Quintessence International, 07/2014

Objectives: To determine the effect of proper light-curing instruction on the radiant exposure (energy density) delivered by dentists using six dental curing lights to a posterior Class 1 restoration. Method and Materials: Twenty-five dentists attending a professional meeting were instructed to position a patient simulator (MARC-PS, BlueLight), as they would for a patient, and then to expose the simulated Class 1 maxillary second molar preparation for a specified amount of time. At this point, the dentists were unaware of the purpose of the experiment. Each participant used three different curing lights, and the irradiance and radiant exposure (J/cm2) delivered to the preparation was recorded. Participants were then informed of the purpose of the exercise, and given specific light-curing instructions and training using the patient simulator, after which they re-exposed the same preparation using the same curing lights. Pre- and post-instruction radiant exposure values were compared using one-way ANOVA (α = .05), and for each light among all operators using a two-tailed, paired Student's t test. Results: There was a wide variation in the radiant exposure delivered by the dentists and by the six curing lights, from 2.9 to 15.4 J/cm2. Before receiving additional light-curing instruction, 68% of dentists delivered less than 10 J/cm2. The radiant exposure delivered increased significantly (P < .001) by up to 30%, as a result of training using MARC-PS. Conclusion: The results indicate that some of the dentists participating in the present study delivered an inadequate amount of radiant exposure before instruction. More energy was delivered after a short training session using the MARC-PS. Reinforcing the proper photo-curing techniques may improve the outcome when placing resin-based restorations. Keywords: clinical performance, composite resin, light curing, operative dentistry, polymerization

The restoration of endodontically treated teeth is often required and may represent a challenge as there is no consensus on ideal treatment. The failure of endodontically treated teeth is usually not a consequence of endodontic treatment, but inadequate restorative therapy or periodontal reasons. Prior to the initiation of endodontic treatment the restorability, occlusal function, periodontal health, biologic width, and crown-to-root ratio need to be assessed. If acceptable, the appropriate technique, material, and type of restoration to restore function need to be considered. Posts are used to provide retention for the core material and to replace missing tooth structure. The residual amount of tooth structure will determine its stability for restoration. The creation of adequate ferrule (approaching 2 mm circumferentially is ideal) minimizes the damaging effects of lateral and rotational forces on the restoration and post. Keywords: core, endodontically treated tooth, post

Objective: Fractured endodontic instruments inhibit optimal cleaning and filling of dental root canals, which may result in a less favorable prognosis for the tooth. Several techniques are available to remove fractured instruments; however, healthy tooth substance often must be destroyed in the process. This study was intended to evaluate Nd:YAG laser treatment as a method to remove fractured stainless steel instruments without destroying healthy tooth substance. Method and Materials: Stainless steel endodontic instruments were fractured in 33 unprocessed root canals of mandibular central and lateral incisors and premolars in vitro. A brass tube charged with solder was placed at the coronal end of the fractured instrument and laser energy was used to melt the solder, connecting the fractured instrument with the brass tube. The success rates of connecting and removal of fractured instruments from the root channel were recorded for each case. Results: Connecting was achieved in every case in which more than 1.5 mm of the fractured instrument was tangible (22 out of 22). In cases where less than 1.5 mm was tangible, the rate for successful connection decreased to 4 out of 11 (36.4%). Fractured endodontic instruments were removed successfully in 17 out of 22 cases (77.3%) in which more than 1.5 mm was tangible. If less than 1.5 mm was tangible, the removal success rate decreased to 3 out of 11 cases (27.3%). Conclusion: Our data support Nd:YAG laser-mediated connecting of a brass tube to a fractured endodontic instrument as a feasible and tissue conserving removal approach when more than 1.5 mm of the instrument is tangible. Keywords: endodontics, fractured instrument, instrument removal, laser

Objectives: The aim of this study was to evaluate the sitelevel plaque removal efficacy of four commercially available toothbrushes. The adjunctive benefit of dental floss on interproximal plaque removal was also evaluated. Method and Materials: This study was designed as a randomized examiner-blinded clinical study involving 60 subjects. The subjects were randomly divided into four groups of 15 participants each, and a particular branded toothbrush was allotted for each group. Brushing technique, toothpaste, and brushing time were standardized for all the subjects. The Turesky-Gilmore-Glickman modification of Quigley-Hein plaque index was used to evaluate plaque scores at baseline, and 1, 2, 3, and 4 weeks by one blinded examiner. After 2 weeks, the subjects were provided with dental floss to be used in conjunction with the toothbrush. Buccal, lingual, and interproximal plaque reduction percentages were computed and analyzed for statistical significance. Results: The four toothbrushes showed similar plaque removal scores at the three sites, with no statistical significance (P > .05). The interproximal plaque removal scores of the four toothbrushes were the least at 2 weeks (25%) when compared with buccal (65%) and lingual (60%) percentage scores. The addition of dental floss significantly increased the interproximal plaque removal scores, with 4-week scores revealing 70% removal. Conclusion: These data revealed the lack of significance between the four toothbrushes studied, which is in line with previous studies. The addition of dental floss had a significant effect on the interproximal plaque removal, which could be crucial in the maintenance of gingival health. Keywords: dental floss, motivation, oral hygiene, plaque formation, toothbrush

The two most common forms of oral disease, dental caries and periodontal disease, share their main etiologic factor, dental plaque. By specifically targeting their main etiologic factor, bacteria in dental plaque, cause-related therapy allows clinicians and patients to achieve successful control of these diseases. Clinicians should continuously guide and educate patients to understand the pathophysiology of their diseases so that patients will actively participate in the therapy by mechanically removing dental plaque at home. When this is combined with professional intervention (ie, removal of active caries and periodontal mechanical debridement) as well as frequent maintenance therapy, dental caries and periodontal disease can be successfully managed and controlled. This review outlines the steps and components of cause-related therapy as well as its proven long-term clinical benefit. Keywords: dental plaque, gingivitis, nonsurgical periodontal therapy, oral hygiene, periodontitis

The evolution of adhesive procedures and ceramic systems has allowed for the placement of minimum thickness laminate veneers on unprepared teeth. A 20-year-old post-orthodontics male patient with multiple diastemas required restorative procedures. A multidisciplinary approach was performed, involving gingivectomy, in-office bleaching, and application of minimum thickness veneers. The immediate and 1-year followup results exceeded expectations; however, long-term clinical trials are necessary to evaluate the performance of this new type of indirect restoration. Keywords: bleaching, diastema, esthetics, gingivectomy, lithium disilicate, porcelain veneer

Objective: To evaluate the success and survival rates of dental implants in patients with oral lichen planus (OLP). Method and Materials: A narrative review literature search was conducted in the PubMed/Medline, Scopus, and Cochrane databases for articles published between 1990 and April 2013, using key search words "dental implants" and "oral lichen planus". Results: This review did not identify any publications that were randomized controlled trials. A total of 60 OLP patients and 199 dental implants were analyzed. Three cases of OLP-related oral squamous cell carcinoma were reported. Conclusion: The extent and severity of underlying disease should be determined before dental implant placement. Keywords: dental implants, oral lichen planus, oral squamous cell carcinoma

Objective: The cardinal signs and symptoms of temporomandibular disorder (TMD) are pain in joints and/or muscles, joint sounds, and limitation of movement. They are also associated with other complaints, one of which is headache. Myogenous TMD patients can be divided into those with a high and low temporomandibular opening index (TOI). These two subgroups appear to vary in several ways, including symptom severity. The objective was to assess the relationship between reported headache and TMD patients and a control group with no TMD and to compare the report of headache in high- and low-TOI myogenous TMD patients. Method and Materials: Sixty-six patients with TMD were included in the study. Fortythree were diagnosed with myogenous TMD, 23 with arthrogenous TMD, and 20 with no TMD were included as a control. Patients reported a history of headache using a four-point Verbal Rating Scale for both severity and frequency. Multiple logistic regression analysis was performed, after adjusting for confounders of sex and age. This helped investigate the association between the study groups and reported headache. Seventeen of the myogenous TMD patients were studied further. Seven were assigned to the high and 10 to the low-TOI group. Mean ages were 38.43 years and 33.00 years respectively. The Mann Whitney test was used to examine the difference in report of headache between these two groups. Results: 76.7% of the myogenous group, 26.1% of the arthrogenous group, and 35% of the control group reported headache. Age and myogenous TMD were significantly associated with reported headache (P = .001 and .01, respectively). Myogenous TMD is a significant risk factor (OR = 5.20, P = .01) for reported headache while arthrogenous TMD is not (OR = 0.75, P = .69) A significant difference in report of headache between the two myogenous TMD groups was found (P = .0067). Conclusion: The risk for reported headache is 5.20-times greater for myogenous TMD patients compared to the control group, but no difference was noted between the arthrogenous TMD and the control group. Age serves as a mild protective for reported headache. Younger patients tend to report more headaches. More frequent and severe headache occurred in the high-TOI group. This study serves as a reminder for clinicians in general practice to consider the effect of comorbidity when faced with TMD patients with headache. Keywords: facial pain, headache, temporomandibular disorder (TMD), temporomandibular opening index

Objective: To discuss the challenges in diagnosis and appropriate management of critical underlying pathoses if a patient presents with signs and symptoms indicative of different conditions that may coexist. Summary: This case features clinical and radiographic challenges in reaching a diagnosis in a middle-aged man undergoing bisphosphonate therapy for multiple myeloma. The patient had history of bisphosphonaterelated osteonecrosis of the jaw (BRONJ) in the mandible. The patient presented with pain and swelling in the anterior maxilla, associated with paresthesia of upper lip. The radiographic features were suggestive of BRONJ and invasive fungal sinusitis. MRI appearance was suggestive of malignant involvement by plasmacytoma or lymphoma. Although biopsy is usually not advocated in bisphosphonate-affected jaws, it was advised in this case and was positive for multiple myeloma. Vigilance is required to correlate clinical and radiologic findings and further investigations must be considered if malignancy is suspected. Keywords: bisphosphonate-related osteonecrosis of jaw, invasive fungal sinusitis, multiple myeloma

Prior to performing preventive measures, a specific caries risk diagnosis is necessary. Individual risk factors and personal habits influence the exposure to caries-producing bacteria and thus affect the caries incidence. The general etiologic parameters and necessary therapeutic foci are weighted differently depending on the patient's age. This determines the selection of treatment as well as the frequency of the recommended preventive measures. Keywords: individual caries risk, professional care, saliva test, Streptococcus mutans, sugar intake