Quintessence International, 07/2002

Periodontal-prosthesis guidelines have long been defined to specifically address dental reconstructions after moderate to advanced periodontal disease has occurred. More recently, specific dental techniques and materials have shown promise in addressing patients' increasing esthetic demands. However, treatment planning to achieve pleasing results for patients with advanced periodontitis requires a complex, multispecialty approach that is rarely discussed. A case report and literature review illustrate that the original periodontal-prosthesis guidelines not only remain useful today for obtaining esthetic results but also conform to recent understanding of maxillomandibular physiology.

Objective: The purpose of this study was to evaluate the effect of erbium:yttrium-aluminum-garnet laser instrumentation of root surfaces on the morphology of fibroblasts from continuous lineage. Method and materials: Dentinal slices with 4 mm² of surface area were obtained from teeth extracted for severe periodontal involvement. Specimens were assigned to one of three treatment groups: group 1, application of the laser with an energy level of 250 mJ at 103 pulses per second; group 2, application of the laser with an energy level of 80 mJ at 166 pulses per second; and group 3, similar to group 2, but with concomitant water irrigation of the device. The specimens were incubated in multiwell plates containing cell culture media. After 24 hours, the specimens were submitted to routine preparation for scanning electron microscopy. Three independent and blind examiners used photomicrographs to evaluate the morphology of the fibroblasts: 0 = without cells; 1 = flat cells; 2 = round cells; and 3 = combination of round and flat cells. Results: Statistical analysis indicated that there were significant differences among treatment groups and that group 3 was significantly different from groups 1 and 2. Conclusion: There was no difference between groups 1 and 2 in the morphology of fibroblasts. Laser instrumentation with concomitant irrigation impaired the adhesion of fibroblasts to dentinal surfaces.

Objective: The purpose of this study was to retrospectively evaluate leucite-reinforced glass-ceramic crowns placed over a 6-year period at two different private dental practices. Method and materials: One hundred twenty-five Empress crowns were placed in 54 patients. The 93 anterior and 32 posterior crowns were evaluated clinically with a mirror and probe, radiographically, and from clinical photographs, in accordance with a modified California Dental Association and Ryge quality evaluation system. The risk of fracture was determined with the Kaplan-Meier survival analysis. Results: Crowns were studied over periods ranging from 4 to 11 years. The probability of survival of the 125 crowns was 95.2% at 11 years (98.9% in the anterior segment and 84.4% in the posterior segment). Six crowns had to be replaced. Most of the 119 successful crowns were rated excellent; Alfa ratings were assigned to 94.2% for color match, 91.6% for porcelain surface, 86.6% for marginal discoloration, and 94.2% for marginal integrity. Conclusion: Leucite-reinforced glass-ceramic crowns showed a low clinical failure rate and excellent esthetics after up to 11 years.

Objective: Although the use of an arbitrary facebow and a full-sized articulator can reduce laboratory errors, many dentists do not use a facebow routinely because the procedure seems to be both intricate and time consuming.The purpose of the present study was to evaluate four earpiece-type facebows and the Snow facebow and to compare the time required for registration, the ease of manipulation, and cost-benefit considerations. Method and materials: Twenty-five dentists who routinely used only the Snow facebow were asked, after a brief explanation, to perform registrations with the Snow facebow and four new-generation, earpiece-type facebows. The time required for each facebow registration was recorded. Dentists were also asked to fill out a questionnaire concerning ease of manipulation and cost-benefit factors. Results: The Quick facebow was the facebow of choice of most of the dentists because of its favorable design and usage characteristics and cost-benefit ratio. The Artex 3-D facebow proved to be both the easiest and the fastest to manipulate. The Spring-bow and the Whip-Mix Quickmount were next in rank, and the Snow facebow scored the lowest. Conclusion: The use of earpiece-type facebows is both simple and fast, and practitioners judged this type of facebow to be superior to the Snow facebow.

Erosive tooth wear appears to be no less frequent in the United States than in the United Kingdom and Europe and is of increasing concern as a significant cause of tooth destruction in younger persons. Consumption of numerous dietary sources of acids is increasing in modern societies. In addition, involuntary regurgitation may be a significant cause of tooth erosion. These primary causes can be exacerbated by xerostomia, which is induced by many drugs. Initial preventive treatments are directed at neutralizing the effects of the acids, and initial restorative treatments should be conservative, using adhesive materials. Treatment of advanced tooth tissue loss is difficult and expensive, and preventive management is emphasized.

Oral candidosis is the most common opportunistic fungal infection encountered in dentistry. Normally a benign inhabitant of mucous membranes, the fungal organism, Candida albicans, may present serious, even life-threatening infection in specific patient populations. As an opportunistic organism, Candida albicans is extremely responsive to any process resulting in immunosuppression. The clinical manifestations of oral candidosis are variable, occasionally complicating the clinical diagnosis and management. Treatment is often initially rendered based on a provisional clinical diagnosis and supplemented with adjunctive laboratory tests. Specific therapeutic intervention should be tailored to the individual patient, based on the current health status of the patient and the clinical presentation and severity of the infection.

A 33-year-old male presented for evaluation of several large, recently discovered white oral lesions of unknown duration. Clinical examination revealed multiple white plaques on the soft palate, uvula, buccal mucosa, and tongue. These lesions could be wiped away, leaving an erythematous base. The lesions were asymptomatic, and the patient did not report difficulty in swallowing. The patient's medical history was noteworthy for several significant diagnoses within the previous 6 months: type 2 diabetes mellitus, mild systolic hypertension, gastroesophageal reflux disease, and adult idiopathic nephrotic syndrome, determined by kidney biopsy to be caused by focal segmental glomerulosclerosis. A provisional diagnosis of pseudomembranous candidosis was made, and the patient responded to a 14-day course of clotrimazole, administered in 10-mg troches, five times a day. Management of nephrotic syndrome predisposes patients to recurrent fungal infections, and the disease has implications for the selection of systemic antifungal agents.

Objectives: The colorimetric values of two different kinds of esthetic stainless steel crowns were measured and compared with the colorimetric values of primary anterior teeth in Japanese children. Method and materials: The colorimetric values of resin composite-faced stainless steel crowns (Kinder Krown) and epoxy-coated stainless steel crowns (White Steel Crown) were measured with a color difference meter. The Commission Internationale de Eclairage L*, a*, b*, and ΔE*ab values and Munsell value, chroma, and hue were calculated. The data were compared with previously reported colorimetric values of Japanese primary anterior teeth measured with the same color difference meter used in this study. Results: Compared to Japanese primary anterior teeth, Kinder Krown Pedo I and Pedo II showed much higher L* values and lower hue; on the other hand, White Steel Crown showed much higher L*, a*, b* values, much higher value and chroma, and much lower hue. Conclusion: Color analysis revealed that the colors of the White Steel Crown and Kinder Krown Pedo I were substantially different from the color of Japanese primary anterior teeth. The color difference between Pedo II crowns and Japanese primary anterior teeth was relatively high, but the color of Pedo II might be acceptable for clinical use.

Objective: The aim of the study was to compare the clinical performances of four polyacid-modified resin composites (F2000, Dyract AP, Compoglass F, and Elan) and one resin-modified glass-ionomer cement (Vitremer) in Class V abrasion/erosion lesions. Method and materials: Twenty restorations of each of the five restorative materials were placed in noncarious cervical abrasion/erosion lesions by one dentist. No cavity preparation was attempted. All teeth were isolated with cotton rolls and gingival retraction cord. The materials were manipulated according to the manufacturer's instructions and placed with the help of cervical matrixes. Restorations were finished and polished immediately after the placement. Evaluations were performed at baseline and 6 months, 1 year, and 2 years after placement for retention, color match, cavosurface marginal discoloration, anatomic form, marginal adaptation, secondary caries, and postoperative sensitivity. Results: Retention levels at 2 years were 90% for F2000, 90% for Dyract AP, 89% for Compoglass F, 84% for Elan, and 95% for the Vitremer restorations. No statistically significant differences were found among the materials after 2 years for any evaluation category. Conclusion: Polyacid-modified resin composite and resin-modified glass-ionomer cement restorations showed acceptable clinical performance after 2 years.

The restoration for an endodontically treated tooth should be conservative and should not increase horizontal and vertical forces. A recently developed bondable reinforcement fiber is reported to be an alternative to conventional post materials because of its esthetic qualities, mechanical properties, and the neutral color of the reinforcing material. This article describes the treatment of one patient, in whom a bondable polyethylene ribbon was used as a post-and-core build-up material.