Quintessence International, 09/2019

This report describes a clinical technique to facilitate the placement of direct composite resin restorations in structurally compromised posterior teeth, to restore proper anatomical contours and interproximal contacts using sectional matrix kit and thermoplastic impression material. Keywords: composite restoration, interproximal contact, sectional matrix, structurally compromised teeth, thermoplastic impression material

Objective: The aim of this study was to evaluate the effect of maintaining apical patency on periapical healing and postoperative pain levels in teeth with necrotic pulp and apical periodontitis. Method and materials: Fifty mature teeth with periapical lesions were randomly distributed into two treatment groups: patency, and nonpatency (n = 25). Patients were followed up over a 12-month period using clinical and radiographic assessments. The data were statistically analyzed using independent-samples t test and chi-square tests at a 95% confidence level (P = .05). Results: Seventeen teeth in the patency group (85.0%) and 19 teeth in the nonpatency group (86.4%) were classified as being successfully treated (P = .900). Conclusions: Within the limitations of the present study, maintaining apical patency did not affect endodontic treatment outcomes. Keywords: apical periodontitis, mature tooth, necrotic tooth, patency, root canal, success

Objectives: Prosthetic joint infection (PJI) is a severe complication for patients and represents an increasing health problem. At present, very limited data are available on the potential role of periodontopathogenic bacteria in PJI. The aim of this analysis was to compare the presence of periodontopathogenic bacteria in surgically treated patients diagnosed with PJI (study) to that of surgically treated infected orthopedic patients without PJI (controls). Method and materials: Patient records of all orthopedic surgical treatments performed between January 2009 and March 2014 were retrospectively screened. The study group consisted of 996 PJI patients, and the control group of 677 individuals, following surgical treatment of orthopedic infections. During surgery, microbiologic smears were taken and processed by standard procedures for microbiologic diagnosis. Results: Periodontopathogenic bacteria were detected in both groups (4.3% study and 5.6% control group). Nine periodontal pathogenic species from the yellow, violet, and orange complex were identified, without any statistically significant difference between the two groups. Conclusions: Within their limits, the presented results indicate that periodontal bacteria may contribute similarly to PJI and other surgically treated orthopedic infections. The finding that periodontal pathogenic bacteria were identified in both groups highlights the importance of oral infection control prior to orthopedic surgery. Keywords: oral and periodontopathogenic bacteria, orthopedic surgery, prosthetic joint infection

Objectives: The aim of this retrospective pilot study was to analyze the clinical performance of computer-engineered complete dentures (CECDs) in edentulous patients regarding survival and maintenance. Method and materials: For this retrospective analysis, data from 10 patients who received CECD treatment in each arch (Digital Denture, Ivoclar Vivadent) between 2015 and 2016 were analyzed. The following aspects were assessed: number of appointments required for treatment, number of interventions during the initial (≤ 4 weeks after insertion) and functional periods (> 4 weeks after insertion), and survival. Additionally, whether these aspects were influenced by function or esthetics, the arch, or recall participation was assessed. Poisson regression models were used for the statistical analysis (P < .05). Results: All CECDs survived the observation period of 2.54 ± 0.48 years. More than four appointments were required for treatment (mean ± standard deviation, 4.6 ± 0.7), mainly for esthetic concerns. An average of 1.7 ± 0.05 appointments during the initial period and 2.07 ± 0.32 during the functional period were noted as a consequence of functional concerns. During both periods, the major reason for intervention was removal of pressure spots. Relining was required in 40% of the CECDs, and fracture of the denture base occurred in two CECDs. Conclusions: Within the limitations of this retrospective pilot study, the CECDs showed acceptable clinical performance in terms of survival and maintenance. Nevertheless, transferring more information about the patient from the dental practice to the dental laboratory might reduce the number of appointments for treatment and avoid technical complications such as fractures of the denture base. Keywords: CAD/CAM complete denture, computer-engineered complete dentures, maintenance, survival

The injectable composite resin technique is an indirect/direct method that uses a transparent silicone index for accurate and predictable translation of a diagnostic wax-up into composite restorations without the need for tooth preparation. This case report involves a 22-year-old man who presented with esthetic and functional problems associated with diastemas and insufficient tooth visibility. Clinical examination revealed inadequate canine guidance in lateral excursion. The treatment plan included the fabrication of composite veneers for the maxillary incisors and canines. A wax-up was prepared by simulation of functional movements on an articulator, and a transparent silicone index was prepared after checking a mock-up in the oral cavity. The teeth were restored with flowable composite injected and polymerized through the transparent silicone index. The conventional technique was modified by cutting the silicone index at the gingival margin, using individual mock-ups as space holders, and the use of gingival retraction cords. The final outcomes were elongated teeth for increased visibility, closed diastemas, and reshaped canines for adequate guidance in lateral excursion. A protective splint for night-time wear was fabricated and delivered to ensure long-term stability. The patient did not exhibit any soft tissue inflammation or significant wear during a 24-month follow-up period. The technique described is minimally invasive and inexpensive, and it can be used for definitive as well as translational restorations. The treatment goals are to establish adequate function and esthetics, with advantages including minimal tooth structure loss and cost-effectiveness. Stable and predictable results can be achieved with proper planning and a careful workflow. Keywords: composite resin injection, composite veneer, esthetic rehabilitation, functional rehabilitation, transparent silicone index

Objectives: To compare the cleaning efficacy of glycine air polishing against two different professional oral hygiene techniques on implants supporting full-arch fixed prostheses. Method and materials: Thirty patients with a total of 32 implant fixed full-arch rehabilitations in the maxilla and/or mandible (134 implants) were included. After the removal of the screw-retained prostheses, baseline peri-implant spontaneous bleeding (SB), Plaque Index (PI), probing depth (PD), and bleeding on probing (BOP) were recorded (T0). Three oral hygiene treatments were assigned randomly following a split-mouth method: all the patients received glycine air polishing (G) in one side of the arch (n = 32), and sodium bicarbonate air polishing (B) (n = 16) or manual scaling with carbon-fiber curette (C) (n = 16) was performed in the opposite side. After the hygiene procedures, PI and SB were recorded and patient's comfort degree towards the three techniques was analyzed by questionnaires using a rating scale from 1 to 5 (T1). Results: PI reduction was significantly higher for G (T0, 2.88 ± 1.37; T1, 0.04 ± 0.21) and B (T0, 3.13 ± 1.34; T1, 0.0 ± 0.0) as compared with C (T0, 2.15 ± 1.46; T1, 0.44 ± 0.7) (P < .001). B reported the highest mean value of SB (T0, 0.0 ± 0.0; T1, 3.42 ± 0.75) compared with G (T0, 0.05 ± 0.21; T1, 1.60 ± 1.05) and C (T0, 0.07 ± 0.24; T1, 0.73 ± 0.91) (P < .001). A significant difference in comfort mean score was found between G (4.8 ± 0.5) and B (3.5 ± 1.7) (P = .014), no difference between G and C (4.7 ± 0.7) (P = .38). Conclusion: Professional oral hygiene on implants using glycine air polishing showed high levels of both cleaning efficacy and patients' acceptance. Keywords: dental implants, full-arch, glycine air polishing, oral hygiene, sodium bicarbonate air polishing

Objectives: Close approximation and stabilization of gingival flaps, vital for optimum outcome of surgical procedures, may be difficult to achieve in deep periodontal pockets by routinely used suturing techniques. Modified vertical internal mattress sutures have been reported to be useful in reducing dead space along with achievement of wound stability. The present study compares the outcome of flap closure by use of modified vertical internal mattress sutures and simple loop interrupted sutures in the surgical management of chronic periodontitis. Method and materials: In total, 83 participants with chronic periodontitis received scaling and root planing. After 8 weeks, modified Widman flap surgery was performed in 48 patients at sites with probing pocket depth ≥ 4 mm. Modified vertical internal mattress sutures were placed in the test group (n = 24) and simple loop interrupted sutures were used in the control group (n = 24). Plaque Index (Silness and Loe), Gingival Index (Loe and Silness), bleeding on probing, probing pocket depth, clinical attachment level, and gingival recession were recorded on the day of surgery, and at 3 and 6 months of follow-up. Results: Statistically significant improvement was noted in all the clinical parameters of both groups. The test group showed significantly greater improvement in probing pocket depth, clinical attachment level, bleeding on probing, and Gingival Index, although Plaque Index scores were similar. This improvement was confined to nonmolars only. Conclusion: Flap closure by modified vertical internal mattress suturing technique results in better improvement in periodontal clinical parameters than the use of simple loop interrupted sutures, especially in nonmolars. Keywords: chronic periodontitis, modified Widman flap surgery, surgical flaps, sutures, wound healing

Objectives: To evaluate the efficacy of diagnostic imaging for temporomandibular joint rheumatoid arthritis (TMJ RA). Inflammation of the TMJ has a high correlation (> 17%) with the late stages of RA. Clinical recognition of TMJ RA using diagnostic imaging techniques such as computed tomography (CT), magnetic resonance imaging (MRI), and cone beam computed tomography (CBCT), is limited to osseous and soft tissue components of the TMJ. Positron emission tomography (PET) and positron emission tomography/CT (PET/CT) are novel technologies that have shown increasing relevance in the detection and management of TMJ RA. Method and materials: Following the preferred reporting items for systematic reviews and meta-analysis (PRISMA, 2009) guidelines, and using databases such as PubMed, Ovid Medline, Google Scholar, Web of Science, Scopus, and EBSCOhost, 94 publications were identified, and 27 studies were selected for this systematic review. A flowchart of the comprehensive study selection was generated. Quality assessment and data extraction were performed independently by three reviewers. Results: It was noted that two-dimensional radiographs, CBCT, multidetector CT, and MRI are the most commonly used methods in TMJ RA assessment, although they are not useful for determination of active disease. MRI has excellent contrast resolution and can acquire dynamic imaging for demonstration of the functionality of the TMJ. CT and ultrasound imaging also have specific indication in imaging the TMJ. PET used in conjunction with CT is the only imaging modality that can quantify TMJ RA in active disease. Conclusions: PET/CT images provide unique quantitative information that cannot be obtained from any other imaging modalities. Keywords: computed tomography, conventional imaging, functional imaging, panoramic, positron emission tomography, radiography, rheumatoid arthritis, temporomandibular joint, x-ray tomography

Objectives: Drug reference databases provide information on potential drug-related medical complications in a dental patient. It is important that database entries and recommendations are supported by evidence-based original studies focused on drug-related dental management complications. The aim of this study was to review and identify database drug categories associated with evidence-based drug-related medical complications during dental treatment. Data sources: Relevant publications on adverse drug reactions and dental management complications were thoroughly reviewed from the literature published between July 1975 and July 2019. Method and materials: The drug reference database "Lexicomp Online for Dentistry" was reviewed to identify medications associated with the highest propensity to trigger drug-related dental management complications, and these were correlated with published original studies in PubMed, Embase, and Scopus databases that associated drug actions with dental treatment complications. Results: Fifty-four publications (1.2% of all full-text articles) reported original studies that directly tested drug associations with dental management complications. The cautions in the drug reference database on drug-related dental treatment mainly focused on local anesthetic precaution (P < .001), xerostomia (P < .001), bleeding (P < .001), and a combination of xerostomia and bleeding (P < .001). Antipsychotics/antidepressants were mostly associated with local anesthetic complications (80.95%), xerostomia (81.93%), and a combination of xerostomia and bleeding (22.89%). Bleeding complication was associated with anticoagulants (80.00%) and cancer chemotherapeutic agents (59.21%). Conclusions: Similarities exist within and across different drug categories in the database entries on drug-related medical complications in a dental patient. There were a relatively limited number of publications that directly tested the association between drug-related medical complications and dental therapies. Clinical relevance: The most common drug cautions during dental treatment reported in Lexicomp Online for Dentistry were limited to drug-drug interactions with local anesthetic actions, excessive bleeding, xerostomia, or a combination of any of these. These recommendations were supported by limited evidence-based studies. Keywords: bleeding, dental treatment planning, drug effects, medical complications, xerostomia