Quintessence International, 04/2015

Dental restorations without tooth preparation are among today's more advanced treatment options. This article presents the case of a young man who was treated with a non-prep laminate veneer that provided 3.5 mm of incisal elongation. A Photoshop assessment and functional evaluation, as well as a wax-up and mock-up, were used during pre-prosthetic planning. A combination of pressable and feldspathic ceramics was used as a restorative material, which was applied to the tooth surface without any preparation of dental hard tissue. An ideal functional and esthetic restoration was achieved thanks to close collaboration between the patient, the dentist, and the technician. Keywords: Creation CP, esthetics, mock-up, non-preparation laminate veneer, non-prep veneer, pressable ceramics, "tenuia" veneer

Objective: To analyze the evolution of the thickness, bacterial vitality, covering grade, and the structure after 2 and 4 days of aging in "non-disturbed" plaque-like biofilm (PL-biofilm). Method and Materials: Twenty healthy volunteers wore a specific appliance. After 2 days half of the samples were removed from the appliance. Posteriorly, after bacterial vital staining, samples were analyzed using a confocal laser scanning microscope. In the first volunteer, one of the disks was analyzed using a scanning electronic microscope. The same process was realized on the remaining disks after 4 days. Results: The thicknesses of the PL-biofilm after 2 and 4 days were not significantly different. The bacterial vitality changed significantly from 72.50 ± 15.50% to 57.54 ± 15.66% over time, which was in contrast to the covering grade (53.08 ± 18.03% and 70.74 ± 19.11%). The structure changed from an irregular surface and compact deepest layer with a high predominance of the coccus shape to a complex structure with voids in the deepest layer and a great proportion of bacillus-shaped bacteria. Conclusion: The PL-biofilm thickness remained practically constant, decreasing the bacterial vitality and increasing the covering grade over time. Regarding the structure, differences were principally bacterial disposition in the surface and bacterial shape. Clinically, the findings show that new control strategies for combating the oral biofilm should be focused on inhibiting bacterial adhesion to tooth surfaces, which would reduce biofilm formation. Keywords: bacterial vitality, covering grade, laser scanning confocal microscopy, plaque-like biofilm, scanning electron microscopy, structure, thickness

Objective: The purpose of this study was to compare the effect of eugenol-based and resin-based endodontic sealers on the push-out bond strengths of prefabricated fiber posts luted with different resin cements. Method and Materials: Ninety prefabricated fiber posts were luted into extracted singlerooted teeth with one of three resin cements (Variolink II, ParaCore, or Rely X Unicem). Each group was subdivided into three groups with 10 teeth each. The first two groups were obturated with gutta percha and one of two eugenol-based endodontic sealers (Endofil or TubliSeal) each. The third group was obturated with gutta percha and (AH26) resin-based root canal sealer. Push-out tests were performed in a universal testing machine by applying a load speed at 0.5 mm/min by using a 1-mm-diameter metallic plunger which induced a load in an apical to coronal direction. The maximum value for post dislodgement (in Newtons) was recorded. Data were collected and statistically analyzed using two-way ANOVA and Tukey multiple comparison tests (α = .05). Results: The highest mean bond strength values were recorded for the AH26 sealer group (non-eugenol sealer) luted with Rely X Unicem resin cement (mean ± SD = 326.1 ± 66.1 N), while the lowest mean bond strength values were observed with posts luted with Variolink II resin cement into canals obturated with gutta-percha and Endofil (eugenol-based) sealer (90.3 ± 25.2 N). There was no significant difference between the means of push-out strengths for the Endofil and TubliSeal groups (P = .745). Conclusion: Eugenol-based sealers (Endofil and TubliSeal) significantly reduced the push-out bond strength of prefabricated fiber posts luted with resin cement. Keywords: bond strength, endodontic sealer, eugenol, fiber posts

Intrusions are considered among the most severe forms of dental trauma and are associated with severe late complications. Usually general dental practitioners are the first to see and treat these children. The present case describes the challenges associated with the diagnosis and treatment of late complications of complete intruded maxillary incisors accompanied by profound buccal displacement in an 8-year-old patient. The treatments performed included root-canal treatment of right central incisor using mineral trioxide aggregate (MTA) and a combination of surgical and orthodontic repositioning of the intruded left incisor. Clinical and radiographic examinations at 2 years' follow-up revealed intact lamina dura and no sign of ankylosis in both incisors, apexogenesis of the right central incisor, and positive response to pulp testing of the left central incisor. The present report emphasizes the need to follow a child with severe dental injury and to consult with trained specialists when needed. Keywords: inflammatory resorption, intrusion, splint, surgical orthodontic retraction, traumatic injury

Objective: The aim of the study was to compare the effect of submucosal injection of dexamethasone and triamcinolone acetonide on postoperative pain, swelling, and trismus occurring after impacted mandibular third molar surgery. Method and Materials: A total of 78 patients (aged 18 to 35) with asymptomatic, unilateral, impacted mandibular third molar, and without any systemic disease were included in this study. Patients were divided into three groups randomly (control, dexamethasone, and triamcinolone acetonide). In the experimental groups, dexamethasone and triamcinolone acetonide were injected into submucosa at about 1 cm above the surgical area submucosally. The control group of patients did not take any drug submucosally but the same surgical procedure was applied. Pain evaluation was performed by visual analog scale (VAS). Swelling was measured using a flexible standard ruler measuring the dimensions of the axes between certain points on the face. For trismus evaluation, maximum mouth opening was measured. Measurements taken on the preoperative, and on postoperative first, third, and seventh days were compared with each other and statistically evaluated. Results: There were statistically significant differences between the control and experimental groups on the different days of the postoperative period. The effect of triamcinolone acetonide on pain started on the first day postoperatively and the effect of triamcinolone acetonide on trismus and pain was better than other groups at the third and seventh days. However, there was no statistically significant difference between the effects of dexamethasone and triamcinolone acetonide regarding postoperative complications. Conclusion: The submucosal injection of dexamethasone or triamcinolone acetonide might be an effective treatment for postoperative discomfort occurring following impacted mandibular third molar surgery, and triamcinolone acetonide could be applied as an alternative to dexamethasone. Keywords: submucosal dexamethasone, submucosal triamcinolone acetonide, third molar surgery

Objective: To report two cases of solid type primary intraosseous carcinoma (PIOC) with a critical appraisal of one of the WHO diagnostic criteria. Summary: Both patients had radiographic and histopathologic findings showing massive mandibular destruction as well as the involvement of the inferior alveolar nerve, without lip or chin paresthesia. Patients were treated through hemimandibulectomy followed by reconstruction through fibula free flap and forearm flap. Conclusion: Lip and/ or chin paresthesia are rather frequent in metastatic and salivary gland tumors but not in primary tumors of the jaws. Reasons for such a discrepancy are mostly unknown. A few hypotheses are put forward here. It is the opinion of the authors that most of the diagnostic criteria for solid type PIOC are acceptable. However, the criterion "absence of ulcer formation on the overlying mucosa" mainly depends on the dimension of the tumor at diagnosis. Keywords: diagnostic criteria, oral surgery, paresthesia, primary intraosseous carcinoma

Objective: The hypothesis that dental malocclusions may be a risk factor for temporomandibular disorders (TMD) has been greatly debated in the literature. Whilst the association between features of dental occlusion and TMD has been proven weak, if existing, it seems that the transfer of such knowledge into clinical practice is yet to be completed. This study evaluated the prevalence of static and dynamic malocclusion features in a population of TMD patients and compared it with literature data on the general population. Method and Materials: A total of 625 consecutive TMD patients (75% female; aged 34.2 ± 6.7 years, range 25-44 years) were examined and were clustered into four groups on the basis of pain absence (ie, disk displacement and/or arthrosis without pain), or pain presence within the muscles and/or the temporomandibular joint (TMJ). As for the occlusal features, posterior crossbite, excessive overbite, anterior open bite, excessive overjet, and molar and canine asymmetry were recorded as static malocclusion findings. Medio-/laterotrusive interferences and slide length from retruded contact position (RCP) to maximum intercuspation (MI) ≥ 2 mm were also recorded as dynamic malocclusion findings. The ɸ correlation coefficient assessed the strength of the correlation between each occlusal feature and the presence of pain-related TMD condition. Results: No significant correlation was seen between the various malocclusion findings and the presence of any pain-related TMD condition, with ɸ values ranging from -0.081 to +0.043 for molar asymmetry and laterotrusive interferences, respectively. The prevalence findings in this TMD population were within the range reported from general population studies. Conclusions: In adult subjects, static or dynamic malocclusion findings show similar prevalence irrespective of the presence of any specific pain-related TMD condition. Also, the prevalence values are similar to the available data at general population level. Based on the above, general practitioners should note that occlusal features may not be considered a discriminant factor for TMD. Keywords: epidemiology, occlusion, prevalence, temporomandibular disorders

Odontogenic infections are common in the dental practice and their treatment should be a standard procedure for every dentist. For optimal management of septic intraoral problems, the practitioner must understand the underlying causes and etiologies of odontogenic infections. Therefore, the purpose of this article is to outline basic inflammatory processes involved in the development of odontogenic and intraoral infections including relevant pathogens, biochemical processes mediated by pro-inflammatory molecules, the basics of abscess formation, the host response, and the clinical appearance of intraoral septic processes. Furthermore, treatment modalities of odontogenic infections and associated lesions are discussed and a brief explanation of possible complications and their management is provided. Keywords: abscess formation, inflammation, inflammatory mediators, lymphoma, phlegmonous infection