Quintessence International, 01/2008

Fluorescence, opalescence, and translucency are critical for restorative materials to mimic the optical properties and appearance of natural teeth. This case report describes the restoration of multiple anterior teeth with CAD/CAM-fabricated glass-infiltrated aluminum oxide ceramic (In-Ceram Alumina, Vita Zahnfabrik) crowns and illustrates the technical steps to achieve an adequate amount of fluorescence in the ceramic veneering material. CAD/CAM aluminum oxide ceramic copings and frameworks can be predictable and successful when replacing missing tooth structure and imitating optical properties of natural teeth. A modified layering technique enhances fluorescence within the veneering ceramic and provides an esthetic appearance of glass-infiltrated aluminum oxide ceramic restorations. Keywords: ceramic, crown, fluorescence, glass-infiltrated ceramic

Objectives: Oral bacteria implying a natural resistance may deteriorate the antibacterial efficacy of chlorhexidine on cariogenic microorganisms. Xylitol, mostly applied via chewing gum, is known to possess favorable plaque-reducing properties. The aim of this study was to investigate the effect of a xylitol rinse formulated as pure solution or combined with chlorhexidine on the viability of Streptococcus sanguis (early colonizer of human teeth) and Streptococcus mutans (the most causal strain for caries) during initial steps of biofilm formation. Method and Materials: After exposure to the test solutions, the bacteria suspended in human sterile saliva were allowed to attach to human enamel slides for 60 minutes in a preclinical flow chamber system. The bacterial vitality of suspended and attached cells was monitored using 2 fluorescent DNA stains by epifluorescence microscopy. Further parameters measured were the total bacterial cell counts on enamel slides and growth of suspended streptococci. Results: The sensitivity of S mutans to pure chlorhexidine or in combination with xylitol is contrary to the natural resistance of S sanguis to chlorhexidine. The combination of xylitol/chlorhexidine showed a statistically significant antivital effect on S sanguis cells compared to the pure agents xylitol and chlorhexidine. The bacterial cell density on enamel and bacterial reproduction on agar plates were similarly affected by the combination of xylitol/chlorhexidine or the single substances. Conclusion: The newly discovered synergistic antivital effect of xylitol combined with chlorhexidine may contribute to the favorable potential of xylitol use for the improvement of new formulations of caries-preventive mouthrinses. Keywords: chlorhexidine, initial biofilm, Streptococcus mutans, Streptococcus sanguis, synergistic effect, xylitol

Objective: To compare in vitro the influence of 3 cementation techniques on leakage and fracture strength of alumina all-ceramic crowns after cyclic loading in an artificial chewing simulator. Method and Materials: Forty-eight extracted molars were mounted in a way that simulates natural tooth mobility. Crowns (Procera Alumina, Nobel Biocare) were fabricated and inserted with either conventional cementation with zinc phosphate cement without pretreatment (group ZOP); cementation with a universal adhesive resin cement without pretreatment (group HYB); or adhesive bonding with composite resin after pretreatment of the tooth (dentin bonding agent) and the crown (airborne-particle abrasion and a special ceramic priming agent containing adhesive monomers that bond to metal-oxide ceramics) (group ADH). All specimens were stored in artificial saliva and subjected to 1.2 million load cycles in a dual-axis chewing simulator (Willytec). Eight specimens per group were subjected to compressive load until failure, while the remaining 8 specimens were stained and sectioned for measuring of dye penetration. One-way ANOVA and Tukey HSD were used for statistical analyses (a = .05). Results: Cementation techniques were significantly different (P = .009) in regard to mean load at failure. Fracture strength was significantly greater for ADH (mean load at fracture, 2,782 ± 419 N) as compared to HYB (1,980 ± 270 N) or ZOP (1,788 ± 242 N). All groups differed significantly for leakage values (P < .001), with ADH showing the lowest mean leakage (0.04 ± 0.07 mm), followed by HYB (0.96 ± 0.16 mm) and ZOP (2.44 ± 0.19 mm). Conclusion: Cementation technique affects fracture strength and leakage of all-ceramic molar crowns. Fracture strengths were well above natural chewing forces for all cementation methods. However, adhesive bonding significantly increased fracture strength and improved marginal seal of alumina crowns. Keywords: all-ceramic, alumina crown, cementation, fracture strength, marginal leakage

Objective: To evaluate the capability of different adhesive systems to inhibit in vitro caries formation. Method and Materials: Four materials were tested: Gluma Comfort Bond (GL; Heraeus Kulzer), Gluma Comfort Bond + Desensitizer (GL+; Heraeus Kulzer), iBond (iB; Heraeus Kulzer), and One-up Bond F (OUB; Tokuyama). Bovine roots were ground to obtain flat mesial and distal dentin surfaces. Nail varnish was applied to the entire root surface except for two 10 mm X 2 mm windows on the flattened surfaces. The adhesives were applied to the exposed areas according to the manufacturers' instructions. The roots were incubated at 37°C for 1 week in a suspension of StreptococcuS mutans and Lactobacillus acidophilus. Control groups either received no root surface treatment or were etched with 37% phosphoric acid (without immersion in the bacterial suspension). Specimens were sectioned perpendicular to the long axis of the roots, stained for 24 hours with Rhodamine B, and analyzed with confocal laser microscopy. The data were analyzed by 1-way ANOVA and Fisher's PLSD test at 95% confidence level. Results: Lesions in the OUB, iB, and GL+ groups were significantly shallower than those in the no-treatment group. Acid etching did not produce any measurable lesions. Mean lesion depth in the GL group was similar to that in the no-treatment group. There was no significant difference between mean lesion depths in the GL+, GL, and iB groups. Conclusion: Fluoride- and glutaraldehyde-containing adhesive systems might be an aid in root caries prevention. Keywords: adhesive, inhibition, in vitro, Lactobacillus acidophilus, root caries, Streptococcus mutans

Human myiasis is characterized by larval infestation of body tissues or cavities of live individuals. Although most frequently observed in underdeveloped and tropical countries, reports of human myiasis have been encountered throughout the world. Conventional treatment is the mechanical removal of the larvae, one by one, which is painful and embarrassing and repugnant to both health professional and patient. Even though human myiasis is not considered rare, most dental professionals have very little knowledge of the diagnosis and treatment of this pathology. The purpose of this article, therefore, is to report a case of advanced-stage oral myiasis in a 9-year-old patient treated at a health and dentistry clinic. Diagnosis was based on visual observation of Cochliomyia hominivorax larvae, a dipterous fly of the Calliphoridae family, which were between the second and third stages of development. Predisposition factors include lack of information, malnutrition, poor oral hygiene, preexistence of oral lesions, and severe halitosis, which decisively influence the appearance and development of oral myiasis. A brief review of the literature is also included, in which the importance of early clinical diagnosis, myiasis etiology, and possible associations with other pathologies and different types of treatment are discussed. Keywords: Cochliomyia hominivorax, fly, infestation, myiasis

Objective: In part 1 of this study, the authors showed that coating polymethyl methacrylate (PMMA) provisional restorations with bonding resin (BR) or liquid polish (LP) significantly reduced early in vivo biofilm formation on these restorations. The aim of the present study was to determine the mechanism through which these materials inhibit biofilm formation. Method and Materials: The antimicrobial properties of the tested materials were examined using the agar diffusion test (ADT) and the direct contact test (DCT). Surface energy was determined using contact angle measurements; salivary protein adsorption was analyzed by polyacrylamide gel electrophoresis (SDS-PAGE). Results: ADT and DCT showed that the tested materials had no antimicrobial properties. Contact angle measurements revealed that liquid polish and PMMA have a similar contact angle, tending toward the hydrophobic region, and that bonding resin was more hydrophilic. SDS-PAGE analysis showed a significant reduction in salivary protein adsorption to the tested materials compared with that to the PMMA control. Conclusion: Liquid polish prevents biofilm formation by preventing protein adsorption. Keywords: acryl, adhesion, biofilm, bonding resin, liquid polish, provisional crown

Objectives: To investigate the complications of oral and facial piercing and its frequency in an extensive series of cases. Method and Materials: A sample of 2,266 consecutive patients requiring dental care over a period of 1 year was included in this cross-sectional observational study. A total of 83 piercing wearers were identified. Demographics, piercing site, clinical complications, adverse effects of piercing, motivation, and setting of piercing were determined through an interview and intraoral examination. Results: The 18- to 27-year age bracket showed a significantly higher prevalence of piercing wearers (mean years of wear 2.9 ± 3.8). Esthetic reasons were the most frequent stimulus for piercing insertion (86.7%). Up to an 80.8% of the devices were inserted in a tattooing studio. Forty-nine patients (59.0%) reported postoperative or late piercing complications. Postoperative pain (40.9%; 95% CI = 29.7 to 52.1) was significantly more frequent than infection (10.8%; 95% CI = 3.5 to 18.1) or postpiercing bleeding (7.2%; 95% CI = 1.0 to 13.4). When oral locations were compared to facial sites, the former had caused significantly more problems (X2 = 10.1; P = .001), pain (OR = 0.96; 95% CI = 0.08 to 0.97) and swelling (OR = 0.20; 95% CI = 0.06 to 0.68) being the most frequent undesirable effects associated with oral piercing. Conclusions: Complications associated with oral and facial piercing are frequent, and many of them might well be avoided if effective legal and hygienic measures were adopted. Educational interventions targeted to the population between 18 and 27 years of age are advisable, particularly when dealing with oral piercing. Keywords: adverse effects, body piercing, complications, epidemiology, facial, oral

The first step in a successful endodontic treatment is to gain access to the pulp chamber and find all of the canals. To achieve this goal, practitioners need to be familiar with all possible variations of the root canal and have adequate information of the tooth needing treatment. The present case report describes an anatomical variant of the maxillary second molar with 6 canals, a variation that has not been previously reported. Helpful hints for detection of the unusual canal are presented, as well. Keywords: maxillary second molar, root canal, root canal variation

Objective: The aims of this prospective clinical study were (1) to evaluate the clinical performance of Signum composite inlays over a 3-year period; (2) to investigate the clinical efficacy of composite inlays in premolars versus molars; and (3) to evaluate differences between 1- or 2-surface inlays and multisurface inlays. Method and Materials: One hundred thirteen composite inlays were placed in 30 patients by a clinician. All the inlays were made by the same laboratory technician using only one composite material (Signum, Heraeus Kulzer). All the restorations were bonded with a 3-step bonding system and a composite luting cement. The restorations were assessed after placement by a clinician who had not been involved with the placement of the restorations, in accordance with the modified US Public Health Service criteria. Results: Three of the 113 experimental restorations had to be replaced; the total failure rate was 2.6% after 3 years. At baseline, 88.5% to 100% of the inlay restorations were rated as excellent (Alpha). Statistically significant (P < .05) differences were observed during the study for surface roughness, anatomic form at the margin, marginal integrity, and inlay integrity. The comparison of the clinical outcome of inlays in premolars versus molars and with 1 or 2 surfaces versus multisurfaces showed no significant differences, except for the parameters anatomic form at the margin and marginal integrity. Conclusion: Composite inlays demonstrated a very high success rate (97.4%) after 3 years. Neither the size of the restorations nor the tooth type significantly affected the clinical outcome of the restorations. Keywords: composite inlay, composite resin, indirect restoration, posterior teeth

Objectives: To assess the general dental health, orthodontic status, and orthodontic treatment need in young adults. Method and Materials: The subjects were 121 first-year dental students. Fifty-one individuals without orthodontic treatment were compared with 70 orthodontically treated individuals. It was differentiated whether orthodontic treatment had been performed by a certified orthodontic specialist or a general dental practitioner. DMF(T) and DM(T) Index values were recorded. Dental casts were analyzed, and the orthodontic treatment need was assessed using the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN). Results: Orthodontically treated subjects exhibited statistically significantly lower DMF(T) and DM(T) values than untreated individuals. Treatment performed by a certified orthodontist resulted in statistically significantly better treatment results with more Class I relationships and less crowding. The remaining degree of orthodontic treatment need was also lower in subjects treated by a certified orthodontist. A moderate to very high degree of treatment need (DHC degrees III to V) was present in 59% of the subjects treated by a general practitioner but only 29% of the subjects treated by a certified orthodontist. Conclusion: Orthodontic treatment improves general dental health. Treatment performed by a certified orthodontist leads to better treatment results and lower remaining treatment need compared with that performed by a general practitioner. Keywords: certified orthodontist, dental health, efficiency, general dental practitioner, IOTN, orthodontic treatment

Ectodermal dysplasias represent a large and complex group of diseases comprising more than 170 clinical conditions. They are caused by impaired development of the ectodermal appendages and characterized by a primary defect in at least one of the following tissues: nails, hair, sweat glands, or teeth. Ectodermal dysplasia has emotional consequences for affected individuals at early ages. This case report outlines a possible routine approach to restoring function and esthetics and aiding in the social interaction for a 9-year-old girl diagnosed with hypohidrotic ectodermal dysplasia at about 7 years of age. Keywords: ectodermal dysplasia, fixed prosthesis, hypodontia

Myoma is a nonmalignant neoplasm rarely found in the oral cavity and even more rarely mentioned in the world's dental or surgical literature. Not one case of oral cavity leiomyoma has been reported in Poland. This article describes a case of leiomyoma of the oral cavity in a 51-year-old patient. To remove the tumor, a carbon dioxide laser was used. Because of the method used, perioperative bleeding was avoided, which enabled better visibility of the surgical area and minimized duration of the operation. The postoperative wound did not require sutures, and healing occurred without complications. Keywords: carbon dioxide, laser, leiomyoma, neoplasms, oral cavity, surgery

A favorable prognosis after tooth avulsion depends on some variables, such as the extra-alveolar period and storage medium. Vitality of the periodontal ligament cells is considered a critical factor for a successful outcome without root resorption. The dental surgeon is provided with clinical information and radiographic findings to establish a diagnosis and may rely on current available guidelines. Once trauma has occurred, treatment must be quick and effective, and periodic follow-up must be performed. Clinical, radiographic, and histologic characteristics for each type of root resorption due to tooth replantation are presented, with the aim to provide information for the diagnosis and treatment of healing complications. Keywords: ankylosis, periodontal ligament, prognosis, root resorption, tooth avulsion, tooth replantation

This case report describes the clinical and laboratory procedures used to fabricate resin-bonded castings with cingulum rest seats and guide planes for a removable partial denture using a noble metal alloy (silver-palladium-copper-gold alloy), a metal conditioner (V-Primer, Sun Medical), and an adhesive resin-luting agent (Super-Bond C&B, Sun Medical). The castings have been functioning for more than 11 years. The use of resin-bonded castings with cingulum rest seats for support and a guide plane to brace removable partial dentures is a successful method of treatment. Keywords: cingulum rest seat, guide plane, metal conditioner, noble metal alloy, preparation, removable partial denture, resin-bonded casting

Intraligamentary anesthesia was described in France early in the 20th century as a novel and effective method of dental local anesthesia, but the method did not become established because of the inadequacy of dental instruments available at the time. Today, the use of a state-of-the-art armamentarium and the administration of well-proven anesthetic agents with intraligamentary anesthesia reduce the experience of typical unwanted effects, that is, sensation of elongation, pressure pain, precontact after the end of the analgesia, and reversible tissue changes. Dosing lever and dosing wheel syringes in combination with system-adapted injection needles enable the operator to feel the back-pressure and inject the anesthetic smoothly into the periodontal ligament. The results of most recent studies show that periodontal ligament injections do not generate unwanted effects when sensible instruments are used, proven anesthetics are administered, and the anesthesia method is practiced lege artis and mastered safely by the operator. This article discusses the advantages and technique of intraligamentary anesthesia and presents results from recent studies in the literature. Keywords: dosing lever syringe, dosing wheel syringe, intraligamentary anesthesia, periodontal ligament injection, pistol-type syringe, single-tooth anesthesia, unwanted effects

Objective: To investigate the effects of socioeconomic factors and oral health behaviors on adolescents in Turkey. Method and Materials: Data were collected through a self-administered questionnaire. The sample consisted of 582 randomly selected adolescents, 309 boys and 273 girls, who presented over a 3-month period with various complaints to the Hacettepe University Medical Faculty Adolescent Clinic. Results: Halitosis complaints were higher in the 11-, 12-, and 13-year-old groups than in other age groups (P < .05). When the sex factor was examined, prevalence of dental fear was found to be higher among girls, while irregular toothbrushing was seen more among boys. In parallel to the increase in the education levels of the parents, an increase was seen in the regular dental visits by the adolescents (P < .05). As the socioeconomic status of the family increased, frequency of dental visits, rate of dental floss usage, and number of teeth with restorations increased. In parallel with the dental visit increase, the rate of restored teeth increased. Of those who did not have regular dental visits because of financial difficulties, however, the rate of teeth with restorations was low. Conclusion: A strong correlation exists between the oral health behaviors, socioeconomic and sociodemographic factors, and the oral health status of Turkish adolescents. Keywords: adolescent, dental fear, oral health behaviors, socioeconomic factors