Managing a fractured implant: A clinical report.

Implant fixture fracture is one of the reasons for late implant failure, with incidence rates ranging from 0.2% to 7.5%. Material defects, occlusal overload, prosthetic design, and nonpassive prosthesis fit have been identified as causative factors for implant fixture fractures. A custom-made prosthetic post was made to connect the remaining implant fixture and the implant-retained crown, as the fractured implant fixture exhibited no signs of infection and the fixture had adequate remaining length. In addition, complete removal of the implant could have resulted in significant bone loss at the site.

Clinical evaluation of an all-ceramic restorative system: a 36-month clinical evaluation.

PURPOSE: To clinically evaluate an all-ceramic restorative system (Finesse All-Ceramic) when used in conjunction with an ultra-low fusing porcelain (Finesse) using bonded esthetic resin cements (Enforce & Calibra). METHODS: This report describes the 3-year results of a prospective, consecutive case clinical evaluation for Finesse All-Ceramic. Forty posterior and anterior crowns, 20 all ceramic inlays and onlays, and 26 veneers were placed in 43 patients at the initiation of this study. Standard ceramic preparations were performed followed by conventional polyvinylsiloxane (Aquasil) impression techniques using cord retraction. The bonded resin cement was used to place the restorations following manufacturer's instructions. RESULTS: A majority of restorations (95-100%) were evaluated to be optimal at baseline (B), 1 month, 12, 24 and 36 months using a modified Ryge criteria for the following categories: color match, marginal adaptation, porcelain staining, secondary caries, postoperative sensitivity, and retention. Assessment of color match at 36 months resulted in 97% of all crowns and 100% of all veneers and onlays being rated alfa for shade match to Vita Lumin shade guide. The overall 3-year success rate at the 3-year recall (inlay/onlays, crowns, and veneers) was 98.57%, with the success rate for crowns and veneers at this time period being 100%.

Clinical and histological evaluation of white ProRoot MTA in direct pulp capping.

PURPOSE: To evaluate the clinical, radiographical and histological findings in human third molars in which mechanical pulp exposures were capped with white ProRoot mineral trioxide aggregate (WMTA). METHODS: Forty-eight human third molars, caries-free or with incipient caries, scheduled to be extracted, were used and randomly divided into two groups: Group A: (n= 24) received WMTA and control Group B: (n= 24) received chemical set calcium hydroxide (Dycal). The teeth were isolated with rubber dam and Class I cavities prepared. Pulp exposure was performed using a sterile diamond bur and confirmed by frank bleeding. A sterile cotton pellet dipped in saline solution was placed over the exposure for 60 seconds. The preparation was then lightly rinsed with water and gently air-dried. WMTA or CH was placed over the exposure site followed by a small amount of a light-cured compomer. After etching with 35% phosphoric acid gel for 15 seconds, rinsing and blot drying, Prime and Bond NT adhesive was applied and light-cured. The cavity was then restored with a resin composite and light-cured. Evaluations were performed by phone after 7 days and clinically at 30 +/- 5 and 136 +/- 24 days, using standardized tests and radiographs. The teeth were extracted after 136 +/- 24 days; the roots were cut +/- 4-5 mm from the apex to allow for rapid fixation in 10% neutral buffered formalin. They were then processed for routine histological evaluation, embedded in paraffin, sectioned and stained with hematoxylin and eosin and Brown and Brenn for recognition of bacteria. Statistical analyses were performed using a Mann-Whitney U-test, a Chi-square test, a Fisher's exact test and an ANOVA. RESULTS: No significant differences in post-operative sensitivity were reported after 7 days between the two materials (P> 0.05). Clinical examination demonstrated no significant differences at 30 +/- 5 days (P> 0.05) and at 136 +/- 24 days (P> 0.05). Histological findings: 45 of 48 teeth were suitable for microscopic evaluation (22 with WMTA and 23 with CH). Twenty from the WMTA and 18 from the CH group had developed a bridge. No statistically significant differences were found for superficial and deep inflammatory cell response (P> 0.05), presence of a dentin bridge (P> 0.01), and pulp vitality (P> 0.01), between WMTA and calcium hydroxide. A statistically significant difference was found for the diameter of exposure (P< or = 0.05) between WMTA (x= 0.35 +/- 0.19 mm) and CH (x= 0.25 +/- 0.09 mm). Only a minimal association between clinical and histological findings could be established for either material.

Clinical evaluation of an all-ceramic restorative system: 24-month report.

PURPOSE: To clinically evaluate an all-ceramic restorative system (Finesse All-Ceramic) when used in conjunction with an ultra-low fusing porcelain (Finesse) using bonded esthetic resin cements (Enforce & Calibra). METHODS: 40 posterior and anterior crowns, 20 all-ceramic inlays and onlays, and 26 veneers were placed in 43 patients. Standard ceramic preparations were performed followed by conventional polyvinylsiloxane (Aquasil) impression techniques using cord retraction. The bonded resin cement was used to place the restorations following manufacturer's instructions. A majority of restorations (95-100%) were evaluated to be optimal at baseline (B), 6, 12, and 24 months using a modified Ryge criteria for the following categories: color match, marginal adaptation, porcelain staining, secondary caries, postoperative sensitivity, and retention. RESULTS: There were sufficient shades available to obtain desired esthetic result with 98% of all restorations being rated Alfa for shade match to Vita Lumin shade guide. The overall 2-year success rate (inlay/onlays, crowns, and veneers) was 98.75%.

Double-masked, randomized, placebo-controlled study to evaluate the efficacy and tolerability of intranasal K305 (3% tetracaine plus 0.05% oxymetazoline) in anesthetizing maxillary teeth.

BACKGROUND: The authors compared the local anesthetic efficacy and safety of an intranasally administered formulation of tetracaine and oxymetazoline (K305) with placebo in adult participants undergoing single dental restorative procedures in teeth nos. 4 through 13. METHODS: The authors screened and allocated 150 participants in a double-masked, randomized fashion to either K305 or placebo nasal spray. The authors delivered the study drug as two 0.2-milliliter sprays separated by 4 minutes inside the nostril on the side ipsilateral to the tooth being treated. The authors administered a third 0.2-mL spray, if necessary, and administered 4% articaine with 1:200,000 epinephrine by means of injection if anesthesia was inadequate. Safety evaluations included participant reports of adverse events, vital signs, and alcohol sniff tests during the 2-hour study period and at a 1-day follow-up visit. The primary efficacy end point was anesthetic success defined as the completion of the dental procedure without the need for rescue injectable local anesthetic. The authors evaluated differences in success rates observed between K305 and placebo by using a 1-sided Fisher exact test. RESULTS: The overall success rates were 88.0% (95% confidence interval, 80.0-93.6) and 28% (95% confidence interval, 16.2-42.5) for K305 and placebo, respectively (P < .0001). The most frequent adverse effects in the K305 group were rhinorrhea (57.0%) and nasal congestion (26.0%). No serious adverse events occurred during this study. CONCLUSIONS: K305 was effective and well tolerated during restorative procedures in adult participants. PRACTICAL IMPLICATIONS: K305 provides a needleless alternative for obtaining maxillary pulpal anesthesia on premolars, canines, and incisors.

Attitudes of advanced dental education students toward individuals with AIDS.

The number of patients with HIV/AIDS who receive dental care is increasing. This study was undertaken to gain a better understanding of the attitudes of dentists enrolled in postgraduate training toward AIDS and homosexuals. Each respondent received a 500-word patient case vignette and two scales for recording impressions of the person described in the vignette. There were four vignettes, identical except that the portrayed individual's illness was identified as either AIDS or leukemia and sexual preference as either homosexual or heterosexual. Two-way analyses of variance and t tests (p<.05) revealed a bias toward individuals with AIDS and toward homosexuals. Respondents reacted more negatively to both groups on the Social Interaction Scale as seen in total scale scores as well as to individual scale items. In addition, although overall Prejudicial Evaluation Scale scores displayed no evidence of bias, several individual scale items did. It is important to ensure that dentists' attitudes toward patients with AIDS and homosexuals are not a barrier to these patients receiving the best possible care. Therefore, dental education programs at all levels should give consideration to interventions to address provider attitudes and potential biases.

Clinical evaluation of a 15% in-office hydrogen peroxide tooth-whitening touch-up agent.

The success of tooth whitening has increased public demand for quicker results of the tooth-whitening process. More and more patients are opting for in-office treatments, if available, to expedite the process, and they are looking for ways to re-whiten quickly when they feel their teeth have reverted from their after-treatment results. This article will discuss the use of a commercially available product as a touch-up procedure for patients who had been previously treated with a 2-week carbamide peroxide whitening regimen.