Restorative Management of Intrinsic and Extrinsic Dental Erosion.

The restorative management of tooth surface loss is highlighted through the presentation of two advanced cases of dental erosion. On presentation, the causes of the dental erosion in both patients had been previously diagnosed and stopped. The first patient was a 67 year old with intrinsic erosion and an element of attrition where a multidisciplinary approach was used. The other, a 17 year old patient with extrinsic erosion managed via adhesive restorations. Adhesive techniques are a relatively simple, effective and conservative method for the treatment of dental erosion. The two treatment modalities (conventional versus contemporary) are compared and discussed.

The diagnosis and management of invasive cervical resorption.

UNLABELLED: A 23-year-old female patient presented complaining of sensitivity relating to LR4. She had good oral health and no history of trauma. Cone beam computed tomography, however, revealed advanced invasive cervical resorption (ICR) in LR4, as well as an incidental finding of ICR in LR6. CLINICAL RELEVANCE: CBCT proved essential in the diagnosis and treatment planning of this unusual case. Owing to the destructive nature of ICR, it is imperative to remove the entire lesion to avoid any chance of recurrence.

Management of open apex in a central incisor using mineral trioxide aggregate.

UNLABELLED: Trauma to an immature tooth can result in pulpal devitalization and arrested apexogenesis, resulting in open apices; this is most common in anterior teeth of the permanent dentition. The attainment of an apical seal in such cases is challenging. The management of an open apex in a central incisor in a 16-year-old male patient is described in this report. The satisfactory result achieved suggests that mineral trioxide aggregate (MTA) can be used successfully as a filling material in teeth with open apices. CLINICAL RELEVANCE: Preservation of anterior teeth following trauma is essential, especially in young patients. A good option is the use of mineral trioxide aggregate in the treatment of open apices.

Assessment of the quality of endodontic re-treatment and changes in periapical status on a postgraduate endodontic clinic.

OBJECTIVE: The aim of this study was to assess endodontic retreatment outcomes based on quality of obturation and healing. MATERIALS AND METHODS: A total number of 223 radiographs of patients who had received endodontic retreatment during the period (2008-2015) at a postgraduate teaching clinic were selected. Unreadable radiographs were all excluded. From the original sample of 223 in total 24 radiographs were discarded. The final sample thus consisted of 199 root canal fillings. All radiographs were individually evaluated for the density of the root filling as well as the distance between the end of the root canal filling and radiographic apex based on a six-point scoring system. Subsequently, patients were reviewed and follow up periapical radiographs were exposed. The outcome of healing was assessed using the Periapical Index (PAI) scoring system. The data were analysed using Chi Square test (p < 0.05). RESULTS: The study revealed that 78.9 % of the endodontic retreatments were both homogeneity and length acceptable. The corresponding figure was only 13.1 % before endodontic retreatment. Conversely, homogeneity and length unacceptable before endodontic retreatment was 47.2 % reducing to a mere 2.5 % after retreatment. The results were statistically significant (P < 0.001). There was over 80 % improvement in periapical healing following endodontic retreatment and this was also statistically significant (P < 0.001). CONCLUSION: There was a significant improvement in outcome after endodontic retreatment on the postgraduate endodontic clinic. The success rate of endodontic retreatment was over 70 % which is in line with the endodontic literature. Radiographic follow up confirmed some 81 % improvement in healing rate following endodontic retreatment. CLINICAL SIGNIFICANCE: Endodontic re-treatment cases are normally categorised as high complexity and as such referral to specialist settings should be considered to help improve treatment outcomes.

Restoring function and aesthetics in a patient previously treated for amelogenesis imperfecta.

A 26-year-old male patient presented with generalised gingival recession related to the margins of crowns fitted between the ages of 12 and 15 years. The patient, previously treated for Amelogenesis Imperfecta, suffered a mandibular fracture at the age of 22 years. He had an anterior open bite and in the retruded contact position the 28 and 38 were the only teeth in contact. This case demonstrates the management of compromised fixed prosthodontic care following further growth and trauma. On completion of treatment a good functional and aesthetic result was achieved.

The relationship between endodontic case complexity and treatment outcomes.

OBJECTIVE: The aim of this work is to correlate between endodontic case complexities and treatment quality outcomes. METHODS: Three hundred and forty nine radiographs of patients who had received endodontic treatment at a postgraduate dental institute in Dubai were retrieved from the Institute's data base. The majority of the cases were referred by in house general dental practitioners (GDPs). Unreadable radiographs were all excluded. From the original sample of 349,in total 51 radiographs were discarded. The final sample thus consisted of 298 root canal fillings of 211 patients treated by the endodontic postgraduate students. All radiographs were individually evaluated following the American Association of Endodontic Case Difficulty Assessment Form. Based on this, the technical quality of the root filling was evaluated for each individual case. RESULTS: The sample consisted of 53% high,35% moderate and 12% minimal difficulty cases. Adequate homogeneity of root canal fillings were found in 93% of the cases. This compared with 90% of cases with adequate length of root fillings. There were statistically significant differences between the length of root canal filling and level of difficulty (p = 0.016) but, no statistically significant difference between homogeneity of root canal filling and case difficulty (p = 0.794). CONCLUSION: Eighty four percent (0.93 × 0.90 = 0.84) of the cases treated proved to be adequate in terms of length and homogeneity which is in line with published work of Endodontic treatment carried out by specialists. CLINICAL SIGNIFICANCE: GDPs require robust guidelines to help with appropriate referral of patients to Endodontic specialists.

Ion release from experimental Au-Pt-based metal-ceramic alloys.

OBJECTIVE: The aim of the study was to assess the effect of individual metallic elements within experimental Au-Pt-based dental alloys for porcelain veneering on ion release. METHODS: A binary Au-10at% Pt alloy (AP10) was designed as a parent alloy. Six ternary AP10-X (X=In/Fe/Sn/Zn) and four quaternary (AP10-In2)-Y (Y=Fe/Sn/Zn) alloys containing oxide-forming elements, X and Y, up to 2at% were prepared and ion release from the experimental alloys in deionized water and commercial soft drink was examined. For ion release determination samples with size 10 mm x 10 mm x 0.5mm were immersed in 20 ml of deionized water for 5 min. Samples were then removed and immersed in 20 ml of Sprite Light for a further 5 min, and 2h at 37 degrees C. The amounts of ions released in the test solutions were analyzed by inductively coupled plasma-mass spectrometry. RESULTS: When looking at individual elemental ion release, the order of the amount of dissolved ions was Fe>Zn>In>Sn. Among the base metal elements examined, Fe showed significantly higher levels of ion release than the other base metal elements for all three testing conditions (P<0.05). When looking at the effects of test solution on ion release from the alloys, Sprite Light caused significantly higher level of ion release than deionized water, with the exception of In in the ternary AP10-In1.0 and AP10-In1.7 alloys and the quaternary (AP10-In2)-Sn1.0 alloy, which showed similar or slightly greater amounts of ion release into deionized water. SIGNIFICANCE: Significant ion release was only observed from the Fe element. Sn and In elements showed less ion release than the Fe and Zn elements. Accordingly, Sn and In elements should be recommended as oxide-forming elements in Au-Pt-based metal-ceramic systems.

Magnetic retention for obturators.

Prosthetic rehabilitation can be challenging in cases of maxillectomy or developmental defect. This article describes a case in which a magnetically retained, implant-supported denture was used to restore the maxilla following hemi-maxillectomy. Use of the Oral Health Impact Profile before and after treatment showed a marked diminution in the number of adverse impacts 2 weeks post-placement and during review 6 months later.