-liner dentures did not show an appreciable reduction. Viral analyses found that both types of dentures retained large amounts of virus when washed with water, but no virus was recovered from any of the 40 samples treated with Medical. Conclusion: A single use of Medical Tabs for Dentures is effective in eliminating certain species of microorganisms, including selected viruses, in vitro.

Objective: The aim of this study was to evaluate the progress of dentin caries under resin composite and glass-ionomer cement restorations in vivo. Method and materials: Sixteen rats were subjected to oral inoculation of the bacterial strain, Streptococcus mutans, and experimental dental caries was induced in the rats' molars. The dental caries induced in rat molars was sealed with resin composite or glass-ionomer cement without removal of the caries; the depth and width of bacterial penetration in the lesion were measured from histopathologically stained sections. Inflammatory cell infiltrations within the pulp were also examined. Results: Both bacterial penetration into dentin and caries spread were significantly reduced by sealing with glass-ionomer cement or resin composite. No significant differences in bacterial penetration and caries spread were seen between the sealing materials. Regarding the pulpal reactions, moderate to severe inflammatory cell infiltration was observed even in the sealed teeth. Conclusion: The caries lesions could not be completely arrested by sealing alone, although their progress was slowed from an active to a chronic status.

A dental patient with post-traumatic stress disorder (PTSD) may present with greater dental and behavioral challenges than most dental patients. The background review of PTSD's initiating factors, diagnostic criteria, and medical management should help practitioners better understand and manage these challenges. Many of the challenges the clinician may encounter and managing recommendations are described. A case report of a PTSD patient complaining of constant bilateral tooth pain of the maxillary and mandibular bicuspids and molars is presented. Recommended techniques for identifying the tooth pain source and contributing factors are provided. The primary contributing factor for the patient's tooth pain was determined to be his severe tooth clenching activity. A maxillary acrylic appliance provided some pain reduction and a subsequent mandibular soft occlusal appliance worn opposing the maxillary appliance provided additional relief.

The aim of this systematic review of population-based studies was to establish whether or not associations exist between different types of malocclusions, as well as factors of functional occlusion (eg, occlusal interferences, nonworking-side occlusal contacts) and temporomandibular disorders (TMD) in adults 20 years or older. Defined criteria were employed in the search of MEDLINE and EMBASE databases, as well as in a manual search. Finally, using inclusion criteria (eg, random sampling from residents' registration office files or census lists, adequate response rates), out of 22 preselected studies, four relevant population-based studies on this subject were found. Eighteen studies were excluded because of insufficient description of material and methods (eg, lack or unclear description of sample method, randomization, age distribution), mixed under- and over-20-year-old study population, or different outcome of interest (eg, tooth loss, dentures). The methodologic quality of the selected studies was established with a quality assessment list. The average total methodologic score achieved was 43 out of a possible 100 points. Few associations were reported between malocclusion and parameters of functional occlusion and clinical as well as subjective TMD, and these associations were not uniform. No particular morphologic or functional occlusal factor became apparent. Additionally, the occlusal factors found were partly protective for TMD, ie, subjects with these occlusal parameters showed fewer signs and symptoms of TMD (angle Class II malocclusion, deep bite, anterior crossbite). A positive relationship was only described in two cases-between the number of rotated lateral teeth and subjective symptoms of dysfunction, and between excessive abrasions and clinical dysfunction. In neither case, however, was the strength of the correlation given. In summary, few associations were established between malocclusion or functional occlusion and signs and symptoms of TMD. In view of the small number of randomized studies and their methodologic quality, these results should be verified through further valid representative studies.

Recurrent aphthous stomatitis (RAS) and oral lichen planus (OLP), two of the most common stress-related ulcerations of the oral mucosa, have distinct etiologies, courses, and histopathologic features. In light of increased understanding of the psychobiology of stress, the authors propose that RAS and OLP fundamentally differ from the perspective of the psychobiologic response to stress. This article presents possible clinical implications.

Osteosarcoma of the jawbones is a rare malignant mesenchymal neoplasm with the tendency for new bone being directly formed by the tumor cells. Clinically, the tumor may be central or peripheral-periosteal-and histologically can be divided into three subtypes: osteoblastic, fibroblastic, and chondroblastic. This report presents a case of a central osteoblastic osteosarcoma of the left maxillary tuberosity and maxillary sinus. Problems related to definitive diagnosis and therapy are described and discussed.

This study was designed to determine whether solvent-preserved dura mater and fascia lata grafts would be as effective as palatal mucosal grafts for vestibuloplasty. All graft systems succeeded in covering the alveolar ridge with firmly attached tissue, which is needed to ensure prosthetic stability. There was no remarkable reduction in area until the stents were removed. However, after 6 months of vestibuloplasty, there was a significant reduction in gained vestibular area in the fascia lata group, whereas no significant difference between dura mater and palatal grafts was observed. These findings suggest that dura mater could serve as a biologic oral dressing for mucosal defects as effectively as palatal grafts in vestibuloplasty.

Objective: This report evaluates the use of pedicled buccal fat pad for closure of oroantral communications. Method and materials: Seventy-five patients were treated with pedicled buccal fat pad. Fifty-two were treated immediately after tooth extractions. The remaining 23 had chronic oroantral communication and were treated similarly after irrigation of the maxillary sinus with saline for 7 days. Results: The 6-month follow-up revealed uneventful healing in all of the patients. Though partial necrosis of the flap was observed in three patients, this did not effect the final healing. Total necrosis of the flap was not noted. Conclusion: The use of pedicled buccal fat pad is an acceptable and reliable alternative in acute or chronic oroantral communications management and may even be used as a first treatment choice by experienced surgeons.