Quintessence International, 10/2017

Objective: To clinically evaluate the outcomes following surgical coverage of single and multiple Miller Class I and III gingival recessions at crown-restored teeth in the esthetic area by means of the modified coronally advanced tunnel (MCAT). Method and Materials: Eight systemically healthy patients (5 females) with a total of 23 single or multiple maxillary Miller Class I or III gingival recessions were consecutively treated with MCAT in conjunction with a subepithelial connective tissue graft (SCTG). Out of the 23 recessions, 16 were classified as Miller Class I and seven as Miller Class III. All patients presented at least one facial gingival recession at a crown-restored tooth, located in the maxillary anterior area. In all cases, the facial recession was associated with an impaired esthetic appearance. Clinical measurements were made at baseline (immediately before reconstructive surgery) and at 12 months postoperatively. The primary outcome variable was complete root coverage (CRC) (ie, 100% root coverage). Results: Healing was uneventful in all cases. At 12 months, statistically highly significant (P < .0001) root coverage was obtained in all patients and defects. CRC was obtained in 22 out of the 23 recessions (in 16 Miller Class I and in six out of the seven Miller Class III recessions). In one Miller Class III recession, root coverage measured 89.10%. The treatment yielded a mean root coverage of 92.62% and 3.75 mm, respectively, and was associated with a mean gain of keratinized tissue width of 0.62 ± 1.15 mm (P < .05). Conclusion: Within their limits, the present findings indicate that MCAT in conjunction with SCTG represents a valuable option for treating single and multiple gingival recessions at crown-restored teeth in the maxillary esthetic area thus avoiding the replacement of the prosthetic restorations. Keywords: crown-restored teeth, gingival recession, Miller Class I and III recessions, modified coronally advanced tunnel, root coverage, subepithelial connective tissue graft

Objective: To compare the efficacy of tooth bleaching after using ozone, before and after application of hydrogen peroxide (H2O2). Method and Materials: In total, 120 extracted teeth were assigned to three groups (n = 40 in each group). Teeth were bleached using 38% H2O2 application for 20 minutes followed by use of the ozone (delivered by means of the healOzone X4 device) for 60 seconds in group 1, via ozone for 60 seconds then 38% H2O2 for 20 minutes in group 2, and via 38% H2O2 for 20 minutes (plus normal air, delivered by the healOzone X4 device for 60 seconds) in group 3 (control). Teeth shades were assessed using a colorimeter before and after bleaching in each group. Significant statistical differences were recorded at P < .05. Results: Teeth attained lighter shades (higher L* and lower b* values) subsequent to bleaching in all groups (P < .001). Groups 1 and 2 revealed similar bleaching results (P > .05), and showed lighter final teeth shades than group 3 (P < .05). Conclusions: Bleaching using 38% H2O2 for 20 minutes (combined with ozone for 60 seconds) produced similar results, regardless of applying the ozone before or after H2O2. Also, bleaching by combining ozone and H2O2 produced better tooth shades than bleaching by H2O2 only. Therefore, it might be practical to consider ozone when H2O2 is used for bleaching as this might potentially reduce treatment time and concentrations of H2O2, thus leading to improved bleaching results. Keywords: esthetic dentistry, healOzone machine, hydrogen peroxide, ozone, tooth bleaching

Atypical root resorption (ARR) is the condition of a superficial and circumferential resorption process along the lateral and/or apical root surface of a primary maxillary incisor. This case series demonstrates longitudinal observations of six patients with atypical root resorption following root-fractured primary incisors. The characteristics of atypical root resorption were different from pathologic root resorption. Keywords: dental trauma, primary tooth, root resorption, tooth injury

Currently, there are three major groups of dentists who provide orthodontic services to the public: postgraduate trained orthodontists, postgraduate trained pediatric dentists, and general dentists who have taken various orthodontic training courses. All of them can expect to encounter a variety of clinical situations that require a proper understanding of how normal temporomandibular joints (TMJs) function, and also how the masticatory system can develop pain-dysfunction problems; those problems are classified and defined as temporomandibular disorders (TMDs). In this paper, six "intersections" between these groups of practitioners and those clinical situations will be discussed, with an emphasis on practical approaches to managing problems that may arise during orthodontic treatment. Specific recommendations are offered to help clinicians recognize clinical problems and to deal with them successfully. Keywords: orthodontic treatment, temporomandibular disorders, temporomandibular joint

Septic arthritis of the temporomandibular joint as a complication of acute otitis media is rare in the Western world. This report describes the case of a 7-year-old boy who had pain in his right ear and limited mouth opening, following the onset of acute otitis media. A contrast-enhanced computed tomography scan revealed right-sided mastoiditis and hydrops of the right temporomandibular joint, suggesting septic arthritis. Real-time PCR and microbiologic analysis identified Streptococcus pyogenes and Staphylococcus epidermidis in the joint aspirate. Treatment with arthrocentesis and antibiotics led to full recovery of temporomandibular joint function. Keywords: acute otitis media, arthrocentesis, diagnosis septic arthritis, mastoiditis, real-time PCR, Streptococcus pyogenes, temporomandibular joint, therapy

Objective: The purpose of this manuscript is to present a clinicopathologic review of the literature concerning all the detailed cases of primary oral melanoma (OM) that were confirmed by immunohistochemistry. In addition, a pertinent case presentation is addressed. Data Sources: An extensive electronic search of the literature was performed using PubMed/Medline from 1953 to 2017. Relevant articles were selected based on specific inclusion criteria. Statistical analyses were conducted by the Shapiro-Wilk, Fisher's exact, chi-square, and Z tests (α = .05). Results: Forty-nine cases of primary OM reported in the literature plus the current case were analyzed; patient ages ranged from 17 to 89 years with a mean of 60.8 years; male to female ratio was 1.5:1; Caucasian patients were the most affected and the most frequent locations were maxillary alveolar mucosa and palate; the majority of the lesions were pigmented (62%); differences among the proportions of positivity to S-100, HMB-45, Melan-A, NKFC3, vimentin, tyrosinase, CK, microphthalmia transcription factor (MITF), and Ki-67 were found (P < .0001), especially when comparing with vimentin (P < .05) and CK (P < .01); recurrence was reported in 11.6% and mortality in 54.8%. The case presented is of a 71-year-old mixed-race woman who presented multiple pigmented lesions over the maxillary alveolar mucosa and palate. Positivity for S-100, HMB-45, Melan-A, and Ki-67 confirmed the diagnosis of primary OM. Conclusion: Primary OM is rare and very aggressive, with only 49 detailed cases confirmed by immunohistochemistry existing within the English literature, in addition to the present case. S-100 and HMB-45 are excellent markers to confirm the diagnosis of primary OM, although the use of adjuvant specific markers such as Melan-A, tyrosinase, and MITF should be also encouraged. Keywords: immunohistochemistry, melanocyte, melanoma, oral cancer

Masticatory myofascial pain is the one of the most common etiologies for nonodontogenic pain, often characterized by the presence of trigger points. Conventional management includes approaches such as jaw exercises, physical therapy, intraoral appliances, medications, and trigger point injections. Peripheral/regional nerve blocks have shown to be effective in managing myogenous pain conditions. The twin block is a nerve block that blocks both the masseteric and the anterior deep temporal nerves. The objective of this case series is to illustrate expeditious and sustained efficacy of the twin block in the management of chronic masticatory myofascial pain. Keywords: chronic myofascial pain, trigger point injections, twin block

With the plethora of medical malpractice claims, health care providers are forced to deal not only with medical matters but also with legal issues. Thus, unfortunately, every time health care providers give a medical treatment, they should be aware of the legal implications of their act. Most medical malpractice cases will be resolved in civil law and will have financial implications, but in extreme cases (such as causing death by negligence) criminal procedure may also be conducted, meaning criminal sanctions (imprisonment or fine). This paper is intended to provide dental practitioners with an introduction to basic legal knowledge and concepts regarding medical malpractice law along with a short legal overview regarding the liability regime in different countries. The paper focuses on tort law and the meaning of "negligence," reviewing the main different liability regimes that exist and the legal elements that must be proven in each regime in order to receive compensation. In an era of increase in medical malpractice law suits, it is essential that physicians and dental professionals recognize the basic legal concepts of medical malpractice. Keywords: civil, criminal, law, lawsuit, liability, litigation, malpractice, negligence

Objective: To assess possible associations between torus palatinus (TP), torus mandibularis (TM), occlusal force (OF), Klemetti's classes, mandibular cortical index (MCI), and sociodemographic variables in a selected sample of Jordanians. Previous studies have suggested that oral tori are benign anatomical variations probably related to several factors such as functional stress, gender predisposition, number of teeth present, and nutritional factors. Method and Materials: A total of 130 Jordanian adults were included. Shape, location, and appearance of tori were recorded from study casts. Size was measured using digital calipers. OF was recorded in Newtons. MCI and Klemetti's classification were assessed using panoramic radiographs. Data were statistically analyzed, and level of significance was set at P < .05. Results: The mean ± SD recorded OF was 524 ± 183 N in the tori group, compared to 417 ± 172 N in controls (P = .001). OF was significantly higher in males compared to females (P < .001), and was significantly higher in subjects with TM only (543 ± 201 N) (P < .001). TP and TM were predominantly more than 6 mm in size. The average OF in subjects with Klemetti class 3 was 418 ± 174 N, while OF in Klemetti class 1 subjects amounted to 535 ± 187 N (P = .043). Conclusion: Average OF was significantly higher in tori subjects and in males (if compared to controls and female subjects, respectively). The presence of oral tori, Klemetti's classification, and MCI ratio seems to be positively correlated with OF. Keywords: Jordanian population, Klemetti's classification, mandibular cortical index, occlusal force, oral tori