Quintessence International, 03/2012

Implant therapy offers a wide range of possibilities in prosthetics. Especially for completely edentulous patients with early tooth loss due to periodontitis, implant therapy is an option to regain a comfortable, esthetic dental rehabilitation. Several studies have indicated that osseointegrated implants can be placed successfully in periodontally compromised patients but with lower survival and success rates than in uncompromised patients. This case report describes a patient that received periodontal therapy for generalized aggressive periodontitis and achieved prosthetic rehabilitation 16 years later with telescopic crowns by means of template-guided flapless implant insertion. In particular, in patients with a history of periodontitis in which bone loss makes implant planning more complicated and in whom wound healing might be compromised, the approach presented in this paper describes a method that is predictable and minimally traumatic. Keywords: backward planning, bone loss, computer-aided 3D implant planning, dental implants, flapless, implant insertion, periodontitis, telescopic crowns, template-guided surgery

Multiple idiopathic cervical resorption is an uncommon condition, the etiology of which remains unknown. The case of a 36-year-old woman with idiopathic resorption in the cervical areas of multiple teeth is presented. Her medical history was noncontributory, but her dental history was valuable in reaching a diagnosis. Hematologic and endocrinal investigations were unremarkable, but a computed tomography scan revealed relevant information. The progression of the lesion and involvement of multiple teeth without any pattern or chronology are challenges faced when diagnosing and treating this condition. Keywords: computed tomography scan, diagnosis, multiple idiopathic cervical resorption, radiograph

The placement of implants in a tilted position may provide a viable treatment modality, especially for patients with atrophic maxillae. The treatment steps and procedures for a maxillary implant-supported removable dental prosthesis, as well as a mandibular telescopic crown-retained removable dental prosthesis, are described. The concept of tilted implants via 3D planning and flapless surgery is presented. The final outcome facilitated improvement in the patient's satisfaction and comfort, as well as long-term stability of the implants and prosthesis. In addition, there was a reduction in cost by avoiding augmentation procedures. Keywords: flapless, guided surgery, maxillary dental prosthesis, tilted implants

The objective of this article is to present evidence-based protocols for the diagnosis and treatment of deep caries lesions in vital teeth. These protocols combine caries-detecting dye with anatomical and histologic knowledge to arrive at ideal caries removal end points for adhesive restorations. DIAGNOdent laser fluorescence technology can also be used to confirm these end points. These ideal caries removal end points generate a peripheral seal zone that can support long-term biomimetic restorations. A review of the published literature since 1980 on caries, caries diagnosis, and caries treatments and their relationships to adhesive bonding techniques was carried out. Combining anatomical measurements and pathologic and histologic knowledge with caries-detecting dye and DIAGNOdent laser fluorescence technologies can produce ideal caries removal end points for adhesive dentistry without exposing vital pulps. Keywords: adhesive dentistry, biomimetic restorations, caries removal, indirect pulp capping

Objective: To assess the effect and safety of pre-emptive oral nonsteroidal anti-inflammatory drugs (NSAIDs) for the success of inferior alveolar nerve block (IANB) in irreversible pulpitis treatment. Method and Materials: Medline (via OVID, 1948 to July 2011), Cochrane Central Register of Controlled Trials (CENTRAL, Issue 2, 2011), EMBASE (via OVID, 1984 to July 2011), Chinese BioMedical Literature Database (1978 to July 2011), China National Knowledge Infrastructure (1994 to July 2011), and WHO International Clinical Trials Registry Platform were searched electronically. In addition, relevant journals as well as reference lists of included studies were hand searched for randomized clinical trials comparing the effect or safety of NSAIDs in irreversible pulpitis treatment. Risk of bias assessment with the Cochrane collaboration tool and data extraction were independently performed by two reviewers. Metaanalysis was delivered with RevMan 5.1. Results: Seven studies were included. Six of them had low risk of bias, and one had an unclear risk of bias. A dosage of 600 to 800 mg of ibuprofen showed a significant effect in increasing the success rate of IANB (relative risk [RR], 1.52; 95% confidence interval [CI], 1.17 to 1.98; P = .002), and the results were moderately reliable. A dosage of 75 mg of indomethacin had a significant effect compared to a placebo (RR, 1.94; 95% CI, 1.22 to 3.06; P = .005), as did 8 mg of lornoxicam (RR, 2.80; 95% CI, 1.59 to 4.93; P = .0004) and 50 mg of diclofenac potassium (RR, 2.40; 95% CI, 1.34 to 4.31; P = .003). Other NSAIDs such as ketorolac, ibuprofen and acetaminophen together, and acetaminophen alone showed no statistical significance compared to the placebo. No serious adverse events were reported. Conclusion: The clinical evidence suggests that pre-emptive oral NSAIDs might have a good effect and are safe in increasing the success rate of IANB, but more studies are necessary to confirm such outcomes. Keywords: anesthesia, anti-inflammatory agent, meta-analysis, nonsteroidal, pulpitis

Objective: New fluoride varnishes have been marketed that reportedly release more fluoride (Enamel Pro) or release fluoride more slowly (Vanish XT). The purpose of this study was to compare the amount and rate of fluoride release of new fluoride varnishes with other traditional fluoride varnishes. Method and Materials: Extracted molars were cut into block sections. The enamel surfaces of the sections were painted with Enamel Pro, Duraphat, Vanish, or Vanish XT fluoride varnishes. One group was not treated and served as a negative control. The tooth sections were immersed in artificial saliva. The concentration of fluoride in parts per million was measured after the first 30 minutes, daily for the first week, and weekly until the level was below the limit of detection. Fluoride release was plotted over time. Cumulative fluoride release and rate of release (slope) were analyzed using one-way ANOVA/Tukey (α = .05). Results: Enamel Pro had the greatest cumulative fluoride release. There was no significant difference between Duraphat and Vanish. Vanish XT had the lowest cumulative fluoride release. The rate of fluoride release from 1 week to limit of detection was Enamel Pro > Vanish > Duraphat > Vanish XT. Conclusion: The two newly marketed fluoride varnishes (Enamel Pro and Vanish XT) had significantly different fluoride release from the two conventional fluoride varnishes (Duraphat and Vanish). Keywords: caries, fluoride, varnish

Abuse of methamphetamine (meth), a potent central nervous system stimulant, has been associated with significant dental disease. Current descriptions of "meth mouth" are limited in their scope and fail to illuminate the potential pathogenic mechanisms of meth for oral disease. The purpose of this pilot study was to characterize the oral health of subjects with a history of meth abuse as compared to nonabusing control subjects. A total of 28 meth abusers and 16 control subjects were enrolled. Interviews and surveys regarding meth abuse, dental history, oral hygiene, and diet were collected. A comprehensive oral cavity examination including salivary characterization was completed. We observed significantly higher rates of decayed surfaces, missing teeth, tooth wear, plaque, and calculus among meth abusers. No significant difference in salivary flow rates were noted, yet results showed significant trends for lower pH and decreased buffering capacity. These findings suggest that salivary quality may play a more important role in meth mouth than previously considered. Salivary analysis may be useful when managing a dental patient with history of methamphetamine abuse. Keywords: dental caries, methamphetamine, saliva

Objective: Candida colonization is a consequence of orthodontic treatment and can lead to oral candidosis as a complication of maxillary removable appliance treatment. During orthodontic treatment, it is important to minimize colonization to prevent active infection that could consequently interfere with treatment. Hygiene is the most important factor in managing colonization; in this study, the efficacy of NitrAdine to reduce Candida was tested. Method and Materials: A randomized, double-blind, placebo-controlled trial was performed. Ninety-two patients 11 to 14 years of age were recruited at the Children's and the University Dental Clinics at Mater Dei Hospital, Tal-Qroqq, Msida, Malta. Forty-four patients used the product with NitrAdine, while 48 patients used a placebo. Sampling employing the imprint technique was performed before and after the product was used. Brilliance Candida agar was used for cultures and identification. Further identification was performed using Auxacolor 2 when required. Results: The control group had a statistically significant increase in Candida during treatment, while the experimental group had a nonstatistically significant decrease. Conclusion: It was concluded that NitrAdine may reduce the Candida burden in maxillary removable appliances. Larger sample sizes are needed to achieve statistical significance. Keywords: Candida, maxillary removable orthodontic appliances, oral candidosis, oral hygiene

Objectives: Only a few studies have attempted to detect differences in microbiologic profiles of patients with chronic periodontitis (CP) and aggressive periodontitis (AgP). The aim of this analysis was to assess if clinical diagnosis or other subject factors showed association with the presence of Actinobacillus actinomycetemcomitans and Porphyromonas gingivalis in a cohort of periodontitis patients. Method and Materials: Statistical analysis for association between bacterial detection and clinical diagnosis was performed on a total of 267 consecutive periodontitis cases diagnosed with either CP (n = 183) or AgP (n = 84). All subjects had microbiologic samples collected from the four deepest pockets and analyzed by nested polymerase chain reaction. Results: A actinomycetemcomitans was detected in 54% and 48% of CP and AgP subjects, respectively. A slightly higher detection of P gingivalis was found in CP (67%) compared with AgP (52%) cases. The detection of P gingivalis was associated with older age (P = .002), less disease severity (P = .015), and IL6-1480 genotypes (P = .026), while A actinomycetemcomitans was associated with IL6-1480 genotypes (P = .001). Conclusion: Detection of known periodontopathogenic bacteria is not able to discriminate different forms of periodontitis. Keywords: aggressive, bacteria, chronic, genetics, periodontitis

Objective: To verify a potential association between the presence of noncarious cervical lesions, parafunctional habits, and temporomandibular disorder (TMD) diagnosis. Method and Materials: Sample-size calculation provided a value of 130 participants with a confidence level of 95% and an error margin of 5%. A population of 132 volunteers (30 men: mean age, 23.7 ± 3.05 years; 102 women: mean age, 24.9 ± 5.86 years) underwent an oral examination and was interviewed by a trained dentist. The following parameters were registered: personal details, TMD diagnosis, parafunctional habits, and noncarious cervical lesion presence. The population was then divided into a noncarious cervical lesion group and a control group and subjected to the t test, chi-square test, Fisher exact test, and Spearman correlation (α = .05). Results: Noncarious cervical lesions were present in 39% of the population, with the largest concentrations found in the maxillary premolars (32%). The data showed a significant association between noncarious cervical lesion presence, tooth clenching (P = .03), and nail biting (P = .02), as well as a relation with TMD diagnosis (Fonseca Index [P = .01] and Research Diagnostic Criteria for TMD (RDC/TMD) [P = .004]). In the noncarious cervical lesion group, direct rank correlation was found between maxillary premolars and clenching (P = .03), mandibular canines and nail biting (P = .05), and mandibular incisors and parafunctional habits without dental contacts (P = .02). Conclusion: Parafunctional habits and TMD presence should be taken into account in the diagnosis and treatment plan of noncarious cervical lesions. Keywords: bruxism, facial pain, noncarious cervical lesions, tooth attrition, traumatic dental occlusion

Mucopolysaccharidosis (MPS) is a group of rare metabolic diseases characterized by intralysosomal accumulation of glycosaminoglycans. MPS type VI or Maroteaux-Lamy syndrome is an autosomal-recessive syndrome caused by mutations in the lysosomal enzyme arylsulfatase B. A defect in the gene leads to accumulation of nondegraded mucopolysaccharides, resulting in severe cellular dysfunction with multisystem expression. The oral manifestations of MPS VI are not well described in the literature. This paper presents a series of seven patients with MPS VI, with the description of the general clinical manifestations and focus on the still rarely studied oral manifestations of the syndrome. Among them were high palate, open bite, impacted and/or included teeth, thickening of the pericoronal follicle, and changes in the temporomandibular joint. Keywords: arylsulfatase B, metabolic diseases, mucopolysaccharidosis, oral manfestations