Quintessence International, 01/2014

Objectives: All-ceramic resin-bonded fixed dental prostheses (RBFDPs) were introduced as a conservative treatment many years ago. The purpose of this study was to evaluate for 8 years the clinical survival of RBFDPs made with a conventional tworetainer design. Method and Materials: A total of 54 anterior RBFDPs were made from the glass-infiltrated alumina ceramic In-Ceram. The restorations were placed in 49 patients, aged 18 to 60 years, by a single operator using the same clinical procedure. The restorations were examined for debonding, fracture rate, caries, and patient acceptance. All restorations were examined clinically at 1, 2, 4, 6, and 8 years after placement. Results: At 8 years, the success rate was 85.18%. Patient acceptance was very encouraging and dental caries were not detected with any abutment. Two restorations debonded during the evaluation period and fracture of porcelain occurred in six restorations (two total fractures and four partial fractures). Conclusion: All-ceramic RBFDPs made from high-strength oxide ceramics offer an effective conservative treatment for replacing anterior teeth. Keywords: clinical performance, esthetics, fracture, In-Ceram system, resin-bonded FDP

Objective: Connective tissue grafts (CTGs) have been used as a barrier for closing mandibular Class II furcation defects. The present study compared long-term (48 months) effectiveness of CTG as a barrier with bioresorbable collagen membrane in the treatment of mandibular Class II furcation defects in humans. Method and Materials: Twenty chronic periodontitis patients with a single Class II furcation defect on the buccal surface of mandibular teeth were included in the study. Vertical probing pocket depth (V-PPD), vertical relative attachment level (V-RAL), and relative gingival margin level (RGML) were recorded at baseline, 6 months, 12 months, and 48 months post-surgery. Results: The mean V-PPD reductions observed in the test group and control group were statistically significant at all time intervals when compared with the baseline. Similarly, the mean V-RAL gain at 6 months, 12 months, and 48 months were statistically significant, compared with the baseline data in both the groups. At 48 months the difference in V-RAL gain between the groups was found to be statistically significant, with greater improvements in test group. Complete closure of furcation and improvement in horizontal classification were better in the test group than in the control group. Conclusion: It can be concluded that both treatment modalities result in improvement in clinical parameters. However, the results obtained with CTG appeared to be more stable. Keywords: Class II furcation, collagen membrane, subepithelial connective tissue graft

A scalloped anatomy maintained between two adjacent crowns supported by immediate implants is presented in this clinical case. This is a modified concept of the socket-shield technique, which allows preservation of the papilla due in part to preservation of interproximal root fragments. Clinical results at 11 months after implant placement are presented. Keywords: implant esthetics, papilla preservation, socket shield

Objectives: This retrospective survey assessed the clinical survival of zirconia-based crowns (PFZ) and conventional porcelain- fused-to-metal (PFM) crowns on posterior teeth in private practice. Method and Materials: A print survey of 13 private practitioners was conducted to assess the long-term survival of previously placed full-coverage crowns. The practitioners reported a total of 2,182 premolar (n = 881) and molar (n = 1,301) full-coverage single crowns, 1,102 PFZ and 1,080 PFM, fabricated by one dental laboratory (Cusp, Boston) and followed over 7.4 years. All post-cementation complications (eg, porcelain fractures and chippings) were recorded as failures. In the PFZ group, one veneering porcelain (CZR, Kuraray Noritake) was used in combination with three coping systems (Lava, 3M ESPE; Procera, Nobelbiocare; Katana, Kuraray Noritake). Kaplan-Meier survival analysis was used for statistical analyses. Results: The probability of survival of posterior crowns investigated over the period of study (7.4 years) was 99.3% for PFM and 99.2% for PFZ restorations. There was no statistically significant difference (P = .614) between PFZ and PFM groups. In the PFZ group, probability of survival was 97.7% for Lava, 100% for Procera, and 99.5% for Katana. There were no statistically significant differences (P = .34) between the three PFZ systems or the location of the crowns (premolar or molar; P = .454). Conclusion: PFZ crowns fabricated with CZR and three commercial zirconia coping systems revealed excellent long-term success rates. Survival times and survival probabilities of posterior PFZ crowns did not differ from PFM crowns and were independent of type of coping system and location (molar or premolar teeth). Keywords: crowns, long-term survival, PFM, private practice, zirconia

Background: Accurate implant impressions are critical for the achievement of passive fit of an implant prosthesis which in turn contributes to the long-term success of the implant treatment. There is inconclusive evidence on the techniques and materials used for making multi-unit implant impressions. Objective: To evaluate the scientific data related to different aspects of multi-unit implant impression accuracy and draw useful conclusions from the review for application in clinical practice. Method and Materials: Studies from 1990 to November 2012 were evaluated. Papers examining implant impression accuracy for two or more implants were selected for review. Case reports, technique articles, and incomplete studies were excluded. Fifty-nine studies were selected in total for evaluation, three among them clinical and the rest in vitro. Results: Fifteen studies compared PVS (polyvinyl siloxane) and PE (polyether), 11 found no differences between the two materials in terms of impression accuracy. Thirty studies analyzed the splint effect, 13 found splinting better and 13 others elicited no differences between splinting and non-splinting. Among the 25 studies examining pickup and transfer impression techniques, 12 favored pickup over transfer and 11 found no differences between the two. Twelve studies assessed implant angulation effects and found significant differences in accuracy for 20- to 25-degree angulation, and no differences for 5- to 15-degree angulation for most studies, except two. Conclusion: PVS and PE were the preferred impression materials for multi-unit implant impressions. The evidence on splinting was inconclusive and the data supporting splint to non-splint were neutral. Pickup was the better performing technique than transfer, especially with increased number of implants. Implant angulation of 20 to 25 degrees negatively affected the multi-unit implant impression accuracy. Keywords: accuracy, angulated implants, digital impressions, impression material, misfit, multi-unit implant impressions, passive fit, splinting

Objective: The aim of this short communication is to describe an easy technique illustrating how to correct an esthetic mismatch between a natural tooth and a free hand bonded restoration. Method and Materials: The proposed technique is based on a case report showing the procedures required to perform a shade correction of an unesthetic anterior composite resin restoration. Results: The clinical case shows an easy and minimally invasive procedure which allows for color correction of anterior free bonded restorations, avoiding the complete removal of a class IV composite resin. Conclusion: This technique is suitable especially for anterior restorations whenever an imperfect color match is detected. Keywords: bonded restorations, chroma, color, esthetics, hue, shade, value

Objective: To analyze the closure, persistence or reopening of the maxillary midline diastema after frenectomy in patients with and without subsequent orthodontic treatment. Method and Materials: All patients undergoing frenectomy with a CO2 laser were included in this retrospective study during the period of September 2002 to June 2011. Age and sex, the dimension of the diastema, eruption status of the maxillary canines, and the presence of an orthodontic treatment were recorded at the day of frenectomy and during follow-up. Results: Of the 59 patients fulfilling the inclusion criteria, 31 (52.5%) had an active orthodontic therapy, while 27 (45.8%) had a frenectomy without orthodontic treatment. For one patient, information concerning orthodontic treatment was not available. In the first follow-up (2 to 12 weeks), only four diastemas closed after frenectomy and orthodontic treatment, and none after frenectomy alone. In the second follow-up (4 to 19 months), statistically significantly (P = .002) more diastemas (n = 20) closed with frenectomy and orthodontic treatment than with frenectomy alone (n = 3). At the long-term (21 to 121 months) follow-up, only four patients had a persisting diastema, and in three patients orthodontic treatment was ongoing. Conclusion: Closure of the maxillary midline diastema with a prominent frenum is more predictable with frenectomy and concomitant orthodontic treatment than with frenectomy alone. This study demonstrates the importance of an interdisciplinary approach to treat maxillary midline diastemas, ideally including general practitioners, oral surgeons, periodontists, and orthodontists. Keywords: CO2, frenectomy, frenum, laser, midline diastema, maxillary diastema

Objectives: The aim of the present study was to evaluate post-biopsy pain using a questionnaire supported by a visual analog scale (VAS), and the role of pharmacological agents in pain relief. Method and Materials: Three hundred patients undergoing oral biopsy were included in the study and divided into three groups. Group A: Patients received no analgesic post biopsy, except when required (SOS). Group B: Patients received anesthetic mouthwash along with oral analgesic post biopsy. Group C: Patients received anesthetic mouthwash alone. The statistical analysis was done using statistical analysis software SPSS version 11.0. ANOVA was used to compare the VAS scores and hygiene status of the three groups, while Pearson's chisquare test was used for determining association between age, sex, educational status, and association of pain with biopsy site. Results: A highly significant difference was found between the VAS scores of patients in Groups A, B, and C, and significant correlation was observed between hygiene status and degree of pain. Conclusion: Oral biopsy is definitely associated with pain, if proper medications are not deployed. Anesthetic mouthwash alone is sufficient to relieve the pain produced by oral biopsy. Direct correlation exists between hygiene status and the level of discomfort, thereby indicating that pain control is essential for good oral hygiene maintenance. Keywords: local anesthesia, oral biopsy, pain, questionnaire, visual analog scale

In the dental office, the dentist may have to examine patients with facial asymmetry and functional disorders caused by facial paralysis (FP). Following clinical examination, it is important for the dental practitioner to establish whether FP was caused by injury to the facial nerve, and to focus on the site of the lesion and potential risk factors. The risks of dental treatment in a patient with FP should also be assessed. Through dental or surgical procedures, the dentist may cause transient or permanent FP. Interdisciplinary collaboration is required for the confirmation of diagnosis and etiology, and for the complex treatment of FP. This article aims to examine the role of the dentist within the multidisciplinary medical team and to present two cases with transient FP following intraoral anesthesia in the dental office. Keywords: dental office, dentistry, facial nerve, facial palsy, facial paralysis, oral medicine

As very few studies regarding dentists' professional burnout have been published, we provide an updated review and recommendations with regards to the published dental literature of this phenomenon, which is relevant to the general dental community around the world. Professional burnout has been found to be prevalent among dentists and dental students. The challenge lies in early recognition and developing intervention programs specifically for the dental profession. Attention to realistic career expectation and the type of dentist one prefers to be, attention to practice management skills and the stressfulness of work, as well as longitudinal monitoring of newly qualified dentists on burnout development are recommended. Learning about professional burnout and its potentially serious consequences, as well as increasing knowledge about how to prevent and treat it are crucial. It is not only a caregiver problem, but also a public health problem. Keywords: burnout level, dental education, general dentistry, specialist dentistry