Quintessence International, 10/2010

Objective: To test if using a CAD/CAM system might reduce the necessity of bone augmentation in patients with atrophic maxillary arches before implant therapy. Method and Materials: Twenty male and female patients consecutively scheduled for bone augmentation of the jaw before implant surgery were included in this study, with a total of 29 jaws (maxillary and mandibular) to analyze for the implant-supported fixed prosthesis group and 19 maxillary arches for the implant-supported removable prosthesis group. NobelGuide System (Nobel Biocare), Autocad System (Autodesk), and routine manual CT measurements of available bone were used in this study. Results: The total results of the mean values of the fixed prosthesis group plus the mean values of the removable prosthesis group showed a statistically significant difference between the NobelGuide intervention score and both manual (P = .004) and Autocad (P = .001) measurements. Conclusions: The NobelGuide System represents a viable diagnostic device to reduce the entity or avoid bone reconstructive surgery before implant placements in the atrophic maxilla and mandible. Keywords: diagnosis, oral implant, radiology, surgical guides

Odontogenic anomalies can occur as a result of conjoining or twinning defects. This article reports the case of fusion in a 10-year-old boy in relation to the primary maxillary right incisors. Clinicoradiographic examination revealed the presence of triple teeth, ie, fusion between the maxillary right incisors along with a supernumerary tooth on the labial surface. The offending triple tooth was extracted under local anesthesia. The extracted tooth was sectioned using a hard tissue microtome at three levels-the coronal, middle root, and apical levels, respectively-and these sections were visualized under a stereomicroscope. Based on the histologic findings, a final diagnosis of fusion was confirmed. A brief review of the literature on triple teeth is also presented. Keywords: fusion, gemination, histologic evaluation, odontogenic anomalies, triple teeth

Chondrosarcomas are malignant mesenchymal tumors characterized by the differentiation of pure hyaline cartilage, and they are relatively uncommon in jawbones. Chondrosarcoma of the jaws usually presents as a painless mass or swelling associated with loosening of the associated teeth. This report describes an unusual case of chondrosarcoma that mimicked pulp disease on initial presentation in the maxilla of a 22-yearold man. The relevant literature is reviewed regarding clinicopathologic features and therapeutic management of chondrosarcomas. Keywords: chondrosarcoma, histopathology, jawbone, maxilla, pulp disease

Objective: The development of new longer-lasting composite resins is an urgent public health need. It has been shown that surface roughness of composite resins is increased by Streptococcus mutans biofilm in vitro and further that incorporation of small amounts of antibacterial nanoparticles (polyethyleneimine [PEI]) into composite resins renders a strong antibacterial effect against S mutans biofilm. The present study tested the hypotheses that incorporation of PEI nanoparticles into composite resins prevents the increase of surface roughness caused by S mutans biofilm and that PEI incorporation into composite resin has a long-lasting antibacterial effect. Method and Materials: Composite resin incorporating PEI nanoparticles was characterized using contact angle goniometry, X-ray photoelectron spectroscopy (XPS), and SEM. Six-month-aged samples were tested for antibacterial effect against S mutans using the direct contact test. Surface roughness following 1 month of bacterial challenge was depicted using atomic force microscopy (AFM). Results: Contact angle increased following PEI incorporation, and XPS revealed surface iodide and nitrogen elements. Direct contact test results showed that 6-month-aged composite resins incorporating PEI nanoparticles completely inhibited S mutans growth (P < .05). AFM analysis showed an increase in root mean square roughness following bacterial challenge in composite resin samples (P < .05); no effect was depicted in samples incorporating PEI. Conclusion: Changing the surface properties of composite resins by incorporating PEI antibacterial nanoparticles may improve their clinical performance both by inhibiting bacterial growth and by preventing changes in the surface roughness. Keywords: biofilm, composite resins, nanoparticles, polyethyleneimine

Objective: To evaluate the optical integration and fluorescence of three contemporary restorative materials used for incisoproximal restorations. Method and Materials: A microfilled hybrid composite (Amaris, VOCO; MHC), a nanofilled hybrid composite (Grandio, VOCO; NHC), and an experimental ormocer (VOCO; ORM) were used to consecutively restore 10 extracted incisors with incisoproximal restorations using the natural layering concept, mimicking the natural anatomy of the tooth. Before and after placement of each restoration, the teeth were photographed under standardized conditions (direct, indirect, and fluorescent light), and spectrophotometric measurements (SpectroShade, Handy Dental Type 713000, MHT) were made using a black-and-white background. Between measurements, the teeth were allowed to rehydrate for 2 weeks. Ten independent evaluators scored each light condition using an optical integration score on a scale from 0 to 10 (0 = worst optical integration, restoration can be easily distinguished from remaining tissue; 10 = optimal optical integration). Differences in L*a*b and ΔE values and optical integration scores were statistically analyzed using ANOVA. Results: MHC obtained the highest optical integration and fluorescence scores (P < .01), followed by NHC, although there were no statistically significant differences found among ΔE of the restorative materials. ORM achieved the worst optical integration and fluorescence. Conclusion: The microfilled hybrid composite obtained the highest optical integration scores (P < .01), followed by the nanofilled hybrid composite. The experimental ormocer showed the least favorable optical behavior. Spectrophotometric measurements showed no statistically significant differences among all three restorative materials. Keywords: Class 4, composite resin, fluorescence, incisoproximal restoration, optical integration, ormocer, spectrophotometric

Objective: In vitro studies showed superior impression correctness for one-stage impressions. However, clinical data, especially clinical trials, are lacking in this matter. The aim of the study was to investigate the three-dimensional correctness of impressions for final restorations applying three different impression techniques. Method and Materials: Three impressions each were made from 48 patients with different techniques using metal stock trays. In a randomized order, one-stage putty-wash, two-stage putty-wash, and monophase impressions (respectively, Dimension Penta H and Garant L, Dimension Penta H Quick and Garant L Quick, Impregum Penta; 3M ESPE) were made with either polyvinyl siloxane or polyether materials. The double-cord technique was applied at all abutment teeth. Factors potentially influencing the correctness of the impressions were recorded. The precision of the impressions was three-dimensionally analyzed using the resulting gypsum models. Discrepancies between the impressions were calculated using the one-stage putty-wash impression as reference. Results: Discrepancies between the one-stage puttywash impressions and the monophase impressions are significantly lower compared with two-stage putty-wash impressions. The depth of the most subgingival portion of the preparation margin significantly influences the discrepancies between the impression techniques. Conclusion: In light of the major influence of clinical parameters on impression correctness, one-stage procedures should be favored. These findings support the results of in vitro investigations. Keywords: crown, fixed partial denture, impression, monophase, one-stage putty wash, randomized controlled trial, three-dimensional precision, two-stage putty wash

Objective: The aim of this double-blind study was to evaluate the clinical efficacy of the association of triclosan-containing mouthrinse and dentifrice on biofilm and gingivitis reduction. Method and Materials: Forty patients with a diagnosis of gingivitis were selected and randomly divided into four groups (n = 10): group TT-triclosan-containing mouthrinse and triclosan-containing dentifrice; group CT-control mouthrinse and triclosancontaining dentifrice; group TC-triclosan-containing mouthrinse and control dentifrice; group CC-control mouthrinse and control dentifrice. Patients were evaluated by a calibrated examiner using a quantitative Plaque Index and Gingivitis Index at 0, 15, and 30 days. Intragroup analysis was performed by Friedman test and intergroup analysis by Kruskal- Wallis. Results: Intragroup evaluation revealed a statistically significant reduction in Plaque Index for groups that used triclosan, independently of the group (TT, CT, and TC) (P < .05). Intergroup analysis suggested that only the group that used the association of triclosan dentifrice and mouthrinse (group TT) demonstrated statistically reduced Plaque Index at 30 days, when compared to the control group (CC) (P < .05). With regard to gingivitis reduction, no difference was observed between groups, although the association presented a faster reduction in bleeding levels. Conclusion: Only the association of triclosan dentifrice and triclosan mouthrinse statistically reduced Plaque Index, when compared to the control group; however, regarding the additional benefits to gingivitis control, more studies should be done to confirm the results. Keywords: dentifrice, gingivitis, mouthrinse, plaque, triclosan

Systemic lupus erythematosus (SLE) is a chronic inflammatory autoimmune disease with multisystemic involvement. Immune-suppressive drugs used in the treatment of the disease can increase the risk of infection and delay healing, which are of concern in dentaltreatment procedures. Because of the involvement of the salivary glands, the composition and amount of saliva released are usually altered in patients with SLE. Significantly lowered salivary flow rate causes difficulties during dental procedures and makes it difficult to maintain oral hygiene and conserve both fixed and removable prostheses. This case report presents a patient who had an extremely dry mouth and oral lesions due to SLE and describes how oral rehabilitation was achieved with implant-supported fixed dentures. To the best of our knowledge, this is the first report of the use of oral implants in a patient with SLE. Dental practitioners should consider dental implants as a preferred treatment choice in the oral rehabilitation of patients with SLE. Keywords: dental implants, fixed prosthesis, systemic lupus erythematosus

Objective: Errors made by clinicians in dental practice require changes in the original planning of patient management. The purpose of this study was to analyze events that led to wrong tooth extraction. Method and Materials: A total of 54 insurance claims for wrong tooth extractions were reported and evaluated by Medical Consultants International from 1993 to 2004. Data were collected and analyzed according to parameters regarding the clinician who performed the procedure, the nature of the referral for extraction, the demographics of the patient, the venue in which the extraction took place, the reason for the error, and the nature of the insurance claim. Results: General practitioners performed 72% of the extractions, 49% of the referring clinicians were orthodontists, 74% of the errors were made during extraction, and 77% of the errors were made in polyclinics. Conclusions: Errors during treatment and poor communication among clinicians led to extraction of the wrong teeth. This can be avoided by greater caution on the part of the extracting clinician when following the treatment plan. Guidelines toward this end are recommended. Keywords: tooth extraction, treatment error, wrong tooth extraction

Pigmentary demarcation lines are rare physiologic pigmentations shaped as lines of deeper discoloration with abrupt transition from less pigmented areas. These lines are known and seen by dermatologists in the skin of African, Indian, and Japanese patients, usually females. No report of intraoral pigmentary demarcation lines was found in the literature. This article presents a rare case of pigmentary demarcation lines of the skin of the face and oral mucosa, which should be of interest to the general dentist. Keywords: blaschkolinear dermatoses, Futcher lines, pigmentation, Voigt lines

Objective: To evaluate the levels of interleukin-1ß (IL-1ß) and alkaline phosphatase (ALP) in gingival crevicular fluid (GCF) and correlate these measurements with clinical characteristics of healthy patients and patients with gingivitis and periodontitis. Method and Materials: Thirty-six individuals were subdivided into three groups of 12: control, gingivitis, and periodontitis groups. GCF samples were obtained from 2 sites for each patient. GCF volume was measured with the Periotron 8000; IL-1ß levels were evaluated using the ELISA technique; ALP was measured by the kinetic method. Results: Mean levels of IL-1ß and ALP in the 3 groups were, respectively, 22.34 ± 16.53 µL/site and 7.68 ± 2.46 U/L in the control group; 41.46 ± 27.98 µL/site and 9.80 ± 1.53 U/L in the gingivitis group; and 105.97 ± 89.26 µL/site and 11.56 ± 1.82 U/L in the periodontitis group. The amount of IL-1ß in the periodontitis group was significantly higher than in the other groups, but no significant difference was found between the control group and the gingivitis group. The amount of ALP differed significantly among the 3 groups (P < .05). A positive correlation was observed among IL-1ß levels, GCF volume, and probing depth. There was no evidence for a correlation between IL-1ß and ALP levels. Conclusion: Monitoring immune markers may give additional information on healthy or diseased sites. Keywords: alkaline phosphatase, cytokines, gingival crevicular fluid, inflammation, interleukin 1, periodontitis

Objective: To compare the ability of four light-emitting diode (LED) curing lights to polymerize five composite resins in 10 seconds at 4 and 8 mm. Method and Materials: Two second-generation, single-peak LED curing lights (Bluephase 16i, Ivoclar Vivadent, and LEDemetron II, Kerr) and two third-generation polywave LED curing lights (UltraLume 5, Ultradent, and Bluephase G2, Ivoclar Vivadent) were compared. Three examples of each brand of curing light were used, and their light outputs were measured with a spectro-radiometer. Five composite resins (Filtek Supreme A2B, 3M ESPE; Vit-l-escence A2, Ultradent; Aelite LS Posterior A2, Bisco; and Tetric EvoCeram A2 and Tetric EvoCeram Bleach M, both Ivoclar Vivadent) were polymerized for 10 seconds at 4 and 8 mm from the end of the light guide. The Knoop microhardness (KHN50gf) was measured at 49 locations across the top and bottom surfaces of the specimens to determine the ability of each light to cure each brand of composite in 10 seconds. Results: At 4 and 8 mm, the Bluephase G2 light delivered the broadest spectral range of wavelengths, greatest irradiance, and energy density. The Bluephase G2 always produced harder, better-cured resins compared to the other three lights. Overall, the ability of the lights to cure these five composites was ranked from highest to lowest: Bluephase G2, UltraLume 5, Bluephase 16i, and LEDemetron II (ANOVA with REGWQ multiple comparison test, P < .01). Conclusion: This study suggests that polywave LED curing lights should be used in preference to single-peak LED curing lights. Keywords: chemistry, composite resins, curing light, dental materials, hardness testing, Knoop microhardness, light-emitting diode, physical properties, radiation effects

Objective: As resin-modified glass-ionomer cement (RMGIC) is an adhesive material, its association to dentin bonding agents (DBAs) was previously proposed. This study investigated the adjunctive behavior of an RMGIC with etch-and-rinse bonding systems under in situ/ex vivo cariogenic challenge. Method and Materials: Bovine enamel blocks (3 x 3 x 2 mm) were randomly assigned to group VP, Vitremer + its own primer (3M ESPE); group VSB, Vitremer + Single Bond (3M ESPE); and group VPB, Vitremer + Prime & Bond 2.1 (Dentsply). Two blocks of each group were randomly placed in an acrylic palatal appliance, so each appliance included six blocks. Volunteers (n = 10) wore these appliances according to given instructions to promote a sucrose challenge eight times/day for 15 days. After this period, the blocks were removed from the devices and cleaned, and demineralization was assessed through longitudinal microhardness analysis (Knoop indenter, 25 g/5 s). Data were submitted to three-way ANOVA and Tukey test (P < .05). Results: No treatment was able to completely avoid demineralization. All materials showed a statistically significant difference in mineral loss when the microhardness on the outer enamel was compared with deeper regions (P < .05). Conclusion: Association of the tested RMGICs with etch-and-rinse DBAs did not seem to be more beneficial against caries than the conventional treatment with RMGIC. Keywords: demineralization, dentin bonding agent, enamel, in situ