Quintessence International, 04/2007

Objectives: To evaluate the stability of 18 immediately loaded Brånemark System dental implants in an insulin-controlled, diabetic, 71-year-old patient over the first 30 months after surgery, and to correlate this data with implant stability in healthy patients. Method and Materials: Stability measurements were taken using resonance frequency analysis on all implants at surgery placement and at 5 postsurgical examinations (1, 2, 3, 6, and 30 months). Results: All 18 implants remained in function after 2.5 years of follow-up. The mean stability of the implants decreased 12.7% during the first 30 days, a value twice as much as seen in the general population. After the first 30 days, the stability of the implants increased slightly over the next 60 days. After 30 months of follow-up, the mean implant stability continued to increase, however, not to a value equal to that of the initial measurement taken at the time of implant placement. Conclusion: Despite the metabolic differences seen in diabetic patients, an immediate loading protocol can be successful and result in osseointegration. Keywords: bone-implant interface, diabetes, immediate loading, implant stability, resonance frequency analysis, Teeth in a Day

Objective: To perform a retrospective study on immediately loaded implants supporting mandibular overdentures. Method and Materials: From the period between July 1996 and October 2004, 50 patients were selected in whom 200 implants had been inserted (4 implants per patient) in the interforaminal area, rigidly connected with a U-shaped bar, and then loaded with a mandibular overdenture. Implant diameter and length ranged from 3.4 to 5.5 mm and from 10.0 to 18.0 mm, respectively. Sixty implants were placed after extraction, and bone quality was D1 in 22 cases and D2 in 178 cases. Because no implants were lost (ie, survival rate, 100%) and no statistical differences were detected among the studied variables, no or reduced crestal bone resorption was considered as an indicator of success rate to evaluate the effect of several host-, surgery-, and implant-related factors. A general linear model was then performed to detect those variables statistically associated with crestal bone resorption. Results: No implants were lost (ie, survival rate, 100%) after a mean postloading follow-up of 43 months, and thus no differences were detected among the studied variables. On the contrary, the general linear model showed that longer (ie, length > 13.0 mm) and wider (ie, diameter > 3.75 mm) implants and implant type (Frialoc and XiVE TG) are correlated with a lower crestal bone resorption and thus a better outcome. Conclusion: Immediate loading of implants retaining a mandibular overdenture is a reproducible, predictable, and reliable method to deliver efficient return of function for totally edentulous patients. Keywords: general linear model, immediate loading, implants, overdenture

A case of acinic cell adenocarcinoma of the left facial area of 10-years' duration in a 29-year-old man is presented. The patient reported surgical resection of a nodular lesion in the left buccal mucosa 8 years earlier in another hospital. Since then, the lesion recurred 3 times within 2 years. The first lesion and 2 recurrent ones were surgically removed. With the third recurrent lesion, the patient did not return promptly for treatment and was directed to our clinic after 6 years. The clinical, tomographic, immunohistochemical, and therapeutic aspects are analyzed. Keywords: acinic cell carcinoma, cytokeratin, immunohistochemistry, Ki-67, salivary gland neoplasm, vimentin

Objective: To evaluate the efficacy and tolerance of azithromycin in the prevention of post-extraction alveolar osteitis (dry socket) in women according to their use of tobacco and oral contraceptives. Method and Materials: A clinical trial was conducted in 400 women who underwent tooth extraction, stratified into 4 risk groups according to their use of tobacco (yes/no) and oral contraceptives (yes/no). Each stratum (n = 100) was randomly divided into 2 groups: a study group that received azithromycin 500 mg once daily for 3 days after extraction and a control group that received physiologic saline 3 times daily from 24 hours after extraction for 7 days. Results: Azithromycin was significantly superior to conventional postextraction treatment with physiologic saline. There were no significant interactions with the use of either tobacco or oral contraceptives, and these variables had no confounding effects. Conclusion: Azithromycin is a safe and efficacious treatment for the prevention of dry socket in women. Keywords: alveolar osteitis, azithromycin, dry socket, orofacial pain, third molar extraction

Objective: To analyze sodium, potassium, calcium, phosphorus, and magnesium concentrations in whole saliva of adolescents with cerebral palsy (CP) and compare them with those of normal individuals. Method and Materials: Thirty-six adolescents with CP aged 12.0 ± 1.8 years were compared with 36 healthy age-matched individuals. Saliva was collected under slight suction. Electrolyte concentrations were determined by inductively coupled argon plasma with atomic emission spectrometry. Results: Significant differences were observed with matched and unmatched flow rates. Sodium concentrations were significantly decreased, whereas potassium levels were significantly increased in the CP group. No statistically significant differences were observed regarding phosphorus, magnesium, and calcium concentrations between adolescents with CP and controls. Conclusion: Our results suggest that there is an alteration in the sodium and potassium concentration in whole saliva of individuals with CP. Keywords: adolescent, cerebral palsy, electrolyte, flow rate, potassium, saliva, sodium

Squamous cell papilloma is a benign proliferation of the stratified squamous epithelium. It is typically an exophytic lesion smaller than 1 cm. Its appearance varies from cauliflowerlike to fingerlike, while the base may be pedunculated or sessile. This article describes the case of an 11-year-old girl who presented with an asymptomatic whitish lesion of papillomatous appearance in the oral mucosa distal to the maxillary left permanent first molar. The lesion was removed using an Er,Cr:YSGG laser. For anesthesia, 10 mg of 2% lidocaine with epinephrine 1:100,000 was infiltrated around the lesion. No pain medication was required after surgery, and wound healing was excellent and rapidly achieved. The oral pathology report confirmed the presurgical clinical diagnosis. Laser dentistry is a modern technology that can be used by dental clinicians to treat these kinds of oral lesions and should be considered as an alternative to conventional surgery. Keywords: laser dentistry, laser technology, modern dentistry, oral papilloma, pediatric dentistry, squamous cell papilloma

Objective: To evaluate a remineralizing fluid for its influence on in vitro caries formation and progression. Method and Materials: Caries-free teeth (n = 12) were sectioned into 3 segments. Each segment was assigned to a treatment group: (1) remineralizing fluid for 2 minutes; (2) 1.23% acidulated phosphate fluoride (APF) gel for 1 minute; (3) no-treatment control. Following treatment, the tooth segments were rinsed in distilled/deionized water and exposed to synthetic saliva for 24 hours. In vitro caries were formed and longitudinal sections obtained. The tooth segments were treated again and rinsed as above, before undergoing in vitro caries progression. Longitudinal sections were evaluated for lesion depth (ANOVA, Duncan multiple range analysis). Results: Following lesion formation, mean lesion depths were 173 ± 19 µm for no-treatment control; 97 ± 11 µm for APF gel; and 52 ± 12 µm for remineralizing fluid. After lesion progression, mean lesion depths were 236 ± 23 µm for no-treatment control; 184 ± 26 µm for APF gel; and 112 ± 17 µm for remineralizing fluid. Mean lesion depths for the remineralizing fluid and APF gel groups for the lesion formation and progression periods were significantly less than those for the control group (P < .05). After lesion formation and progression, the APF group had significantly greater mean lesion depths than did the remineralizing fluid group (P < .05). Conclusions: A remineralizing fluid containing calcium, phosphate, and fluoride in a carbopol base enhanced resistance against in vitro caries formation and progression when compared with APF treatment. Keywords: APF, calcifying fluids, caries, demineralization, enamel, fluoride, remineralization

Intrinsic and extrinsic physiological stressors (physical, metabolic, or psychological) are constantly challenging the body's homeostatic mechanisms. Regardless of their nature, the body will initiate a series of autonomic responses in an effort to maintain homeostasis. For example, to cope with a perceived threat, cardiac output and respiration are increased, the availability of glucose is increased, and blood flow to the heart, brain, and muscles is increased. Conversely, once the threat subsides, conter-regulatory mechanisms act to down-regulate these responses. The adaptive stress response is essential for a patient's well-being. An altered adaptive stress response may lead to illness, and, at times, even to death. Oral healthcare providers must develop preventive and therapeutic strategies compatible with the functional capacity of a patient's adaptive stress response. Keywords: adrenal dysfunction, dental management, addisonian crisis

Objectives: To compare the Ca2+ loss of enamel treated with 38% hydrogen peroxide (HP), 35% HP with light, and 10% carbamide peroxide (CP). Method and Materials: Ten extracted premolars were sectioned buccolingually and longitudinally so that 4 specimens were obtained from each tooth. The specimens were randomly assigned to 1 of 4 groups to receive the following bleaching agents: 38% HP, 35% HP with light, 10% CP, and no agent (control). The specimens were treated with an artificial caries solution (pH 4) for 16 days; the solution was replaced on days 4, 8, 12, and 16. Calcium concentration was determined by an atomic absorption spectrophotometer. Repeated measures ANOVA was performed on concentrations on days 4, 8, 12, and 16. Results: At the end of day 16, calcium ions released per square millimeter were calculated cumulatively as follows: 38% HP group: 27.52 ± 5.22 µg/mL; 35% HP with light group: 25.15 ± 4.99 µg/mL; 10% CP group: 19.53 ± 4.03 µg/mL; control group: 18.35 ± 4.00 µg/mL. The differences between the control group and the 35% HP with light group and between the control group and 38% HP group were statistically significant. Although demineralization differences were observed between the control group and the 10% CP group, this difference was not significant. Conclusions: It can be concluded that 35% HP with light and 38% HP may cause significantly more loss of Ca2+ from the enamel surfaces than 10% CP. Also, 10% CP does not vary significantly from the control. Keywords: carbamide peroxide, demineralization, enamel, hydrogen peroxide, tooth bleaching

Mesenchymal chondrosarcoma (MCS) is a rare malignant neoplasm of bone or soft tissue origin, locally aggressive, rare in the oral cavity, of which fewer than 100 cases have been reported in the English literature. This is the first case described of this type of tumor affecting the coronoid process. The report describes a unique case of MCS in a 64-year-old woman who presented with swelling and pain at the left preauricular area just anterior to the left tragus. An orthopantomograph showed a large mass in the temporomandibular joint involving the left coronoid process and extending to the left ramus of the mandible. Biopsy and histopathologic examination revealed a biphasic pattern, composed of an undifferentiated small round-cell component surrounding a myxoid of malignant cartilage; a focally pericytic vascular pattern resembling hemangiopericytoma was observed. Immunohistochemical studies were positive for CD99, S-100, and CD45 and negative for desmin, actin, chromogranin, epithelial membrane antigen (EMA), and cytokeratin. The tumor was treated by extensive hemimandibulectomy followed by reconstruction of the area. There was no evidence of disease at the 8-year follow-up. Previously reported cases are reviewed as well. Keywords: chondrosarcoma tumor, jaw, mandible, mesenchymal tumor

Object: The aim of this study was to report the reasons for placement and replacement of direct restorations in private general dental practices in Brazil. Method and Materials: Thirty-seven practitioners recorded information regarding 16 consecutive direct restorations placed by themselves in a 4-week period. The information recorded reported the patient's age, gender, tooth number, the class of restorations, the restorative material used, and the reasons for placement and replacement of amalgam and tooth-colored restorations. The data were statistically analyzed through chi-square tests. Results: The average age of the patients was 37 years, with female patients occurring more frequently. Of all the restorations placed (n = 551), 39.75% were first-time placements, while 60.25% were replacements. For first-time restorations, the primary reason for placement was primary caries, followed by noncarious tooth substance loss. For amalgam restorations, the main reason for replacement was to obtain improved esthetic appearance with a tooth-colored material. For restorations of resin composite, secondary caries was the principal reason of failure. The resin composite was statistically (P < .01) the most indicated material (88.93%) for the placement and replacement of restorations. Conclusion: Replacements have been the main reason for performing direct restorations, and the chosen restoration material was resin composite. Keywords: amalgam, primary caries, replacement, resin composite, restoration, restorative material, secondary caries

Objective: To produce and test a prototype carrier for the Thermafil obturation system. Method and Materials: A prototype carrier was created in a new plastic material (Delrin) with a new profile design made up of 15 intersecting cones of decreasing diameter and a 0.06 taper. Thirty extracted premolar teeth were root filled, 15 with obturators with the prototype carriers and 15 with the traditional Thermafil obturators. The samples were made transparent and examined with an optical microscope equipped with a millimeter scale in order to observe the aspect of gutta-percha stripping from the carrier and evaluate its degree by measuring the length of carrier deprived of gutta-percha on the buccal, mesial, distal, and lingual root surface. The analysis of variance (ANOVA) test was carried out for statistical analysis. Results: The prototype carriers made contact with the dentinal walls (mean length of stripping: 5.80 mm for size 25, 3.42 for 30, and 1.40 for 35) but less than the traditional Thermafil obturators (mean length of stripping: 6.68 mm for size 25, 7.98 for 30, and 6.86 for 35). The ANOVA test revealed no statistically significant difference between groups for P < .01. The prototype carriers contacted the walls in short horizontal band-shaped areas around the circumference, while the Thermafil obturators had contact in long vertical strip-shaped areas. Conclusion: The prototype carrier, contacting the dentinal walls in short areas all around the circumference, allows the centering of the obturator into the root canal. Keywords: endodontics, gutta-percha, pulp canal, root canal filling materials, root canal sealants, Thermafil

Conservative techniques for treatment of discolored human enamel include in-office bleaching with heat-activated 35% hydrogen peroxide, Nightguard vital bleaching with 10% carbamide peroxide, and enamel microabrasion with 18% hydrochloric acid. Objectives: In this study, these bleaching techniques were performed on 30 extracted teeth to evaluate their effects on microhardness of enamel surfaces. Methods: The enamel surface microhardness measurements were performed 0, 24, 48, and 72 hours and 1 week after treatment. Paired t tests were performed in the statistical analyses. Results: No changes were found on specimens treated with carbamide peroxide. There was a significant decrease in the surface microhardness of enamel after 0 and 24 hours when the specimens were treated with 18% hydrochloric acid (softening 85.7 and rehardening 99.4) or with 35% hydrogen peroxide (softening 85.7). However, after 72 hours, significant rehardening was observed in these groups (P < .001). Conclusion: According to the results, except Nightguard vital bleaching, all other techniques softened the enamel surface. Keywords: controlled microabrasion, enamel, microhardness, Nightguard vital bleaching, office bleaching

Objective: Currently, the trend in dentin adhesion seems to be shifting from moist bonding systems to self-etching systems and from several application steps to single steps. However, recent studies have indicated that the performance of single-step adhesives was lower than the 2-step self-etch or total etch systems. In the present study, microtensile bond strength of a total etch, 2-step self-etch and single-step self-etch adhesives was comparatively evaluated. Method and Materials: The superficial occlusal dentin of 12 noncarious extracted human molars was exposed, finished with wet 600-grit silicon carbide paper, and a block of resin composite bonded with adhesives according to the manufacturers' instructions. The teeth were kept in tap water for 24 hours at 37°C and sectioned to produce beams, with adhesive areas of ± 0.9 mm2 (4 beams per tooth were obtained). The specimens were stressed at a crosshead speed of 1 mm per minute until the bonds ruptured. Results: The mean bond strengths were calculated as MPa and compared by performing analysis of variance and Tukey tests to identify significant differences between the materials (P = 0.05). The mean bond strength of Clearfil SE Bond was significantly higher than that of OptiBond Solo Plus and iBond (P < .05). OptiBond Solo Plus gave significantly higher bond strengths than iBond (P < .05). Conclusions: The self-etching adhesive system Clearfil SE Bond (2 step) had higher bond strength than the 1-bottle self-etching adhesive iBond (single application) and the 2-step single-bottle system OptiBond Solo Plus (total etch). However, the 1-bottle adhesive system OptiBond Solo Plus (total etch system) had higher bond strength than the 1-bottle self-etching adhesive system iBond. Keywords: acid etching, dentin, dentin adhesive, failure mode, layer, microtensile bond strength

Objective: The purpose of this study was to evaluate the diagnostic utility of the Clinpro Cario-L-Pop test as it relates to dental caries rates and severity in infants and children. Method and Materials: The study population was comprised of 771 infants and children who were on average 5.2 years of age (range of 1.5 to 8 years of age). Examiners conducted dental caries clinical examination using established criteria. In addition, lesion severity was determined be measuring its depth. An indicator swab was applied to the tongue dorsum until completely moistened with saliva. The indicator swab was processed according to the manufacturer's instructions, and acid production was assessed with the aid of a color chart. Results: Twenty-three percent of children were caries free, and 7% (n = 50) of participants were categorized as having low production of lactic acid (scores 1 to 3), 17% (n = 135) moderate production of lactic acid (scores 4 to 6), and 76% (n = 586) high production of lactic acid (scores 7 to 9). There was a tendency for moderate and high lactic acid formers to exhibit higher surface-based caries prevalence rates, higher rates for deep dentinal lesions, and increased lesion severity. There was a linear increase of white spot surface-based lesions from low to high lactic acid formers and for initial dentinal lesions. Clinpro Cario-L-Pop test results, when controlling for age and gender, significantly distinguished caries-free participants from those exhibiting any form of decay. Conclusion: These results suggest that Clinpro Cario-L-Pop test was useful in explaining elevated frequency and severity of dental caries in spite of the high levels of decay and of microbial acid production observed in this population. Keywords: children, dental caries, infants, lesion severity, microbial acid production

This case report describes the nonsurgical creation of an interdental papilla in orthodontic therapy of a patient with severe periodontal disease. A large diastema between the maxillary incisors was closed completely, and the lost interdental papilla was re-created by orthodontic therapy after nonsurgical periodontal therapy. Radiographs showed improvement of the bone defect. Periodontal/orthodontic soft tissue manipulation is a nonsurgical technique that can lead to reformation of the interdental papilla, provided that periodontal health is maintained. Keywords: children, dental caries, infants, lesion severity, microbial acid production