Quintessence International, 08/2014

The demand for esthetic restorations has resulted in an increased use of dental ceramics as a biocompatible and functionally sufficient alternative to conventional restorative materials. Silicate ceramic restorations are widely used for veneers, inlays, onlays, and crowns in dentistry. Long-term data are of crucial importance to optimize clinical practice. The purpose of the present article is to summarize data of the Innsbruck ceramic evaluation up to 261 months with the focus on longevity and failure characteristics. Keywords: all-ceramic, bruxism, failure, longevity, silicate ceramic

Objectives: To present a case of endodontic failure obturated with a methacrylate-based root filling material, Resilon/ RealSeal (RS). To determine if RS is susceptible to biodegradation by endodontically relevant microbes by a method known to show RS degradation. Method and Materials: Emulsions of RS were dispersed in agar with minimal bacterial nutrients in culture plates. Lipase PS served as a positive control. Pseudomonas aeruginosa, Fusobacterium nucleatum, Prevotella intermedia, Porphyromonas gingivalis, Porphyromonas asaccharolytica, Enterococcus faecalis, Streptococcus sanguis, Streptococcus mutans, Staphylococcus aureus, and Staphylococcus epidermidis were tested for their ability to biodegrade RS. The bacteria were inoculated in the plates and examined daily for RS degradation for 7 days. Results: Degradation of the emulsified RS manifested in the formation of clear zones around P aeruginosa, P intermedia, P asaccharolytica, S aureus, and S epidermidis. No degradation was seen with the other tested bacteria or in plates that did not contain RS emulsion. Conclusion: Endodontic pathogenic bacteria can degrade RS. These findings complement other work and suggest that the seal and integrity of root canal fillings obturated with RS may be impaired by a microbial insult. Keywords: clear zone, degradation, endodontic bacteria, Resilon, root canal treatment failure

Objective: The aim of this randomized, single-blind, splitmouth design, clinical trial was to evaluate the effectiveness in plaque removal of two brushing methods, the vertical and the horizontal, in a sample of healthy young adults. Method and Materials: Forty-nine subjects were enrolled and 43 completed the study. All subjects abstained from oral hygiene practices for 48 hours. Plaque and gingival abrasions were recorded according to the Rustogi Modified Navy Plaque Index (RMNPI) and the van der Weijden method by one calibrated examiner before and immediately after the brushing session. A dental hygienist performed the two brushing methods using a randomized split-mouth design. The average plaque scores from the whole mouth, interproximal surfaces, and gingival margin were obtained before and after brushing, and the differences were evaluated using one-way analysis of variance. Results: The differences in mean plaque scores between preand postbrushing were statistically significant for both methods. Considering the interbrushing differences, the vertical method produced lower plaque scores compared to the horizontal for the whole mouth (P = .02). In the interproximal surfaces, the vertical method removed more plaque compared to the horizontal one (P < .01). In the gingival margin no statistically significant differences in plaque scores were recorded. Only 10 gingival abrasions were registered, mainly produced by the horizontal method. Conclusion: Results suggest that both toothbrushing methods are effective in plaque removal; nevertheless, the vertical brushing method has demonstrated to remove more plaque from the interproximal surfaces than the horizontal method. Keywords: dental Plaque Index, horizontal scrub, oral hygiene, toothbrushing, vertical brushing

Objective: To objectively evaluate the effect of mini-implant-supported mandibular overdentures on electromyographic activity (EMG) of the masseter muscle during chewing of hard and soft foods. Method and Materials: Twelve completely edentulous patients (4 females and 8 males) with maladaptive experience of wearing mandibular dentures received new maxillary and mandibular dentures. After 3 months of adaptation, four mini dental implants (MDIs) were inserted in the interforaminal region of the mandible, and the new mandibular dentures were connected to the implants immediately with O/ring attachments. The activity of masseter muscle (EMG) and the duration of chewing cycle were measured during chewing hard (carrot) and soft (gum) foods. The measurements were made 3 months after wearing each of the following prostheses: the new conventional dentures; and the MDI-retained mandibular overdentures. Results: The EMG of masseter muscle increased and the DC decreased with MDI-retained mandibular overdentures when compared to conventional dentures. Hard food (carrot) was associated with increased EMG and decreased DC when compared to soft food (gum) for both conventional dentures and MDI-retained mandibular overdentures. Conclusion: Mini-implant-supported mandibular overdentures are associated with increased activity of masseter muscle and decreased duration of chewing cycle for both hard and soft foods when compared to conventional dentures. Keywords: chewing, EMG activity, mini-implant, overdenture

Objective: Maxillary sinus augmentation is used when performing implant treatment in the maxillary molar region with inadequate bone height. Posterior superior alveolar artery (PSAA) is the branch of the maxillary artery that supplies the lateral sinus wall and sinus membrane. When performing an osteotomy via lateral approach, however, damage to the PSAA can occur, because it runs inside the lateral wall of the maxillary sinus, causing hemorrhage and hampering surgery. The objective of the present study was to compare the defect patterns with the distances from the alveolar crest and sinus floor to the PSAA. Method and Materials: 280 lateral regions in 235 patients with at least three missing consecutive posterior teeth were measured. Measurement locations were the 1st premolar (P1), the 2nd premolar (P2), the 1st molar (M1), and the 2nd molar (M2). Results: The detection rate was 29% to 59%, and the longest diameter was between 1.1 mm and 1.3 mm. The average distances between the PSAA and the alveolar crest were 24.1 mm, 21.3 mm, 15.4 mm, and 15.3 mm (P1-M2), with statistically significant differences in all locations except M1 and M2. The average distances between the PSAA and the maxillary sinus floor were 10.4 mm, 10.4 mm, 9.0 mm, and 8.5 mm (P1-M2), with no significant differences. There were no significant differences between different defect patterns in the distance between the PSAA and either the alveolar crest or the maxillary sinus floor. PSAA detection rate and the longest diameter were related to the spatial resolution of the computed tomography (CT) scan. Conclusion: Although the distance between the PSAA and the alveolar crest was significantly shorter in the molar region than in the premolar region, it did not affect the defect pattern. Keywords: defect pattern, dental implant, maxillary sinus augmentation, PSAA, x-ray computed tomography

Objective: Bromelain is the name given to a family of proteolytic enzymes obtained from Ananas comosus, the pineapple plant. It is considered a potent anti-inflammatory and antiedematous substance. Surgery of impacted third molars in the outpatient setting is one of the procedures most often associated with postoperative pain and swelling. The aim of this study was to evaluate the efficacy of bromelain in reducing postoperative pain and swelling. Method and Materials: 80 patients were recruited to the study from patients attending the Maxillofacial Surgery Unit of the Istituto Stomatologico Italiano, Milan, Italy, for impacted third molar surgery. At time 0 when surgery was performed, patients started simultaneous antibiotic and analgesic therapy. On the following day, patients were divided into two groups. Patients in group 1 were prescribed bromelain. Patients in group 2 were prescribed only the analgesic if required. Three parameters were evaluated: pain, edema, and erythema. The first evaluation visit was performed 3 hours after surgery, the second 48 hours after surgery, and the final evaluation 7 days after surgery. Results: Postoperative pain, edema, and erythema were significantly lower in the study group than in the control group. Analgesic consumption, both in terms of days of treatment and number of tablets taken, was slightly lower in the study group. Only one adverse event was recorded, which occurred in a patient in the control group. Conclusion: The present study demonstrates an important anti-inflammatory and anti-edematous effect of bromelain. Statistical analysis shows that in the group treated with bromelain the inflammatory response was significantly less than in the control group. Keywords: bromelain, postoperative pain, third molar surgery

The use of a once-yearly IV infusion of 5 mg zoledronic acid has become more common, as the drug is being reported as safe, with few to minimal adverse reactions. This one-time annual administration has a favorable outcome for patients with osteoporosis and spares the burden of taking daily oral bisphosphonates. The present literature search found 10 welldocumented cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) associated with annual administration of 5 mg zoledronic acid for the treatment of osteoporosis. Two new cases are also described, with underlying risk factors similar to previous reports. These include prior dental surgical procedures, the presence of diabetes, autoimmune conditions, past use of bisphosphonate and steroids, and concomitant immunosuppression. Although the reported incidence of BRONJ related to once-a-year IV administered zoledronic acid is low, it may be plausible. Both medical and dental clinicians should be aware of its manifestation. Keywords: bisphosphonate, ONJ, reclast, yearly, zoledronic acid

Background: Recurrent aphthous ulceration represents a very common mucosal disorder that general dentists may encounter on a daily basis, and for which there is no curative treatment. The best treatment that can be achieved is to avoid local traumatic precipitants, lessen the pain and duration of ulceration by suppressing the local immune response, and prevent secondary infection. Objective: The objective of this study was to clinically determine the efficacy of honey as a topical treatment of recurrent minor aphthous ulceration in a Saudi cohort. Method and Materials: A randomized, blind, controlled, parallel, double-center clinical trial was carried out. Honey was applied by patients four times a day for 5 days. Clinical parameters (ulcer size, pain scale, and degree of erythema and healing) were recorded both at baseline and during the follow-up period. Results: There were 94 subjects, with 180 minor recurrent aphthous ulcerations. The ulcers were distributed as 67, 57, and 56 ulcers for honey, topical corticosteroid, and Orabase treatment, respectively. There was a statistically significant difference between the honey group and the other two groups in terms of reduction of ulcer size, days of pain, and degree of erythema. No side effects were reported in any group. Conclusion: Honey was found to be effective and safe in reducing minor aphthous ulcer pain, size, and erythema in a Saudi cohort. Keywords: corticosteroids, honey, minor aphthous ulcer

Objective: The present double-blind randomized clinical trial aimed to compare the efficacy in reducing dentin hypersensitivity of a dentifrice formulation containing nano-hydroxyapatite with a fluoride dentifrice and a placebo. Method and Materials: 105 subjects were recruited to participate in the study. A computer-generated random table with blocking to one of the three study treatments was used in order to have 35 subjects per group: 1) nano-hydroxyapatite 15% toothpaste, fluoride-free; 2) fluoride toothpaste; 3) placebo. Groups 1, 2, and 3 were instructed to brush their teeth for 2 minutes twice a day with the provided toothpaste. The participant's dentin hypersensitivity was evaluated at baseline and after 2 and 4 weeks using airblast and tactile tests. In addition, a subjective evaluation using a visual analog scale (VAS) was used. Results: Significantly lower values of cold air sensitivity and tactile sensitivity (P < .001) were found for the test group at 2 weeks and 4 weeks. In addition, statistically significantly (P < .001) lower values of sensitivity were reported for group 1 compared to groups 2 and 3, at 2 and 4 weeks respectively. The VAS scores were significantly lower (P < .001) in the test group at 2 and 4 weeks compared to baseline and to the control groups. Conclusion: The findings of the present study encourage the application of nano-hydroxyapatite in fluoride-free toothpaste as an effective desensitizing agent providing quick relief from symptoms after 2 and 4 weeks.