Quintessenz Verlag Berlin @ zahnigroups

Online Article: Thurston syndrome: Oral and systemic manifestations. Case report and review of the literature

Quintessenz Verlag Berlin — Fri, 05 Mar 2010 12:00:26 +0100

Orofaciodigital (OFD) syndrome is a generic name for a variety of different but possibly related genetic disorders that result in malformations of the mouth, teeth, jaw, facial bones, hands, and feet and are therefore categorized as oroacral disorders. Nine subtypes of OFD syndromes have been identified. OFD type V is known as Thurston syndrome, of which only 11 cases have been reported to date. A case is reported of a 19-year-old man with this syndrome. A brief review of previously reported cases and discussion of anomalies of the syndrome is presented.

Online Article: Cavernous sinus thrombosis in a patient with facial myiasis

Quintessenz Verlag Berlin — Fri, 05 Mar 2010 12:00:25 +0100

Cavernous sinus thrombosis is a severe encephalic complication of the cervicofacial infections that can lead to death if not treated in adequate time. Among the several etiologies related to the development of this infection, myiasis has not been reported, enforcing the importance of the report of a case of thrombosis of the cavernous sinus developed from a facial myiasis.

Bacterial leakage of provisional restorative materials used in endodontics

Quintessenz Verlag Berlin — Thu, 04 Mar 2010 16:00:19 +0100

Objective: To test the bacterial sealing ability of commonly used provisional endodontic restorative materials.
Method and Materials: This study investigated Cavit (3M ESPE), Ketac (3M ESPE), DuoTemp (Coltène/Whaledent), and a combination technique using Ketac and Cavit. One hundred molars were randomly selected and then mounted in an apparatus that isolated the crown portion of the tooth. Provisional restorative materials were placed in an open access following manufacturer guidelines. Streptococcus mutans was applied to the samples, and results were tabulated over the course of 4 weeks.
Results: Cavit and DuoTemp performed the best, and Ketac performed the worst. After 14 days, however, all materials leaked in over half of the samples.
Conclusion: No material can be recommended as superior in providing a reliable seal after 14 days.

Influence of root-surface conditioning with acid and chelating agents on clot stabilization

Quintessenz Verlag Berlin — Thu, 04 Mar 2010 16:00:19 +0100

Objective: To compare the adhesion and maturation of blood components on chemically conditioned root surfaces.
Method and Materials: Clinical root samples of human teeth were obtained (n = 150) and manually scaled. Five groups of 30 samples were treated as follows: (1) saline solution irrigation (control); (2) 24% EDTA gel; (3) 25% citric acid solution; (4) tetracycline solution (50 mg/mL); and (5) 30% sodium citrate solution. After these treatments, 15 samples of each group received a blood drop and were analyzed by SEM. The remaining 15 had their surface morphology evaluated for collagen fibrils exposure by SEM. Photomicrographs were analyzed according to the score of adhesion of blood components. Kruskal-Wallis and Dunn multiple comparison tests were employed.
Results: The control group was characterized by the absence of blood elements on the surface. The best result was observed in the citric acid group, which had a dense fibrin network with blood elements adhered. The EDTA group showed a moderate fibrin network formation. In contrast, a scarce fibrin network and a few cells were present in the tetracycline samples, and an absence of blood elements was found on sodium citrate specimens. The citric acid group was statistically different from the control group (P .05).
Conclusion: Under these experimental conditions, citric acid is indicated to stabilize clots on the root surface, which act as a scaffold for connective tissue cell development.

Novel ceria-stabilized tetragonal zirconia/alumina nanocomposite as framework material for posterior fixed dental prostheses: Preliminary results of a prospective case series at 1 year of function

Quintessenz Verlag Berlin — Thu, 04 Mar 2010 16:00:18 +0100

Objective: To examine the clinical performance of veneered ceria-stabilized tetragonal zirconia/alumina-nanocomposite (Ce-TZP/A-nanocomposite) frameworks for three-unit fixed dental prostheses (FDPs).
Method and Materials: Eight patients in need of one FDP replacing one premolar or molar were included in this case series. Eight Ce-TZP/A- nanocomposite FDP frameworks were fabricated with a CAD/CAM system (Hint-Els) and veneered with a zirconia veneering ceramic (Vintage ZR, Shofu). The FDPs were cemented with resin cement (baseline) and were evaluated at baseline; 2 weeks; and 3, 6, and 12 months after cementation. For the technical evaluation, the USPHS criteria were used. The biologic outcome was judged by comparing the plaque control record (PCR), bleeding on probing (BOP), and probing pocket depth (PPD) of the abutment teeth (test) and untreated contralateral teeth (control). Radiographs were made at baseline and at 6 and 12 months of follow-up. The data were descriptively analyzed.
Results: The mean observation period of the eight examined FDPs was 12.8 ± 1.1 months. The survival rate of the FDPs was 100%. Furthermore, no technical or biologic complications were found. No differences of the mean (m) PCR (test: 0.1 ± 0.1, control: 0.2 ± 0.2), mBOP (test: 0.2 ± 0.2, control: 0.1 ± 0.1), and mPPD (test: 2.6 ± 0.8, control: 2.6 ± 0.6) were found between test and control teeth.
Conclusions: Ce-TZP/A nanocomposite was found to be a reliable framework material at 1 year of function. Longer observation periods and randomized controlled clinical trials including more patients are needed to validate these findings.

Etiolgic factors of hyposalivation and consequences for oral health

Quintessenz Verlag Berlin — Thu, 04 Mar 2010 16:00:18 +0100

Hyposalivation is represented by a reduced salivary flow rate and can be caused by etiologic factors such as systemic diseases and intake of various medications or by radiotherapy following head and neck cancer. The aim of this review was to compile data about the qualitative and quantitative changes of salivary components during hyposalivation, and to summarize their consequences for oral health. A Medline/PubMed/Scopus search was conducted to identify and summarize articles published in English and German that reported on etiology of hyposalivation and changes in the salivary composition due to hyposalivation of different origins. The search revealed 94 articles, 71 of which were original articles. Apart from the reduction of the salivary flow rate, the quality of saliva is strongly altered because of systemic diseases, medications, and radiotherapy, including increased viscosity and pH shift to more acidic values and changes in salivary protein compositions. Furthermore, hyposalivation may be accompanied by pronounced shifts in specific microbial components, in particular toward a highly acidogenic microflora. Moreover, therapy of hyposalivation is often restricted to palliative treatment (ie, saliva substitutes or gels). To prevent tooth tissue demineralization, clinicians should consider saliva substitutes that are supersaturated with calcium and phosphates and contain fluoride.

Three cases of subpontic osseous hyperplasia of the mandible: A report

Quintessenz Verlag Berlin — Thu, 04 Mar 2010 16:00:17 +0100

Subpontic osseous hyperplasia is a relatively uncommon benign submucosal mass of normal bone found beneath a pontic. Three cases of mandibular subpontic osseous hyperplasia are described, adding to the 40 existing cases in the English-language literature. Subpontic osseous hyperplasia may represent a unique reactive osseous metaplasia in the subpontic region, with chronic stimuli and functional or occlusal stress as possible etiologies. This article aims to address the clinical significance, treatment considerations, and radiographic correlation of subpontic osseous hyperplasia.

Short-term effects of systemic antibiotics during periodontal healing

Quintessenz Verlag Berlin — Thu, 04 Mar 2010 16:00:17 +0100

Objectives: To investigate the short-term effects of nonsurgical therapy (scaling and root planing, SRP) on the subgingival microbiota in chronic (CP) and aggressive (AP) periodontal disease.
Method and Materials: Ninety-seven CP and AP subjects underwent fullmouth SRP on 2 consecutive days. AP patients were randomly assigned to either receive systemic metronidazole plus amoxicillin (AP+AB) or were treated mechanically alone (AP). Pathogens were identified with 16S rRNA oligodeoxynucleotide probes and dot-blot hybridization before and at days 2, 3, 4, 7, 10, and 21 of healing. CP subjects were treated by scaling and root planing along with placebo tablets.
Results: Initially, AP cell counts were 69.9- (Porphyromonas gingivalis), 10.2- (Aggregatibacter actinomycetemcomitans), 5.7- (Tannerella forsythia), and 3.3-fold (Prevotella intermedia) enhanced compared to CP cell counts. Following SRP, immediate elimination occurred in single individuals of all three treatment groups at day 2. After SRP plus antibiotic therapy (AP+AB), the prevalence scores dropped beyond the levels of AP and CP, beginning at day 7, and remained low until day 21 (P ≤ .05). Clinical healing statistically benefited from SRP with no differences among the three treatment groups.
Conclusion: Nonsurgical therapy resulted in both a suppression and early elimination of single taxa immediately after completion of active treatment. Systemic antibiotics significantly accelerate the suppression of the periodontal microflora, but have limited effect on the elimination of target isolates during healing.

Dystrophic calcifications arising in the masseter muscle: A case report

Quintessenz Verlag Berlin — Thu, 04 Mar 2010 16:00:16 +0100

Calcium salt deposits in the presence of normal calcium/phosphorus metabolism involving tissues that do not physiologically calcify are referred to as dystrophic calcification. The condition may be associated with a variety of systemic disorders. Additionally, injured tissue of any kind is predisposed to dystrophic calcification. The case of a 21-year-old man with two isolated dystrophic calcifications in the right masseter muscle is presented. Dystrophic calcifications should be studied carefully and differentiated from lesions resulting from other syndromes that manifest calcification of soft tissues. The lack of a classification system of soft tissue calcifications complicates the management and study of the condition.

Clinical evaluation of a fixed (retrievable) implant-supported prosthesis in the edentulous jaw: A 5-year report

Quintessenz Verlag Berlin — Thu, 04 Mar 2010 16:00:15 +0100

Objective: This retrospective study evaluated the success rate of a fixed retrievable prosthesis based on an electroforming technique combining the advantages of screw- and cement-retained principles.
Method and Materials: Forty patients (17 men and 23 women) with a mean age of 62.2 years were treated. A total of 353 implants were placed in the edentulous maxilla, mandible, or both jaws to allow prosthetic rehabilitations with 55 fixed prostheses. Clinical success of the implants was based on the criteria of Buser. Technical complications monitored throughout the wearing period are described. Retrievability of the restoration with a conventional crown remover was checked at 6, 12, and 36 months. The cumulative survival rate of the implants was measured.
Results: After a mean observation period of 4.08 years (range 22 to 62 months), a cumulative survival rate of 99.15% was recorded for the 234 maxillary implants (234 Camlog RootLine, Camlog) and for the 119 mandibular implants (72 Camlog RootLine, 47 Camlog ScrewLine). Three implants failed before prosthetic loading. Monitored technical complications were seen in 10.91% of the restorations; they comprised ceramic chip-off and relining.
Conclusions: This fixed implant-retained prosthesis based on electroforming indicates a comparable clinical efficacy to other techniques and allows scheduled retrieval.

Immediate loading of full-arch fixed protheses supported by axial and tilted implants for the treatment of edentulous atrophic mandibles

Quintessenz Verlag Berlin — Thu, 04 Mar 2010 16:00:15 +0100

Objectives: This study aimed to evaluate the long-term prognosis of immediately loaded fixed full prostheses for the treatment of edentulous patients with extreme bone atrophy in the posterior mandibular region.
Material and Methods: Twenty-four edentulous patients with atrophic posterior mandibles were treated by means of a complete prosthesis sustained by both axial and tilted fixtures. The insertion of tilted implants was carefully planned by means of computed tomography scan analysis and measuring width and height of residual bone. Implant type, length, and diameter were chosen, as well as implant angulation, according to the All-on-Four protocol and avoiding the course of the mandibular nerve. The prosthesis was delivered no later than 2 days after implant surgery. Implant survival and prosthesis success were assessed clinically and radiographically up to 42 months of follow-up. Measurement of peri-implant bone loss was based on periapical radiographs after 12 months of loading.
Results: All implants survived and all prostheses were successful at the time of this study reporting. The mean follow-up was 30.1 months with a range of 14 to 44 months. The average peri-implant bone loss was 0.85 mm after 12 months (0.8 mm for tilted implants and 0.9 mm for axial implants). No significant difference in marginal bone loss was observed between axial and tilted implants.
Conclusions: The immediate rehabilitation of patients with extreme atrophic mandibles can be successful with careful planning and particular attention during the surgical placement of the implants, as shown by the excellent outcomes of the present study.

Editorial: The role of clinical experience in the implementation of evidence-based dentistry

Quintessenz Verlag Berlin — Thu, 04 Mar 2010 16:00:13 +0100

Long-term Provisional Anterior Tooth Replacement using Fiber-reinforced Composite and Avulsed Tooth Crowns as Pontics

Quintessenz Verlag Berlin — Fri, 12 Feb 2010 16:00:22 +0100

The loss of anterior teeth due to trauma requires immediate attention for function and esthetics. While implant- supported or conventional fixed prostheses may be the treatments of choice for adults, relatively noninvasive and reversible provisional procedures for tooth replacement are necessary for adolescents. In recent years, developments in fiber and composite technology offer a conservative treatment approach to restore the anterior edentulous space as a fixed provisional tooth replacement.
This case report presents the chairside procedures of anterior tooth replacement in an adolescent using the avulsed tooth crowns as pontics which were bonded to teeth on either side of the edentulous space and reinforced with a preimpregnated fiber.

Bonding Strategies to Pulp Chamber Dentin Treated with Different Endodontic Irrigants: Microshear Bond Strength Testing and SEM Analysis

Quintessenz Verlag Berlin — Fri, 12 Feb 2010 16:00:21 +0100

Purpose: To evaluate the effect of 6 irrigant regimens on the microshear bond strength of different adhesives to pulp chamber dentin and to determine their interfacial morphology by SEM.
Materials and Methods: Forty-three human molars were split into halves and ground to provide flat pulp chamber dentin. Eighty-five halves were used. The specimens were assigned to 6 groups according to the irrigant regimen used. Group I (n=10) was irrigated with distilled water (control). The remaining 5 groups (n=15 each) were irrigated with 5.25% NaOCl followed by either 5.25% NaOCl, 17% EDTA, benzalkonium chloride (Tubilcid Plus) or MTAD (Biopure), either rinsed or not. Irrigated specimens were bonded using Clearfil S3 Bond or Adper Single Bond 2, which was employed with or without etching. Resin composite cylinders were bonded using tygon tubes for microshear bond strength testing. Data were analyzed using two-way ANOVA followed by Tukey’s post-hoc test. Representative specimens of each group were prepared from 17 further mmolars for interfacial SEM examination.
Results: The different irrigant regimens used did not significantly alter the microshear bond strength values using either of the bonding systems, except NaOCl, which significantly reduced the microshear bond strength values with Adper Single Bond 2. Bonding irrigated specimens directly using the Adper Single Bond 2 without prior etching provided significantly reduced values.
Conclusion: The irrigant regimens examined could be used safely prior to bonding except for the NaOCl, which should be negated if it is to be followed by Adper Single Bond 2, and the etching step cannot be omitted if an etch-and-rinse adhesive system is the adhesive of choice.

Benefits of a Two-step Cementation Procedure for Prefabricated Fiber Posts

Quintessenz Verlag Berlin — Fri, 12 Feb 2010 16:00:21 +0100

Purpose: To determine whether two-step cementation of prefabricated fiber posts leads to higher bond strengths.
Materials and Methods: Forty-eight human canine teeth were divided into six groups and fiber posts were cemented with DC Core, RelyX Unicem and Panavia F2.0, according to a one-step or two-step procedure. Per root, four cross-sections were prepared. The differences in push-out strength between procedure, cement and location within the root were determined.
Results: For all cements, the push-out strengths for the two-step procedure were significantly higher than for the onestep procedure (p < 0.001). Differences between the cements for both the one-step and two-step procedure were not statistically significant (p = 0.05).
Conclusion: The reduction of the C-factor by means of a two-step cementation, a procedure equivalent to the layering technique of composite restorations, resulted in significantly higher bond strengths. The increase of 60% in bond strength may be beneficial to the retention of post and core restorations.

Water Sorption and Solubility of Four Self-etching, Self-adhesive Resin Luting Agents

Quintessenz Verlag Berlin — Fri, 12 Feb 2010 16:00:20 +0100

Purpose: To evaluate and compare the water sorption and water solubility of four self-etching, self-adhesive resin luting agents.
Materials and Methods: Four self-etching, self-adhesive resin luting agents (RelyX Unicem, Maxcem, Biscem, Multilink Sprint) and one classic resin luting agent (Multilink Automix) as a control group were used. Twelve disks (8 mm x 1 mm) of each material were prepared according to ISO 4049. Water sorption and solubility were calculated, using the formulae which the ISO 4049 specification provides.
Results: Maxcem and Biscem were found to have very high water sorption values. RelyX Unicem and Multilink Sprint exhibited water sorption values only slightly higher than the control group. Regarding water solubility, the greater mass loss was found for Maxcem. Multilink Sprint exhibited no mass change. Biscem was found to have low solubility values, whereas RelyX Unicem and Multilink Automix exhibited negative solubility.
Conclusion: Multilink Sprint and RelyX Unicem were found to comply with the ISO requirements regarding water sorption and solubility, while Maxcem and Biscem did not. Materials of the same group exhibited very different behavior during their interaction with water.

Restoring Strength of Incisors with Veneers and Full Ceramic Crowns

Quintessenz Verlag Berlin — Fri, 12 Feb 2010 16:00:20 +0100

Purpose: The aim was to determine the in vitro fracture resistance of incisors restored with veneers and full ceramic crowns compared to unrestored teeth.
Materials and Methods: Seventy intact, extracted human maxillary central incisors were randomized and assigned to 7 groups (n = 10). The teeth in group 1 remained intact (control). The teeth in groups 2 to 6 were prepared and IPS Empress restorations were conditioned and bonded using an adhesive luting cement, Variolink II/Syntac (group 2: labial veneer with incisal overlap, group 3: 3/4 veneer with margin in enamel, group 4: 3/4 veneer with margin in dentin, group 5: crown with margin in enamel, group 6: crown with margin in dentin group 7: veneer on worn tooth. After finishing and polishing, specimens were stored in water and thermocycled for 2000 cycles between 5°C and 55°C. The maximal fracture load of the specimens (40-degree inclination) was determined using the universal testing machine (Zwick) at a constant crosshead speed (0.5 mm/min). The statistical analysis was performed using the Kruskal-Wallis test with Bonferroni correction (p < 0.05). Fracture surfaces were qualitatively analyzed by SEM.
Results: All restored teeth with cervical preparation margins in enamel showed a fracture load not significantly different from the intact teeth (control). Restored teeth with cervical preparation margins in dentin showed a significantly lower fracture load. All restorations showed a fracture load far above 400 N, serving as functional reference for anterior teeth. The failures were predominantly cohesive.
Conclusion: For the restoration of tooth strength, defining the finishing lines of veneers and crowns in enamel is recommended. Restorations with finishing lines in dentin resulted in significant loss of strength. Three-quarter veneers with finishing lines in enamel are functionally equal to crowns with the advantage of conserving tooth structure.

Degree of Conversion and Antimicrobial Activity of Etch-and-Rinse Versus Self-etching Adhesives

Quintessenz Verlag Berlin — Fri, 12 Feb 2010 16:00:19 +0100

Purpose: This study was designed to compare the self-etching with the etch-and-rinse adhesives regarding the degree of conversion and antimicrobial activity against cariogenic bacteria.
Materials and Methods: The materials used were AdheSE (two-step self-etching), Adper Prompt L-Pop (self-etching, single-step) and Excite (etch-and-rinse) adhesives. The degree of conversion was measured using Fourier Transformation Infrared Spectroscopy. The absorbance peaks of infrared rays by the aliphatic C=C was detected at 1632 to 1637cm-1 and the aromatic C=C peak at 1610 to 1500 cm-1.The antimicrobial activity was evaluated using the microorganisms Streptococcus mutans, Lactobacillus salivarius, and Actinomyces odontolyticus, with a disk diffusion method. Chlorhexidine digluconate solution 0.2% was used as a positive control. Zones of inhibited bacterial growth were observed and measured.
Results: AdheSE showed the highest degree of conversion, followed by Excite, while Adper Prompt L-Pop had the lowest values. A significant difference in the degree of conversion was found between Excite and Adper Prompt L-Pop as well as AdheSE and Adper Prompt L-Pop. On the other hand, there was no significant difference between Excite and AdheSE. Adper Prompt L-Pop showed an antimicrobial effect against Streptococcus mutans and Actinomyces odontolyticus while it was unable to inhibit the growth of Lactobacillus salivarius. AdheSE could inhibit the growth of Streptococcus mutans only. Excite did not produce inhibition zones to the tested microorganisms.
Conclusion: Adper Prompt L-Pop showed the worst degree of conversion. AdheSE and Excite had the highest degree of conversion. Appreciable antimicrobial activity was noted with self-etching adhesives, while the etch-and-rinse demonstrated no antimicrobial action.

Bond Efficacy and Interface Morphology of Self-etching Adhesives to Ground Enamel

Quintessenz Verlag Berlin — Fri, 12 Feb 2010 16:00:18 +0100

Purpose: This study compared the microshear bond strengths to ground enamel of three one-step self-etching adhesive systems, a self-etching primer system and an etch-and-rinse adhesive system.
Materials and Methods: Three self-etching adhesives, Futurabond DC (Voco), Clearfil S Tri Bond (Kuraray) and Hybrid bond (Sun-Medical), a self-etching primer, Clearfil SE Bond (Kuraray), and an etch-and-rinse system, Admira Bond (Voco), were selected. Thirty human molars were used. The root of each tooth was removed and the crown was sectioned into halves. The convex enamel surfaces were reduced by polishing on silicone paper to prepare a flat surface. The bonding systems were applied on this surface. Prior to adhesive curing, a hollow cylinder (2.0 mm height/0.75 mm internal diameter) was placed on the treated surfaces. A resin composite was then inserted into the tube and cured. After water storage for 24 h, the tube was removed and shear bond strength was determined in a universal testing machine at a crosshead speed of 0.5 mm/min. The results were analyzed with ANOVA and the Tukey.-Kramer test at a 59° confidence level. The enamel of five additional teeth was ground, and the etching component of each adhesive was applied and removed with absolute ethanol instead of being light cured. These teeth and selected fractured surfaces were examined by SEM.
Results: Adhesion to ground enamel of the Futurabond DC (25 ± 3.5 MPa) and Clearfil SE Bond (23 ± 2.9 MPa) selfetching systems was not significantly different from the etch-and-rinse system Admira Bond (27 ± 2.3 MPa). The two self-etching adhesives Clearfil S Tri bond and Hybrid Bond demonstrated significantly lower bond strengths (14 ± 1.4 MPa; 11 ± 1.9 MPa) with no significant differences between them (p < 0.05).
Conclusion: Bond strengths to ground enamel of self-etching adhesive systems are dependant on the type of adhesive system. Some of the new adhesive systems showed bond strength values comparable to that of etch-and-rinse systems. There was no correlation between bond strength and morphological changes in enamel.

Effect of Chlorhexidine Application in a Self-etching Adhesive on the Immediate Resin-Dentin Bond Strength

Quintessenz Verlag Berlin — Fri, 12 Feb 2010 16:00:18 +0100

Purpose: To investigate whether the application of chlorhexidine in a two-step self-etching adhesive has an adverse effect on the immediate resin-dentin bond strength.
Materials and Methods: Different amounts of 20 wt% chlorhexidine digluconate were added directly to the Clearfil SE Bond primer to prepare mixtures of 4 different concentrations of chlorhexidine: 0.05 wt%, 0.1 wt%, 0.5 wt%, and 1.0 wt%. Sixteen extracted third molars were randomly divided into 4 groups. Each group corresponded to one of the 4 chlorhexidine concentrations. Each of the 16 teeth was sectioned into halves. One half was customarily bonded with Clearfil SE Bond without chlorhexidine, and the other half was bonded with Clearfil SE Bond containing different concentrations of chlorhexidine. Microtensile bond strengths were tested immediately after specimen preparation. The modes of fractures were examined under a stereomicroscope.
Results: No significant difference of immediate resin-dentin bond strength was observed between the control groups and any of the experimental groups containing chlorhexidine (p > 0.05).
Conclusion: The addition of chlorhexidine to a two-step self-etching adhesive primer (Clearfil SE Bond primer) has no adverse effect on the immediate resin-dentin bond strength when the chlorhexidine concentration in the primer is lower than or equal to 1.0 wt%.

The Influence of a Local Anesthetic Containing Vasoconstrictor on Microtensile Bond Strengths of Two Adhesive Systems to Human Dentin In Situ

Quintessenz Verlag Berlin — Fri, 12 Feb 2010 12:00:14 +0100

Purpose: To evaluate the bond strengths of an etch-and-rinse adhesive and a self-etching adhesive to human dentin in vitro and under two in situ conditions: non-anesthetization and anesthetization of the teeth with a local anesthetic containing vasoconstrictor.
Materials and Methods: An in situ study was performed on 49 maxillary premolars scheduled for extraction due to orthodontic reasons. For the bond strength test, occlusal cavities were prepared either with or without a local anesthetic containing vasoconstrictor. The cavities were bonded with Adper Single Bond or Clearfil SE Bond and filled with a resin composite, Filtek Z250. The teeth were then extracted, sectioned, trimmed, and tested for microtensile bond strength. For the observation of dentin surfaces, 20 premolars were used. The impressions of the cavity floors in the anesthetized and non-anesthetized groups were taken before and after acid etching. The replicas were observed under a scanning electron microscope. In vitro, the bond strength test and the SEM observation were also carried out on 24 extracted premolars with the same procedures used in the in situ study.
Results: The bond strengths of the two adhesives bonded to dentin in situ were significantly lower than those in vitro. When both adhesives were tested under in situ conditions, there were no significant differences between the bond strengths to dentin of anesthetized and non-anesthetized groups (p > 0.05). No fluid droplets were found on dentin on the cavity floor prepared in vitro, either before or after acid-etching. For the unetched dentin prepared in situ, fluid droplets were found and covered on the smear layer in anesthetized and non-anesthetized groups, but the droplets were slightly larger in the non-anesthetized group. In the non-anesthetized, acid-etched group, dentin surfaces were covered with coalescent dentinal fluid in most specimens. However, in the anesthetized, acid-etched group, patent tubules and some dentinal fluid were observed on the surfaces.
Conclusion: It was concluded that in situ, dentinal fluid had a detrimental effect on the dentin bond strengths of an etch-and-rinse adhesive and a self-etching adhesive. However, reduction in dentinal fluid due to the effect of a local anesthetic containing vasoconstrictor did not improve the bond strengths in either adhesives.

Adhesion Performance of New Hydrolytically Stable One-component Self-etching Enamel/Dentin Adhesives

Quintessenz Verlag Berlin — Fri, 12 Feb 2010 12:00:14 +0100

Purpose: To demonstrate that hydrolytically stable methacrylamide monomers allow one-component self-etching adhesives with comparable adhesive properties and better storage stability than hitherto available methyacrylate-based adhesive formulations.
Materials and Methods: The shear bond strength and storage stability of the new one-component self-etching, methacrylamide-based adhesive AdheSE One F (Ivoclar Vivadent) to enamel and dentin was compared to the methacrylate-based Clearfil S3 Bond (Kuraray), G-Bond (GC), Hybrid Bond (Sun Medical), iBond (Heraeus Kulzer), Optibond All In One (Sybron-Kerr), and the methacrylamide-based Xeno V (Dentsply). Hydrolytic stability and adhesive performance of these adhesives was evaluated by accelerated aging at 42°C over 16 weeks and monthly assessment of shear bond strength to dentin. The null hypothesis was that the bond strength of one-bottle self-etching dental adhesives is independent of storage duration and that, disregarding their higher stability against hydrolysis, methacrylamide- based materials offer performance beyond shelf-life time, comparable to methacrylate-based adhesives. Statistical analysis included 1-way-ANOVA and the Tukey-B post-hoc test (p < 0.05).
Results: Shear bond strengths on enamel ranged from 32.7 MPa (AdheSE One F) to 16.6 MPa (iBond) and on dentin from 36.1 MPa (Optibond All In One) to 20.5 MPa (G-Bond). During accelerated aging, methacrylate-based adhesives with a pH < 2 exhibited decreasing bond strengths over time with material-dependent losses of up to 68% (Hybrid Bond, 8 weeks, 42°C). Under the same conditions, the methacrylamide-based formulations AdheSE One F and Xeno V were stable for 16 weeks regarding shear bond strength to dentin.
Conclusions: The shelf life of one-component self-etching adhesives is determined by their chemical composition. In conventional methacrylate-based adhesives, the inherently acidic environment of such formulations leads to monomer degradation due to hydrolysis. In contrast, methacrylamide-based adhesives are stable to aqueous acid and exhibit much superior storage stability without monomer degradation-related losses in adhesion performance.

Editorial: The Art of Publishing

Quintessenz Verlag Berlin — Fri, 12 Feb 2010 11:00:13 +0100

Research in focus

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:44:56 +0100

This section presents brief reviews of articles on dental implants that are of special interest, to help readers develop skills for research, analysis and the evaluation of scientific publications.

The Keyhole Access Expansion Technique for Flapless Implant Stage-Two Surgery: Technical Note

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:48 +0100

In addition to osseointegration and restoration of function, patient satisfaction is a key element in the success of implant therapy. Especially in the esthetic zone, an essential part of the procedure aims at creating a definitive implant restoration that cannot be distinguished from the adjacent natural teeth. The present patient shows that, after localized ridge defects are reconstructed during implant surgery, a favorable esthetic and functional result can be achieved employing the keyhole access expansion technique for stage-two surgery, which is easy to perform, safe, and minimally invasive.

Influence of Implant Length, Diameter, and Geometry on Stress Distribution: A Finite Element Analysis

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:47 +0100

The aim of this study was to evaluate the influence of the length, diameter, and geometry of Biotechnology Institute dental implants on stress distribution in bone. Three-dimensional finite element models of osseointegrated titanium dental implants were created for this study. A force of 150 N was applied at an angle of 30 degrees. The four implant systems used were: Tiny, Interna Universal, Interna Plus, and Interna Wide, and presented the following platforms: 3.5, 4.1, 4.1 (with a 4.8-mm neck), and 5.5 mm, respectively. Implant lengths of 8.5, 10.0, 11.5, 13.0, and 15.0 mm and diameters of 2.5, 3.3, 3.75, 4.0, 4.5, and 5.0 mm were evaluated. Results showed that the effect of implant diameter on stress distribution in bone was more significant than the effect of the implant’s length or its geometry. The maximum stress was located around the neck of the implant and the majority of the stress, independent of the parameter being studied, was distributed in the bone adjacent to the first six threads of the implant. Based on these finite element studies, the use of wider implants may be better to dissipate the acting forces and thus reduce the stress in the bone surrounding the implant. Additionally, the use of shorter and wider implants might be a reasonable alternative in sites limited by the height of the residual ridge.

Anorganic Bovine Bone (Bio-Oss) Regulates miRNA of Osteoblast-like Cells

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:46 +0100

Bio-Oss (Geistlich) is composed of anorganic bovine bone and has been widely used in several bone regeneration procedures during oral surgery. However, how this biomaterial enhances osteoblast activity to promote bone formation is not completely understood. MicroRNAs (miRNAs) represent a class of small, functional, noncoding RNAs of 19 to 23 nucleotides that regulate the transcription of messenger RNAs (mRNAs) in proteins. In this study, the miRNA microarray technique was used to investigate translation regulation in an osteoblast-like cell line (MG63) exposed to Bio-Oss. Nine up-regulated miRNAs (mir-423, mir-492, mir-191, mir-23a, mir-377, mir-494, mir-214, mir-193b, mir-320) and 4 down-regulated miRNAs (mir-27a, mir-24, mir-188, let-7c) were identified. Because each miRNA regulates 100 mRNAs, only mRNAs related to bone formation were analyzed. The vast majority of detected mRNAs are down-regulated, including some homeobox genes (genes that regulate the morphogenesis of an entire segment of the body), such as noggin and EN1. An indirect positive effect was demonstrated on bone morphogenetic protein-4. To the authors’ knowledge, the data reported here are the first on translation regulation in osteoblasts exposed to Bio-Oss. This study may be relevant in better understanding the molecular mechanism of bone regeneration and used as a potential tool for analyzing the combined use of cytokines.

The Use of Piezosurgery to Mobilize the Mandibular Alveolar Nerve Followed Immediately by Implant Insertion: A Case Series Evaluating Neurosensory Disturbance

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:45 +0100

One of the therapeutic options proposed for reconstruction of the atrophic posterior mandible is inferior alveolar nerve (IAN) mobilization with simultaneous implant placement. However, studies on the functionality of this neurovascular bundle after its mobilization have shown mixed results. This variability can be attributed both to the test methodology, which typically requires subjective answers from patients, and to the surgical procedure itself, which is highly dependent on operator technique. This article reports on a series of 10 cases of IAN mobilization using a device specifically engineered to simplify bone surgery. This device enables the oral surgeon to avoid overstretching the nerve by creating a smaller bone window and using an apicocoronal inclination of instruments to capture the neurovascular bundle. Evaluation by means of neurosurgery function tests over a 36-month period found that all patients had a return to normal sensation after a brief period of neurosensory disturbance. Subjective responses to a patient questionnaire confirmed these findings. The implant success rate was 100%.

Full-Mouth Disinfection as a Nonsurgical Treatment Approach for Drug-Induced Gingival Overgrowth: A Series of 11 Cases

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:44 +0100

The treatment of drug-induced gingival overgrowth is compounded by the high recurrence rate resulting from chronic use of the medication and the persistence of other risk factors. In this case series, the treatment outcome of a nonsurgical periodontal therapy, according to the concept of full-mouth disinfection in 11 patients with drug-induced gingival overgrowth, is described. All clinical parameters improved significantly after therapy. Only 6% of teeth received further surgical treatment. The clinical situation remained stable during the recall. The present case series suggests that full-mouth disinfection might be a beneficial treatment concept for drug-induced gingival overgrowth, reducing the need for further surgical intervention.

Sinus Grafting with Magnesium-Enriched Bioceramic Granules and Autogenous Bone: A Microcomputed Tomographic Evaluation of 11 Patients

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:42 +0100

Eleven sinuses were grafted with a magnesium-enriched bioceramic bone substitute in granules (SINTlife) mixed with 10% autogenous bone retrieved from intraoral donor sites. Bone biopsies retrieved after 8 months were visually and quantitatively analyzed with microcomputed tomography (microCT). MicroCT evaluation of the grafted material was feasible, since the radiodensity of the bone substitute was different from the density of mineralized bone. MicroCT showed good integration of the graft in all treated cases. The tested bioceramic bone substitute, mixed with autogenous bone, seemed to have a positive effect in sinus grafting, with values of total mineralized tissue volume around 66%. Residual graft particles occupied 31% of the total volume of the specimen. Particles of the ceramic bone substitute seemed mainly unresorbed. MicroCT analysis evaluated several morphometric parameters, demonstrating that the newly formed bone could be used for placement and loading of implants.

Immediate Provisionalization of Single Extraction-Site Implants in the Esthetic Zone: A Clinical Evaluation

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:41 +0100

Forty patients received a total of 43 implants placed in fresh extraction sites in the anterior maxilla. Within 1 week, a provisional crown was placed without occlusal contact. After 1 year, the implant survival rate, marginal bone resorption, and papillae preservation were assessed. The overall survival rate was 95.3%. The 1-year marginal bone loss was not statiscally significant when compared to the marginal bone level at implant placement. In 78% of patients, the papilla was completely preserved. Single-tooth rehabilitation patients with buccal or circumferential defects can be predictably treated with a favorable esthetic outcome using the immediate provisionalization approach.

Tissue-Engineered Bilayered Cell Therapy for the Treatment of Oral Mucosal Defects: A Case Series

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:40 +0100

In this case series, a tissue-engineered bilayered live cell therapy (LCT) is examined as an alternative to free gingival grafts in subjects with oral mucosal defects. Four patients with five sites requiring mucogingival surgery because of limited vestibular depth and limited keratinized oral mucosa were selected for treatment. All included patients had limited graft availability or preferred to avoid autogenous soft tissue grafting. The oral mucosal defects were treated with a tissueengineered bilayered LCT, a circular disk of allogeneic live, human-derived, confluent, and bilayered keratinocyte and fibroblast cells. Sites were evaluated for wound healing, histologic appearance of the regenerated mucosa, and DNA persistence of the LCT. All sites healed uneventfully, with complete epithelialization by 14 days postoperative and no significant adverse events. The treated sites matched the surrounding tissues in both texture and color. Histologic samples revealed gingival tissue architecture characterized by a parakeratinized epithelium with a very sparse and diffuse chronic inflammatory response within the connective tissue. DNA persistence indicated that the pairs of samples (swab and biopsy) collected from each subject displayed the same identifier DNA, with no evidence of any other source. Further research is needed to evaluate the utility of LCT in clinical practice.

Prosthetic Gingival Reconstruction in Fixed Partial Restorations. Part 3: Laboratory Procedures and Maintenance

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:39 +0100

Part 1 of the present series presented a rationale for including prosthetic gingiva in the planning of a fixed restoration to ensure an esthetic result for patients with severe horizontal and vertical ridge deficiencies. The second part focused on the diagnostic and treatment planning aspects of the use of artificial gingiva. This third and final installment in the series focuses on the laboratory and clinical procedures involved in fabricating a prosthesis with artificial gingiva and provides information on proper maintenance of these restorations.

Prospective Study of 94 Platform-Switched Implants Observed from 1992 to 2006

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:39 +0100

The purpose of the present prospective study was to evaluate implant survival and crestal bone levels around implants that used the platform-switching concept and were followed for a minimum of 11 years. Radiographs of 94 implants obtained 11 to 14 years after loading were evaluated by measuring the location of the crestal bone level relative to the implant platform. All implants had been placed at the crestal level at the time of surgery. Using the known distance of 0.8 mm between the peaks of adjacent threads, a determination was made on the radiographs of the amount of bone lost. Seventy-one of the 94 implants (75.5%) showed no bone loss on the mesial aspect, and 67 (71.3%) showed no bone loss on the distal aspect. Eighty-four percent of the mesial surfaces and 88% of the distal surfaces had 0.8 mm or less of bone loss. This is the longest follow-up to a prospective investigation of platform-switched implants and confirms the concept for preservation of crestal bone levels.

Editorial: Endodontics Versus Single-Tooth Implants

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:38 +0100

Online Article: A stepwise multiple regression model to assess the odds ratio between myofascial pain and 13 occlusal features in 238 Italian women

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:36 +0100

Objective: To quantify the relative risk of multiple occlusal variables for muscular disorders of the stomatognathic system.
Method and Materials: Thirteen occlusal features were clinically assessed by the same three operators: partial unilateral posterior reverse articulation, anterior open occlusal relationship, vertical anterior overlap (normal value < 4 mm), complete unilateral posterior reverse articulation, anterior overjet (normal value < 5 mm), incisor midline discrepancy (normal value < 2 mm), Angle Class I canine and molar relationship; plus dynamic occlusion features such as length and symmetry of retruded contact position-intercanine position (RCP/ICP) slides (normal value < 2 mm), occlusal guidance patterns, and mediotrusive and laterotrusive interferences. The sample consisted of 156 women with only muscular disorders according to the Group I Research Diagnostic Criteria for temporomandibular disorders and 82 healthy women (control group). A stepwise multiple logistic regression model was used to identify the significant correlation between occlusal features and disease.
Results: The odds ratio for myofascial pain was 2.6 for absence of canine guidance, 2.0 for laterotrusive interference, 2.3 for mediotrusive interference, and 1.9 for reverse articulation. Other occlusal variables did not reveal statistical significance. The percentage of the total log likelihood for myofascial pain explained by the significant occlusal factors was acceptable with a Nagelkerke R2 = 0.2. The final model including the significative occlusal features revealed an optimal discriminant capacity to predict patients with myofascial pain with a sensitivity of 62.2%, or healthy subjects with a specificity of 93.6%, and an accuracy of 82.8%.
Conclusions: Few occlusal features show a significative predictive value for myofascial pain.

Online Article: Sulcus depth reproduction with polyvinyl siloxane impression material: Effects of hydrophilicity and impression temperature

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:33 +0100

Objective: To determine the sulcus penetration ability of hydrophilic and hydrophobic polyvinyl siloxane (PVS) impression materials by impression technique, temperature, and sulcus width.
Method and Materials: Hydrophilic Flexitime (FLE; Heraeus Kulzer) and its hydrophobic counterpart (EXP) without surfactant were investigated, using light (L), monophase (M), and heavy (H) consistencies. A truncated steel cone surrounded by a 2-mm-deep and 50-, 100-, or 200-μm-wide sulcus, simulating the gingival tissue with agar, served as the test model. Impressions were made with single-mix (L or M) and doublemix (LM or LH) techniques at 23°C and 37°C, respectively. The reproduced sulcus heights were measured with a 3D laser scanner. Data were analyzed by ANOVA and Tukey HSD (P 1.9 mm); FLE-M, -LM, and -LH reproductions were shorter with narrow sulci. Reproductions of 50- and 100-μm sulci with EXP-L were shallower than with FLE-L. The shortest reproduction was, however, greater than 1.6 mm.
Conclusions: In spite of some significant differences found in sulcus-reproducing ability with hydrophilic and hydrophobic impression materials applied at different impression-making temperatures and with different techniques, the practical relevance is limited.

In vitro evaluation of the effect of dietary acids and toothbrushing on human root dentin permeability

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:32 +0100

Objectives: The purpose of this in vitro study was to quantify the alterations in human root dentin permeability after exposure to dietary acids and to evaluate the effect of toothbrushing after acid application.
Method and Materials: Extracted human third molars had their crowns sectioned above the CEJ, pulp tissue removed, and cervical root dentin exposed using a high-speed bur (approximately 1 mm in depth of substance loss). From each root fragment, one specimen was prepared. A total of 25 specimens were used and distributed randomly into five groups. The specimens were attached to a hydraulic pressure apparatus to evaluate the alterations of root dentin permeability after exposure to different acids. Dentin permeability was measured after the following sequential steps: (1) treatment with EDTA for 3 minutes to obtain the maximum permeability; (2) root planing to create a smear layer; (3) exposure to different acidic substances for 5 minutes (vinegar, cola drink, lemon juice, white wine, and orange juice); and (4) brushing for 3 minutes.
Results: All acidic substances increased dentin permeability after root planing. Lemon juice produced higher values for permeability when compared to the other substances (P = .009); moreover, orange juice showed similar results (P < .02) except when compared to vinegar (P = .12). Brushing right after acid exposure significantly reduced dentin permeability except in the vinegar group (P = .07).
Conclusion: Under the experimental conditions, dietary acids increased root dentin permeability, and immediate brushing reduced permeability levels.

Influence of immediate attachment loss during instrumentation employing thin ultrasonic tips on clinical response to nonsurgical periodontal therapy

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:31 +0100

Objective: Mechanical instrumentation is fundamental to periodontal treatment. However, independent of the instrument used in scaling, an immediate attachment loss occurs at the bottom of the periodontal pocket. This study aimed to determine the influence of tip diameter on attachment loss and the influence of attachment loss on the periodontal response to nonsurgical treatment.
Method and Materials: Fifteen patients presenting periodontal pockets with a probing depth of 3.5 mm or more in bilateral teeth were divided into two groups: test groupinstrumented with a thin tip, and control groupinstrumented with a traditional tip. Probing depth, relative gingival position, and relative attachment level were evaluated immediately before and after and at 1 and 3 months after treatment using an electronic computerized probe. The data were analyzed using ANOVA and Tukey tests (P = .05).
Results: Both groups presented attachment loss immediately after instrumentation; however, the thin tip resulted in statistically higher immediate clinical attachment loss than the traditional tip (0.85 and 0.15 mm, respectively; P .05).
Conclusion: In spite of the higher immediate clinical attachment loss inflicted by thin ultrasonic tips during instrumentation, this did not affect the clinical response to the nonsurgical treatment.

Evaluation of serum levels of C-reactive protein and lipid profiles in patients with chronic periodontitis and/or coronary heart disease in an ethnic Han population

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:30 +0100

Objective: To investigate the relationship of coronary heart disease (CHD)-associated factors C-reactive protein (CRP) and lipid profileswith periodontitis in an ethnic Han population.
Method and Materials: Forty healthy individuals as control, 40 patients with chronic periodontitis (CP), 28 patients with CHD, and 47 patients with both CP and CHD were included in the study. Serum CRP levels, lipid profile concentrations, and three periodontal clinical parameters (probing depth, clinical attachment level, and bleeding on probing) were measured and analyzed. The chi-square test, Student-Newman-Keuls test, analysis of covariance, and a logistic regression analysis were used in this study.
Results: The mean CRP level of patients with CP alone was 2.4 ± 1.5 mg/L. There were significant differences in mean serum CRP levels among groups after confounders were adjusted, with CP+CHD patients having the highest level (7.3 ± 5.7 mg/L) and the controls the lowest (1.0 ± 0.6 mg/L) (P < .001). Mean HDL cholesterol level of CP patients (1.1 ± 0.7 mmol/L) was significantly lower than that of controls (1.4 ± 0.6 mmol/L) (P < .05), although it was significantly higher than that of the other two groups with CHD (0.8 ± 0.5 mmol/L and 0.7 ± 0.4 mmol/L) (P < .001). Significant correlations of CRP and HDL cholesterol with the three clinical periodontal parameters were apparent (P < .05). CRP and HDL cholesterol were found to be significantly associated with an increased frequency of CHD in this regression model (OR = 3.7 and OR = 1.9, respectively, P < .05).
Conclusions: In an ethnic Han population with a low normal range of serum CRP levels, chronic periodontitis is associated with increased CRP levels and decreased HDL cholesterol concentrations, which suggests that there may be some relationship between periodontal inflammation and CHD.

Periodontal disease and the oral-systemic connection: “Is it all the RAGE?”

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:29 +0100

Ample studies have reported on the association between periodontal diseases, a persistent inflammatory process, and other chronic ailments such as cardiovascular diseases, diabetes mellitus, Alzheimer disease, and cancer. Other conditions such as low birth weight and premature delivery due to chorioamnionitis are also known to be linked to poor periodontal health. Although much epidemiologic data support these associations, a cause-and-effect relationship has not been established. The receptor for advanced glycation end products (RAGE) is a multiligand receptor expressed on various cell membranes, including immune, endothelial, and epithelial, and cells of the central nervous system. This receptor, which is frequently associated with proinflammatory responses, has been shown to be activated by various ligands such as high mobility group box-1 (HMGB1/amphoterin), amyloid fibrils, transthyrein, Mac-1 (Integrin Mac-1), as well as advanced glycation end products (AGEs). Recent studies indicate that signaling through RAGE has been implicated as an underlying condition in diverse pathologies including periodontal disease, cardiovascular diseases, diabetes mellitus, Alzheimer disease, cancer, and neurologic conditions. Review of the literature supports the hypothesis that activation of RAGE by ligands in a variety of cell types and tissues may play a role in oral systemic associations. In addition, the ligand cell source and timing of RAGE stimulation may determine the disease produced by this axis. Understanding the distribution and functions of RAGE and its ligands would enhance clinicians’ knowledge on pathogenesis of the oral-systemic connection.

A histochemical and immunohistochemical study of mast cells in differentiating oral lichen planus from oral lichenoid reactions

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:27 +0100

Objective: Oral lichen planus (OLP) is a chronic mucocutaneous disease with unknown etiology. Oral lichenoid reactions (OLRs) comprise a family of lesions with different recognized etiologies. OLR lesions have clinical and histopathologic characteristics similar to those of OLP, although their management is different from that for OLP. Discrimination between OLP and OLR has always been a major challenge for both clinicians and pathologists. For this purpose, this study evaluated mast cells in the lamina propria of OLP and OLR lesional tissues.
Method and Materials: The study was performed on 23 cases of OLP and 23 cases of OLR categorized based on clinical examination, histopathology evaluation, and history in accordance with WHO definitions of OLP. Mast cells in the reticular layer of the lamina propria for OLP and OLR lesions were evaluated both quantitatively (total number) and qualitatively (degranulation status) using light microscopy. Two staining methodstoluidine blue (histochemistry) and antitryptase (immunohistochemistry)were used for identification and mapping of the mast cells.
Results: No significant difference was observed in the total number of mast cells between the two disease groups (P = .74 toluidine blue, P = .47 antitryptase). A statistically significant difference was noted between the number of degranulated mast cells of OLP and OLR lesions with only toluidine blue stain (P < .001 toluidine blue, P = .14 antitryptase). A statistically significant difference in the ratio of degranulated mast cells to the total population was observed between OLP and OLR lesions with both staining methods (P < .001 for both methods).
Conclusion: The observed difference in the ratio of degranulated to total mast cell population in the reticular zone of the lamina propria may be a useful criterion for histopathologic distinction between OLP and OLR. This may also explain the different therapeutic approaches toward these two lesions.

The subepithelial connective tissue pedicle graft combined with the coronally advanced flap for restoring missing papilla: A report of two cases

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:16:26 +0100

This case report describes the clinical application of the coronally advanced flap procedure associated with the subepithelial connective tissue pedicle graft in the reconstruction of interdental papilla. This procedure was used in two distinct situations: to reconstruct missing papilla and cover two Miller Class IV gingival recessions between the maxillary right lateral incisor and canine (case 1) and to improve esthetics and restore missing papilla between the maxillary left central and lateral incisors (case 2). In case 1, there was a clinical attachment level gain, complete root coverage (canine), and an increase in papillary height. Case 2 showed similar improvements for the interdental papilla, ie, significant reduction of the black triangle. Subepithelial connective tissue pedicle graft associated with a coronally advanced flap yielded satisfactory esthetics and may be considered a viable approach for the treatment of missing papilla associated or not with recession-type defects. However, further investigation is required.

Diminutive, interradicular “hybrid” desmoplastic / acanthomatous ameloblastoma

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:15:56 +0100

Ameloblastomas are benign aggressive odontogentic tumors that exhibit insidious growth rates with attainment of extensive dimesions. Because ameloblastomas are not usually symptomatic unitl late in their clinical course, few are detected early. This article reports an atypical case of a small, painful ameloblastoma arising between the roots of the mandibular left canine and lateral incisor in a 66-year-old female. The patient underwent an en bloc resection of the mandible, and no recurrence was demonstrated on an 11-month recall examination. Histopathology revealed a “hybrid" ameloblastoma with a pronounced desmoplastic pattern and acanthomatous changes. Practitioners should be vigilant for diminutive radiolucent lesions of the jaws with poorly defined borders. Timely recognition and intervention of ameloblastomas may improve treatment outcomes.

Simplified technique for rebuilding a post and core foundation with a preexisting crown: A case report

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:15:55 +0100

A 58-year-old patient presented with a dislodged crown and post and core on the maxillary right first premolar. After endodontic retreatment, two tapered glass-fiber posts were adhesively cemented. The core foundation was completed by retrofitting the existing crown with a self-curing composite core material. The intaglio surface was lubricated with petroleum jelly, which allowed for easy removal of the crown. Adequate cement thickness was ensured by the finishing procedures of the core buildup that respected the existing tooth margins. The glass-fiber posts and composite buildup provided adequate stability and retention to the original casting. The technique described in this short clinical report enables clinicians to rebuild a post-and-core foundation using the existing crown without the original die or its replica in a simple and time-saving way.

Sinus grafting with mineralized allograft and staged implant placement

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:15:54 +0100

Advanced atrophy of the partially edentulous maxilla necessitates bone augmentation as a prerequisite for successful implant osseointegration. This case shows that sinus grafting at the left first molar (free-end gap) by means of particulated mineralized solvent-preserved cancellous bone and sealing of the recipient site with a bioabsorbable xenogenic collagenous membrane provides optimum conditions for a staged implant placement. Four months after sinus membrane elevation, a trephine biopsy was recovered from the augmented floor and a microtextured implant placed into the augmented area. The ultrastructural observations testify to the biocompatibility and osteoconductivity of the grafting material used.

Multidisciplinary management of multiple maxillary anterior supernumerary teeth: A case report

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:15:53 +0100

Supernumerary teeth are a relatively frequent disorder of odontogenesis. They may occur alone or in multiple; be unilateral or bilateral; and appear in the maxilla, mandible, or both. Mesiodens is a supernumerary tooth in the anterior maxilla between the two central incisors. This case report describes the treatment of maxillary central incisors displaced and impacted because of the presence of four mesiodens in a 12-year-old boy. After clinical and radiographic examination, surgical removal of the mesiodens and exposure of the maxillary right central incisor was performed. This resulted in a 14-mm space between the displaced central incisors. Successively, fixed orthodontic treatment was planned with cephalometric analysis. The central incisors were brought to the occlusal plane and aligned, and the space between the incisors was redistributed. Remaining minor spaces between the incisors were closed with composite resin buildup.

A modified treatment approach for fabricating a mandibular distal-extension partial denture: A clinical report

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:15:52 +0100

An altered cast impression technique is routinely used for fabricating distal-extension partial dentures. The advantages of an altered cast impression technique are that it evenly distributes stresses between hard and soft tissues and reduces stresses to the abutment teeth. However, there is some controversy among clinicians as to the technique and requirements of both tooth and tissue management of the distal-extension partial denture. A modified approach of fabricating a distal-extension partial denture is presented using a laboratory-processed functional reline method. The functional reline is performed after the removable partial denture is processed to perfect the fit of the denture base to the residual ridge. This enables the partial denture to be constructed from a cast made from a single impression and results in a prosthesis that is stable and has well-extended borders. Not only is it easy and less technique-sensitive for the operator, but it also results in increased comfort and reduced need for multiple adjustment visits for the patient.

Editorial: TMD: Taxonomic mix-up beyond descripton

Quintessenz Verlag Berlin — Mon, 08 Feb 2010 13:15:51 +0100

Use of the Coronoid Process as a Donor Site for Sinus Augmentation: A Case Report

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:22 +0100

In a sinus lift procedure, bone grafting is usually performed concomitantly. The mandibular coronoid process is an advantageous donor site for autogenous bone grafts. A clinical case of sinus bone grafting using the coronoid process of the mandible is presented here, along with the surgical technique to accomplish this procedure. A successful outcome was obtained in the patient, who experienced no functional problems.

Peripheral Giant Cell Granuloma Associated with Dental Implants: A Rare Case Report

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:22 +0100

The peripheral giant cell granuloma is a benign reactive exophytic lesion of unknown etiology occurring on the gingiva and alveolar ridge. Different local causal factors have been associated with this type of lesion. Although peripheral giant cell granuloma is the most common giant cell lesion of the jaws, it is rarely seen in association with implants. This report discusses the etiology and management of a peripheral giant cell granuloma around dental implants in a 60-year-old woman. A new implant-supported prosthesis with adequate marginal adaptation between the restoration and abutments was made. There were no complications during 1 year of clinical and radiologic follow-up.

Nasal Suction Technique for Maxillary Sinus Floor Elevation: A Report of 24 Consecutive Patients

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:21 +0100

Purpose: Inadvertent perforation of the sinus membrane is a frequent complication encountered during sinus floor elevation (SFE). Different strategies have been described for the prevention or treatment of perforations, with varying results. This paper reports the findings of a preliminary study into the application of a novel nasal suction technique in which negative antral air pressure was used to facilitate the raising of the sinus lining and to reduce the risk of perforations occurring during SFE.
Materials and Methods: In 24 consecutive patients, nasal suction was applied through the ipsilateral nostril during SFE. The suction device was attached to a high-flow vacuum regulator that incorporated a suction canister connected to a -10-kPA medical vacuum (-75 mm Hg). Fifteen subjects received unilateral SFE, and six subjects had bilateral staged lateral wall sinus elevation; the remaining three subjects had osteotome sinus floor elevation (three unilateral and one bilateral) with simultaneous implant placement.
Results: During SFE, the use of nasal suction facilitated the inversion of the sinus lining around the edges of the lateral access window. This made the sinus lifting easier, as the need for extensive instrumentation was significantly reduced. In three subjects, elevation of the sinus lining occurred spontaneously from the lateral, medial, and inferior surfaces of the antrum when nasal suction was applied.
Conclusion: Sinus lifting was facilitated by nasal suction. No perforation of the sinus lining occurred in this series. Controlled clinical trials are being designed to further demonstrate the clinical efficacy of the nasal suction technique in SFE.

Augmentation of the Mandible via a “Tent-Pole Procedure and Implant Treatment in a Patient with Type III Osteogenesis Imperfecta: Clinical and Histologic Considerations

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:21 +0100

The present report describes the oral rehabilitation of a female patient suffering from type III osteogenesis imperfecta. Agenesis of the mandibular anterior teeth and malocclusion caused partly by heavily worn teeth made dental rehabilitation necessary. Before a decision to use implants following a grafting procedure, the osseointegration of microimplants was tested. After 4 and 12 months, bone plugs containing two microimplants were retrieved from the patient. Histologic evaluation showed very sparse/poor osseointegration, and the healing time seemed to be much longer than normal. A decision was made to use the “tent-pole" procedure described by Marx et al, followed by prolonged healing. Surgery was uneventful, and the patient was provided with four implants that were partly covered with bone obtained from the iliac crest. Platelet-rich plasma was used to accelerate bone healing. After 9 months, the implants were uncovered and the prosthetic construction was completed. The implant-supported metal-ceramic restoration was serving well at the 1-year and 3-year follow-ups. Minimal resorption of marginal bone was detected during the first year.

Evaluation of Survival and Success Rates of Dental Implants Placed at the Time of or After Alveolar Ridge Augmentation with an Autogenous Mandibular Bone Graft and Titanium Mesh: A 3- to 8-year Retrospective Study

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:20 +0100

Purpose: The purpose of this retrospective longitudinal study was to evaluate the survival and success rates of 56 implants consecutively placed in alveolar ridges following a one- or two-stage augmentative procedure, using autogenous bone and titanium micromeshes.
Materials and Methods: This study included 24 consecutive patients treated with 27 micromeshes and mandibular particulated bone. In 13 patients, 20 implants were placed at the time of the reconstructive procedure. In the remaining 11 patients, 36 implants were positioned in a second surgery 8 to 9 months after grafting. Follow-up data (implant survival, success rate, marginal bone resorption) were collected after 3 to 8 years of prosthetic loading.
Results: Four of the 27 micromeshes (complication rate, 14.8%) were exposed prematurely and were removed before the intended time. The mean vertical bone augmentation obtained was 5.4 ± 1.81 mm for implants placed in simultaneous procedures and 4.5 ± 1.16 mm in delayed procedures. None of the 56 implants was lost during the observation period (cumulative implant survival rate, 100%). Radiographic analysis showed stable marginal bone levels, with a mean bone resorption of 1.58 ± 0.48 mm after 3 to 8 years. Only two implants demonstrated increased bone loss (3.12 and 3.37 mm) over the follow-up period, whereas the remaining 54 implants were considered clinically successful, resulting in a cumulative success rate of 96.4%.
Conclusions: This study revealed that implant placement in augmented ridges using micromeshes and autogenous bone provided satisfactory long-term survival and success rates, with minimal bone resorption.

The Use of Extraoral Implants for Distal-Extension Removable Dentures: A Clinical Evaluation Up to 8 Years

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:20 +0100

Purpose: This retrospective study reports the clinical outcome following placement of extraoral implants in severely resorbed posterior ridges to support distal-extension removable dentures.
Material and Methods: Consecutively treated patients with partially or completely edentulous ridges, with available bone height in the posterior region of 6 mm or less, were included in the study. Implants originally intended for extraoral use (Straumann) were placed in second molar regions and allowed to heal for 4 to 6 months before abutment connection. At recall appointments, the peri-implant hard and soft tissues were evaluated. Complications with implant components, as well as mechanical and structural failures of the prostheses, were recorded. Two-year survival rates were calculated and life table analyses undertaken.
Results: Twenty-nine patients (19 women and 10 men; average age 61.2 years, range, 44 to 75 years) were included in the study. Forty-seven extraoral implants in 26 patients were placed in the second molar site of the mandible. Two extraoral implants in 2 patients failed during the osseointegration phase, yielding an 8-year cumulative success rate of 91.8%. The mean distance from the extraoral implants to the most distal tooth/implant was 28.1 mm (range, 16.7 to 39.2 mm). Twenty-three extraoral implants were restored with magnets, 18 with ball anchors, and 4 with conical cylinders. Replacement of abutments and retention elements was necessary in 2 patients. Four abutments in 2 patients were disconnected from the restorations.
Conclusions: Within the limits of the employed research design, extraoral implants may be used successfully to provide support for distal-extension removable dentures in severely resorbed posterior alveolar ridges.

Immediate Functional Loading in the Maxilla Using Implants with Platform Switching: Five-year Results

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:19 +0100

Purpose: Immediate loading in the maxilla is not a routinely recommended treatment concept; however, some clinical series have shown a high survival rate for nonfunctionally loaded implants. The purpose of this study was to demonstrate the prognosis for immediately loaded implants with a progressive thread design and platform switching placed in the maxilla with or without simultaneous augmentations using autogenous bone.
Materials and Methods: Ninety implants were placed (six in each maxillary arch) in 15 patients. Immediately after surgery, the implants were loaded with a provisional acrylic resin prosthesis (immediate occlusal loading). Splinting of the implants with the provisional remained for 6 to 8 weeks of healing. In patients with augmented sites, a 3-month period of provisionalization was necessary to ensure implant stability; a soft/liquid diet was recommended for this intermediate transitional period. Definitive fixed restorations were then fabricated and delivered. Clinical and radiologic examinations of the implants were performed at various times.
Results: After a mean loading period of 42.4 (± 19.15) months, only three failures were reported. This represented a survival rate of 96.66%. No complications, including inflammation or bone loss, were reported during the study period.
Conclusions: Based on these results, the immediate loading protocol in the maxilla can be used successfully when implant primary stability, cross-arch stabilization, and a soft diet for the initial stages of healing are considered.

A Retrospective Study of the Survival of Smooth- and Rough-Surface Dental Implants

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:19 +0100

Purpose: To compare the time-dependent cumulative survival rates of smooth- and rough-surface dental implants.
Materials and Methods: A retrospective chart review was conducted for two time periods: January 1, 1991, through December 31, 1996, during which smooth-surface implants were used, and January 1, 2001, through December 31, 2005, during which rough-surface implants were used. This study included all implants placed and restored in one institution during the two time frames. Data were collected relative to patient age, gender, implant diameter, implant length, and anatomic location of implants. To facilitate the comparison, implants from the first and second time periods were followed through mid-1998 and mid-2007, respectively. Associations of patient/implant characteristics with implant survival were evaluated using marginal Cox proportional hazards models (adjusted for age and gender) and summarized with hazard ratios and corresponding 95% confidence intervals.
Results: A total of 593 patients (322 women and 271 men; mean age, 51.3 ± 18.5 years) received 2,182 smooth-surface implants between 1991 and 1996, while 905 patients (539 women and 366 men; mean age, 48.2 ± 17.8 years) received 2,425 rough-surface implants between 2001 and 2005. At 5 years after implant placement, survival rates were 94.0% and 94.5%, respectively, for smooth- and rough-surface implants (difference not significant). Among the smooth implants, implant length ≤ 10 mm and anatomic location were identified as significantly associated with implant failure. In contrast, among the rough implants, implant length ≤ 10 mm and anatomic location were not identified as risk factors for implant failure.
Conclusions: Based on this retrospective study of two groups of patients with different implant surfaces and more than 2,000 implants in each group, there was no significant difference in the survival rates of smooth- and rough-surface dental implants. Anatomic location and implant length ≤ 10 mm were associated with failures of the smooth-surface implants only.

Evaluation of the Effect of Tumor Necrosis Factor-Alpha Gene Polymorphism on the Risk of Peri-implantitis: A Case-Control Study

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:18 +0100

Purpose: Tumor necrosis factor-alpha (TNFa) is a proinflammatory cytokine, which promotes bone resorption and mediates the inflammatory response to infection. Because implant failures appear to cluster in subsets of individuals, this phenomenon may be related to gene polymorphisms. Therefore, the aim of this study was to investigate the relationship between a specific polymorphism in the TNFa gene (allele 2 of TNFa-308) and peri-implantitis.
Materials and Methods: This case-control study included Caucasian nonsmoking Brazilian patients with implant-supported restorations. Oral epithelial cells were taken from patients with and without peri-implantitis to evaluate the frequencies of different alleles of the TNFa-308 gene by polymerase chain reaction.
Results: Ninety patients (49 with peri-implantitis and 41 with healthy implants) were enrolled in this study. Polymorphism in allele 2 of TNFa-308 was not associated with an increased risk for peri-implantitis (P = .8171), although 14.63% of the subjects in the control group carried allele 2 and 19.39% in the peri-implantitis group carried allele 2 (chi-squared = 0.708; P = .5202).
Conclusion: Polymorphism of the TNFa-308 gene was not associated with an increased risk of peri-implantitis in the population evaluated in this study.

Mechanical Stability of Immediately Loaded Implants with Various Surfaces and Designs: A Pilot Study in Dogs

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:17 +0100

Purpose: Immediate loading is among the most innovative techniques in implant therapy today. This pilot study investigates the biomechanical outcome of various designs and surfaces that claim to shorten implant treatment.
Materials and Methods: In each quadrant of two mongrel dogs, four different implants were used for immediate loading. The following implants were placed 3 months after tooth extraction: screw with low thread profile and anodic oxidized surface (LPAOS), solid screw with wide thread profile and titanium plasma spray coating (WPTPS), screw with low profile and hybrid design of double-etched and machined surface (LPHES), and screw with two thread profiles and a sandblasted and acid-etched surface (DTSAE). The insertion torque of each implant was above 35 Ncm. Resonance frequency analysis was performed after implant placement and again after sacrifice. Additionally, the removal torque and the amount of embedded titanium particles in the peri-implant bone were measured.
Results: All 16 prostheses were functional after a 5-month loading period. The highest mean removal torque values were recorded with WPTPS implants (24.4 Ncm/mm), followed by DTSAE implants (22.3 Ncm/mm) and LPAOS implants (18.7 Ncm/mm); the lowest score was obtained by LPHES (12.0 Ncm/mm). The ISQ values increased between the time of surgery and recall for all systems on average, but a significant positive correlation was found for DTSAE only. Significantly higher amounts of titanium were found in the surrounding bone with WPTPS (0.76%) and LPAOS (0.41%) in comparison with DTSAE (0.10%) and LPHES (0.03%).
Conclusion: Immediate loading is possible with various designs and surfaces if high primary stability can be achieved during implant placement.

Clinical Histology of Microimplants Placed in Two Different Biomaterials

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:17 +0100

Purpose: This randomized, controlled study was designed to compare bone formation around microimplants with a sandblasted, acid-etched surface placed at the time of maxillary sinus floor augmentation with a synthetic biphasic calcium phosphate (BCP) or deproteinized bovine bone (DBB).
Materials and Methods: Nine completely edentulous patients and two partially edentulous patients (six women, five men) with a mean age of 67 years (range, 50 to 79 years) requiring bilateral sinus augmentation were included in the study. The patients were randomized for augmentation with BCP (test) in one side and DBB (control) in the contralateral side. At the time of augmentation, one microimplant on each side was placed vertically from the top of the alveolar crest, penetrating the residual bone and the grafting material. After 8 months of graft healing, at the time of ordinary implant placement, all 22 microimplants were retrieved with a surrounding bone core for histologic analyses.
Results: The bone-to-implant contact in the BCP group was 64.6% ± 9.0%, versus 55.0% ± 16.0% for the DBB group. The difference was not significant. The corresponding values for the area of newly formed bone in the biopsies were 41.1% ± 9.8% and 41.6% ± 14.0% for BCP and DBB, respectively. There were significantly more DBB particles in contact with newly formed bone than BCP particles (87.9 ± 18.2% versus 53.9 ± 26.1%; Wilcoxon rank sum test; P = .007).
Conclusion: In this randomized, controlled clinical trial, new bone formation and bone-to-implant contact around microimplants with a sandblasted, acid-etched surface was found to be equivalent between sinuses augmented with BCP or DBB. Significantly more DBB particles than BCP particles were in contact with newly formed bone, but the clinical relevance of this has yet to be established.

The Effects of Growth Hormone on the Initial Bone Formation Around Implants

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:16 +0100

Purpose: The aim of this study was to evaluate the effect of the topical application of growth hormone on the osseointegration of dental implants in beagle dogs 14 days after placement.
Materials and Methods: Maxillary and mandibular premolars and molars were extracted from 12 beagle dogs. Two months later, each mandible received cylindric screw-type implants of 3.25 mm in diameter and 10 mm in length. The implants were randomly assigned to the mesial and distal sites on each side of the mandible. Prior to implantation, lyophilized powdered growth hormone was applied to one osteotomy on each side of the mandible. No growth hormone was applied at the control sites. Eight histologic sections per implant were obtained for histomorphometric analysis.
Results: After a 2-week treatment period, the growth hormone-treated sites showed significant (P < .0001) increases in the perimeter of bone that was in direct contact with the treated implants (40.19% ± 2.51%), total peri-implant area (P < .001) (69.57% ± 3.53%), and new bone formation (P < .0001) (35.18% ± 0.31%), in comparison to control implants (25.05% ± 2.43%, 53.40% ± 4.58%, and 28.65% ± 1.92%, respectively). There was no significant increase in interthread bone in growth hormone-treated implants (27.92% ± 3.31%) in comparison to control implants (25.08% ± 3.47%) (P > .05).
Conclusion: Topical application of growth hormone may act as a bone stimulant in the placement of endosseous dental implants.

Influence of Osteopenia in Autogenous Bone Graft Healing With or Without Expanded Polytetrafluoroethylene Membranes: Histologic and Histomorphometric Study in Rats

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:16 +0100

Purpose: The aim of this study was to quantitatively evaluate and qualitatively describe autogenous bone graft healing with or without an expanded polytetrafluoroethylene (e-PTFE) membrane in ovariectomized rats.
Materials and Methods: Eighty Wistar rats, weighing approximately 300 g each, were used. A graft was obtained from the parietal bone and fixed to the sidewall of each animal’s left mandibular ramus. The animals were randomly divided into four experimental groups (n = 20 in each group): group 1, sham operated and autogenous bone graft only; group 2, sham operated and autogenous bone graft covered by e-PTFE membrane; group 3, ovariectomized (OVX) and autogenous bone graft only; group 4, OVX and autogenous bone graft covered by e-PTFE membrane. The animals were sacrificed at five different time points: immediately after grafting or at 7, 21, 45, or 60 days after grafting. Histologic examination and morphometric measurement of the sections were performed, and values were submitted to statistical analyses.
Results: Both groups (sham and OVX) experienced loss of the original graft volume when it was not covered by the membrane, whereas use of the membrane resulted in additional bone formation beyond the edges of the graft and under the membrane. Histologic analysis showed integration of the grafts in all animals, although a larger number of marrow spaces was found in OVX groups.
Conclusions: Association of bone graft with an e-PTFE membrane resulted in maintenance of its original volume as well as formation of new bone that filled the space under the membrane. Osteopenia did not influence bone graft repair, regardless of whether or not it was associated with e-PTFE membrane, but descriptive histologic analysis showed larger numbers of marrow spaces in the bone graft and receptor bed and formation of new bone in the OVX animals.

Evaluation of the Osteogenic Potential in Experimental Defects, With and Without Bone Marrow, in the Rabbit Tibia: A Pilot Study

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:15 +0100

Purpose: The influence of bone marrow in the osteogenic potential of bone has not been evaluated in the rabbit tibia model. Previous studies employed this model extensively to test the osteogenic capabilities of bone grafts. The primary aim of the present study was to assess the role of bone marrow in the healing of experimental defects in the rabbit tibia model.
Materials and Methods: Ten New Zealand rabbits were divided into two groups of five each. In the first experimental test group (PoP), the marrow cavity was emptied completely under a 6-mm defect in the rabbit tibia metaphysis; the marrow was replaced by plaster of Paris, and a round piece of lyophilized collagen membrane was placed in contact with the endosteum and rested on the plaster. In the second experimental group (control), similar artificial defects were made, but the marrow was left intact. After 8 weeks, the animals were sacrificed and prepared for histologic and histomorphometric analysis.
Results: There was a statistically significant difference (P = .016) in newly formed bone area between the control group (mean, 68.08% ± 12.09%) and the PoP group (mean, 54.02% ± 13.93%). Similarly, there was a statistically significant difference in new bone density (P < .001) between the control group (mean, 95.99% ± 1.74%) and the PoP group (mean, 75.37% ± 13.27%).
Conclusions: The current study confirms the significant effect that bone marrow has in bone regeneration and also the true regenerative capabilities of the osseous walls of the defects. The proposed experimental model may be a more reliable method of investigating and comparing the potential of different graft materials and methods.

In Vitro Evaluation of Reverse Torque Value of Abutment Screw and Marginal Opening in a Screw- and Cement-Retained Implant Fixed Partial Denture Design

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:15 +0100

Purpose: The purpose of this study was to evaluate the clinical efficacy of implant prostheses retained by screws and cement (SCPs) by examining the reverse torque values (RTVs) of the abutment screws and the marginal openings of the implant prostheses.
Materials and Methods: Two implants (3.8 3 13 mm; Camlog Biotechnologies) were embedded in an acrylic resin block 5 mm apart. Eighteen copies of this resin specimen were fabricated and randomly divided into two groups. Two-unit implant prostheses with two different designspurely cement-retained implant prostheses (group 1) and SCPs (group 2)were made out of type IV gold alloy and placed on the implants. After tightening to about 30 Ncm, the preloading RTVs of the abutment screws were measured. After retightening the abutment screws or cementing the prostheses, followed by cyclic loading, the postloading RTVs of the abutment screws were examined. Also, the marginal openings of the prostheses in the two groups were measured under a stereomicroscope. These measurements were compared statistically.
Results: The postloading RTVs and their differences from the preloading RTVs of the abutment screws demonstrated no significant differences between groups (P > .05). Group 2 prostheses showed significantly smaller marginal openings than group 1 prostheses (P < .05).
Conclusion: The forces generated when torquing the abutment screw of the SCP did not cause more loosening of the abutment screws than the purely cement-retained implant prosthesis. The SCP showed better marginal adaptation of the cement-retained part than the purely cement-retained implant prosthesis, possibly as a result of the screw-retained abutment seating the restoration. Within the limitations of this in vitro test, the SCP showed no significant difference in RTV of the abutment screw and a smaller marginal gap compared to a purely cement-retained implant prosthesis.

Stress Analysis in Simulation Models With or Without Implant Threads Representation

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:14 +0100

Purpose: This study aimed to evaluate the influence of implants with or without threads representation on the outcome of a two-dimensional finite element (FE) analysis.
Materials and Methods: Two-dimensional FE models that reproduced a frontal section of edentulous mandibular posterior bone were constructed using a standard crown/implant/screw system representation. To evaluate the effect of implant threads, two models were created: a model in which the implant threads were accurately simulated (precise model) and a model in which implants with a smooth surface (press-fit implant) were used (simplified model). An evaluation was performed on ANSYS software, in which a load of 133 N was applied at a 30-degree angulation and 2 mm off-axis from the long axis of the implant on the models. The Von Mises stresses were measured.
Results: The precise model (1.45 MPa) showed higher maximum stress values than the simplified model (1.2 MPa). Whereas in the cortical bone, the stress values differed by about 36% (292.95 MPa for the precise model and 401.14 MPa for the simplified model), in trabecular bone (19.35 MPa and 20.35 MPa, respectively), the stress distribution and stress values were similar. Stress concentrations occurred around the implant neck and the implant apex.
Conclusions: Considering implant and cortical bone analysis, remarkable differences in stress values were found between the models. Although the models showed different absolute stress values, the stress distribution was similar.

The Effect of Different Screw-Tightening Techniques on the Stress Generated on an Internal-Connection Implant Superstructure

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:14 +0100

Purpose: This study evaluated the effect of different screw-tightening sequences, forces, and methods on the stresses generated on a well-fitting internal-connection implant (Astra Tech) superstructure.
Materials and Methods: A metal framework directly connected to four parallel implants was fabricated on a fully edentulous mandibular resin model. Six stone casts with four implant replicas were made from a pickup impression of the superstructure to represent a “well-fitting" situation. Stresses generated by four screw-tightening sequences (1-2-3-4, 4-3-2-1, 2-4-3-1, and 2-3-1-4), two forces (10 and 20 Ncm), and two methods (one-step and two-step) were evaluated. In the two-step method, screws were tightened to the initial torque (10 Ncm) in a predetermined screw-tightening sequence and then to the final torque (20 Ncm) in the same sequence. Stresses were recorded twice by three strain gauges attached to the framework (superior face midway between abutments). Deformation data were analyzed using multiple analysis of variance at a .05 level of statistical significance.
Results: In all stone casts, stresses were produced by the superstructure connection, regardless of screw-tightening sequence, force, and method. No statistically significant differences for superstructure preload stresses were found based on screw-tightening sequences (-180.0 to -181.6 µm/m) or forces (-163.4 and -169.2 µm/m) (P > .05). However, different screw-tightening methods induced different stresses on the superstructure. The two-step screw-tightening method (-180.1 µm/m) produced significantly higher stress than the one-step method (-169.2 µm/m) (P = .0457).
Conclusions: Within the limitations of this in vitro study, screw-tightening sequence and force were not critical factors in the stress generated on a well-fitting internal-connection implant superstructure. The stress caused by the two-step method was greater than that produced using the one-step method. Further studies are needed to evaluate the effect of screw-tightening techniques on preload stress in various different clinical situations.

Meta-analysis of Methods Used to Assess Implant Stability

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:12 +0100

Purpose: To evaluate correlations between Periotest, cutting torque or insertion torque, and/or the reverse torque test with resonance frequency analysis measurements.
Materials and Methods: The combined search terms dental implant, primary stability, resonance frequency analysis, removal torque, vibration analysis, torque, Periotest, cutting torque, and insertion torque and specific inclusion and exclusion criteria were used to retrieve eligible articles published between 1998 and 2008 (up to April 1) from PubMed, EMBASE, OVID, The Cochrane Library databases, and 10 journals by hand-searching. The pooled P value was calculated with the Fisher method. The correlation coefficients (r) were combined using fixed and random effect models. Heterogeneity of the studies was tested by performing the homogeneity test.
Results: Fifty articles were identified, but 3 studies were excluded because of limitations in study design. Studies that fulfilled the inclusion criteria fell into a variety of categories (11 human cadaver, 16 clinical, 15 animal, and 5 in vitro studies). Assessment of P values revealed that correlation between cutting torque or insertion torque and resonance frequency analysis was significant (6 studies; P = .0022). Correlation between Periotest and cutting torque or insertion torque was significant (1 study; P = .015), and correlations between resonance frequency analysis and reverse torque test values (1 study; P = .319; r = 0.405) and Periotest and resonance frequency analysis (P = .28) were insignificant. Nine articles provided r values, and cutting torque or insertion torque and resonance frequency analysis showed a statistically significant and direct relationship of 55.4% (P = .000). One study provided an r value of -0.149. A statistically significant and direct relationship of 87.6% was found between cutting torque or insertion torque and reverse torque (2 studies; P = .000).
Conclusion: This meta-analysis of 47 studies showed a statistically significant correlation between cutting torque or insertion torque and resonance frequency analysis.

Divergence Correction Associated with Implant Placement: A Radiographic Study

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:12 +0100

Purpose: To evaluate implant angulations and alignments with neighboring teeth/implants and compare them to angulations and alignments measured with preinsertion surgical gauges.
Materials and Methods: Two hundred implants placed freehand were included. For each site, two panoramic radiographs were obtained, one with a gauge and one with an implant. The mesiodistal angular relationships between gauge and subsequently placed implant, gauge and gauge (for neighboring implants), gauge and neighboring teeth, implant and neighboring teeth, and gauge and the inferior border of the mandible were measured.
Results: The mean gauge-implant discrepancy was -0.72 degrees. The gauge to teeth angulation was -3.95 degrees, the implant-teeth angulation was -4.67 degrees, the gauge-gauge angulation was 0.49 degrees, and the angulation between the gauge and the inferior border of the mandible was 86.86 degrees. Maxillary implants were more divergent than mandibular implants (-9.89 degrees versus -2.14 degrees). Likewise, implants placed away from (opposite) the clinician’s side had smaller gauge-implant discrepancies than those placed in the ipsilateral side (-0.94 degrees versus -1.66 degrees). Implant location (incisor, premolar, molar) also affected this angular relationship; implants placed in the anterior region diverged more (-3.96 degrees) than implants placed in premolar (-1.02 degrees) and molar regions (0.06 degrees). Implants that were placed adjacent to teeth had greater divergence than implants placed in an edentulous region (-1.66 degrees versus 0.09 degrees). Likewise, gauges placed in conjunction with shorter implants (10 mm or shorter) were more divergent than those placed in conjunction with longer implants (-8.29 degrees versus -3.259 degrees, respectively).
Conclusion: Placement of dental implants, even without the use of a surgical guide, can result in adequate dental implant angular relationships. An implant’s location (arch, side, or site) and the presence of adjacent teeth might affect these relationships.

Quantifying the Influence of Bone Density and Thickness on Resonance Frequency Analysis: An In Vitro Study of Biomechanical Test Materials

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:11 +0100

Purpose: Resonance frequency analysis (RFA) offers the opportunity to monitor the osseointegration of an implant in a simple, noninvasive way. A better comprehension of the relationship between RFA and parameters related to bone quality would therefore help clinicians improve diagnoses. In this study, a bone analog made from polyurethane foam was used to isolate the influences of bone density and cortical thickness in RFA.
Materials and Methods: Straumann standard implants were inserted in polyurethane foam blocks, and primary implant stability was measured with RFA. The blocks were composed of two superimposed layers with different densities. The top layer was dense to mimic cortical bone, whereas the bottom layer had a lower density to represent trabecular bone. Different densities for both layers and different thicknesses for the simulated cortical layer were tested, resulting in eight different block combinations. RFA was compared with two other mechanical evaluations of primary stability: removal torque and axial loading response.
Results: The primary stability measured with RFA did not correlate with the two other methods, but there was a significant correlation between removal torque and the axial loading response (P < .005). Statistical analysis revealed that each method was sensitive to different aspects of bone quality. RFA was the only method able to detect changes in both bone density and cortical thickness. However, changes in trabecular bone density were easier to distinguish with removal torque and axial loading than with RFA.
Conclusions: This study shows that RFA, removal torque, and axial loading are sensitive to different aspects of the bone-implant interface. This explains the absence of correlation among the methods and proves that no standard procedure exists for the evaluation of primary stability.

Biomechanical Evaluation of Implant Placement in the Reconstructed Mandible

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:10 +0100

Purpose: Following resection of malignant tumors from the mandible, immediate reconstruction of the discontinuous jaw is commonly performed. The present study aims to define the risks associated with dynamic loading of the reconstructed mandible.
Materials and Methods: Computer-aided design simulations of eight mandibles were produced and termed normal models. The normal models were then modified by removing part of the right body and restoring the defects with bone from the rib or fibula. These modified models were termed reconstructed models. Thereafter, an implant was embedded in the first molar region of the left side for all models. Using finite element analysis, the stresses occurring at the implant-bone interface with simulated mastication were calculated. The Wilcoxon signed rank test was applied to compare the magnitudes of stresses in both models.
Results: In terms of the stress exerted at the implant-bone interface during mastication, the normal models and the reconstructed models showed no significant differences (P > .05).
Conclusion: Placement of an implant on the nonreconstructed side following partial resection and mandibular reconstruction presents no significant risk.

Thematic Abstract Review

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:10 +0100

Adult Stem Cells Derived from Human Maxillary Sinus Membrane and Their Osteogenic Differentiation

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 16:00:10 +0100

Purpose: To investigate the method and conditions of isolation and proliferation of multipotent mesenchymal stem cells (MSCs) from human maxillary sinus membrane in vitro and to induce osteogenic differentiation directly for identification.
Materials and Methods: A human maxillary sinus membrane specimen was collected in aseptic conditions from an orthognathic surgery patient and cultured. The cells at passage three were sorted by flow cytometry and treated with osteogenic differentiation media. To determine the osteogenic potential of these cells, the authors analyzed alkaline phosphatase (ALP) expression, mineralization of extracellular matrix, and osteocalcin expression; staining with alizarin red and von Kossa and reverse-transcriptase polymerase chain reaction were also performed.
Results: Maxillary sinus membrane-derived cells were positive for STRO-1 and CD105 and negative for CD34. After 7 days, ALP began to be expressed. After 21 and 28 days, most cells showed expression of ALP. Mineralization of the extracelluar matrix was observed and, after 21 and 28 days, most of the cells showed mineralization. After 7 days, the osteocalcin gene was expressed; this expression was strongest on the 28th day.
Conclusions: The results suggest that there are MSCs in human maxillary sinus membrane tissue, which can be differentiated into osteoblasts under osteogenic induction. This indicates that maxillary sinus membrane may be a useful source of MSCs for cell therapy.

Editorial: Material World

Quintessenz Verlag Berlin — Wed, 20 Jan 2010 15:00:09 +0100

World News

Quintessenz Verlag Berlin — Tue, 19 Jan 2010 16:00:15 +0100

Dental Maturation In Patients With Unilateral Posterior Crossbite

Quintessenz Verlag Berlin — Tue, 19 Jan 2010 16:00:15 +0100

Aim: To investigate whether there is a difference in dental maturation between patients with a skeletal unilateral crossbite and a control sample (individuals with an Angle Class I and no crossbite) and to compare the dental maturation on the right and left posterior segments in both samples.
Materials and Methods: The sample consisted of 101 Turkish individuals (53 boys and 48 girls, 8 to 13 years of age, mean age 10.90 ± 1.62 years). These subjects were divided into two groups: unilateral posterior crossbite (23 boys and 28 girls, mean age 10.87 ± 2.01 years) and control (25 boys and 25 girls, mean age 10.93 ± 1.14 years). Each subject’s dental age (according to Demirjian’s dental maturity score) was determined with an orthopantomogram. A difference of 6 months at a significance level of P < .05 was considered clinically significant, so the power of the statistical test was 85%.
Results: No sexual dimorphism was detected for the chronological or dental age in either group. In both groups, the dental ages determined from Demirjian and Goldstein’s tables were more advanced than the chronological ages. Dental age did not differ significantly between sides. Subjects with a posterior crossbite had a tendency for a delayed dental maturation compared to the control individuals. A difference of about 1 month was observed between the right and left sides in the crossbite and control groups.
Conclusion: The difference in dental age between the crossbite and control groups was big enough to be clinically relevant. No significant side differences in either group were detected.

Ankylosing Spondylitis Associated With Craniomandibular DisorderA Combined Orthodontic And Prosthodontic Therapeutic Approach

Quintessenz Verlag Berlin — Tue, 19 Jan 2010 16:00:14 +0100

Ankylosing spondylitis is a disease that causes inflammatory changes of the involved joints. Although the initial clinical signs are pain and discomfort, synovial changes progressively involve all the axial joints, including the temporomandibular joint (TMJ). Eventually, bony alterations develop (condylar erosions, flattening, sclerosis) that affect the position of the condyle, the superior joint space, and the range of movements. These symptoms correlate with the severity of the disease. Besides physiotherapy and surgery, no dental rehabilitation has been reported for these patients. This report of a female patient with ankylosing spondylitis and a TMJ disorder emphasizes dental rehabilitation. The aim of the splint, orthodontic, and prosthodontic treatment was to relieve the subjective symptoms through establishing a stable optimum occlusion. Anamnestic, laboratory, and clinical findings including pre- and postradiographic examination records are presented.

Treatment Of A Mutilated Dentition With The Mandibular Protraction Appliance: A Patient Report

Quintessenz Verlag Berlin — Tue, 19 Jan 2010 16:00:14 +0100

A 35-year-old female presented missing her maxillary right first premolar, left central and lateral incisors, and left second premolar and mandibular left first molar. The referring dentist had requested that only the maxillary left first molar be intruded to facilitate the prosthodontic replacement of the missing mandibular left first molar. After clinical examination and consultation with her dentist, it was decided to protract the mandibular left second and third molars, intrude the maxillary left first molar, replace the missing incisors with a temporary partial denture, and restore the missing maxillary right first premolar with an implant.

The Importance Of The Facial Profile In Orthodontic Diagnosis And Treatment Planning: A Patient Report

Quintessenz Verlag Berlin — Tue, 19 Jan 2010 16:00:13 +0100

Orthodontic treatment to improve not only tooth alignment but also facial esthetics is a given in modern society. This paper illustrates this assumption with a report of a patient with a Class I, maxillary retrusion, concave profile, and retrusion of the upper and lower lips. Maxillary expansion was followed by face mask therapy and orthodontic treatment, which significantly improved the soft tissue profile by projecting the upper lip.

Treatment Of A Periodontally Compromised Patient With Mini-Implant Anchorage

Quintessenz Verlag Berlin — Tue, 19 Jan 2010 16:00:12 +0100

Background: Advanced periodontal disease and its sequelae are characterized by severe attachment loss, tooth mobility, and migration. This pathology often leads to compromised function and esthetics. A multidisciplinary approach combining orthodontic, periodontic, and restorative treatment is necessary to provide complete rehabilitation both in terms of function and esthetics with a satisfactory long-term prognosis.
Methods: A simple and effective treatment of an adult patient with periodontally migrated teeth using mini-implants in the maxilla and mandible is described. Mini-implant placement was aided by a 3D surgical guide, which made the procedure exceedingly safe.
Results: Gradual intrusion of the maxillary and mandibular anterior teeth was achieved with a relatively simple orthodontic force system. A significant profile improvement was observed during the 18 months of treatment due to the retraction and intrusion of the incisors in both arches. This intrusion was accomplished without any sign of apical root resorption. The mandibular incisors were uprighted 6.5 degrees, and their maxillary counterparts were uprighted 13.4 degrees. The 2-year follow-up examination revealed a stable result with an increase in periodontal attachment as well as esthetics and function.
Conclusion: A combined orthodontic, periodontic, and restorative treatment approach with adequate patient motivation can lead to improved masticatory function, esthetics, and periodontal conditions.

Orthodontic Management Of A Patient With Impacted And Transposed Mandibular Canines

Quintessenz Verlag Berlin — Tue, 19 Jan 2010 16:00:12 +0100

This patient report describes the treatment of a 10-year-old female with complete transposition of her impacted mandibular canines and lateral incisors. The patient had a Class I occlusion, and her mandibular lateral incisors were in crossbite with the maxillary central incisors. The treatment objectives were to create space for the impacted canines and align them with the incisors, one of which was extracted. After treatment, the appearance of the patient’s teeth was improved, the occlusion was preserved, and overjet and overbite were corrected.

Surgically Assisted Rapid Maxillary Expansion Combined With Maxillary Protraction In An Adult: A Patient Report

Quintessenz Verlag Berlin — Tue, 19 Jan 2010 12:00:11 +0100

The aim of this article is to discuss an alternative treatment for adult patients who have a dental or skeletal Class III relationship. A 20-year-old woman presented with a dental and skeletal Class III relationship and a transverse maxillary deficiency. Surgically assisted rapid maxillary expansion was followed by maxillary protraction with a face mask and orthodontic treatment with standard edgewise technique. At the end of treatment, a Class I molar and canine relationship was attained with an adequate transverse intercuspation and improvement of the patient’s facial profile.

Long-Term Follow-Up Of Patients With A Skeletal Angle Class III Relationship Treated With Chin Caps

Quintessenz Verlag Berlin — Tue, 19 Jan 2010 12:00:10 +0100

Aim: To evaluate the long-term result of chin-cap treatment in patients with a skeletal Angle Class III relationship due to mandibular prognathism.
Material and Methods: Records of nine patients (five girls and four boys) with a mean age of 10.8 ± 1.6 years at the start of treatment were retrieved from the archives. The records comprised lateral cephalograms, intra- and extraoral photographs, and dental casts. The subjects were recalled at 6.1 ± 1.5 years after the completion of active orthodontic treatment. Cephalometric measurements from the treatment’s beginning (T1), end (T2), and follow-up (T3) were calculated by using PorDios software. Subjects with a positive overjet at T3 were grouped as stable, and those with a negative overjet were grouped as relapse. Differences between the two groups were analyzed by repeated measures analysis of variance (ANOVA) and the Duncan test.
Results: Five individuals maintained a positive overjet at T3, while four relapsed as indicated by a negative overjet. SNA increased in the stable group between T2 and T3 but not in the relapse group.
Conclusion: About half of the young individuals with a mandibular prognathism treated with a chin cap relapsed over time. The relapse seemed to originate from skeletal rather than dentoalveolar changes.

Strategies To Finish Orthodontic Treatment With A Class III Molar Relationship: Three Patient Reports

Quintessenz Verlag Berlin — Tue, 19 Jan 2010 12:00:10 +0100

The purpose of this article is to review treatment concepts for patients with congenitally missing teeth in the mandible, for patients in whom teeth in only the mandibular arch were extracted, or for patients with Class III camouflage treatment. The therapy result in these situations is a Class III molar relationship. With this type of intercuspation, esthetic and functional aspects must be observed.

Epidemiology Of Malocclusions And Assessment Of Orthodontic Treatment Need For The Population Of Eastern Nepal

Quintessenz Verlag Berlin — Tue, 19 Jan 2010 12:00:09 +0100

Aim: To evaluate the prevalence of malocclusions in eastern Nepal, estimate the treatment need, and compare the findings with those of other populations.
Methods: Seven hundred patients between 7 and 48 years of age were evaluated. Their orthodontic treatment need was assessed subjectively and via the Index of Orthodontic Treatment Need (IOTN) (dental health component [DHC]). Dependency of the subjective assessment grades and those of the IOTN (DHC) on sex were checked with the chi-square test. Age and Angle class were cross-tabulated to test for relationships using analysis of variance (ANOVA).
Results: The prevalence of Class I, II, and III were 67.5%, 28.8%, and 3.7%, respectively. The most common age group was 12 to 24 years. The female to male ratio was 2:1. The subjective assessment indicated that treatment was indicated in 66.9%, urgently indicated in 30.9%, and not indicated in 2.2%. The IOTN (DHC) showed that 62.0% had a severe/extreme need of treatment, 28.1% a moderate/borderline need, and 9.9% little/no need. The mean age was not related to any specific malocclusion. Also, there was no relationship among sex, IOTN, and the subjective assessment grades (except for IOTN grade 4, which was found significantly more frequently in females).
Conclusion: Class I malaoolusion is the most common, while Class III is the least prevalent in eastern Nepal. The most prevalent age group seeking treatment was that of 12 to 24 years of age, with more females than males. The majority of those visiting the orthodontic department actually needed treatment.

Orthodontic Treatment Needs Of Brazilian 12-Year-Old School Children

Quintessenz Verlag Berlin — Tue, 19 Jan 2010 12:00:08 +0100

Aim: To assess the orthodontic treatment need of 12-year-old Brazilian school children using the Index of Orthodontic Treatment Need (IOTN).
Methods: One experienced examiner evaluated the IOTN’s dental health component (DHC) and its esthetic component (EC) in 1,182 individuals from 50 randomly selected state schools of Rio de Janeiro. He also requested that these students score their own EC (self-perception).
Results: The DHC showed that 51.1% of the children had no/little need, while 26.7% had a need/high need/priority for orthodontic treatment. There was no significant difference between the two sexes (P = .156). According to the EC, esthetics were good in 59.1% of the children, borderline in 32.7%, and unattractive in 8.1%. The self-perception of the EC showed that 89.0% judged themselves as having good esthetics, with girls significantly more critical than boys (P = .035). The statistical correlation between EC (examiner) and EC (children) was low (kappa coefficient = .13).
Conclusions: About half of the scored Brazilian 12-year-old schoolchildren had no/little need for treatment. Orthodontists were more critical in their esthetic evaluation than the children themselves, with girls being more critical in self-perception than boys.

Soft Tissue Cephalometrics: An Overdue Evaluation

Quintessenz Verlag Berlin — Tue, 19 Jan 2010 12:00:08 +0100

The purpose of this study was to compare the accuracy of cephalometric soft tissue linear measurements obtained from conventionally traced cephalograms with those taken directly on patients. This study was conducted on 11 orthodontic patients. Small pieces of orthodontic wire were fixed on five soft tissue landmarks in the midline of the face of each patient. Five linear measurements were taken directly on each patient’s face using an electronic Boley gauge reading to the nearest 0.05 mm. Also, a lateral cephalogram was taken of each patient with the aforementioned wires still in place. Using the same gauge, the same linear measurements were taken from the tracings of all cephalograms. The two sets of readings were statistically analyzed using the concordance correlation coefficient and Pearson correlation coefficient. The study concluded that soft tissue measurements on lateral cephalometric radiographs do not give reliable values. A single magnification factor cannot be applied for lateral cephalometric soft tissue measurements in all patients, nor within the same patient.

Evaluation Of The Periodontal Status Of Palatally Impacted Maxillary Canines After Exposure Using A Modified Window Technique

Quintessenz Verlag Berlin — Tue, 19 Jan 2010 12:00:07 +0100

Aim: To evaluate the periodontal status of surgically exposed maxillary canines after their alignment.
Patients and Methods: Twenty consecutive patients with one palatally impacted maxillary canine and one fully erupted synergist were selected. The impacted canines were surgically exposed with a modified window technique, an attachment was bonded, and the teeth were extruded and aligned. Six months after therapy, the periodontal status of both canines was evaluated by registering the following parameters: (1) keratinized gingiva level, (2) attached gingiva level, (3) sulcus probing depth, (4) length of clinical crown, (5) quality of marginal tissue, (6) bleeding on probing, and (7) height of alveolar bone. The data were analyzed with the Mann-Whitney test.
Results: There was no significant difference between the periodontal status of the two canine groups concerning the keratinized gingival level, the attached gingival level, the sulcus probing depth, and the length of the clinical crown. The quality of marginal tissue and bleeding on probing were acceptable. However, the level of alveolar bone was significantly lower in the surgically exposed group.
Conclusion: The periodontal health of impacted maxillary canines that were exposed using a modified window technique and subsequently orthodontically aligned is acceptable. The only concern is a somewhat reduced alveolar bone level.

Maxillary Arch Width Changes During Orthodontic Treatment With Fixed Self-Ligating And Traditional Straight-Wire Appliances

Quintessenz Verlag Berlin — Tue, 19 Jan 2010 12:00:07 +0100

Aim: To evaluate the transverse dimensions of the maxillary arch induced by fixed self-ligating and traditional straight-wire appliances during orthodontic therapy.
Patients and Methods: Forty consecutive patients (age range 14 to 30 years) with normal or low mandibular plane angle, normal overbite, and mild crowding were included. The traditional appliance was composed of Victory Series MBT brackets (3M Unitek), and the self-ligating appliance of Damon-3MX brackets (Ormco). The leveling and aligning phase with round archwires lasted 6 months and was followed by another 6 months of rectangular archwires. The archwire sequence with the MBT appliance was 0.016-inch and 0.019 X 0.025-inch Ni-Ti form II (3M Unitek), while in the Damon- 3MX, it was 0.014-inch and 0.016-inch followed by 0.016 X 0.025-inch copper nickel-titanium (Ormco). Intercanine, first and second interpremolar, and intermolar widths in the maxilla were recorded before treatment (T0) and 12 months later (T1).
Results: In both groups, a significant increase from T0 to T1 was recorded for all transverse measurements, but no significant difference was observed between groups.
Conclusion: Within 12 months of treatment, both appliances increased maxillary dentoalveolar widths.

Editorial: Welcome aboard Dr Mike Papadopoulos

Quintessenz Verlag Berlin — Tue, 19 Jan 2010 11:00:06 +0100

Academy News

Quintessenz Verlag Berlin — Mon, 18 Jan 2010 16:00:21 +0100

Meeting Review: The Fifth International Conference on Orofacial Pain and Temporomandibular Disorders-ICOT August 26-30, 2009 Praia do Forte, Bahia, Brazil

Quintessenz Verlag Berlin — Mon, 18 Jan 2010 16:00:21 +0100

Literature Abstracts

Quintessenz Verlag Berlin — Mon, 18 Jan 2010 16:00:20 +0100

Giant Cell Arteritis Misdiagnosed as Temporomandibular Disorder: A Case Report and Review of the Literature

Quintessenz Verlag Berlin — Mon, 18 Jan 2010 16:00:20 +0100

Giant cell arteritis (GCA) is a systemic vasculitis involving medium and large-sized arteries, most commonly the extracranial branches of the carotid artery. Early diagnosis and treatment are essential to avoid severe complications. This article reports on a GCA case and discusses how the orofacial manifestations of GCA can lead to misdiagnosis of GCA as temporomandibular disorder. GCA should be included in the differential diagnosis of orofacial pain in the elderly based on the knowledge of related signs and symptoms, mainly jaw claudication, hard end-feel limitation of range of motion, and temporal headache.

Randomized Clinical Trial of Acupuncture for Myofascial Pain of the Jaw Muscles

Quintessenz Verlag Berlin — Mon, 18 Jan 2010 16:00:19 +0100

Aims: To evaluate the effectiveness of acupuncture in treating symptoms associated with myofascial pain of the jaw muscles.
Methods: Twenty-eight subjects over the age of 18 and diagnosed with chronic myofascial pain of the jaw muscles were randomized to receive real (n = 16) or sham (n = 12) acupuncture. Prior to treatment, each subject clenched his or her teeth for 2 minutes. Acupuncture or sham acupuncture was then administered at the Hegu large intestine 4 (LI4) acupoint for 15 minutes. Real acupuncture was given by penetrating the needle through a sticky foam pad at the acupoint. Sham acupuncture was conducted by pricking the skin, without penetration, with a shortened, blunted acupuncture needle through a foam pad placed away from the acupoint. General head and neck pain ratings were obtained before and after treatment on a numerical rating scale. A mechanical pain stimulus on the masseter muscle was given before and after treatment and rated on a visual analog scale to measure pain tolerance level. Paired t tests were performed to detect significant changes in pain levels.
Results: Subjects receiving real acupuncture experienced a significant reduction in jaw pain (P = .04), jaw/face tightness (P = .04), and neck pain (P = .04), and a significant increase in pain tolerance of the masseter muscle (P = .001). Subjects were not able to determine whether they received real or sham acupuncture (P = .69). No significant pain reductions were observed in the sham acupuncture group.
Conclusion: A single acupuncture session using one acupoint at Hegu large intestine 4 significantly reduced most myofascial pain endpoints when compared to sham acupuncture.

Prevalence of Temporomandibular Disorders in Obstructive Sleep Apnea Patients Referred for Oral Appliance Therapy

Quintessenz Verlag Berlin — Mon, 18 Jan 2010 16:00:18 +0100

Aims: To evaluate the prevalence of pain associated with temporomandibular disorders (TMD) in obstructive sleep apnea syndrome (OSAS) patients referred for oral appliance therapy.
Methods: Eighty-seven patients (46 men and 41 women), between 18 and 65 years of age, with an apnea-hypopnea index (AHI) of > 5 and < 30 (events by sleep hour), and body mass index (BMI) of ≤ 30 Kg/m2 were evaluated according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) to determine the presence of signs and symptoms of TMD. Statistical analyses included correlations assessed by Pearson's test.
Results: Fifty-two percent of patients presented symptoms of TMD. Thirty-two patients (average age 47 ± 11 years, AHI 17.3 ± 8.7, BMI 25.9 ± 3.8 kg/m2) completed the study. According to the Scoring Protocol for Graded Chronic Pain (Axis II-RDC/TMD), 75% of the patients presented chronic pain related to TMD, categorized as low disability grade I (< 50 points for pain intensity, and < 3 disability points). The most common TMD diagnosis was myofascial pain with and without limited mouth opening and arthralgia (50%).
Conclusion: The high prevalence of TMD in the current study indicates that patients with OSAS referred for oral appliance therapy require specific evaluation related to TMD.

Time Courses of Myofascial Temporomandibular Disorder Complaints During a 12-Month Follow-up Period

Quintessenz Verlag Berlin — Mon, 18 Jan 2010 16:00:18 +0100

Aims: To investigate the time courses of myofascial temporomandibular disorder (TMD) pain and mandibular function impairment (MFI), and to identify predictive factors associated with these time courses.
Methods: During a 12-month period following conservative TMD treatment, the time courses of myofascial TMD pain and pain-related disabilities were assessed by questionnaires. Ninety-six myofascial TMD patients participated, of whom 70 completed the study. Before treatment (baseline data), Characteristic Pain Intensity (CPI), MFI, parafunctional activities, and psychological status were assessed, and at completion of treatment and at 3, 6, 9, and 12 months, CPI and MFI were scored again. Individual time courses in scores were analyzed using linear growth modeling.
Results: Baseline values of CPI had a positive correlation with CPI during follow-up (P = .002), whereas the influences of reported parafunctions and of pain elsewhere on CPI scores were close to significance (P = .058 and .06, respectively). Patients with a low somatization score showed a further decline in CPI during follow-up (P = .027), whereas patients with a high score showed a gradual increase (P = .030). Baseline values of MFI were positively correlated with MFI scores during the follow-up period (P = .000). The influence of reported parafunctions on MFI was not significant (P = .174), but that of pain elsewhere was (P = .004). The trend for a further decline in MFI values during follow-up was close to significance (P = .063) for patients with low somatization scores. Patients with high somatization scores showed a significant increase in MFI values (P = .007).
Conclusion: Baseline reports of pain and impairment, oral parafunctional activities, pain elsewhere in the body, and somatization are associated with the severity and time course of myofascial TMD complaints following treatment.

Postoperative Pain Relief After Surgical Removal of Impacted Third Molars: A Single-Blind, Randomized, Controlled Study to Compare Levobupivacaine and Mepivacaine

Quintessenz Verlag Berlin — Mon, 18 Jan 2010 16:00:17 +0100

Aim: To compare the efficacy of 0.75% levobupivacaine with that of 3% mepivacaine for pain control after surgical removal of impacted mandibular third molars.
Methods: Forty-two subjects (23 females and 19 males, mean age 23.5 ± 4) underwent surgical removal of third molars in two separate sessions. Within each patient, levobupivacaine was used to anesthetize one extraction side and for the other side, mepivacaine. Onset of anesthesia, duration of surgery, lip numbness, timing of pain appearance and analgesic consumption were evaluated.
Results: There were no significant differences in onset of anesthesia, duration of surgical procedure, and lower lip numbness between the two groups (P > .05). Timing of pain appearance and of first drug consumption was significantly lower in the mepivacaine group (P < .05). Patients with levobupivacaine anesthesia had significantly lower visual analog (VAS) pain scores at 1 and 2 hours postoperatively than those with mepivacaine anesthesia.
Conclusion: Levobupivacaine is a valid alternative to traditional local anesthetics for surgical removal of lower third molars. It presents better pain relief when compared to mepivacaine in the immediate postoperative period as evidenced by lower VAS scores.

Self-Reports of Pain-Related Awakenings in Persistent Orofacial Pain Patients

Quintessenz Verlag Berlin — Mon, 18 Jan 2010 16:00:17 +0100

Aims: To assess whether pain-related awakenings occur with persistent orofacial pain conditions and whether it is related to pain severity.
Methods: Reports of pain-related awakening were prospectively collected at initial interview, prior to treatment, during a 24-month period from 328 patients with orofacial pain. The pain conditions were diagnosed according to the International Headache Society, the American Academy of Orofacial Pain, and the Research Diagnostic Criteria for Temporomandibular Disorders.
Results: Pain-related awakening was significantly correlated to pain intensity (odds ratio [OR] 1.5, 95% confidence intervals [CI] 1.3-1.8; P < .001), the total muscle tenderness score (OR 1.1, 95% CI 1.01-1.14; P = .03), and the presence of lacrimation (OR 4.6, 95% CI 1.7-12.3; P = .002) but not to the clinical diagnosis. Two groups of patients were specifically examined; patients with masticatory myofascial pain (MMP) and patients with classical trigeminal neuralgia (CTN). Twenty-eight of the 120 MMP patients (23.3%) reported pain-related awakening and this was associated with a high muscle tenderness score (OR 1.13, 95% CI 1.01-1.3; P = .02) and unilaterality of pain (OR 3.9, 95% CI 1.2-12.3; P = .02). Seven of the 31 patients with CTN (22.6%) reported pain-related awakenings. Continuous background pain was the most significant parameter associated with awakening (OR 26, 95% CI 1.1-594; P < .05).
Conclusion: Persistent orofacial pain often induced pain-related awakening and this was significantly associated with pain intensity.

Critical Commentary 2: Evaluation of the Research Diagnostic Criteria for Temporomandibular Disorders for the Recognition of an Anterior Disc Displacement with Reduction

Quintessenz Verlag Berlin — Mon, 18 Jan 2010 16:00:16 +0100

Critical Commentary 3: Evaluation of the Research Diagnostic Criteria for Temporomandibular Disorders for the Recognition of an Anterior Disc Displacement with Reduction

Quintessenz Verlag Berlin — Mon, 18 Jan 2010 16:00:16 +0100

Quintessenz Verlag Berlin @ zahnigroups

Online Article: Thurston syndrome: Oral and systemic manifestations. Case report and review of the literature

Online Article: Cavernous sinus thrombosis in a patient with facial myiasis

Bacterial leakage of provisional restorative materials used in endodontics

Influence of root-surface conditioning with acid and chelating agents on clot stabilization

Novel ceria-stabilized tetragonal zirconia/alumina nanocomposite as framework material for posterior fixed dental prostheses: Preliminary results of a prospective case series at 1 year of function

Etiolgic factors of hyposalivation and consequences for oral health

Three cases of subpontic osseous hyperplasia of the mandible: A report

Short-term effects of systemic antibiotics during periodontal healing

Dystrophic calcifications arising in the masseter muscle: A case report

Clinical evaluation of a fixed (retrievable) implant-supported prosthesis in the edentulous jaw: A 5-year report

Immediate loading of full-arch fixed protheses supported by axial and tilted implants for the treatment of edentulous atrophic mandibles

Editorial: The role of clinical experience in the implementation of evidence-based dentistry

Long-term Provisional Anterior Tooth Replacement using Fiber-reinforced Composite and Avulsed Tooth Crowns as Pontics

Bonding Strategies to Pulp Chamber Dentin Treated with Different Endodontic Irrigants: Microshear Bond Strength Testing and SEM Analysis

Benefits of a Two-step Cementation Procedure for Prefabricated Fiber Posts

Water Sorption and Solubility of Four Self-etching, Self-adhesive Resin Luting Agents

Restoring Strength of Incisors with Veneers and Full Ceramic Crowns

Degree of Conversion and Antimicrobial Activity of Etch-and-Rinse Versus Self-etching Adhesives

Bond Efficacy and Interface Morphology of Self-etching Adhesives to Ground Enamel

Effect of Chlorhexidine Application in a Self-etching Adhesive on the Immediate Resin-Dentin Bond Strength

The Influence of a Local Anesthetic Containing Vasoconstrictor on Microtensile Bond Strengths of Two Adhesive Systems to Human Dentin In Situ

Adhesion Performance of New Hydrolytically Stable One-component Self-etching Enamel/Dentin Adhesives

Editorial: The Art of Publishing

Research in focus

The Keyhole Access Expansion Technique for Flapless Implant Stage-Two Surgery: Technical Note

Influence of Implant Length, Diameter, and Geometry on Stress Distribution: A Finite Element Analysis

Anorganic Bovine Bone (Bio-Oss) Regulates miRNA of Osteoblast-like Cells

The Use of Piezosurgery to Mobilize the Mandibular Alveolar Nerve Followed Immediately by Implant Insertion: A Case Series Evaluating Neurosensory Disturbance

Full-Mouth Disinfection as a Nonsurgical Treatment Approach for Drug-Induced Gingival Overgrowth: A Series of 11 Cases

Sinus Grafting with Magnesium-Enriched Bioceramic Granules and Autogenous Bone: A Microcomputed Tomographic Evaluation of 11 Patients

Immediate Provisionalization of Single Extraction-Site Implants in the Esthetic Zone: A Clinical Evaluation

Tissue-Engineered Bilayered Cell Therapy for the Treatment of Oral Mucosal Defects: A Case Series

Prosthetic Gingival Reconstruction in Fixed Partial Restorations. Part 3: Laboratory Procedures and Maintenance

Prospective Study of 94 Platform-Switched Implants Observed from 1992 to 2006

Editorial: Endodontics Versus Single-Tooth Implants

Online Article: A stepwise multiple regression model to assess the odds ratio between myofascial pain and 13 occlusal features in 238 Italian women

Online Article: Sulcus depth reproduction with polyvinyl siloxane impression material: Effects of hydrophilicity and impression temperature

In vitro evaluation of the effect of dietary acids and toothbrushing on human root dentin permeability

Influence of immediate attachment loss during instrumentation employing thin ultrasonic tips on clinical response to nonsurgical periodontal therapy

Evaluation of serum levels of C-reactive protein and lipid profiles in patients with chronic periodontitis and/or coronary heart disease in an ethnic Han population

Periodontal disease and the oral-systemic connection: “Is it all the RAGE?”

A histochemical and immunohistochemical study of mast cells in differentiating oral lichen planus from oral lichenoid reactions

The subepithelial connective tissue pedicle graft combined with the coronally advanced flap for restoring missing papilla: A report of two cases

Diminutive, interradicular “hybrid” desmoplastic / acanthomatous ameloblastoma

Simplified technique for rebuilding a post and core foundation with a preexisting crown: A case report

Sinus grafting with mineralized allograft and staged implant placement

Multidisciplinary management of multiple maxillary anterior supernumerary teeth: A case report

A modified treatment approach for fabricating a mandibular distal-extension partial denture: A clinical report

Editorial: TMD: Taxonomic mix-up beyond descripton

Use of the Coronoid Process as a Donor Site for Sinus Augmentation: A Case Report

Peripheral Giant Cell Granuloma Associated with Dental Implants: A Rare Case Report

Nasal Suction Technique for Maxillary Sinus Floor Elevation: A Report of 24 Consecutive Patients

Augmentation of the Mandible via a “Tent-Pole Procedure and Implant Treatment in a Patient with Type III Osteogenesis Imperfecta: Clinical and Histologic Considerations

Evaluation of Survival and Success Rates of Dental Implants Placed at the Time of or After Alveolar Ridge Augmentation with an Autogenous Mandibular Bone Graft and Titanium Mesh: A 3- to 8-year Retrospective Study

The Use of Extraoral Implants for Distal-Extension Removable Dentures: A Clinical Evaluation Up to 8 Years

Immediate Functional Loading in the Maxilla Using Implants with Platform Switching: Five-year Results

A Retrospective Study of the Survival of Smooth- and Rough-Surface Dental Implants

Evaluation of the Effect of Tumor Necrosis Factor-Alpha Gene Polymorphism on the Risk of Peri-implantitis: A Case-Control Study

Mechanical Stability of Immediately Loaded Implants with Various Surfaces and Designs: A Pilot Study in Dogs

Clinical Histology of Microimplants Placed in Two Different Biomaterials

The Effects of Growth Hormone on the Initial Bone Formation Around Implants

Influence of Osteopenia in Autogenous Bone Graft Healing With or Without Expanded Polytetrafluoroethylene Membranes: Histologic and Histomorphometric Study in Rats

Evaluation of the Osteogenic Potential in Experimental Defects, With and Without Bone Marrow, in the Rabbit Tibia: A Pilot Study

In Vitro Evaluation of Reverse Torque Value of Abutment Screw and Marginal Opening in a Screw- and Cement-Retained Implant Fixed Partial Denture Design

Stress Analysis in Simulation Models With or Without Implant Threads Representation

The Effect of Different Screw-Tightening Techniques on the Stress Generated on an Internal-Connection Implant Superstructure

Meta-analysis of Methods Used to Assess Implant Stability

Divergence Correction Associated with Implant Placement: A Radiographic Study

Quantifying the Influence of Bone Density and Thickness on Resonance Frequency Analysis: An In Vitro Study of Biomechanical Test Materials

Biomechanical Evaluation of Implant Placement in the Reconstructed Mandible

Thematic Abstract Review

Adult Stem Cells Derived from Human Maxillary Sinus Membrane and Their Osteogenic Differentiation

Editorial: Material World

World News

Dental Maturation In Patients With Unilateral Posterior Crossbite

Ankylosing Spondylitis Associated With Craniomandibular DisorderA Combined Orthodontic And Prosthodontic Therapeutic Approach

Treatment Of A Mutilated Dentition With The Mandibular Protraction Appliance: A Patient Report

The Importance Of The Facial Profile In Orthodontic Diagnosis And Treatment Planning: A Patient Report

Treatment Of A Periodontally Compromised Patient With Mini-Implant Anchorage

Augmentation of the Mandible via a “Tent-Pole Procedure and Implant Treatment in a Patient with Type III Osteogenesis Imperfecta: Clinical and Histologic Considerations

Ankylosing Spondylitis Associated With Craniomandibular DisorderA Combined Orthodontic And Prosthodontic Therapeutic Approach