Quintessence International, 04/2011

Objective: Immediate loading of dental implants in the edentulous mandible has proven to be an effective, reliable, and predictable procedure. There is little long-term data available on similar treatments in the edentulous maxilla. The aim of the present study was to clinically evaluate edentulous maxilla rehabilitation with removable prostheses supported by the Ankylos SynCone (Dentsply-Friadent) system. Method and Materials: The treatment method was based on immediate loading of four implants in the completely edentulous maxilla. A total of 180 implants were inserted in 45 patients. Dentures were placed on and retained by prefabricated conical crowns that were inserted into the existing denture base by direct intraoral polymerization immediately after surgery and supported by corresponding conical primary implant abutments. Results: During the observation period, two implants (1.11%) were removed due to the lack of osseointegration. One implant was removed due to peri-implantitis, and one other (0.55%) implant was removed because of a fracture after 6 months of function. The overall implant survival rate was 97.77%, while the prosthesis survival rate was 100%. Swelling or suppuration was not observed. After a total observation period of 26.7 months (range 12 to 54 months), all implants had healthy peri-implant soft tissue that showed low values of clinical parameters. Only seven implants (3.97%) presented a sulcus bleeding index of 3. Conclusion: This method facilitates edentulous maxilla rehabilitation with removable prostheses. The conical crown concept presented resulted in stable complete-denture retention, reduced denture base, and improved oral hygiene. Keywords: dental implants, edentulous maxilla, full dentures, immediate loading, prefabricated telescopic restorations

Objective: To evaluate the efficacy of ß-tricalcium phosphate (ß-TCP) (Synthograft, Bicon USA) in periodontal osseous defects in comparison to open flap debridement (OFD). Method and Materials: Twelve patients showing clinical and radiographic evidence of almost identical bilateral infrabony defects were selected. The infrabony defects in the 12 patients were treated with OFD+ß-TCP on one side and OFD on the other side. Clinical evaluation was performed at baseline and 6 months following therapy. Results: No differences in probing depth (PD) reduction or clinical attachment level (CAL) gain were observed, although a statistically significant difference was observed for the defect fill between the two groups. Six months after therapy, sites treated with OFD+ß-TCP showed a reduction in mean PD from 9.67 ± 2.35 mm to 4.00 ± 1.60 mm (P < .05), a change in mean CAL from 9.92 ± 3.15 mm to 5.00 ± 3.86 mm (P < .05), and the mean defect fill was 2.92 ± 0.90 mm. In the sites treated with only OFD, the mean PD was reduced from 7.58 ± 1.08 mm to 2.67 ± 0.65 mm (P < .05), the mean CAL changed from 6.83 ± 1.34 mm to 1.83 ± 1.64 mm (P < .05), and the mean defect fill was 0.83 ± 0.39 mm. Reduction of 5 mm in PD was observed in 5 of the 12 defects (42%); 4 of the 12 defects (33%) gained 3 mm of CAL in the test sites. PD reductions and CAL gains of 3 to 6 mm were measured in the majority of the cases (60% to 75%) regardless of treatment modality. Conclusion: Within the constraints of this study, both therapies resulted in significant PD reductions and CAL gains 6 months after surgery. Sites treated with OFD+ß-TCP showed a significant defect fill compared to those treated with OFD alone. Keywords: alloplasts, ß-tricalcium phosphate, bioceramics, bone graft, infrabony defects, regeneration

Objective: To explore the feasibility of identifying potential radiometric differences in periapical radiolucencies with and without actinomycotic colonization as seen on periapical radiographs using histopathology for ground truth. Method and Materials: Periapical radiographs demonstrating apical lesions with and without biopsy-proven actinomycosis were included in the study. Lesion sizes were estimated on standardized images using anatomical reference points. The reading session was repeated after 2 weeks, and mean lesion sizes were calculated. All measurements were made by a single, calibrated observer. Results: The mean dimension of lesions with actinomyces was 13.51 × 16.43 mm, while lesions without actinomyces had a mean size of 10.24 × 11.27 mm. Conclusion: Apical lesions with biopsy-proven actinomyces may be larger in dimension than those without bacterial colonization. Further controlled studies are required to confirm this finding. Keywords: actinomyces, histology, intraoral, periapical, radiographic

Objective: A variety of oral topical agents have been used for prevention and management of radiotherapy-induced adverse effects. The antimicrobial nature of some of the commonly used agents is unknown. The purpose of this study was to evaluate antimicrobial efficacies of various oral topical agents on common microorganisms associated with radiated head and neck cancer patients. Method and Materials: Seven commonly used topical oral agents-0.12% chlorhexidine with alcohol, 0.12% chlorhexidine without alcohol, baking soda-salt rinse, 0.4% stannous fluoride gel, 0.63% stannous fluoride rinse, calcium phosphate mouthrinse, and acemannan hydrogel (aloe vera) rinse-were evaluated in vitro for their antimicrobial efficacies against four common microorganisms. A combination of baking soda-salt rinse and 0.4% stannous fluoride gel was evaluated as the eighth agent. The microorganisms used were Staphylococcus aureus, group B Streptococcus, Escherichia coli, and Candida albicans. An ELISA reader was used to measure the turbidity of microbial culture wells and optical density (OD) values for each of the 960 wells recorded. Mean OD values were rank ordered based on their turbidity. One-way ANOVA with Tukey HSD post hoc analysis was used to study differences in OD values (P < .05). Results: Mean OD values classified for topical agents from lowest to highest were chlorhexidine with alcohol, chlorhexidine without alcohol, baking soda- salt, calcium phosphate rinse, and the combination of baking soda-salt and stannous fluoride gel. Mean OD values classified for microorganisms from lowest to highest were Escherichia coli, Staphylococcus aureus, group B Streptococcus, and Candida albicans. Conclusion: A significant difference among the antimicrobial efficacies of topical agents was evident for each of four microorganisms (P < .05). There was also a significant difference among the antimicrobial efficacies of the same topical agent on the four microorganisms tested (P < .05). Keywords: antimicrobial rinse, chlorhexidine, head and neck cancer, microorganism, mucositis, radiated patient

Objective: To evaluate the influence of different cement combinations on coronal microleakage in restored endodontically treated teeth using dye penetration. Method and Materials: Human, noncarious single-rooted extracted premolars (n = 60) were divided into four experimental groups (each n = 15). After endodontic treatment, different combinations of cements were used to lute prefabricated posts and complete crown restorations: zinc phosphate cement applied on posts and cast crowns (Z) or on zinc phosphate cement posts and resin cement applied on cast crowns (ZR); resin cement applied on posts and zinc phosphate cement applied on cast crowns (RZ); and resin cement applied on posts and cast crowns (R). After artificial aging through thermal cycling (5°C to 55°C) for 2,000 cycles at 38 seconds for each cycle and 15 seconds of dwell time, specimens were immersed for 72 hours in basic fuchsin at 37°C. A buccolingual section was made through the vertical axis of specimens. A Toolmaker's microscope (Mitutoyo) was used to measure (µm) dye penetration. The Kruskal-Wallis nonparametric test was used to determine intergroup difference. A nonparametric Mann-Whitney test compared each group regarding its maximal linear penetration depths on the mesial and distal aspects of each specimen (α = 0.05). Results: Dye staining was evident to some degree in all specimens. Among groups Z, ZR, and RZ, no significant difference was shown in dye-penetration depths (mean penetration scores 1,518 to 1,807 µm). However, dyepenetration depth was significantly lower in group R compared to the other groups (mean penetration score 1,073 µm) (P < .05). Conclusions: Under study conditions, the cement combination offering the best coronal sealing was the one using only resin cement for both posts and crown restorations. Keywords: crowns, luting agents, posts, restorations

Objective: To compare the diagnostic efficacy of a minipanel series to a conventional 18-radiograph full-mouth series in a disabled adult population in a university clinic. Method and Materials: Eighty patients who attended the New Jersey Dental School special care services clinic between 2004 and 2006 were selected for a double-blind quasiexperimental study based on existing full-mouth series radiographs. A minipanel series consisting of eight radiographs from the 18-radiograph full-mouth series was used as a comparison against a matched pair of an 18-radiograph exam. The diagnostic efficacy of this eight-radiograph series was tested against the more conventional 18-radiograph full-mouth series to determine whether the minipanel series was an acceptable substitute for the full-mouth series in this population group. Traditionally, it is difficult to obtain full-mouth series radiographs in patients with disabilities. Results: From the 80 studied patients, a total of 2,219 teeth were available for study. A median of 29 teeth per patient was found in the full-mouth series and 28 teeth per patient in the minipanel series category. The difference was statistically significant (P < .001). Of the patients evaluated, 78 (97.5%) had at least one problem detected when the full-mouth series was used. Of these 78 with at least one problem, 74 (94.8%) were identified using the minipanel series. The sensitivity for the minipanel series when compared to the gold-standard full-mouth series was 63% (95% confidence interval [CI], 59.2 to 68.0) for tooth-specific disease; the specificity was 92% (95% CI, 92.2 to 94.5). Conclusion: Prospective studies are needed for the acceptance and use of minipanel radiographic series in conjunction with a clinical examination. Keywords: disabled patients, minipanel series, radiographs

Hallermann-Streiff syndrome is a rare genetic disorder characterized primarily by head and face abnormalities. Patients show birdlike faces; hypotrichosis; various ophthalmic disorders; and dental abnormalities including absence of teeth, natal and neonatal teeth, enamel hypoplasia, and supernumerary teeth. In addition, delayed eruption of existing teeth and severe agenesis of permanent teeth are frequent findings. Dental and hereditary disorders can be associated with disturbances during tooth development and cause shortened roots. Short roots are a rare developmental anomaly in the permanent dentition, and the etiology is not well established. The generalized form is extremely rare. Generalized diminished root formation can lead to early loss of teeth. This article provides a case report of a 9-year-old boy with Hallermann-Streiff syndrome. Extraoral examination revealed a brachycephalic head, proportionate short stature, sparse hair, and atrophic skin. His face was characterized by a thin beak-shaped nose and retrognathia, resulting in a characteristic birdlike appearance. Radiographically, all teeth of the permanent dentition showed severely underdeveloped roots and partially underdeveloped crowns. The predisposition to severe dental caries and dental malformations makes it imperative to schedule effective prevention measures, especially since root canal treatment to preserve teeth can be hampered due to underdeveloped roots. Keywords: anodontia, dental anomalies, Francois syndrome, short roots, underdeveloped roots

Objective: Dental implants and peri-implant tissue are susceptible to disease conditions that may lead to implant loss. The objective of the present study was to describe teeth and implant surroundings as well as clinical health indices and oral microbiologic parameters. Method and Materials: A group of 83 adults (42 men and 41 women) were enrolled in the study. Clinical assessments of dental implants and contralateral natural teeth included dental plaque, gingival inflammation, and bleeding on probing. Microbiologic assessments included bacterial culture, light and phase contrast microscopy, and DNA probe hybridization for a panel of 14 target microorganisms. Clinical and microbiologic data were compared by paired t test and ANOVA. P < .05 was considered statistically significant. Results: The Plaque Index for the implants was 1.85 ± 0.47, whereas the score for natural teeth was significantly higher, 2.15 ± 0.52. Compared to the samples obtained from the dental implants, the samples from natural teeth demonstrated significantly higher total bacterial cell numbers (P < .05). Consistent with the clinical measures of dental plaque, significantly higher numbers of oral bacteria, including aerobic and anaerobic bacteria, were found in dental plaque samples from teeth (aerobic 5.648 ± 0.512, anaerobic 6.243 ± 0.535, P < .0001) compared to implants (aerobic 5.430 ± 0.541, anaerobic 5.917 ± 0.523, P < .0001). In addition, there were significantly higher numbers of anaerobic (6.243 ± 0.535 and 5.917 ± 0.523, P < .0001) than aerobic (5.648 ± 0.512 and 5.430 ± 0.541, P < .008) bacteria for samples from teeth and implants, respectively. Conclusion: Clinical and microbiologic analyses provide consistent findings that suggest differences in quantity of plaque and bacterial species between teeth and dental implants. For long-term treatment success, the importance of plaque control and oral hygiene of both periodontal and dental implant therapy is emphasized. Keywords: clinical health indices, dental implants, microbiologic parameters, natural teeth, oral biofilms

Objective: As a consequence of their liver dysfunction, cirrhotic patients have elevated levels of serum alkaline phosphatase (ALP). Increased ALP activity is seen in periodontal tissues during the progression of periodontitis. The present study was carried out to compare ALP levels in cirrhosis patients with and without periodontitis and to correlate ALP levels with the severity of periodontitis. Method and Materials: Both the test and control groups consisted of 30 liver cirrhosis patients with or without periodontitis. The parameters recorded were modified OHI-S Index, Gingival Index (GI), and clinical attachment level (CAL). All patients underwent standardized panoramic radiographs to assess alveolar bone height. The total serum ALP was determined with the kinetic method (R.A 50). Results: Alveolar bone loss (ABL) was 1.62 ± 0.32 mm in the test group and 0.28 ± 0.04 mm in the control group. Mean clinical attachment level (CAL) for the test group was greater than the control group: 2.34 ± 0.67 mm and 0.43 ± 0.14 mm, respectively. The mean serum alkaline phosphatase level in the test group was higher (39.94 ± 3.34) than the control group (29.42 ± 6.11) and the differences was statistically significant (P > .05). When comparison was made between age group (20 to 40 years and 41 to 60 years), the older age group liver cirrhosis patients exhibited significantly higher values for bone loss, clinical attachment level, and serum ALP level. Conclusion: There is strong positive correlation between periodontal breakdown and serum alkaline phosphatase level in liver cirrhosis patients. Keywords: liver cirrhosis, periodontitis, serum alkaline phosphatase

This case report describes the prosthetic rehabilitation of a patient with ankylosing spondylitis who presented with a malocclusion due to the unfavorable reduction of a mandibular fracture following a traffic accident. The residual malocclusion was successfully corrected with a maxillary removable partial denture and a mandibular onlay removable partial denture. Keywords: ankylosing spondylitis, removable partial denture