Restoring masticatory function in a patient with severe microstomia using rapid prototyped mesh and a custom-made hinge and swing-lock prosthesis.

This clinical report describes the use of rapid prototyped mesh in a complete swing-lock prosthesis to restore masticatory function in an edentulous patient with severe microstomia and perioral scar tissue after an industrial hot tar accident.

Efficacy and Stability of Two in-Office Bleaching Agents in Adolescents: 12 Months Follow-Up.

OBJECTIVE: Although there are several clinical studies on in office vital bleaching in adults, there are no Randomized Clinical Trials for the efficacy of this application in adolescents. The aim the study was to evaluate the efficiency of two bleaching systems on adolescents for twelve-months follow-up. STUDY DESIGN: Twenty-eight volunteers, aged between 13-18, randomly divided into two groups. Two commercial in-office bleaching systems were used: G1 (n=14): Zoom2 25 % HP with UV light and G2 (n=14): Beaming White 36% HP with LED light in a single 3 x 15 minute procedure. The color assessment was made with a spectrophometer; before and after bleaching; 48 hours; 1, 6 and 12 months later. Color enhancement and maintenance of two techniques over 12 months were compared by two ways ANOVA and Student's t test. Sensitivity was evaluated on a scale with Wilcoxon test. RESULTS: Both groups demonstrated similar and significant tooth color enhancement and did not reveal any statistically significant differences between them. However, a relapse of the tooth shade was observed with the low concentration agent/ultraviolet light system. No sensitivity was observed in any patients. CONCLUSION: Two in-office bleaching systems can be used successfully on young permanent teeth. For long-term successful results, high concentration/LED light may be more effective.

Effectiveness of an infiltrant on sealing of composite restoration margins with/without artificial caries.

AIM: The aim of this in vitro study was to evaluate the effectiveness of a resin infiltrant (ICON) on marginal sealing ability of class II resin restorations with/without-caries. MATERIALS AND METHODS: Forty-eight noncarious human pre-molar teeth were embedded and MO and DO preparations of standard dimensions were prepared. The left side of dentin margins of the cavities were left nonbonded (UB) while the right side were bonded using total etch-bonding agent and all restored with a Nanohybrid composite. The teeth were thermocycled and half of the specimens in the UB and B groups were subjected to an artificial caries process. ICON was applied to caries and noncaries subgroups following the manufacturer's directions. Impressions were made at each step: after the restorations were completed, thermocycling, artificial caries procedures, and infiltrant application and the silicone tag lengths were measured with a stereomicroscope. The specimens were immersed in 0.5% basic fuchsine at 37° C for 24 hours, sectioned and microleakage was evaluated with a stereomicroscope. Selected samples and their replicas were assessed for marginal quality under a stereomicroscope and SEM. Statistical evaluation of the data were made using Kruskal-Wallis, Mann-Whitney U and Wilcoxon Sign Rank tests. RESULTS: While bonding application did not create a meaningful difference, the thermocycling and artificial caries significantly increased the gap length and microleakage (p < 0.05). ICON application was decreased the microleakage, created gap-free margins and closed the gaps which were previously occurred at the same cavities (p < 0.05). CONCLUSION: A resin infiltrant (ICON) application decreased the microleakage, created gap-free margins and closed the gaps, which previously occurred at the same cavities. CLINICAL SIGNIFICANCE: Approximal application of resin infiltrant may increase the success of the class II composite restorations also reduced the risk of needing more complex restoration therapy.

Are marginal bone levels and implant stability/mobility affected by single-stage platform switched dental implants? A comparative clinical study.

OBJECTIVES: The aim of this study was to evaluate short-term bone level and stability/mobility measurement alterations at platform switched (PS) and standard platform (SP) implants placed in mandibular premolar/molar regions using a single-stage protocol. MATERIALS AND METHODS: Sixteen PS and 16 SP implants restorated with fixed prosthesis were included. Standard implant dimensions were used for both implant systems. After 3 months of osseointegration, implants were connected to abutments and final restorations were performed. Marginal bone loss was measured by standardized periapical radiographs. Implant stability/mobility was determined by resonance frequency analysis (RFA) and mobility measuring (MM) device values. Peri-implant parameters were evaluated with clinical periodontal indices and all parameters were assessed at baseline, 1, 3, and 6 months after the surgery. RESULTS: After 6 months, all implants showed uneventful healing. Radiographic evaluation showed a mean bone loss of 0.72 mm for PS and 0.56 mm for SP implants, and there were no significant differences between implant types. At 6 months, mean implant stability quotient (ISQ) values were 73.38 and 77 for PS and SP implants, respectively. Mean MM values were -4.75 for PS and -6.38 for SP implants. Mean MM values were lower for SP implants compared to PS implants at all time points. No significant differences were detected between implant types according to clinical peri-implant parameters. CONCLUSIONS: The micro-gap at crestal level which immediately exposed to the oral cavity in non-submerged two part implants seems to have adverse influence on the marginal bone level.

Iliac crest flap for mandibular reconstruction after advanced stage mandibular ameloblastoma resection.

Ablative surgeries for neoplastic processes of the oral cavity, traumas, infections/inflammations, osteoradionecrosis, and congenital deformities are the most common causes of large mandibular defects. Ameloblastoma is a locally aggressive tumor that, if not treated, can gain an enormous size and cause severe facial disfigurement and functional impairment. Although the smaller lesions of ameloblastoma in the mandible are treated by conservative approaches such as marsupialization, enucleation, and curettage combined with liquid nitrogen spray cryosurgery, larger lesions require radical surgical ablation procedures resulting in large tissue defects. A large mandibular defect has deleterious effects on a person's life, with a significant loss in the quality of life unless it is reconstructed successfully. The aim of present case series report is to show the results of the multidisciplinary treatment of patients with advanced stage ameloblastoma, including tumor resection, simultaneous reconstruction with iliac crest flap, followed by placement of endosseous dental implants, and finally the prosthodontic rehabilitation.

Primary stability/mobility of 1-stage and 2-stage dental implants: a comparative in vitro study.

PURPOSE: To evaluate the primary stability of 1-stage (nonsubmerged) and 2-stage (submerged) implants via newest wireless resonance frequency (RF) analyzer and newer wireless mobility measuring (MM) device. MATERIALS AND METHODS: Six 1-stage dental implants with internal hex connection and six 2-stage dental implants, 4.1 mm in diameter and 11.5 mm in length, were inserted bilaterally into the first premolar, second premolar, and first molar regions of 6 standard mandibular transparent self-curing acrylic resin models. After that, the periimplant circular bone defects were created in millimeter increments ranging between 0 and 5 mm to the same extent on all implants. RESULTS: Implant stability quotient values significantly decreased at 1-stage and 2-stage implants when periimplant defects increased. Similar implant stability quotient values were found for both implant types; however, significantly lower MM values were noted for 2-stage implants. Irrespective of implant systems, the results indicated a significant association between wireless RF analyzer and wireless MM device. CONCLUSION: Both wireless RF analyzer and wireless MM device were adequate in assessing implant stability. There was no difference between 2-stage and 1-stage implant systems, except lower MM values were noted for nonsubmerged implants.

Sinus floor elevation from a maxillary molar tooth extraction socket in a patient with chronic inflammation.

BACKGROUND: The compromised nature of the residual interradicular bone after extraction of periodontally hopeless maxillary molars often requires a sinus elevation procedure to ideally place the implants to accept future prosthesis. Maxillary sinus elevation surgery is a procedure used to increase the volume of bone mass so that dental implants can be placed. This article documents a sinus floor elevation technique through an extraction socket in a 65-year-old white male with chronic inflammation to increase the bone mass after the extraction of a periodontally involved maxillary molar tooth. METHODS: Computerized tomography revealed an increased thickness of the sinus membrane, which was attributed to possible chronic sinus inflammation and periodontal inflammation. After consultation with the Department of Otolaryngology, it was diagnosed as chronic inflammation without any contraindication for sinus elevation surgery or implant placement. One month after the extraction, the sinus floor elevation surgery was performed through the extraction socket, and implants were placed 4 months later. RESULTS: An uneventful healing was noted after 6 months of osseointegration; two porcelain-fused-to-metal crowns were fabricated. Clinical follow-up took place every 3 months for 3 years, and successful healing was achieved. The patient was satisfied with the esthetic and functional results of the oral rehabilitation. CONCLUSION: Sinus floor elevation through an extraction socket without any residual bone, followed by dental implant placement, provided successful functional results and acceptable stability.

Achieving Lingualized Balanced Occlusion in a Fixed-Removable Rehabilitation for a Maxillary Complete and Mandibular Kennedy Class II Case.

In this case report, a method to achieve an adequate compensating curve and bilateral balanced lingualized occlusion in a case requiring maxillary complete denture and mandibular Kennedy Class II removable partial and fixed prosthodontic rehabilitation is described.

Analysis of the inflammatory process around endosseous dental implants and natural teeth: myeloperoxidase level and nitric oxide metabolism.

PURPOSE: The aim of the present study was to analyze the 2 molecular measures of inflammation: (1) the nitrite, an end metabolite of nitric oxide (NO) oxidation and (2) myeloperoxidase (MPO). Both are found in peri-implant sulcus fluid (PISF) of implants and gingival crevicular fluid (GCF) of natural teeth in healthy or diseased states. MATERIALS AND METHODS: A total of 109 tooth or dental implant sites, either healthy/noninflamed, inflamed (Gingival Index [GI] > 0), or affected by periodontitis, were classified, and GCF/PISF samples were obtained. GCF/PISF MPO and nitrite levels were spectrophotometrically determined. For comparison of clinical parameters and PISF/GCF nitrite and MPO levels, Kruskal-Wallis analysis followed by Mann-Whitney test with Bonferroni correction was performed. Healthy/noninflamed, slightly inflamed, moderate/severely inflamed sites were also analyzed using the Kruskal-Wallis test followed by the Mann-Whitney test with Bonferroni correction. The correlation between nitrite and MPO levels and clinical inflammatory status were analyzed with Spearman's correlation coefficient. RESULTS: Clinical parameters, including both the GCF and PISF volumes, demonstrated gradual increases with the presence of gingival/peri-implant inflammation (P < .05). Despite the higher PISF than GCF volume at healthy sites (P = .001), there were no volumetric differences at inflamed sites (P = .771). PISF from inflamed sites (P = .025) and GCF from gingivitis and periodontitis sites presented higher total MPO levels (P < .05) than samples from noninflamed sites. Despite the relatively stable GCF nitrite levels at healthy and diseased sites, PISF from inflamed sites had higher nitrite content than noninflamed sites (P < .05). CONCLUSIONS: The present study demonstrated the volumetric similarities of PISF and GCF in terms of response to inflammation. However, some differences between the 2 biochemical measures of inflammation and their presence in PISF and GCF were also observed. PISF is likely to have a considerable diagnostic potential for reflecting the biologic changes around load-bearing endosseous dental implants. (Cohort Study) (More than 50 references.)

Interdisciplinary treatment of an adult patient with old extraction sites.

This case report describes the interdisciplinary treatment of a 31-year-old female patient showing a protrusive profile, maxillary constriction, mandibular crowding, a Class III canine relationship complicated with multiple missing teeth, old atrophic extraction sites, and periodontal defects. The lower dental arch irregularity was eliminated by air-rotor stripping (ARS). The upper extraction site was opened for prosthetic rehabilitation, whereas closure of the lower extraction space was preferred. The narrow alveolar crest of the atrophic bone was augmented with the use of autogenous bone, beta-tricalcium phosphate (Cerasorb), and autogenous platelet-rich plasma. A functional and esthetic occlusion in an improved facial profile was established at the end of orthodontic treatment combined with ARS technique, surgery, and prosthodontics.

Are more endodontic consultations needed in dental school clinic settings? A study of treatment decisions at one school.

With no previous studies of the occurrence of interdisciplinary consultations for tooth extraction in a dental school clinic setting, the aim of this cross-sectional descriptive investigation was to measure and compare the consultation process that occurred among departments at one U.S. dental school for making treatment decisions on tooth extraction. A comprehensive computerized retrieval (Crystal Reports) was used to identify and gather data from patient records from July 1, 2007, to July 1, 2011. Treatment plans and progress notes were analyzed to determine why each tooth had been extracted and which department had recommended the extraction. Results showed that the clinical departments involved in treatment planning decisions were the DMD dental student clinic, Department of Periodontics, and Department of Endodontics. The narrative records of 227 patients who had 516 teeth extracted were examined. About three-fourths (73.26%) of the extracted teeth were extracted based on the recommendation of only one department. Of these extracted teeth, 22.0% (n=114) were previously endodontically treated, and only four were recommended for endodontic consultation prior to extraction. The study found that most extractions were performed without specialty consultations and that the Department of Endodontics was consulted the least of all departments. To foster interdisciplinary collaboration in dental school clinics and help students develop expertise in such collaborations, more specialty consultations are needed for teeth that are treatment planned for extraction in order to preclude needless extraction of potentially salvageable teeth. Doing so will provide benefits for both patient care and students' education.

Effects of pregnancy and lactation on the microhardness of rat incisor dentine and enamel.

Pregnancy and lactation affect the rate of maternal dentine apposition and mineralization in the rat. In this study we have measured the effects of pregnancy and lactation on the degree of mineralization of dentine and enamel by using the microhardness method in rat incisors. At incisal sections, pregnant and lactation group enamel values were increased compared to that of a control group; the pregnancy and post-lactation period dentine values decreased slightly compared to the control group. At neck sections, pregnant and lactation group enamel values were decreased compared to that of the control group; the pregnancy and post-lactation period dentine values were also decreased slightly compared to the control group. At the post-lactation period neck section dentine mineralization was decreased compared with the incisal section. As a result, enamel and dentine layers of rat incisors are affected to varying degrees by these changes in mineralization levels during the maternal period.

Evaluation of articulation of Turkish phonemes after removable partial denture application.

In this study, the adaptation of patients to removable partial dentures was evaluated related to articulation of Turkish phonemes. Articulation of /t,d.n,l,r/, /g,k/, /b,p,m/ and /s,z,s,v,f,y,j,h,c/ phonemes were evaluated by three speech pathologists, on records taken from 15 patients before the insertion of a removable partial denture, just after insertion, and one week later. The test consisted of evaluation of phoneme articulation of independent syllables in terms of distortion, omission, substitution, mass effect, hypernasality and hyponasality. Data were evaluated with Cochrane Q. McNemar and Kruskal-Wallis tests. The results showed that for some phonemes, problems in articulation occurred after the insertion of a removable partial denture while for others a significant amelioration was observed after the insertion of a removable partial denture. In general, problems in articulation of evaluated phonemes were resolved after one week of use.

A critically appraised topic review of computer-aided design/computer-aided machining of removable partial denture frameworks.

A critically appraised topic (CAT) review is presented about the use of computer-aided design (CAD)/computer-aided machining (CAM) removable partial denture (RPD) frameworks. A systematic search of the literature supporting CAD/CAM RPD systems revealed no randomized clinical trials, hence the CAT review was performed. A PubMed search yielded 9 articles meeting the inclusion criteria. Each article was characterized by study design and level of evidence. No clinical outcomes research has been published on the use of CAD/CAM RPDs. Low levels of evidence were found in the available literature. Clinical research studies are needed to determine the efficacy of this treatment modality.

The influence of platform switching on clinical, laboratory, and image-based measures: a prospective clinical study.

PURPOSE: This prospective study was conducted to compare the marginal bone level alterations, stability/mobility measurements, and volume of myeloperoxidase (MPO) and nitric oxide (NO) of peri-implant sulcus fluid (PISF) between platform-switched (PS) and standard platform (SP) implants inserted to mandibular premolar/molar regions with a single-stage protocol. MATERIALS AND METHODS: Thirty-two (16 PS and 16 SP) implants restorated with fixed prosthesis were included in the study. For both implant systems standard implant dimensions were used. Implant abutment connections and final restorations were made after 3 months of osseointegration. Standard parallel periapical radiographs were used to measure marginal bone loss in over time. Resonance frequency analysis (RFA) and mobility measuring (MM) device were used to determine implant stability/mobility. PISF samples were derived with paper strips and PISF MPO and nitrite level analysis were done spectrophotometrically. Peri-implant parameters were assessed by periodontal indices and all parameters were evaluated at baseline, 1, 3, 6, and 12 months follow-up. RESULTS: No healing problems were recorded for all implants at the end of the study period. At 12 months, mean bone loss measures were 0.84 and 0.76 mm, and mean implant stability quotient (ISQ) values were 74.04 and 76 for PS and SP implants, respectively. Mean MM values were found as -4.82 for PS and -6.26 for SP implants. There were no significant differences between implant types according to PISF volume and laboratory biochemical measures including MPO and NO, and clinical peri- implant indices at any time point. CONCLUSION: Platform switching seems not to affect the marginal bone level, clinical peri-implant parameters and MPO and NO metabolism around implants inserted to mandibular premolar/molar regions when using a single-stage protocol.

A comparison of three-dimensional and two-dimensional cephalometric evaluations of children with cleft lip and palate.

OBJECTIVES: The aim of this retrospective study was to compare the consistency of orthodontic measurement performed on cephalometric films and 3D CT images of cleft lip and palate (CLP) patients. METHODS: The study was conducted with 2D radiographs and 3D CT images of 9 boys and 6 girls aged 7-12 with CLP. 3D reconstructions were performed using MIMICS software. RESULTS: Frontal analysis found statistical differences for all parameters except occlusal plane tilt (OcP-tilt) and McNamara analysis found statistical differences in 2D and 3D measurements for all parameters except ANS-Me and Co-Gn; Steiner analysis found statistical differences for all parameters except SND, SNB and Max1-SN. Intra-group variability in measurements was also very low for all parameters for both 2D and 3D images. CONCLUSIONS: Study results indicate significant differences between measurements taken from 2D and 3D images in patients with cleft lip and palate.

Implant stability and peri-implant parameters in free vascularized iliac graft transplantation patients: report of three ameloblastoma cases.

BACKGROUND: Ameloblastoma, a benign but locally aggressive tumor, accounts for 9% to 11% of all odontogenic tumors. Radical procedures, including resection, are performed. To restore functions after resection, free vascularized iliac grafts followed by a dental implant-supported prosthesis are used as a successful treatment option. The aim of this case report is to evaluate the peri-implant clinical status and stability of dental implants placed in patients with advanced-stage mandibular ameloblastomas. METHODS: Examinations of three patients revealed extensive ameloblastomas, and hemimandibulectomies were performed. Six months after surgeries, two to four dental implants were placed. After 6 months of healing, one fixed prosthesis and two removable prostheses were delivered. The stability of implants was evaluated at the surgical baseline and 1, 3, 6, 9, and 12 months after surgery by resonance-frequency (RF) analysis. Peri-implant clinical parameters (i.e., plaque index [PI], gingival index [GI], gingival bleeding time index [GBTI], and peri-implant probing depth [PD]) were recorded at the delivery of the prosthesis and at follow-ups at 1, 3, and 6 months. RESULTS: Nine implants that supported one removable prosthesis and two fixed prostheses were placed. RF analysis revealed no significant changes in implant stability during 12 months of follow-up. Peri-implant clinical parameters (PI, GI, and GBTI) showed slight improvements during follow-up. Although advancements were observed in 6 months, PDs were found to be deeper than optimal measurements for the whole observation time. CONCLUSION: The implant-supported prosthetic rehabilitation of patients with ameloblastomas reconstructed with free vascularized iliac crest grafts can be a predictive alternative for improving the quality of life of patients in which a high implant stability and acceptable peri-implant health may be achieved.

Periauricular mold brachytherapy.

PURPOSE: We present a patient with recurrent basal cell carcinoma (BCCA) who was treated with custom-made mold brachytherapy. METHODS AND MATERIALS: The patient was admitted to the hospital with the complaint of recurrent BCCA of the auditory canal. He has previously treated by surgery and external beam radiotherapy. We decided to continue with reirradiation to tumor bed after surgical excision. A total of 25 Gy to 5mm depth of surgical bed was delivered by mold brachytherapy. RESULTS: The patient did well during the treatment without any acute toxicity. He was lost to followup after 2 years of treatment without any obvious late morbidity. CONCLUSION: Custom-made mold brachytherapy is an alternative treatment modality, for reirradiation of selected group of patients, with minimal morbidity and good disease control.

Resin-dentin interfacial morphology and shear bond strengths to primary dentin after long-term water storage: an in vitro study.

OBJECTIVE: To evaluate the resin-dentin interfacial morphology and shear bond strength of several new dentin bonding systems on deep dentin of primary teeth after a 1-year storage period. METHOD AND MATERIALS: Test specimens were prepared using 5 adhesive systems (Syntac Single-Component [Ivoclar Vivadent], Prime And Bond NT [Dentsply DeTrey], Adper Prompt L-Pop [3M ESPE], Gluma One Bond [Heraeus Kulzer], and iBond [Heraeus Kulzer]) on primary deep dentin. The shear bond strength data were evaluated with Kruskal-Wallis and Mann-Whitney U tests. Debonding surfaces were examined with stereo-microscope and scanning electron microscopy (SEM). RESULTS: The 1-day shear bond strength test values were, respectively, Adper Prompt L-Pop > iBond > Prime And Bond NT > Gluma One Bond > Syntac Single-Component, with the differences between Prompt L-Pop and Syntac (U = 10, P = .006), Prompt L-Pop and Gluma (U = 7, P = .002), and Adper Prompt L-Pop and iBond (U = 16, P = .03) being statistically significant. The 365-day shear bond strength values were, respectively, Adper Prompt L-Pop > Prime And Bond NT > iBond > Syntac Single-Component > Gluma One Bond, with the differences between Adper Prompt L-Pop and Syntac (U = 0, P = .000), Adper Prompt L-Pop and Gluma (U = 1, P = .000), and Adper Prompt L-Pop and iBond (U = 13, P = .01) being statistically significant. The differences between the 1-day and 365-day subgroup values of Syntac (U = 18; P = .05) and Gluma (U = 1, P = .000) were statistically significant. Almost all specimens showed adhesive failure at stereoptical examination (P > .05), with the presence of resin remnants and tags on dentin and dentinlike remnants on resin surfaces at SEM. CONCLUSION: Syntac and Gluma group values decreased with aging. The best values were obtained with both Adper Prompt L-Pop groups.