Quintessence International, 07/2019

For several years, there has been a clear trend in the dental market towards monolithic tooth-colored restorations. In this context, further developments, particularly in the field of zirconia ceramics, have led to considerable improvement in the materials' optical properties. Modern zirconia materials can be divided into several cohorts, differing from each other with respect to their optical and mechanical properties. The knowledge about indications and limitations of each zirconia cohort is essential for a correct clinical application. Clinical long-term experience for the zirconia of the newest generations is still scarce and only in-vitro data are available. Despite all advancements, clinical long-term success remains closely linked to the specific indications, preparation, material selection, knowledge, and experience of the dental practitioner and dental technician, as well as an adequate luting mode and occlusal concept. Due to the high innovation rate within materials and CAD/CAM technology in general, clinicians and dental technicians need to be well informed in order to be able to work successfully with the various options. Keywords: all-ceramics, flexural strength, generations, monolithic restorations, translucency, zirconia

Objective: To evaluate the clinical performance of Glass Carbomer (GC) (GCP Dental) in restoring Class II cavities in primary molars in comparison with resin-modified glass-ionomer cement (RMGIC) and composite resin (CR) restorations. Method and materials: Healthy children aged between 4 and 8 years with a proximal lesion in at least one primary molar were recruited from the Pediatric Dental Clinics. A sample of 162 molars was randomly assigned to one of the following restoration types: GC, RMGIC, and CR. The restorations were evaluated clinically using the Cvar and Ryge criteria at 6 and 12 months postoperatively. Results: At 12 months, the success rates of anatomical form and marginal adaptation were 67% and 54% for GC, 98% and 93% for RMGIC, and 98% and 98% for CR, respectively. The GC restorations were significantly less successful than RMGIC and CR restorations in terms of anatomical form (P < .001) and marginal adaptation (P < .001). Secondary caries formation was not observed in any of the restorations in the three restorative material groups. Conclusion: The 12-month clinical performance of the GC restorative material was not satisfactory in restoring Class II cavities in primary molars. RMGIC and composite resin restorations performed significantly better. The use of GC cannot be recommended for restoring Class II cavities in primary molars. Keywords: composite, Class II, glass carbomer, glass-ionomer cement, primary molars

The clinical report describes a three-dimensional (3D) printed coping for intraoral evaluation before milling final anterior restorations. The use of printed copings allows restorations for complex and esthetically important restorations to be thoroughly tested at relatively low cost without introducing large delays into the fabrication process. Keywords: abutment design, computer modeling, prosthetic procedure, prosthodontics, restorative dentistry

Objectives: The aim of the present double-blind, randomized, controlled clinical trial was to evaluate the effect of ketorolac buccal infiltration of on postendodontic pain of patients with symptomatic irreversible pulpitis in mandibular first/second molars. Method and materials: Sixty patients meeting the inclusion criteria were evaluated. After receiving a standard inferior alveolar nerve block (IANB) followed by a buccal infiltration injection with lidocaine, half of the participants randomly received a supplemental buccal infiltration of 30 mg/mL ketorolac tromethamine and the other half received a buccal infiltration of normal saline adjacent to the periapical region of the tooth being treated. Afterwards, all participants received a single-visit root canal treatment. Pre- and postoperative (immediately after treatment, and at 2, 4, 6, and 24 hours) pain levels were evaluated via Heft-Parker visual analog scale (HP-VAS). Analgesic consumption was also recorded. The data were statistically analyzed using repeated-measures ANOVA and Friedman tests. The significance level was set at P < .05. Results: There was a significant difference in postoperative pain between the two groups in overall evaluations and in each time interval (P < .001 and P = .043 respectively). Of those patients receiving ketorolac, 60% (18/30) did not require any analgesic consumption up to 24 hours postoperatively, whereas this number was 43% (13/30) for the placebo group. Conclusion: Ketorolac buccal infiltration could reduce the postoperative pain experienced by patients requiring endodontic treatment diagnosed with symptomatic irreversible pulpitis. Keywords: buccal infiltration, ketorolac, nonsteroidal anti-inflammatory drug, pain, root canal treatment

Objectives: The purpose of the present study was to review and evaluate the effectiveness of bone substitute materials used for maxillary sinus floor elevation and to propose the most effective bone graft material by assessing newly formed bone, remaining graft particles, and soft tissue ratio. Method and materials: The search protocol used the electronic MEDLINE (PubMed) database for articles published between 1 January 2008 and 1 January 2019. The search was limited to English language only and included clinical studies on humans. Outcomes were the percentage of newly formed bone, remaining graft particles, and soft tissue. Results: Eighteen studies fulfilled the inclusion criteria. Autologous bone and mineralized cancellous bone allograft showed the best results regarding the percentage of newly formed bone (41.74% and 35.41%, respectively). The worst bone formation was observed when Bio-Oss material was used alone (8.25%) and in combination with recombinant human bone morphogenetic protein-7 (rhBMP-7) (6.55%). During estimation of bone regeneration results when anorganic bovine bone (ABB) substitute was used alone and in combination with platelet-rich plasma (PRP), histomorphometric analysis revealed a higher amount of newly formed bone in sites treated with PRP + ABB (31%) compared to ABB alone (21.3%). Conclusions: The present systemic review demonstrated that autologous bone has the best regenerative potential for sinus floor elevation. Combining autologous bone with bone substitutes leads to more matured newly formed bone and better bone graft osseointegration. PRP/plasma rich in growth factors (PRGF) combined together with bone graft materials enhances bone formation and vascularization. It might also reduce inflammation and decrease the risk of complications. Keywords: bone regeneration, bone substitute, histology, sinus floor elevation

Objective: The objective was to assess the outcome of graftless sinus floor augmentation associated with dental implant placement performed with an implant system that has an internal port and screw, combined with the osteotome technique. Method and materials: Between 2012 and 2018, 722 titanium-aluminum-vanadium implants (Ti-6Al-4V ELI, diameter 3.75/4.20 mm) were placed in 331 patients. Implants 11.5 mm in length were inserted in maxillae with bone level ≤ 5 mm, and 13.0-mm-long implants were inserted in maxillae with bone level of > 5 to 8 mm. In all cases, no graft materials or bone substitutes were used for the sinus elevation. Implant condition was assessed at three different centers and the follow-up period ranged from 6 months to 7 years. Results: In total, 412 11.5-mm-long implants and 310 13-mm-long implants were inserted. Implantation was successful in 689 implants (95.4%), based on cone beam computed tomography and clinical evaluation as well as the patients' experience, with no statistically significant difference between the 11.5-mm and 13.0-mm implants. The complication rates were comparable between cases with bone levels from 3 to 5 mm and the > 5- to 8-mm bone level cases. Conclusions: The port and screw implant system may allow maxillary sinus augmentation without grafting or bony substitute. This can simplify relatively major surgery, such as a sinus augmentation procedure, to a less invasive procedure and potentially reduce the risk of complications. Keywords: dental implant, graft, implant maintenance, maxillary sinus floor elevation

Objective: To systematically review the safety of phentolamine mesylate as a reversal agent for pulpal and soft tissue dental anesthesia. Data sources: Comprehensive search, up to August 2018, was performed in three major electronic databases. The methodologic quality of all the included studies was assessed using Cochrane Collaboration for randomized clinical trials. Results: A total of nine studies were included for qualitative and quantitative assessment. The number of events was 269 in 2,057 participants in the phentolamine mesylate group, and 179 in 1,338 participants of the control group (odds ratio 1.19; 95% confidence interval 1.03 to 1.39). In the data segregated based on age, four studies conducted on children and adolescents revealed an odds ratio of 0.68, whereas two studies on adults revealed an odds ratio of 1.58. Conclusion: There were no severe complications reported in any of the included studies, but the occurrence of adverse events (mild and moderate) was greater in the phentolamine mesylate group compared to the control group. Age has a significant effect on the possibility of adverse events with phentolamine mesylate. Keywords: local anesthetic, phentolamine, safety

The volume of the bone in a site past an extraction degrades significantly and thus it is imperative to evaluate the situation for implant placement. Besides the need for sufficient bone, the amount and quality of the soft tissue covering the bone in the missing tooth area and nature of the adjacent teeth must be carefully assessed. In anterior sites, reconstructive surgery is usually performed to restore these hard and soft tissues, mainly for esthetic reasons, but it is equally essential in posterior sites to ensure adequate functional support. In guided bone regeneration procedures, barrier membranes block the augmented areas, provide and maintain space for regenerative material, and protect the blood clot, allowing a normal wound stability process. Clinicians prefer using resorbable membranes in most cases, whereas a nonresorbable membrane is selected to correct large defects. This report proposes the use of a collagen scaffold as a core material for guided bone regeneration in the case of a missing tooth between two existing teeth, when there is sufficient bone to place an implant but a horizontal defect is present in the crestal ridge. The tested question is whether a thick, reinforced, resorbable collagen scaffold (Ossix Volumax) can provide a stable basis for restoring the lost volume of a deficient ridge. The regeneration procedure presented with the collagen scaffold resulted in restoration of the lost tissue volume and a favorable lifelike emergence profile for the implant-supported crown. This augmentation procedure is simpler to perform in certain cases than existing procedures with bone substitute material and/or an interpositional connective tissue graft harvested from a remote donor site, the harvest of which is not required. Keywords: bone resorption, collagen scaffold, guided bone regeneration, posterior implant, resorbable membrane