Quintessence International, 07/2013

A vertical root fracture (VRF) is a frustrating complication that may occur following root canal treatment, and in almost every case leads to the extraction of the affected tooth. This type of fracture is usually diagnosed by secondary symptoms that develop some time after primary treatment, often when prosthodontic restoration has already been completed. The fracture line itself is often not directly visible, and therefore clinical and radiographic signs and symptoms indicate the diagnosis indirectly. Knowledge of the condition and pathogenesis of VRF is required in order to avoid hopeless trials of periodontal and/or endodontic therapy. Several etiologic factors are discussed that make teeth susceptible to VRF, such as the loss of substance due to restorative and endodontic therapy and stress factors associated with root canal debridement, and filling. Keywords: dentinal cracks, endo-perio lesion, halo effect, root canal treatment, vertical root fracture

In the past few years indications for the use of the air polishing technology have been expanded from supragingival use (airflow) to subgingival air polishing (perioflow) by the development of new low-abrasive glycine-based powders and devices with a subgingival nozzle. Several studies on the subgingival use of air polishing have been completed. On 7 June 2012, during the Europerio 7 Congress in Vienna, a consensus conference on mechanical biofilm management took place aiming to review the current evidence from the literature on the clinical relevance of the subgingival use of air polishing and to make practical recommendations for the clinician. Bernita Bush (Bern), Prof Johannes Einwag (Stuttgart), Prof Thomas Flemmig (Seattle), Carmen Lanoway (Munich), Prof Ursula Platzer (Hamburg), Prof Petra Schmage (Hamburg), Brigitte Schoeneich (Zurich), Prof Anton Sculean (Bern), Dr Clemens Walter (Basel), and Prof Jan Wennström (Gothenburg) discussed under the moderation of Klaus-Dieter Bastendorf and Christian Becker (both ADIC Association for Dental Infection Control) the available clinical studies to reach a consensus on available clinical evidence. This paper summarizes the main conclusions of the consensus conference and points to the clinical relevance of the findings for the dental practitioner. Keywords: biofilm management, glycine powder, periodontal maintenance, subgingival air polishing, subgingival biofilm removal

Objective: This article reports a case of severe generalized aggressive periodontitis and subsequent collapse of the occlusion in a psychiatric patient, treated by an extremely conservative orthodontic-periodontal-prosthodontic treatment. Summary: A woman presented with severe anterior proclination caused by severe periodontal disease and Angle's class II molar malocclusion. The patient wanted to preserve her teeth and rejected the idea of implant treatment. This case report demonstrates that combining periodontal therapy, orthodontic treatment, and prosthodontics (through a decision-making system with a proper interdisciplinary coordination) can greatly improve function and the esthetic result. Comprehensive periodontal treatment took place before other intervention, and periodontal maintenance and follow-up throughout the treatment and after played a crucial role. Keywords: dental protrusion, depressive disorders, generalized aggressive periodontitis, intracoronary occlusal retention, orthodontic treatment, periodontal treatment

Objective: This retrospective study investigated the clinical and radiographic changes in the edentulous maxilla in patients with either ball or telescopic attachments of implantretained mandibular overdentures. Method and Materials: Thirty-two completely edentulous patients (21 males and 11 females) received two implants in the canine region of the mandible. New maxillary complete dentures and mandibular overdentures were fabricated. Overdentures were connected to the implants either with ball (group 1, n = 16) or telescopic (group 2, n = 16) attachments. Retention and stability of the maxillary denture as well as mucosal changes of the maxillary ridge were recorded after 4 years of denturewearing. Traced rotational tomograms were used for measurements of maxillary alveolar bone loss. The proportional value between bone areas and areas of reference not subject to resorption was expressed as a ratio (R). Change in R immediately before (T0) and after 4 years (T4) of overdenture insertion was calculated for the anterior and posterior regions of the maxilla. Results: After 4 years of denture-wearing, maxillary denture retention was significantly higher in group 1 than in group 2, while occurrence of flabby ridges was significantly higher in group 2 than in group 1. The change in R of the anterior region of the maxilla was significantly higher than the change in the posterior region in both groups. Group 2 showed significant anterior residual ridge resorption compared to group 1. Conclusion: Telescopic attachments for implant-retained mandibular overdentures are associated with increased maxillary ridge resorption and flabbiness, and decreased maxillary denture retention when compared to ball attachments. Keywords: implant, overdenture, ridge resorption, telescopic attachments

Objectives: Clinical studies to assess dental implants are common in implantology, but such studies are usually performed for specific indications and following a specific protocol with strict inclusion and exclusion criteria. The aim of the current study was to evaluate the Straumann Bone Level SLActive dental implant in a prospective, multicenter, noninterventional trial. Method and Materials: The implant could be used in whatever manner was deemed suitable by the clinician, within approved indications. No particular placement or loading protocol was specified. A total of 1,532 implants were placed in 852 patients in 123 centers in nine countries in the US and Europe. After exclusion of three countries due to patient enrollment and data issues, 759 patients with 1,355 implants were analyzed. Results: Most patients received one or two implants (58.6% and 25.3% of patients, respectively), and 90% of cases were performed with a raised flap. A submerged healing protocol was significantly more prevalent in European centers, while transmucosal healing was significantly more prevalent in North American centers. After 1 year, 538 patients with 908 implants were available for evaluation. The cumulative implant survival and success rates were 98.5% and 96.0%, respectively. Conclusions: This prospective noninterventional study evaluated the use of Straumann Bone Level SLActive dental implants in a large number of patients. The cumulative survival and success rates were similar to those observed in controlled clinical trials, confirming this dental implant's clinical applicability in daily practice. Keywords: bone level dental implant, daily dental practice, noninterventional study, SLActive

Objective: Thermal Nd:YAG laser energy is well known for the purpose of blood coagulation. However, little is known about the bleeding frequency following laser-assisted oral surgery in patients on coumarin drugs. Therefore, the purpose of this study was to compare retrospectively the frequency of bleeding complications following Nd:YAG laserassisted versus conventional local coagulation of blood in oral surgery. Method and Materials: In October 2002, minor oral surgical interventions were found to be indicated in a total of 45 cardiac risk patients. In Group 1, blood coagulation was yielded in 24 patients with a Nd:YAG laser system, whereas in Group 2, treatment was performed in 21 patients with conventional means of local hemostasis. All therapies were performed continuing anticoagulant therapy between November 2002 and March 2003. Clinical data were recorded retrospectively from patient charts in May 2007. Results: In both Groups 1 and 2, a total of two bleeding complications were recorded. However, local re-interventions were sufficient for local hemostasis. Conclusion: These results indicate that Nd:YAG laser-assisted local hemostasis was not able to prevent bleeding complications completely. Within the limitations of this retrospective study it was concluded that in patients with anticoagulant treatment undergoing minor oral surgery, Nd:YAG laser-assisted local hemostasis is not superior to conventional methods of blood coagulation with respect to the frequency of bleeding complications. Keywords: anticoagulant drugs, Nd:YAG laser, oral surgery

Pemphigus vulgaris is a potentially fatal mucocutaneous, vesiculobullous disorder of autoimmune etiology. Regrettably, affected patients frequently experience considerable discomfort and diagnostic delay for months in spite of multiple clinician contacts. The high likelihood of disease manifestations in the oral cavity and serious nature of potential oral and systemic complications mandates dental professionals to recognize early oral signs and symptoms of pemphigus vulgaris and contribute to timely diagnosis and medical intervention to prevent disease progression. This case report presents a young man with pemphigus vulgaris whose oral disease caused him significant suffering and spread to the skin before he was finally diagnosed 3 months after the onset. The signs and symptoms of the disease are reviewed and the potential role of dental providers in timely recognition and management is emphasized. Keywords: pemphigus vulgaris, vesiculobullous disorders

Objective: To report a multidisciplinary treatment of gemination/fusion of the left maxillary first incisor. Case Report: An 11-year-old boy presented to our clinic with the chief complaint of an unpleasant appearance of his anterior teeth. Clinical and radiographic evaluation revealed gemination/fusion of the left maxillary first incisor combined with an Angle's Class II relationship (skeletal), retruded mandible, deep bite, short lower face height, and proclinaion of the maxillary incisors. The multidisciplinary approached treatment included orthodontic treatment engaged with root canal treatment of the left maxillary first incisor followed by periodontal surgical separation of the mesial root of the left maxillary first incisor and restoration of the crown using resin restoration. Conclusion: Tooth shape anomalies in general dental practice may be rare, but the dentist should be aware of the nature of the problems encountered and the specific treatment needs. The treatment may be complex and contain various treatment protocols that may include interdisciplinary endodontic, surgical, and periodontal interventions. Keywords: fusion, gemination, orthodontic treatment, periodontal surgery, root canal treatment, root separation

Objective: Dentin desensitizing agents are used in the treatment of dentin hypersensitivity, which is defined as a painful response in the exposed dentin to stimuli that are thermal, evaporative, tactile, osmotic, or chemical. A systematic review was conducted to analyze the clinical effectiveness of current desensitizer with at least 3 months of follow-up. Method and Materials: Eight electronic databases were searched: MedLine (PubMed), Embase, Lilacs, Ibecs, Web of Science, Scopus, Scielo, and The Cochrane Library. Only those clinical trials published from 2000 to 2012 were included. Results: A total of 3,029 relevant records were identified. After title and abstract examination, 2,645 articles were excluded. A data extraction form was designed and completed by reviewers from the selected studies for a retrospective comparison. From the 99 studies retrieved for detailed review, only 17 had an evaluation time of at least 3-months follow-up and fulfilled the selection criteria. Conclusion: Cervitec Plus, SE Bond & Protect Liner F, laser, and iontophoresis have shown satisfactory posttreatment results between 3 and 6 months. However, additional clinical trials are warranted to better compare the different types of treatments and their effectiveness in the longer term. Keywords: dentin desensitizing agents, dental materials, dentin sensitivity, systematic review