Quintessence International, 06/2020

Objectives: To compare the microhardness and ion content of three glass-ionomer cements (GICs) during setting and up to 15 days, to composite resin-based material in vitro, and after 5 to 10 years in vivo. Method and materials: Disks of three GICs, EQUIA Fil, Riva Self Cure, and Ketac Molar were examined in vitro for microhardness using Vickers indentations after 15 to 60 minutes, 24 hours, and 8 and 15 days, and compared to composite material, Spectrum. The ion content of the GIC and composite was analyzed using the energy dispersive spectroscopy program of a scanning electron microscope. A primary second molar restored with GIC normally exfoliated after 5 years, and a third molar restored with GIC extracted due to periodontitis after 10 years, were sliced through the restoration buccolingually, and the microhardness of the restoration and of the dentin was measured. Results: In comparison to composite material, the Vickers value for the GICs were similar or better after 24 hours to 15 days. The amount of fluorine was three times higher in EQUIA Fil and Riva Self Cure in comparison with Ketac Molar, after 20 days. After 5 years in vivo, the microhardness of GICs was similar to dentin and after 10 years it was significantly higher than that of the dentin. Conclusion: The microhardness of GICs was comparable to composite material after only 24 hours. In vivo the microhardness of GICs increased and after 10 years in vivo it was higher than that of the dentin. After 20 days the amount of fluorine was still high in Riva Self Cure and EQUIA Fil. Keywords: fluorine, glass-ionomer cement, inorganic ions, microhardness

Objective: Qualitative developmental defects of enamel (DDEs) are characterized by an intact hypermineralized surface enamel layer and a porous subsurface hypomineralized layer. This structure is similar to natural early caries lesions, which are effectively arrested by resin infiltration, a micro-invasive clinical procedure. An additional reported effect in early enamel caries is recovery of enamel translucency. Due to structural similarities, a similar mechanism is expected in qualitative DDEs. The objective of the present study was to observe quantitative color masking of qualitative DDEs when subjected to resin infiltration. Method and materials: A total of 70 selected enamel defects were subjected to resin infiltration in a nonrandomized study design. Each defect was subjected to photographic imaging using a digital camera both pre- and post-intervention. Each image was assessed using ImageJ digital software (National Institutes of Health) for CIE L*a*b coordinates. Results: There were significant changes observed in L*a*b coordinates of all DDEs, when subjected to resin infiltration. Conclusion: The resin infiltration intervention was successful in masking the "white" opaque discolorations of developmentally affected enamel. Keywords: developmental defect of enamel (DDE), resin infiltration

Objectives: To clinically evaluate the healing of mandibular Miller Class I and II isolated gingival recessions treated with the modified coronally advanced tunnel (MCAT) or laterally closed tunnel (LCT) combined with hyaluronic acid (HA) and subepithelial connective tissue graft (SCTG). Method and materials: Twelve healthy patients exhibiting one isolated mandibular Miller Class I or II (Cairo Class 1) gingival recession of a depth of ≥ 3 mm, were consecutively treated with the MCAT or LCT in conjunction with HA and SCTG. Treatment outcomes were assessed at baseline and at least 6 months postoperatively. The primary outcome variable was complete root coverage (CRC). Results: Postoperative pain and discomfort were low and no complications such as postoperative bleeding, allergic reactions, abscesses, or loss of SCTG occurred. After a mean follow-up of 18.9 ± 10 months, statistically significant (P < .0001) root coverage was obtained in all 12 defects. CRC was measured in six out of the 12 cases (50%), four cases showed a root coverage of over 95%, while the remaining two cases reached 80% and 85%. Mean root coverage was 96.09%. Mean keratinized tissue width increased from 1.6 ± 0.8 mm to 4.9 ± 1.3 mm (P < .0001) from baseline to follow-up, while mean probing depth showed no statistically significant changes (1.8 ± 0.9 mm vs 1.3 ± 0.5 mm). Conclusion: Within their limits, the present results indicate that the described treatment approach may lead to predictable root coverage of isolated mandibular Miller Class I and II (Cairo Class 1) gingival recessions. (Quintessence Int 2020;51:456–463; doi: 10.3290/j.qi.a44492) Keywords: connective tissue graft, gingival recession, hyaluronic acid, laterally closed tunnel, modified coronally advanced tunnel

Squamous cell carcinomas arising from keratocystic odontogentic tumors are a rare phenomenon in head and neck cancer, accounting for only 1.45% of oral squamous cell carcinomas, and are classified as primary intraosseous carninomas. This cancer is locally aggressive, has a high potential for recurrence, and requires radical resection and subsequent rehabilitation. This case report describes a patient diagnosed with this uncommon tumor who was treated by dental specialists at Mayo Clinic. During convalescence, orthodontic changes to the maxillary dental archform were observed secondary to alterations in the soft tissue equilibrium following mandibulectomy and reconstruction with a microvascular fibula free flap. This highlights the need for treatment plan adaptability, the role of orthodontists in maintenance or treatment of pre-resection archforms, and the interdisciplinary nature necessary in managing the complex oncologic, functional, and esthetic needs in patients undergoing treatment for head and neck cancer. Keywords: head and neck cancer, interdisciplinary oral rehabilitation, orthodontic archform management

Objective: This study evaluated the cleaning potential of a protein-denaturing agent with or without anionic detergent by monitoring the residual contamination on healing abutments used for dental implant treatment. Method and materials: Forty contaminated healing abutments removed from patients were randomized and immediately treated with differing cleaning methods; either Method A (presoaking in 1% sodium dodecyl sulfate followed by ultrasonication with 4 mol/L guanidine hydrochloride), or Method B (soaking in distilled water followed by ultrasonication with 4 mol/L guanidine hydrochloride) was used. Samples were stained with phloxine B and photographed using a light microscope. The proportion of stained and contaminated areas on each healing abutment was then calculated using Image J. The surface was examined with a scanning electron microscope and energy-dispersive x-ray spectroscopy. Results: The percentages of contaminated surfaces of the screwdriver engagement region, upper body, and lower body for methods A and B were 50% and 38%, 10% and 80%, and 38% and 18%, respectively. There was a statistically significant difference (engagement region [P < .001], upper body [P = .043], and lower body [P = .017]; Mann-Whitney) regarding the residually stained areas between the two cleaning methods. No surface alterations were seen by scanning electron microscopy. Energy-dispersive x-ray spectroscopy confirmed that the cleaned surfaces of the healing abutments revealed no signs of organic contamination. Conclusion: Although the combination of a strong denaturing agent and detergent effectively cleaned contaminated healing abutments, perfect cleaning was not always possible, indicating that the reuse of healing abutments in different patients is not recommended. Keywords: anionic detergent, decontamination, healing abutments, protein denaturing agent, ultrasonic cleaning

Objective: Distraction is a highly acceptable technique for diverting a patient's attention from what may be perceived as an unpleasant procedure, reducing anxiety and helping the patient relax. The objective of the present study was to evaluate the effect of watching television during dental treatment on pediatric patients' anxiety and cooperation compared to the commonly used conventional Tell-Show-Do (TSD) behavioral management method. Method and materials: Sixty-nine children (mean age 6.8 years) scheduled to undergo restorative dental treatment were randomly divided into two intervention groups: a group that was managed by television distraction and a control group that was managed by TSD. During treatment, anxiety was assessed by the Facial Image Scale and cooperative behavior was assessed by the Frankl scale. Pulse rate and oxygen saturation were also measured during the treatment. Results: Compared to TSD, television distraction significantly reduced anxiety by 1.27 (95% confidence interval [CI] 0.798 to 1.744, adjusted P < .001), decreased pulse rate by 6.44 beats per minute (bpm) (95% CI 4.60 to 8.28, adjusted P < .001), and significantly increased cooperation by 1.17 (95% CI −1.318 to −1.020, adjusted P < .001). A greater effect of television distraction on reduced anxiety and increased cooperation was observed during administration of the anesthetic injection. No effect of television distraction on saturation levels was noted. Conclusions: Television distraction is an effective method for reducing anxiety and improving cooperative behavior in children during dental treatments. Keywords: anxiety, behavior management, children, cooperation, dental treatment, television distraction

Necrotizing sialometaplasia is a benign, self-limiting, inflammatory disease of salivary glands, mainly involving the minor salivary glands in the palate. This lesion can mimic a malignant neoplasm, both clinically and histopathologically, manifesting as a submucosal swelling or as an ulcer of the palate. This report presents a case of an otherwise healthy bodybuilder with anabolic androgenic steroids abuse with bilateral necrotizing sialometaplasia in the palate, and discusses computed tomography findings in the pre-ulceration phase. Literature review revealed another two cases of necrotizing sialometaplasia with preoperative imaging, both performed in the ulceration phase. The importance of radiographic findings as an aid in differential diagnosis is further discussed, as well as the role of possible predisposing factors including anabolic androgenic steroids abuse in the pathogenesis of necrotizing sialometaplasia. Keywords: anabolic androgenic steroids, contrast media, multidetector computed tomography, necrotizing sialometaplasia, palatine bone

Objectives: Commercial intraoral rectangular collimators are available for collimating to size 2 image receptor. The benefits of reducing the x-ray beam to match the area of the image detector in adult intraoral radiography are endorsed internationally. However, in pediatric dentistry the image receptor can be further decreased to size 1 and 0. Method and materials: For this study size 1 and 0 rectangular collimators were fabricated using 1.65-mm lead sheets (Rotometals). The custom-fabricated collimators were fixed to the plastic body of a Rinn (Dentsply) Universal Collimator attachment. Aperture sizes were extrapolated based on the active imaging area of size 1 and 0 digital image receptors. A dose area product (DAP) measuring device was used to determine the change in radiation absorbed dose as a function of the imaging field of view. Results: DAP measurements were evaluated in the 31.7 cm2 conventional round collimation, Rinn 12.0 cm2 Universal rectangular collimator, and in the manufactured size 1 (8.25 cm2) and size 0 (5.72 cm2) rectangular collimators. The size 1 collimator had a 32% DAP reduction from the size 2, and a 53% reduction for the size 0. Conclusion: Size 1 and size 0 rectangular collimators can be independently manufactured and utilized in pediatric dentistry. This study suggests that a considerable radiation dose reduction is possible in pediatric intraoral imaging when using the size 1 and 0 matched collimation. Since the pediatric population is vulnerable to radiation exposure, any measurable reduction has a potential for long-term health benefits and is therefore clinically significant. Keywords: dental radiography, diagnostic x-ray, pediatric x-ray dose, radiation protection, rectangular collimation, size 0 rectangular collimator, size 1 rectangular collimator

Digital photography has already established its irrefutable importance in today's world. It is becoming an indispensable tool in various fields. In dentistry specifically, photography can be employed in several ways that can be beneficial to the patient and the dental community. It allows a simple and clear depiction of an otherwise abstract concept, but high-quality pictures are always required. The evolution of mobile cameras has made an enormous impact on digital photography and its accessibility: high-quality pictures can now be easily taken. This article explains the assets of smartphone cameras' evolution and how it led to the conception of Smile Lite Mobile Dental Photography. Applications of dental photography are presented, such as documentation and communication with the laboratory technician and the patient. Mobile dental photography is not confined to dentistry but can also be used for artistic purposes. (Quintessence Int 2020;51:510–518; doi: 10.3290/j.qi.a44365; Originally published (in German) in Quintessenz Zahnmedizin 2019(12);70:1408–1417) Keywords: communication, documentation, mobile dental photography, smartphone