Quintessence International, 02/2018

Adhesive bonding techniques in combination with tooth-colored restorative materials are one of the greatest achievements of restorative dentistry. Adhesively bonded veneers made from various silicate ceramic materials have contributed significantly to this. Ceramic veneers had long been considered to be only esthetic implements. However, their range of indications has been steadily increasing, making ceramic veneers a highly viable alternative to classic, far more invasive forms of restorative treatment. Today these veneers are used to restore the biomechanics of the dentition, to establish adequate function, to mask highly discolored endodontically treated teeth, and for many other purposes. The present article explains the principles of modern veneer technology based on clinical examples, with special emphasis on collaboration with the dental laboratory and communication within the dental team. This includes analyzing the case, defining the treatment goal, determining the right shade, selecting the most suitable ceramic material, finding the best preparation design, and choosing the most appropriate adhesive concept. The article will also explore the long-term prognosis of ceramic veneers as reported by a number of scientific studies. Keywords: adhesive bonding, all-ceramics, analysis, material selection, preparation technique, preparation template, shade taking, try-in, veneer, wax-up

Objective: The aim of this study was to investigate in vivo, using cone beam computed tomography (CBCT), the differences between genders regarding the number of roots and root canal morphology. Method and Materials: An existing CBCT scan database was accessed and the scans were divided in two groups according to gender. Tooth inclusion and exclusion criteria were applied. The examined teeth were classified according to the number of roots, and the root canal system was classified according to Vertucci classification. Z-test for independent groups was used to detect differences between groups. Results: In total, 12,325 teeth (4,597 from males and 7,728 from females) from 670 patients were analyzed. Females presented a lower number of roots per tooth in all groups of teeth, except for mandibular canine, the difference being statistically significant in the maxillary first premolar and both maxillary and mandibular second molars. Vertucci Type I configuration had a higher or equal prevalence in nine of the eleven groups of maxillary roots in females, with significance in both maxillary premolars. The same configuration was higher in females in five of the nine groups of mandibular roots, with significance in mandibular central incisor and first premolar. Eight of the nine root groups (maxillary and mandibular roots combined) that presented three-root canal system configurations, had a higher prevalence of that anatomy in males. Conclusion: Few differences were found between genders. It was possible to detect a lower number of roots per tooth and a higher number of Vertucci Type I configurations in females. The three-root canal system configurations were more common in males. Keywords: anatomy, cone beam computed tomography, gender, morphology, root canal

Objective: To compare the 6-month clinical efficacy of Er:YAG laser and standard scalpel technique in treating gingival hyperpigmentation. Method and Materials: Patients requesting treatment for moderate to severe gingival hyperpigmentation in the maxilla were enrolled in this split-mouth study. The contralateral maxillary sides were randomly assigned to receive either Er:YAG laser (continuous wavelength of 2,940 nm) with a noncontact tip or the standard scalpel technique. Dummett oral pigmentation index (DOPI) and Hedin melanin index (HMI) were compared at the baseline and at 1 and 2 weeks, and 1, 3, and 6 months following the treatment. Bleeding Index, total treatment time, patient preference, pain perception at the first 3 days, wound healing, and level of satisfaction were also compared. Mann-Whitney test, Kruskal-Wallis test, and chi-square test were used to test the significance between variables. A P value of less than or equal to .05 was considered statistically significant. Results: Of the 22 patients enrolled, 20 completed this study. After assessing DOPI and HMI at 1 and 2 weeks, and at 1-, 3-, and 6-month follow-up appointments, both Er:YAG laser and scalpel were significantly effective in treating gingival hyperpigmentation when compared to baseline (P < .001) but with no statistically significant difference between the two treatment methods (P > .05). More patients preferred the scalpel technique as it was associated with slightly shorter treatment time and less postoperative pain when compared to Er:YAG laser, but with no statistical significance (P > .05). Er:YAG laser sites showed minimal bleeding and more rapid wound healing (P < .001). Conclusion: Both Er:YAG laser and scalpel technique achieved similar outcomes regarding the efficacy of gingival depigmentation, postoperative pain perception, and the time required for the treatment. Laser therapy requires more advanced technology and is associated with higher financial costs. Therefore, the scalpel technique is still considered the gold standard treatment for gingival depigmentation. Keywords: depigmentation, gingiva, laser, melanin

Objective: The influence of menopause on vascular inflammation and systemic bone loss has been documented. The purpose of this cross-sectional study was to assess the periodontal status, high-sensitivity C-reactive protein (HsCRP) level, and estrogen level in women with early menopause and women with normal menopause. Method and Materials: A total of 103 participants comprising normal menopausal women (n = 53) and early menopausal women (n = 50) were examined. Periodontal parameters, anthropometric parameters, and metabolic parameters including serum levels of HsCRP and estrogen were recorded. Results: Women with early menopause (age 49.02 ± 2.70 years, postmenopausal period 5.86 ± 2.48 years) had higher clinical attachment loss (CAL) and HsCRP along with increased sites with bleeding on probing (BOP) as compared with normal menopausal women (age 50.56 ± 1.94 years; postmenopausal period 2.03 ± 1.15). On partial correlation analysis after controlling for age, Plaque Index (PI), and body mass index (BMI), CAL correlated positively and significantly with HsCRP and duration of menopause (P = .000), and negatively with estradiol in pooled data. Multivariate linear regression analysis revealed that CAL (dependent variable) has significant association with HsCRP (P = .000, r2 = .343) and duration of menopause (P = .001, r2 = .343). Estrogen status also correlated with HsCRP. Conclusion: CAL and HsCRP were higher in women with early menopause. CAL was significantly correlated with postmenopausal period and HsCRP in the population studied. Keywords: chronic periodontitis, C-reactive protein, estrogen, menopause

The treatment of diastemas should be conservative to preserve tooth structure, and porcelain veneers provide an esthetic solution with minimal tooth preparation. However, asymmetric diastemas can be difficult to treat and may require redistribution of spaces. Additionally, extensive proximal restorations may negatively impact periodontal health. Minor tooth movement with elastic separators can be used to redistribute the interdental spaces and provide space for the interdental papilla. The aim of this paper was to present a clinical treatment involving the movement of peg-shaped maxillary lateral incisors with elastic separators to rearrange the spaces of asymmetric diastemas, thereby managing the horizontal distance during rehabilitation of the smile with minimally invasive ceramic veneers. Keywords: dental ceramics, dental esthetics, tooth movement techniques/methods, veneer

Background: Prosthetic treatment of the posterior edentulous maxilla may require bone augmentation to enable the placement and integration of dental implants. This constitutes a complex healing situation, and resorption of the grafted bone and failure of the implants often occurs. The application of platelet-rich plasma (PRP) has been suggested to improve incorporation and preservation of bone grafts. Objective: The objective was to assess the effectiveness of PRP on the implant failure and complication rate, when used as an adjunctive material with bone graft in sinus floor augmentation. Method and Materials: An electronic search of two databases (PubMed and Cochrane) was performed to identify randomized controlled trials (RCTs) in patients requiring sinus augmentation and implant placement in the posterior edentulous maxilla with or without using PRP as an adjunctive material to the bone graft. Data were extracted independently by two reviewers. The Cochrane tool was used for assessing the quality of included studies. Meta-analysis was performed for the included RCTs. Results: Nine RCTs were identified, four of which were included in the study. Three of these trials were judged to be at unclear risk of bias and one was at low risk of bias. The meta-analysis revealed no difference between the PRP versus non-PRP groups regarding implant failure and complication rate. Conclusion: The meta-analysis revealed no statistically significant difference regarding implant failure and complication rate of implants placed in the atrophic posterior maxilla with sinus floor augmentation with or without PRP as an adjunctive material to the bone graft. This finding should be interpreted with great caution given the serious numerical limitations of the included studies. Keywords: dental implants, implant failure, meta-analysis, platelet-rich plasma, sinus augmentation, systematic review

Objective: Tooth hypersensitivity is a common complaint of patients who present to the dental office. The aim of this study was to survey dental professionals in an effort to understand the current treatment trends for tooth hypersensitivity. Method and Materials: A questionnaire that addressed possible treatments for tooth hypersensitivity was developed and validated. The survey included a case presentation in which the responders were requested to list a first and second line of treatment. The questionnaire was distributed to dental professionals and analyzed statistically. Results: A total of 106 questionnaires were collected. The most common first line treatments for tooth hypersensitivity included sensitivity toothpastes (38.7%) and desensitizers (40.6%). Referral for patients with tooth hypersensitivity was indicated by 12.0% of the responders. The most preferred products included sensitivity toothpaste (34.9%) and fluoride varnish (19.8%). In regards to the case presented in the survey, the most common first treatment recommendations for patients were to use a sensitivity toothpaste (37.7%), stop drinking cold water (13.2%), and apply a desensitizing agent (23.6%). Of the 106 responders, 7.5% would opt to graft the recession area and 29.2% would restore the area as the second line of treatment. Conclusion: This study suggests that more invasive treatment options such as grafting and restoring may be used too early in the treatment plan for tooth hypersensitivity. Providing continuing education programs that address simple and less aggressive or invasive modes of treatment will benefit patients and may also reduce the financial burden of the treatment. Keywords: gingival graft, gingival health, plaque, prevention, root coverage

Objective: The objective was to examine the association between health attitudes and behaviors, and oral health practices in Israel. Method and Materials: Secondary data analysis was performed of a cross-sectional national Knowledge, Attitudes and Practices (KAP) survey in Israel. Univariate and multivariate analysis assessed the association between health attitudes and behaviors and oral health practices, namely tooth brushing frequency and routine dental clinic attendance. Results: A statistically significant association was found between gender (women), ethnicity (Jews), socioeconomic status (higher), education (higher), and employment (yes), and better oral health practices. A statistically significant association was also observed between clustered health-compromising behaviors (HCB) and oral health practices: the higher the score, the higher the likelihood of inappropriate tooth brushing and dental clinic attendance (OR = 1.56, 95% CI = 1.85-2.62, and OR = 2.20, 95% CI =1.31-1.86, respectively). A significant association was also observed using a compound variable of negative health attitudes (NHA): the higher the score, the higher the likelihood of inappropriate tooth brushing and dental clinic attendance (OR = 1.43, 95%CI = 1.55-2.17, and OR = 1.84, 95% CI = 1.22-1.68, respectively). Conclusion: Positive general health behaviors and attitudes are associated with better oral health behaviors in a dose-response association. These findings should be used to design appropriate and tailored health promotion programs in order to achieve oral and general behavioral change. Interventions should be also targeted toward high-risk groups in the population. Keywords: health attitudes, health behaviors, Israel, oral health behaviors, sociodemographic variables