Quintessence International, 10/2014

The symmetry, shape, contour, and size of teeth play an important role in the esthetics of the anterior maxillary region of the mouth. However, abnormalities in symmetry and contour can considerably influence the esthetic parameters. Consequently, rehabilitation performed in this region can be challenging and, frequently, multidisciplinary treatment planning that includes esthetics, function, structure, and biologic aspects is paramount. The high demand for esthetic rehabilitations has, therefore, allowed the effective use of minimally invasive techniques to obtain results that mimic natural teeth. This article presents a case report in which both esthetic and functional rehabilitation were obtained by recontouring the gingival zenith followed by placing ultraconservative porcelain veneers. Keywords: dental porcelain, dental prosthesis, rehabilitation

Objective: To assess the sealing ability of ProRoot MTA when placed as an apical barrier using three different techniques. Method and Materials: Sixty freshly extracted single-rooted human teeth were decoronated and standardized to a root length of 15 mm. The root segments were prepared with Gates Glidden burs to simulate a divergent open apex of immature teeth and randomly assigned into three experimental groups of 20 samples each. MTA (5 mm) was placed by pluggers (Group A), paper points (Group B), or ultrasonic tips (Group C). A cotton pellet moistened with saline was placed in the root canals till the material set, and the coronal portion was sealed with Cavit. After 24 hours, the Cavit and cotton pellet were removed and the canals dried and obturated with warm guttapercha (Obtura) and AH 26 sealer. Coronal portions of all samples were then sealed with Cavit. All root segments were double-coated with nail varnish except for the open apex and were exposed to methylene blue dye for 48 hours at room temperature. The samples were sectioned longitudinally (layer thickness 0.4 mm) and the extent of dye penetration was measured with a stereomicroscope (magnification 20×). Results: The mean depth (± standard deviation) of dye leakage for Group A was 1.34 ± 0.5 mm, Group B 1.25 ± 0.4 mm, and Group C 1.14 ± 0.4 mm. There were no significant differences among the three experimental groups (.178 < P < .552). Conclusion: ProRoot MTA has a similar sealing ability when placed as an apical barrier with pluggers, paper points, or ultrasonic tips. Keywords: apexification, mineral trioxide aggregate, sealing ability

Objectives: To clinically evaluate the healing of mandibular Miller Class I and II isolated gingival recessions treated with the modified coronally advanced tunnel (MCAT) in conjunction with an enamel matrix derivative (EMD) and subepithelial connective tissue graft (SCTG). Method and Materials: Sixteen healthy patients (13 women and 3 men) exhibiting one isolated mandibular Miller Class I and II gingival recessions of a depth of ≥ 3 mm, were consecutively treated with the MCAT in conjunction with EMD and SCTG. Treatment outcomes were assessed at baseline and at 12 months postoperatively. The primary outcome variable was complete root coverage (CRC) (eg, 100% root coverage). Results: Postoperative pain and discomfort were low and no complications such as postoperative bleeding, allergic reactions, abscesses, or loss of SCTG were observed. At 12 months, statistically significant (P < .0001) root coverage was obtained in all 16 defects. CRC was measured in 12 out of the 16 cases (75%) while in the remaining 4 defects root coverage amounted to 90% (in two cases) and 80% (in two cases), respectively. Mean root coverage was 96.25%. Mean keratinized tissue width increased from 1.98 ± 0.8 mm at baseline to 2.5 ± 0.9 mm (P < .0001) at 12 months, while mean probing depth did not show any statistically significant changes (ie, 1.9 ± 0.3 mm at baseline vs 1.8 ± 0.2 mm at 12 months). Conclusion: Within their limits, the present results indicate that the described treatment approach may lead to predictable root coverage of isolated mandibular Miller Class I and II gingival recessions. Keywords: enamel matrix derivative, isolated mandibular gingival recessions, modified coronally advanced tunnel, root coverage, subepithelial connective tissue graft

Objective: To test whether or not different types of CAD/CAM systems, processing zirconia in the densely and in the pre-sintered stage, lead to differences in the accuracy of 4-unit anterior fixed dental prosthesis (FDP) frameworks, and to evaluate the efficiency. Method and Materials: 40 curved anterior 4-unit FDP frameworks were manufactured with four different CAD/CAM systems: DCS Precident (DCS) (control group), Cercon (DeguDent) (test group 1), Cerec InLab (Sirona) (test group 2), Kavo Everest (Kavo) (test group 3). The DCS System was chosen as the control group because the zirconia frameworks are processed in its densely sintered stage and there is no shrinkage of the zirconia during the manufacturing process. The initial fit of the frameworks was checked and adjusted to a subjectively similar level of accuracy by one dental technician, and the time taken for this was recorded. After cementation, the frameworks were embedded into resin and the abutment teeth were cut in mesiodistal and orobuccal directions in four specimens. The thickness of the cement gap was measured at 50× (internal adaptation) and 200× (marginal adaptation) magnification. The measurement of the accuracy was performed at four sites. Site 1: marginal adaptation, the marginal opening at the point of closest perpendicular approximation between the die and framework margin. Site 2: Internal adaptation at the chamfer. Site 3: Internal adaptation at the axial wall. Site 4: Internal adaptation in the occlusal area. The data were analyzed descriptively using the ANOVA and Bonferroni/ Dunn tests. Results: The mean marginal adaptation (site 1) of the control group was 107 ± 26 μm; test group 1, 140 ± 26 μm; test group 2, 104 ± 40 μm; and test group 3, 95 ± 31 μm. Test group 1 showed a tendency to exhibit larger marginal gaps than the other groups, however, this difference was only significant when test groups 1 and 3 were compared (P = .0022; Bonferroni/Dunn test). Significantly more time was needed for the adjustment of the frameworks of test group 1 compared to the other test groups and the control group (21.1 min vs 3.8 min) (P < .0001; Bonferroni/Dunn test). For the adjustment of the frameworks of test groups 2 and 3, the same time was needed as for the frameworks of the control group. Conclusions: No differences of the framework accuracy resulting from the different CAM and CAD/CAM procedures were found; however, only after adjustment of the fit by an experienced dental technician. Hence, the influence of a manual correction of the fit was crucial, and the efforts differed for the tested systems. The CAM system led to lower initial accuracy of the frameworks than the CAD/CAM systems, which may be crucial for the dental laboratory. The stage of the zirconia materials used for the different CAD/CAM procedures, ie presintered or densely sintered, exhibited no influence. Keywords: fixed dental prosthesis, internal fit, marginal fit, zirconia

Hypodontia is a relatively common finding, although rarely are the canines the missing teeth. Congenitally missing canines are challenging to treat because of their unique role in the masticatory system and the fact that they are in the esthetic zone. This article discusses two patients with missing permanent canines, various treatment planning considerations, and the provided prosthetic solutions. Keywords: hypodontia, missing canines

Objective: To present the application of two diff erent soft tissue grafts around dental implants during stage-two surgery. Furthermore, the ultrastructure of these materials is shown and discussed using scanning electron microscopy (SEM). Summary: Although soft tissue autografts may be currently regarded as the gold standard, harvesting of these grafts might lead to higher morbidity, longer chair time, and intra-/postoperative complications at the donor site. New developments in collagen scaff olds have provided an alternative to successfully replace autologous grafts in clinical practice. The SEM pictures clearly show the diff erent composition of a bilayer scaff old (collagen matrix, CM) and a porcine acellular dermal matrix (ADM). These distinctive properties lead to different possible indications. Within the presented cases, ADM was used to augment the ridge contour and was placed into a buccal pouch to achieve complete coverage and an uneventful closed healing. On the other side, CM was left exposed to the oral cavity to successfully gain keratinized mucosa around and between two dental implants. Keywords: acellular dermal matrix, bilayer collagen matrix, matrix structure, stage-two surgery, soft tissue augmentation

Objective: The purpose of this study was to evaluate periimplantitis prevalence in patients using implant-supported fixed prostheses that did not have any routine maintenance care. Method and Materials: A total of 161 implants (27 patients) were evaluated in patients using implant-supported fixed prostheses. Collected data included information related to patient general health and local factors such as characteristics of implants, time in function, type of loading, positioning, Modified Bleeding Index, bacterial plaque, bleeding on probing (BOP), marginal recession, probing depth (PD), keratinized mucosa, and radiographic bone loss (BL). Factors related to the prostheses were also evaluated. The exclusion criteria were patients that have had any follow-up visit for plaque control of the prosthesis and/or the implants. Results: From a total of 161 implants, 116 (72%) presented without peri-implantitis (PD > 4 mm + BOP + BL > 2 mm) while 45 (28%) had some sign of the disease. Implants placed in the maxilla were 2.98 times more likely to develop the disease (P < .05). Moreover, patients aged ≤ 60 years old were 3.24 times more likely to develop peri-implantitis (P < .05). Another analysis with statistical relevance (P < .05) was that implants with less than 3 mm interimplant distance were three times more likely to have peri-implantitis. There was no statistical relevance considering other analyses. Conclusion: It can be concluded that patients aged ≤ 60 years have a greater chance of presenting periimplantitis, as well as for implants positioned in the maxilla and those placed with an interimplant distance < 3 mm. Keywords: fixed prostheses, local factors, marginal bone loss, peri-implantitis, prevalence

Recombinant human bone morphogenetic protein-type 2 (rhBMP-2) is used in oral and maxillofacial procedures due to its endochondral bone formation capacity, and this is also the reason for its use off-label in jaw reconstruction. This study reports a case of an extensive central giant cell lesion along the mandibular body and symphysis. Treatment consisted of enucleation and curettage followed by off-label use of rhBMP-2 associated with bovine bone xenograft. The literature concerning mandibular reconstruction using rhBMP-2 was also reviewed. Keywords: bone graft, bone morphogenetic protein-type 2, mandibular reconstruction, xenograft

The sensitive transitional skin of the lips is a favored site for primary skin diseases, especially eczematous dermatitis. An inflammatory condition of the lips, eg chapped lips (cheilitis sicca) in atopic eczema, may be the only manifestation of a skin disease or appear as part of a generalized dermatosis. Inflammatory changes to the lips also occur in the context of systemic disorders such as lupus erythematosus or in allergic diseases. This article presents the most frequent and the most important forms of inflammatory cheilitis. Keywords: angioedema, atopy, cheilitis glandularis, cheilitis simplex, contact eczema, granulomatous cheilitis, lichen planus, lip-licking eczema, lupus erythematosus

Objective: This report describes the case of a 13-year-old patient who experienced traumatic intrusion of the primary maxillary right central incisor and subsequently suffered an atypical tetrad, comprising of an unerupted compound odontoma associated with a dentigerous cyst, and an impacted, doubly dilacerated permanent maxillary right central incisor; however, the high interconnectivity of the occurrence of four pathologies together is unusual has not previously been reported. Summary: The pathologies were detected 7 years after trauma; surgical removal of odontome along with the dentigerous cyst was performed, followed by orthodontic extrusion of the impacted double-dilacerated permanent central incisor. The 18-month follow-up shows no pathology, no gingival recession, and normal probing depth. Keywords: dentigerous cyst, impacted tooth, odontome, tooth intrusion, treatment

Objectives: This study aimed to investigate dental prosthetists' experiences with screening and referral for suspicious oral mucosal pathology. Method and Materials: Questionnaires regarding oral mucosal screening and referral were mailed to 300 randomly selected dental prosthetists in Australia for selfcompletion. Non-responders were sent replacement questionnaires up to three times, according to the Dillman method. Results: A total of 179 prosthetists returned completed questionnaires resulting in a response rate of 64.9% after excluding 24 due to incorrectly listed addresses. Most participants reported that they checked all new patients for oral mucosal pathology (99.4%) and most reported that they checked all recall patients for mucosal pathology (86%). Most participants had detected a suspicious lesion (86%) and most had referred for a suspicious lesion (77.3%). Conclusion: Australian dental prosthetists appear motivated to perform oral mucosal screening and will refer suspicious oral mucosal pathology when detected. Keywords: diagnosis, mouth cancer, oral mucosal pathology, prosthetist, referral, screening