Quintessence International, 02/2011

This article describes the high esthetic value of a single-tooth implant immediately placed in the anterior region using a flapless approach and a custom-made zirconia-ceramic abutment and crown. The case reported illustrates the practical procedure involved in developing natural esthetics with a custom-made zirconia-ceramic prosthesis and abutment. The technique is relatively simple, can be used in a variety of clinical situations, and provides excellent results from an esthetic point of view, which is demonstrated by the results of pink esthetic scores (PES) (9 ± 0.2) and white esthetic scores (WES) (7 ± 0.5) after 4 years. Keywords: esthetics, implant, implant-prosthetic dentistry, treatment planning, zirconia abutment

Failure to tend to inadequate crown contours in the crown trial can cause long-term disharmony of the free gingival form. This case report describes a novel technique for free gingival impression from a final provisional restoration to a zirconia crown. Two die casts were manufactured from a silicone impression. The first die cast was for the zirconia crown; the second die cast was for the final provisional restoration and the provisionalized transfer coping. A free gingival impression was taken using a provisionalized transfer coping, and a soft gingival model was manufactured. The proximal contact position was managed using the predicted convex curve of the interdental papillae. One year after zirconia crown placement, no inflammation was observed around the pyramidal interdental papillae, and symmetric interdental papilla heights were evident. A free gingival impression using a two die-cast technique appears to be useful for achieving optimal interdental papilla height. Keywords: free gingival impression, provisional transfer coping, proximal position, 3D setting

The rehabilitation of prosthetic spaces resulting from severe periodontitis represents a challenge in terms of functional and esthetic aspects. Generally, tooth extraction is followed by alveolar ridge volume reduction, which increases the esthetic problem. The aim of this article is to report the integration of esthetics and functional parameters in the oral rehabilitation of extracted periodontally compromised mandibular central incisors through the construction of a direct glass fiber-reinforced composite fixed partial denture (DFPD). After periodontal therapy, the patient received a periodontal subepithelial graft, enabling an increase in the thickness and height of the alveolar ridge. The DFPD was fabricated with the use of extracted teeth. Mandibular canines and lateral incisors received cavities 2 mm deep and wide. After fiber insertion, tooth adaptation, and composite resin coverage, the teeth were finished and polished. Results showed an excellent esthetic result with stabilization and function of the remaining periodontally affected teeth. Keywords: adhesion, fiber-reinforced composite fixed partial dentures, rehabilitation, subepithelial tissue graft, tooth splinting

Acellular dermal matrix grafts have become a good alternative to autogenous soft tissue grafts in root coverage. Until now, the literature has reported short- or medium-term data regarding the stability of the gingival margin after the use of acellular dermal matrix on root coverage. The aim of this article is to describe a case report with 10 years of evolution with creeping attachment that developed bucally on a moderate recession of a maxillary canine with an old composite restoration subsequent to an acellular dermal matrix. Long-term creeping attachment and complete root coverage on a restored tooth treated with acellular dermal matrix has not been previously reported in the dental literature. Keywords: acellular dermal matrix, creeping attachment, root coverage

Objectives: Oral lesions secondary to chronic renal failure or related to immunosuppressive therapy after transplant are reported in the literature, but their prevalence is still obscure. The aim of this study was to investigate oral clinical findings in patients undergoing renal dialysis and renal transplant recipients. Method and Materials: Forty-six patients treated with dialysis (DL), 33 kidney-transplant (KT) patients, and 37 control (C) patients were examined intraorally. Oral clinical findings were diagnosed and treated. Results: The results showed that 95.6% (44/46) of the DL group, 93.9% (31/33) of KT patients, and 56.7% (21/37) of the control group presented at least one pathological entity in the oral mucosa. A high prevalence of oral lesions, such as saburral tongue and xerostomia, was found in the DL and KT groups. Certain oral lesions demonstrated a predisposition toward one type of group, such as a higher prevalence of metallic taste in the DL group and gingival overgrowth in the KT group. Conclusion: The prevalence of oral lesions was significantly higher in renal patients (DL and KT groups). The most prevalent oral clinical findings were saburral tongue and xerostomia for both groups. Metallic taste was more prevalent in the DL group. Although geographic tongue was more frequent in KT patients and melanin pigmentation in the control group, the number of lesions was low for all groups. In addition, gingival overgrowth was more prevalent in the KT group; however, the difference was not significant (P = .06). Keywords: cyclosporine, dialysis, immunossuppressor drugs, kidney transplant, oral lesions, prevalence

Objective: To evaluate the effects of materials and finishing procedures on the surface roughness of infiltrated subsurface bovine enamel lesions. Method and Materials: Eighty enamel specimens were prepared from 80 bovine incisors and partially varnished (control). The nonvarnished areas were demineralized (pH 4.95, 28 days) and etched with phosphoric acid gel (20%, 5 seconds). Specimens were randomly divided into two groups, which were each split into four subgroups (each n = 10): E1/E2 (Excite, Ivoclar Vivadent), F1/F2 (Fortify, Bisco), G1/G2 (Glaze & Bond, DMG), and I1/I2 (Icon, DMG). In group 1, resin materials were polymerized and polished using finishing strips by means of a polishing device; in group 2, excess material was removed with a rubber cup before polymerization (without polishing). The surface roughness (Sa) of control, demineralized, and treated surfaces were evaluated topometrically using a focus variation 3D scanning microscope. Results: Demineralized surfaces were significantly rougher than sound enamel (P < .0005, t test). Etching increased Sa significantly to more than 450% of demineralization values (P < .0005). Surfaces of nonpolished infiltrated lesions were significantly rougher than demineralized enamel (P < .0005), while no significant differences could be found among infiltrated subgroups (P = .067), nor between polished and nonpolished groups (P = .359). Application of Glaze & Bond (G2) appeared to reduce Sa values of etched lesions (P < .0005), while with all other subgroups Sa values improved only marginally. Conclusion: Regarding surface roughness, the use of finishing strips after infiltration of subsurface lesions does not seem to be advantageous. Excess material should be removed before light curing, but surface quality of nonprocessed infiltrants seems to be perfectible. Keywords: bovine enamel, caries infiltration, focus variation, initial caries, minimum intervention dentistry, polishing procedures, resin infiltration, surface metrology, surface roughness

Since more than 50 million people in the United States have allergies, knowledge of the management of allergic reactions in the dental office is extremely important. Appropriate care may range from a simple referral to a primary care physician to lifesaving measures implemented during acute anaphylactic reactions. The authors present a basic review of the pathophysiology of allergic reactions and provide information detailing the diagnosis and management of allergic reactions that may be encountered in the dental office. Utilizing this information, the dental practitioner and ancillary staff will have a thorough understanding of allergic reactions and be prepared to successfully identify and treat these reactions. Keywords: allergy, anaphylaxis, drug therapy, emergency services and treatment, epinephrine, laryngeal edema, latex allergy

Objective: IL-10 is a cytokine that plays a complex role in the control of immune responses. A case-control study was conducted to investigate the expression pattern of IL-10 in both serum and the whole unstimulated saliva from ethnic Chinese patients with oral lichen planus. Method and Materials: Seventy-nine Chinese patients with oral lichen planus were recruited for this study, and 41 healthy volunteers served as a control group. The levels of IL-10 and IFN-g in the serum and saliva were detected using enzyme-linked immunosorbent assay (ELISA). The IFN-g/IL-10 ratio was calculated by direct counting. Results: The results demonstrated an expression profile of high IL-10 level and low IFN-g level and IFN-g/IL-10 ratio in both serum and saliva from oral lichen planus patients, compared to the controls. Saliva levels of IL-10 and IFN-g were positively correlated to their serum partners. No significant difference was found among subtypes of oral lichen planus. Conclusion: Elevation of IL-10 level might be involved in the pathogenesis of oral lichen planus, and saliva might be a substitute for serum to reflect the disease-related cytokine production in oral lichen planus patients. Keywords: cytokine, oral lichen planus, saliva, serum

Objective: To evaluate the success rate of a calcium hydroxide-based direct capping agent in permanent teeth. Method and Materials: A total of 1,075 permanent teeth were treated in this study. All patients received direct pulp capping with a calcium hydroxide-based agent. Inclusion criteria were teeth with healthy pulps, pulps with signs of reversible pulpitis, and a pulp chamber roof opening smaller than 2 mm2. Pulps with severe degenerative processes or necrosis were excluded. After direct capping, all teeth were definitively restored with amalgam, composite, glass-ionomer cement, or other dental materials. The teeth were observed up to 9 years with a first visit after 3 months followed by an annual routine visit. Results: The success rate of direct capping was 80.1% after 1 year, 68.0% after 5 years, and 58.7% after 9 years. Substantial differences were found regarding the number of tooth surfaces affected by the causal event (P = .0005). The subsequent definitive restorations also significantly influenced the survival rate (P = .0035). Conclusion: Direct pulp capping with calcium hydroxide is a successful therapy when the respective indications and restorative materials are employed. Keywords: calcium hydroxide, clinically healthy pulp, definitive restoration, direct pulp capping, retrospective study, survival rate

Ceramics have a long history in fixed prosthodontics of achieving optimal esthetics. Yttrium tetragonal zirconia polycrystal (Y-TZP)-based systems are a recent addition to the high-strength, all-ceramic systems used for crowns and fixed partial dentures. CAD/ CAM-produced, Y-TZP-based systems are in considerable demand in esthetic and stress-bearing regions. The highly esthetic nature of zirconia coupled with its superior physical properties and biocompatibility have resulted in restorative systems that meet the demands of today's patients. Undoubtedly, these systems are considered to be prospective replacements for metal-ceramic restorations. This article reviews relevant contemporary literature regarding all-ceramic materials and systems and discusses their material properties, biocompatibility, advances in cementation, and more with special emphasis on clinical survival. The article also aims to provide recommendations for their use. Keywords: CAD/CAM, fixed partial dentures, selective infiltration etching, survival rate, yttrium-tetragonal zirconia polycrystals

Objective: This in vitro study evaluated the bond strength of custom cast and prefabricated posts luted with resin or zinc phosphate cements into unobturated canals of extracted teeth. Method and Materials: Forty-eight custom cast and prefabricated posts were placed into extracted single-rooted human teeth. Post-cavity preparation was 1.5 mm in diameter and 10 mm in depth. Specimens were randomly divided into 4 groups of 12 each. Two of the groups were then luted with resin cement, while the other two groups were luted with zinc phosphate cement. A pull-out bond strength evaluation was performed using a universal testing machine. The Kolmogorov-Smirnov test was used to prove normal distribution. Data were statistically analyzed using two-way ANOVA and the Student t test (alpha = .05). Results: For both luting agents, the prefabricated posts group exhibited significantly less bond strength than the custom cast posts group (P = .0001). There were statistically significant differences in mean bond strength for the prefabricated posts group luted with resin cement vs the group cemented with zinc phosphate cement (P = .002). There was no significant difference between the mean bond strength values of custom cast posts luted with resin cement or zinc phosphate cement. Conclusion: Custom cast posts showed significantly greater bond strength than prefabricated posts when luted with either resin or zinc phosphate cements. The type of cement had less significance on the retention of custom cast posts. Keywords: adhesive resin cement, bond strength, cast post, prefabricated Parapost, zinc phosphate cement

Objective: To evaluate the effects of filler addition on the biaxial flexural strength and modulus of two commercial adhesive systems. Method and Materials: The systems were either unfilled (Adper Single Bond [3M ESPE] and Prime and Bond 2.1 [Dentsply]) or filled (Adper Single Bond Plus [3M ESPE] and Prime and Bond NT [Dentsply]). Resin disks of each product (0.6 mm thick and 6.2 mm in diameter) were prepared in Teflon molds (n = 11 each group; 44 in total). The adhesive solutions were light activated with a halogen light-curing unit. The disks were stored dry in the dark 24 hours before biaxial flexural testing in a universal testing machine until fracture (1.27 mm/minute; model 5844, Instron). Data were statistically analyzed by one-way ANOVA and Tukey post hoc test at a preset alpha of 0.05. Results: Flexural strength values (MPa) (SD) were Single Bond 62 (16); Single Bond Plus 46 (15); Prime and Bond 59 (13); and Prime and Bond NT 85 (16). The flexural moduli (MPa) (SD) were Single Bond 1,026 (241); Single Bond Plus 1,180 (188); Prime and Bond 744 (146); and Prime and Bond NT 1,539 (267). Based on the results, Prime and Bond NT (filled) exhibited higher flexural strength and modulus than Prime and Bond (unfilled), while no significant difference in both parameters was noted between Single Bond and Single Bond Plus. Conclusion: Filler addition to bonding agents can increase the flexural strength and modulus; however, results are product dependent. Keywords: biaxial flexural test, bonding agents, flexural modulus, flexural strength, fillers