Quintessence International, 07/2016

Objective: The beneficial effects of antiseptics in the treatment of periodontitis are still controversial. The goal of this randomized split-mouth study was to evaluate the clinical and microbiologic results of a unique subgingival irrigation of 10% povidone-iodine in addition to a full-mouth scaling and root planing for the treatment of chronic periodontitis. Method and Materials: Twenty patients with chronic periodontitis took part in this investigation. In each patient, four initially untreated pockets ≥ 4 mm were randomly selected for one subgingival irrigation. After a one-session full-mouth treatment with scaling and root planing (SRP), two pockets of a split mouth received one unique irrigation with 10 mL 0.9% NaCl solution (control group, CG). Two pockets on the other side received 10 mL of povidone-iodine 10% (test group, PIG). Full-mouth plaque score (FMPS), full-mouth bleeding score (FMBS), Plaque Index (PI), Gingival Index (GI), probing pocket depth (PPD), and clinical attachment level (CAL) parameters were assessed at baseline and after 1, 3, and 6 months (M). Bacterial samplings with sterile paper points were taken at M0 and after M1, M3, and M6. These samplings were separately cultured under aerobic and anaerobic conditions before CFU evaluation. Results: Pl, GI, PPD, and CAL were significantly improved in both groups after 6 months. The major difference was seen between M0 and M3 (P < .001). No significant differences were seen between the groups, except for deep pockets (> 6 mm) where a statistical difference was observed in favor of PIG after 6 months; in these subgroups the mean probing reduction was 2.68 ± 0.37 mm for CG versus 3.93 ± 0.23 mm in PIG (P < .001). No significant differences were seen between CG and PIG regarding the microbiologic results after 6 months. Conclusion: One single irrigation of 10% povidone-iodine associated with full-mouth SRP would bring a small additional benefit in deep pockets. More studies are needed to yield additional results. Keywords: chronic periodontitis, microbiology, povidone-iodine, root planing

Objective: The aim of this paper was to identify the appropriate power setting and operation time required to achieve optimal efficiency in calculus debridement while preventing excessive cementum loss. Method and Materials: The study included 30 extracted molars with heavy deposits of calculus, visible to the the naked eye. Experimental areas (3 × 4 mm) were delineated below the cementoenamel junction. The teeth were cut cross-sectionally and randomly allocated into three groups: low, medium, and high power settings. A magnetostrictive ultrasonic scaler with Dentsply slimline plain insert was used with light force at 0-degree tip angulation for a 10 second interval. Before and after treatment, the samples were visualized using digital stereo microscopy at 100× magnification. Results: Mean time required for dental calculus removal was 70, 50, and 30 seconds for low, medium, and high power settings, respectively. Root calculus removal rates for low, medium, and high power settings were 4.5, 6.7, and 8.2 μm/s, respectively (P = .0045, P < .01). Mean time required for dental cementum removal was 30, 30, and 20 seconds for low, medium, and high power settings, respectively. Cementum removal rates for low, medium, and high power settings were 1.7, 2.2, and 3.3 μm/s, respectively (P = .0127, P < .05). Conclusion: The most efficient dental calculus removal occurred within the first 30 seconds using a high power setting with light force at 0-degree tip angulation, which was recommended for roots with heavy calculus. Later on, to minimize cementum loss, the low power setting should be used for less than 30 seconds to balance between rapid calculus removal and a potential risk of cementum loss resulting in dental sensitivity. Ultrasonic scaling using the high power setting in the first 30 seconds, followed by continuous scaling for less than 30 seconds, using the low power setting, is recommended for roots with heavy calculus. Keywords: cementum removal, dental scaling, lipopolysaccharide, periodontitis, root planing, ultrasonic debridement

Objective: To assess and compare the clinical and radiographic success rates of biodentine and formocresol for pulpotomy in human primary teeth. Method and Materials: A randomized, split-mouth, double-blind, controlled clinical trial was carried out in 37 healthy 4- to 8-year-old children with 56 pairs (112 teeth) of contralateral primary molars indicated for pulpotomy. Matched teeth in each pair were randomized to undergo either biodentine (n = 56 teeth) or formocresol (n = 56 teeth) pulpotomy. In both groups, the teeth were restored with stainless steel crowns. The teeth were evaluated clinically and radiographically at 3 and 6 months by two blinded, standardized, and calibrated examiners. The data were analyzed using chi-square and McNemar tests with a P value of < .05 considered significant. Results: At both the 3- and 6-month follow-ups, all the 37 children with 112 treated teeth were evaluated. Clinical and radiographic success was similar for biodentine (100%) and formocresol (100%), without any statistically significant difference (P = 1). Pulp canal obliteration was radiographically observed in 10/56 (17.9%) and 7/56 (12.5%) cases in the biodentine and formocresol groups, respectively. Conclusion: Both pulpotomy techniques showed favorable clinical and radiographic outcomes at 3 and 6 months posttreatment without any significant difference. Hence, biodentine has the potential to become a substitute for formocresol in primary molar pulpotomies. Keywords: biodentine, formocresol, primary molars, pulpotomy

Objective: Functional sensory recovery from microsurgical intervention for inferior alveolar nerve (IAN) injuries resulting from endodontic treatment were evaluated using a retrospective chart review. Other variables assessed included time from injury to surgery as well as other factors which improved functional neurosensory recovery (FSR). Method and Materials: This case series of seven patients evaluated the outcome of IAN microsurgery following endodontic-related nerve injuries. All patients were referred, evaluated, and operated on by the primary investigator (VBZ). Surgical intervention consisted of external and/or internal neurolysis with irrigation of the mandibular canal and decompression of the affected IAN as well as allogeneic nerve graft in one patient. Preoperative and postoperative sensory levels were recorded and FSR was assessed using the Medical Research Council scale. Results: Seven subjects with a mean age of 35.57 years (range 22 to 55 years old) opted to undergo trigeminal nerve microsurgery for management of their IAN injury resulting from endodontic treatment of mandibular molar teeth. Six women and one man were included in this population. The majority of subjects presented with an initial chief complaint of dysesthesia and hypoesthesia. The mean interval between nerve injury and surgical treatment was 15 weeks (range 1 to 40 weeks). All patients had preoperative sensory level of S0, S1, or S2+, and achieved FSR following surgery. Two patients had postoperative sensory level of S3, four patients had a postoperative sensory level of S3+, and one had a postoperative sensory level of S4 (complete recovery). Conclusions: The results of this study suggest that trigeminal nerve microsurgery for the surgical treatment of endodontic injuries to the IAN can improve neurosensory function. Surgical intervention in this study was beneficial to alleviate neurosensory deficits and symptoms for those injuries to the IAN caused by endodontic treatment. Keywords: endodontic injuries, external neurolysis, inferior alveolar nerve repair, internal neurolysis

Objectives: Previous research has demonstrated the efficacy of using local compression to reduce postoperative pain after third molar surgery. It has been theorized that compression reduces pain intensity through vasoconstriction. The current research tests the veracity of this vasoconstriction hypothesis by testing the impact of local epinephrine (a local vasoconstrictor) versus a control on patients' pain ratings over 7 days following surgery. Method and Materials: Fifty patients scheduled for mandibular third molar surgery were randomly assigned to receive one cartridge of Ultracaine DS Forte (the treatment group) or one cartridge of Ultracaine DS (the control group) after surgical removal of the third molar. Participants used the visual analog scale (VAS) to provide daily ratings of pain intensity for 7 days following surgery. In addition, on day 7, the perceived effectiveness of the pain treatment was measured with the global perceived effect (GPE) scale. A quality- of-life questionnaire was also completed. Results: A repeated-measures ANOVA indicated that the treatment group perceived significantly less pain than the control group on days 2 to 7 following surgery. In addition, 77.8% of the treatment group perceived their pain treatment to be successful, while only 69.6% of the control group reported that their pain was reduced successfully by day 7. Conclusion: The results of this study provide an initial proof of concept that epinephrine may have an analgesic effect on the period following third molar surgery. Further research with larger sample sizes is needed to strengthen evidence for the clinical utility of offering localized epinephrine to patients following third molar surgery. Keywords: epinephrine, mandibular third molar, pain, vasoconstrictor

Objective: To describe a case of bilateral simultaneous squamous cell carcinoma of the gingiva affecting the mandible in a lichen planus patient and discuss the pertinent literature. Method and Materials: We present a case of a 50-year-old woman with a history of oral lichen planus who was diagnosed with a primary and a second primary squamous cell carcinoma originating from the mandibular gingiva. A literature review did not disclose cases of gingival carcinoma arising simultaneously and bilaterally in the mandible. Results: Presentation of two simultaneous clinically distinct squamous cell carcinoma of gingiva, invading underlying mandible, is rare. Second primary tumor refers to a concomitant malignancy that is independent from the primary tumor. Second primary tumor is an independent prognostic factor since the surgical procedure is highly influenced by the extent of bony invasion. Conclusion: The general practitioner should be aware of the possibility of multiple independent lesions at different sites of the oral cavity. A thorough oral examination of sites remote from the obvious main lesion should be performed. The presence of simultaneous primary oral cancerous lesions may indicate a greater morbidity and a grave outcome for the patient. Keywords: gingiva, imaging, lichen planus, oral squamous cell carcinoma, second primary tumor, simultaneous

Objective: Oral cancer is an increasingly growing health care burden in many parts of the world. Due to the relatively low prevalence of oral cancer, screening will lead to a low yield and a high proportion of false positive results. Clinical examination without histologic diagnosis can lead to misdiagnosis in over 40% of cases, especially when premalignant lesions are involved. However, clinical examination is effective especially in detecting the early stages of oral cancer, particularly in high-risk patients, such as smokers and alcoholics. The purpose of the current paper is to describe several cases of failure to diagnose lesions in the oral cavity during clinical and radiographic examinations, and to discuss how these diagnosis failures may be mitigated. Method and Materials: A series of three cases of oral tumors ranging from benign to malignant that were not recognized and referred in a timely manner, are presented. Conclusion: The difficulties faced by clinicians in diagnosing oral lesions are elucidated in this case series. The current case series, presenting instances in which pathologies were not detected and/or treated in spite of obvious signs, should serve as a warning for dental professionals. The general practitioner is the "first line of defense" for symptomatic and asymptomatic patients, and therefore the implementation of well-established screening protocols is of paramount importance. In light of the low sensitivity ratio of oral examinations, use of biopsies is mandatory when a lesion is suspected. Keywords: biopsy, clinical examination, diagnosis, oral tumors

Chronic osteomyelitis of the jaws presents a diagnostic and therapeutic challenge. A 45-year-old woman presented with episodic pain in the right mandible of two and a half years' duration. During active periods, lasting for 2 to 3 weeks, the pain woke the patient from sleep at a regular time, and had features mimicking a variant of cluster headache. However, clinical, radiologic, and histologic findings confirmed the diagnosis of chronic sclerosing osteomyelitis. Conservative treatment, including 6 weeks of intravenous antibiotics, relieved the pain with no signs of recurrence at the 1-year follow-up. We emphasize the importance of including chronic osteomyelitis in the differential diagnosis of idiopathic orofacial pain disorders, particularly in the mandibular area. Keywords: chronic sclerosing osteomyelitis, osteomyelitis of the jaw, osteosclerosis

Non-restorative sleep has considerable consequences for daily life. A sleep disorder is recognized by symptoms such as daytime fatigue and performance or concentration disorders. Furthermore, it increases the risk of developing cardiovascular, metabolic, and neurologic diseases. The diagnosis and therapy of sleep disorders is not only in the sleep medicine doctor's hands. A multidisciplinary approach reflects the affected patients' choice. Dentists can make an important contribution, especially to the therapy of sleep-related breathing disorder. Keywords: mandibular advancement appliance, primary snoring, sleep apnea, sleep-related breathing disorder, upper airway resistance syndrome (UARS)