Quintessence International, 02/2013

Objective: Resin infiltration is a new microinvasive treatment to arrest the progress of proximal initial caries lesions. This study evaluated the clinical applicability of proximal caries infiltration. Method and Materials: In the study population of 50 children, adolescents, and young adults (mean age, 17.3 ± 6.4 years), 10 dentists at the University of Greifswald, Greifswald, Germany, applied the infiltration material Icon on noncavitated proximal lesions in permanent and primary teeth as described by the manufacturer. The applicability was evaluated using two questionnaires filled out by clinicians and patients assessing the comfort, complexity, time, and difficulties of the application in comparison to a filling. Results: The results showed good patient satisfaction with the procedure. The mean time for infiltration (24.3 ± 7.4 minutes), which included rubber dam application (7.7 ± 4 minutes) and the effort were perceived to be comparable to or even easier than a composite filling by clinicians. In three patients (6%), it was not possible to gain sufficient proximal space for the application of an infiltration. The location of the infiltrated tooth, separation problems, and the routine of clinicians with the infiltration technique had an effect on the duration of the infiltration. A clear learning curve with a reduction of treatment time for subsequent treatments was observed (P < .001). Conclusion: Resin infiltration of initial noncavitated proximal lesion showed good clinical applicability for clinicians and very high acceptance by patients. Keywords: caries infiltration, clinical applicability, initial lesions, patient satisfaction, proximal caries

Objective: To test three noneugenol provisional cements (TempBond NE, RelyX Temp NE, and Freegenol) for their antibacterial properties and to test the hypothesis that addition of fluoride varnish confers antibacterial properties on these provisional cements without compromising their tensile strength. Method and Materials: A total of 576 cylindrical samples were prepared (96 of each of six types) from three noneugenol provisional cements, both unmodified and modified by the addition of 5% w/w Duraphat fluoride varnish. The samples were aged in saline that was replaced twice a week for up to 90 days. Twenty-four samples of each type were removed from the saline at 1, 7, 30, or 90 days and assessed for antibacterial properties against Streptococcus mutans by using an agar diffusion test (n = 12) and tensile strength by using a diametral tensile strength test (n = 12). Data were subjected to one- and three-way ANOVA, the Tukey honestly significant difference test, and t test at a significance level of .002 (P < .002). Results: TempBond NE had no antibacterial activity in its unmodified form but showed antibacterial activity when modified by the addition of 5% w/w fluoride varnish. Freegenol had the highest antibacterial activity in its unmodified form, which was not altered by the addition of the varnish. RelyX Temp NE had mild antibacterial activity that was slightly enhanced by adding the varnish. Adding the varnish reduced the tensile strength of TempBond NE and Freegenol, but did not affect the tensile strength of RelyX Temp NE. Conclusion: Antibacterial activity was observed for the unmodified form of Freegenol and TempBond NE after the addition of the fluoride varnish. The addition of the fluoride varnish reduced the tensile strength of both TempBond NE and Freegenol. Keywords: antibacterial, cement, diametral tensile strength, fluoride varnish, provisional cement, Streptococcus mutans, zinc oxide-eugenol

Objective: To compare via a split-mouth randomized clinical trial the efficacy of 1% chlorhexidine gel, calcium hydroxide/camphorated paramonochlorophenol (Callen PMCC), and a one-visit endodontic treatment against mutans streptococci and anaerobic bacteria found in primary molars with necrotic pulps and to assess clinical success rates after 12 months. Method and Materials: Pre- and posttreatment intracanal samples were collected from 37 teeth (from 21 children) for analysis of the number of mutans streptococci and anaerobic bacteria. Clinical and radiographic criteria were analyzed to determine treatment outcome. Results: Chlorhexidine gel significantly reduced mutans streptococci levels (P = .010), whereas Callen PMCC significantly reduced the levels of anaerobic bacteria (P = .002). No differences in the reduction of mutans streptococci (P = .187) and anaerobes (P = .564) were observed between groups. The clinical success rates were 85.71% (Callen PMCC), 78.57% (chlorexidine gel), and 77.77% (one-visit treatment). Conclusion: Teeth treated with Callen PMCC presented the highest clinical success rate. The 1% chlorhexidine gel, as well as calcium hydroxide/camphorated paramonochlorophenol, presented limited efficacy in reducing bacteria from necrotic primary root canals. Keywords: calcium hydroxide, camphorated paramonochlorophenol, chlorhexidine, primary molars, pulp necrosis

Two patients were diagnosed with combined endodontic-periodontal lesions. Endodontic treatment was performed, followed by surgery. In addition, the regeneration process was supported by the application of an enamel matrix derivate alone or in combination with guided bone regeneration techniques. At recall visits after 24 months, the teeth were asymptomatic and marked bone regeneration had occurred in both patients. The successful post-endodontic treatment of combined endodontic-periodontal lesions, using periodontal surgery and as adjunct guided tissue regenerative techniques, is presented. Further, the possibility of saving teeth, even with severely apparent pathology, should be highlighted. Keywords: periodontal-endodontic lesion, root canal treatment, surgery

This case report describes a new method for the fabrication of implant-supported overdentures that are rigidly retained by custom tapered abutments milled from commercially pure titanium using CAD/CAM technology. The dentition of a 60-year-old woman was restored with six implants in the edentulous maxilla. An implant-supported overdenture retained by custom tapered abutments was fabricated using CAD/CAM technology. Screw-retained abutments were designed and milled with a taper of 6 degrees. The reinforcing metallic denture base with integrated secondary crowns, exactly fitting on the tapered abutments, was fabricated from the same data set. The secondary structures could be seated tensionfree on the six abutments, creating friction in the final position. No clinical complications were observed at the 12-month follow-up examination, and the patient remained satisfied with the function and esthetics of the restoration. This case demonstrates the practicality of a fully CAD/CAM fabrication of an implant-supported overdenture retained by friction only. Controlled clinical studies are needed to evaluate the long-term performance of this type of restoration. Keywords: CAD/CAM, CNC milling, custom tapered abutments, edentulous maxilla, implant-supported overdenture, titanium

Objective: The replacement of missing teeth with dental implants has been standard practice in dentistry for many years. The success of dental implants depends on many factors, among which the diagnosis, clinical severity, and treatment of peri-implant diseases play a key role. In this prospective case series, the influence of cumulative treatment modalities on peri-implantitis with and without pus formation on clinical outcome was assessed. Method and Materials: During 2010, 28 patients were referred for peri-implantitis treatment. They presented two different types of peri-implant diseases: peri-implantitis with (17 implants) or without pus formation (33 implants). After microbiologic diagnosis, all patients were treated at baseline with full-mouth scaling and root planing. Two months later, further full-mouth scaling and root planing and additional antimicrobial photodynamic therapy (aPDT) was applied. Four months after baseline, patients with pus formation additionally underwent access flap surgery. Active human matrix metalloproteinase-8 (aMMP-8) levels were measured in eluates before and after all treatment modalities and 7 months after baseline. Results: Clinical parameters (probing depth, bleeding on probing) and aMMP-8-levels improved in both groups after treatment and the final examination. In periimplantitis patients without pus formation, all parameters decreased after full-mouth scaling and root planing and the additional aPDT and no surgery was necessary to improve the parameters. In patients with pus formation, the parameters decreased only after access flap surgery. Conclusion: The presence of pus influences the clinical outcome of the treatment of peri-implant diseases. Whereas peri-implantitis cases without pus formation can be successfully managed nonsurgically, peri-implantitis with pus formation can be effectively treated after an additional observation time of 3 months postoperatively only with additional flap surgery. Keywords: matrix metalloproteinase, microbiology, nonsurgical treatment, periimplantitis, pus, surgical treatment

Objective: To test the hypothesis of the outcome of complete arch flapless guided implant surgery mandibular rehabilitations in the presence or absence of a residual band of keratinized mucosa (KM) < 6 mm wide in the vestibular-lingual aspect, with and without a modification of the surgical protocol. Method and Materials: Thirty-nine patients were included in this study (12 men and 27 women), with a mean age of 62.5 years (range, 42 to 79 years), divided into 3 groups of 13 patients according to the status of residual band of KM: group 1, KM < 6 mm rehabilitated through a modified guided surgical protocol with flap opening to preserve KM; group 2, KM >= 6 mm; and group 3, KM < 6 mm; patients from both groups 2 and 3 were rehabilitated through flapless guided implant surgery without modification of the protocol. Group 2 and 3 patients were age- and sex-matched with group 1. Outcome measures were clinical attachment loss (CAL) >= 2 mm after 1 year (backward conditional regression), incidence of dehiscences, dental plaque, bleeding, and implant infections. The level of significance chosen was 5%. Results: Thirty-nine patients with 156 implants were followed for 1 year, and no dropouts occurred. Absence of a residual band of KM >= 6 mm in the vestibular-lingual aspect was significantly associated with CAL (odds ratio, 39.1; P = .036) and dehiscences (P = .003). Conclusion: Within the limitations of this study, the absence of a residual band of KM >= 6 mm wide in the vestibular-lingual aspect in patients rehabilitated in the complete edentulous mandible with flapless guided implant surgery may be associated with CAL and a higher incidence of dehiscences after 1 year of follow-up. This possible association needs to be confirmed in studies with stronger designs and longer follow-ups. Keywords: flapless surgery, guided surgery, immediate function, implant

Objective: Dental caries among preschool children remains a significant dental public health problem. In Ireland, there are no national data available regarding dental caries levels in preschool children. Furthermore, the number of young children with disabilities and their dental caries levels remains unknown. The aim of the present study was to measure the dental caries levels in a sample of preschool children with disabilities. Method and Materials: A team of trained and calibrated dentists examined a sample of all 0- to 6-yearold preschool children with disabilities in two health service administrative areas under standardized conditions. Dental caries was recorded using WHO criteria. Results: Of a total of 422 participants, 337 datasets were included in the study. Of these 337 examined children, approximately 75.1% had a cognitive disability and 12.9% had a noncognitive disability. In 12% of the children, a diagnosis had not yet been established. Dental caries at dentin level was detected from the age of 4 years. The overall mean decayed/missing/ filled teeth (dmft) was 0.49 (SD, 1.39). The analysis of mean dmft levels in children with positive (dmft > 0) scores revealed a mean dmft of 1.14. Conclusion: The evidence from this study demonstrated that dental caries levels in preschool children with disabilities in Ireland are low when compared with the general population. Furthermore, children aged 3 years or younger exhibited no dental caries at dentin level and therefore were not affected by early childhood caries. An adjustment of current oral health prevention practice may lead to a further reduction in dental caries levels in this section of the child population. Keywords: caries experience, disability, Ireland, preschool children, primary teeth

Lip and oral venous varices are acquired benign vascular lesions characterized by a darkblue to violaceous papule or nodule, commonly found on the ventral tongue and lower lip. Although these lesions are usually asymptomatic, they can bleed if injured. This study assessed the effectiveness of photocoagulation with high-intensity diode laser in the treatment of these lesions. Thirty-two patients (14 men and 18 women; mean age, 56 years) with lip and oral venous varices were examined and treated with a noncontact diode laser. With one exception, all cases were successfully treated with a single irradiation exposure session. Healing was complete in about 2 to 3 weeks; none of the patients experienced complications or recurrence. Photocoagulation with high-intensity diode laser was proven to be safe and effective for the treatment of lip and oral venous varices, with consistent results. Keywords: diode laser, lip and oral sites, photocoagulation, venous varices

Objective: To systematically review the current literature on the maxillary midline frenum and associated conditions and complications, as well as the recommended treatment options. Method and Materials: A detailed MEDLINE database search was carried out to provide evidence about the epidemiology, associated pathologies, and treatment options regarding the maxillary frenum. Of the 206 initially identified articles, 48 met the inclusion criteria. Results: The maxillary frenum is highly associated with a number of syndromes and developmental abnormalities. A hypertrophic frenum may be involved in the etiology of the midline diastema. There is also a tendency by orthodontists to suggest posttreatment removal of the frenum (frenectomy). Studies on the cause of gingival recession due to the maxillary frenum are inconclusive. An injured frenum in combination with other traumas and doubtful history might point to child abuse. The involvement of hyperplastic frena in the pathogenesis of peri-implant diseases remains uncertain. There seems to be a clinical interest regarding lasers for surgery for treatment of maxillary frena. The superiority of laser treatment in relation to conventional surgical methods has not yet been demonstrated in the literature. Conclusion: A maxillary frenum is a clinical symptom in numerous syndromic conditions and plays a role in the development of the median midline diastema. Nevertheless, the contribution to gingival recession and peri-implant diseases in the region of the maxillary incisors is rather controversial. Laser techniques are reported as the method of choice for the surgical removal of frena; however, this needs to be substantiated by appropriate prospective controlled studies. Keywords: frenectomy, gingival recession, maxillary frenum, midline diastema, peri-implantitis

Objective: To assess the impact of media exposure on oral health outcomes among Jewish adults in Jerusalem, Israel, by means of a conceptual hierarchical model. Method and Materials: A cross-sectional study was conducted using a stratified sample of 254 adults 35 to 44 years (mean age, 38.63 years) in Jerusalem, Israel. Media exposure was operationally categorized by type and frequency. Behavioral data included toothbrushing, dental attendance, oral hygiene aids use, plaque level, sugar consumption, and smoking. Clinical outcomes were assessed according to the decayed/missing/filled teeth (DMFT) index and the Community Periodontal Index (CPI). Results were analyzed by chi-square test, independent test, one-way ANOVA, and linear and multiple logistic regression models. Results: A total of 254 examinees consisted of 127 men and 127 mean (married couples). High type and high frequency of media exposure, as compared with other modes, revealed statistically significant higher caries experience (DMFT, 13.10), higher level of untreated decay (D, 1.67), and lower periodontal health (CPI [0], 0.39). A conceptual hierarchical regression model identified that the relationship described was mediated by sociodemographic determinants (education) and behavioral determinants (dental attendance and plaque level). Conclusion: Media exposure should be observed by community health program planners and general practitioners to examine the type and frequency of the messages. They also need to react on time to balanced bad advertising and add a good message at the community. This pragmatic approach could lead to better use of the media and improve oral health behavior and outcomes. Keywords: media exposure, oral health, oral health behavior, sugar consumption