Alternative treatment approach for anterior subgingival dental lesions: Forced eruption using attractive magnets.

This article reports the use of a minimally invasive technique to address a challenging clinical problem in the esthetic zone. The clinical steps taken to achieve forced eruption by 1.5-2.0 mm of a maxillary central incisor that presented minimal clinical crown because of caries are described in detail. This subsequently allowed the successful placement of a crown. The tooth was extruded by forces generated between 2 neodymium-iron-boron magnets. One was affixed to the palatal surface of the tooth, and the other was embedded in a thermoformed splint. Weekly circumferential supracrestal fiberotomies were performed to enable extrusion without osseous migration. The extrusion was clinically and radiographically detectable after 6 weeks of magnetic force application. After an initial retention period of 8 weeks, the maxillary incisors were restored with lithium-disilicate ceramic veneers and crowns.

Fluorescence influence on screening decisions for oral malignant lesions.

OBJECTIVES: The aim of the present study was to assess the capability of the low-cost VELscope device to visualize the tissue auto-fluorescence of potentially malignant oral lesions and to establish the diagnostic accuracy, sensitivity, and specificity of this method when validating the retrieved data through the gold standard, i.e., histological examination. PATIENTS, MATERIALS AND METHODS: Eighteen patients were evaluated by conventional oral examination (COE) followed by direct visual fluorescence evaluation (DVFE) using VELscope. Areas clinically suspicious detected by COE or with positive DVFE (visual fluorescence loss) were further investigated using surgical biopsy. RESULTS: Eight positive biopsies for malignant lesions were detected by COE and DVFE. Only one positive biopsy for a premalignant lesion was not in accordance with COE and DVFE. One lesion identified on the VELscope and COE as a non-malignant lesion was confirmed by the biopsy. Therefore, the VELscope system had a sensitivity of 94.44% and a specificity of 100% in discriminating in situ normal mucosa from carcinoma or from invasive carcinoma, compared with histology. The predictive positive value was 100% and the negative predictive value was 50%, with a 95% confidence interval (CI). CONCLUSIONS: DVFE allows for a simple and cost-effective margin determination, in order to perform the detection and screening of oral precancerous and early cancerous disorders. It was found that the VELscope system could not fully replace the histopathology procedure. Nonetheless, the study demonstrated its usefulness for clinical examination, monitoring oral lesions, and guiding the biopsy. Therefore, this method may add sensitivity to the oral tissue examination and be an effective adjunct for high-risk patients.

Effects of a Short Drilling Implant Protocol on Osteotomy Site Temperature and Drill Torque.

PURPOSE: To establish a protocol for reducing the drilling sequence during implant site preparation based on temperature and insertion torque. The traditional conventional drilling sequence (used several drills with 0.6-mm increment each time) was compared with the proposed short drilling protocol (only used 2 drills: initial and final drill). MATERIALS AND METHODS: One hundred drilling osteotomies were performed in bovine and porcine bones. Sets of 2 osteotomy sites were created in 5 bone densities using 2 types of drilling protocols. Thermographic pictures were captured throughout all drilling procedures and analyzed using ThermaCAM Researcher Professional 2.10. Torque values were determined during drilling by measuring electrical input and drill speed. RESULTS: There were statistically significant differences in bone temperature between the conventional and short drilling protocols during implant site preparation (analysis of variance P = 0.0008). However, there were no significant differences between the 2 types of drilling protocols for both implant diameters. Implant site preparation time was significantly reduced when using the short drilling protocol compared with the conventional drilling protocol (P < 0.001). CONCLUSIONS: Within the limitations of the study, the short drilling protocol proposed herein may represent a safe approach for implant site preparation.

Utilization of Ceramic Inlays for Sealing Implant Prostheses Screw Access Holes: A Case-Control Study.

PURPOSE: The aim of this study was to evaluate, in a case control study, the esthetic and functional clinical performance of ceramic inlays used for covering the screw access hole in single monolithic lithium disilicate full-contour crowns bonded on computer-aided design/computer-aided manufacturing (CAD/CAM) prefabricated titanium abutments in order to eliminate the drawbacks of alternative restorative methods. MATERIALS AND METHODS: Twenty-eight patients with missing teeth in the lateral areas (premolars and molars) received screw-retained implant restorations. In half of the restorations (n = 14), composite fillings were used to seal the access hole (control group), while the other half was sealed with ceramic inlays (test group). To determine the restoration occlusal wear, impressions were obtained after the restorations were finalized, at 1 year, and at 2 years follow-up. The casts were scanned with a 3D Scanner Design System recording the anatomical surfaces of the white model replicates. Wear amounts (µm) were calculated as the maximum loss in height of the occlusal surface. The clinical evaluation was carried out using a kit specifically designed for assessing the FDI criteria. Statistics were performed using analysis of variance (ANOVA). RESULTS: A total of 58 restorations were delivered, and after 2 years of follow-up, the wear values were 228.20 ± 54.68 µm for the control group and 65.20 ± 7.24 µm for the ceramic inlay group. One-way ANOVA showed significant differences among the vertical loss between these two groups (P < .001). Clinical outcomes according to the FDI score for assessing dental restorations revealed substantial deterioration within 2 years of follow-up. CONCLUSION: The use of ceramic inlays appears to be a predictable, esthetic, and successful method of sealing the screw holes of the screw-retained implant restorations.