Influence of Immediate Implant Placement and Provisionalization with or without Soft Tissue Augmentation on Hard and Soft Tissues in the Esthetic Zone: A One-Year Retrospective Study.

The purpose of this clinical research was to evaluate peri-implant marginal changes around immediate implants placed either with the application of SCTG or XCM or without soft tissue grafting. A total of 48 patients requiring a single implant-supported restoration in the anterior jaw were selected for inclusion. Three surgical procedures were performed, as follows: type 1 implant with subepithelial connective tissue graft (SCTG), type 1 implant with xenogenic collagen matrix (XCM), and type 1 implant without soft tissue augmentation (NG) (control group). The marginal change of peri-implant soft tissue, facial soft tissue thickness (FSTT), peri-implant health status, esthetics, and patient satisfaction were assessed at one year after surgery. All of the placed implants showed a survival rate of 100%. No significant differences in FSTT were recorded between the SCTG group and the XCM group after treatment (P > 0.05), while the NG group presented a significant difference (P < 0.05). Patients in the NG group lost significantly more in the buccal marginal level than did patients in the SCTG group and those in the XCM group (P < 0.05). The favourable success rate recorded in all groups confirmed immediate tooth replacement as a choice of treatment for a missing anterior single tooth. The NG group presented significant changes of FSTT and buccal marginal level, while XCM constituted a viable alternative to SCTG.

Composite restorations placed in non-carious cervical lesions-Which cavity preparation is clinically reliable?

The purpose of this in-vivo study was to evaluate the clinical performance of restorations placed in non-carious cervical lesions (NCCLs), using different cavity preparation designs, after 7.7 years. A total of 85 NCCLs with coronal margins in enamel and cervical margins in dentin were randomly assigned to the following treatment protocols: dentin surface cleaning, dentin surface roughening with round bur plus flowable composite, dentin surface roughening/cervical groove preparation with round bur, dentin surface roughening/cervical groove preparation with round bur plus flowable composite. After enamel beveling and selective enamel etching, the defects were restored with composite. The restorations were assessed by two independent, calibrated and blinded investigators, using modified USPHS criteria. At 7 years (7.7 (± 0.35)), a total of 64 restorations (75.3%) were available for follow-up examination. The total retention rate, irrespective of the test groups, was 82.8%. Restorations placed without any preparation showed the highest loss rate (27.8%). Esthetic appearance, marginal adaptation, anatomic form and marginal discoloration did not differ significantly between the groups. Composites are long-term stable materials for restoring NCCLs. Restorations placed without any dentin preparation (cavity cleaning only) showed the highest loss rate.

Reimplante intencional de un 4.7 con reabsorción cervical invasiva y seguimiento a seis años / No disponible

Introducción: La Reabsorción Cervical Invasiva (RCI) se origina en la superficie externa de la raíz, generalmente por un daño previo, y quizá crónico, del ligamento periodontal, y una rotura de la capa de tejido no mineralizado que permite una actividad odontoclástica, invadiendo la dentina en cualquier dirección y con diferentes grados. Dejada a su libre evolución conlleva la pérdida del diente. Caso clínico: Paciente de 45 años que acude a la consulta por presentar un tracto sinusal a nivel del 4.7. Se diagnostica necrosis pulpar con absceso apical crónico de etiología dudosa. Tras el fracaso del tratamiento de conductos, se opta por la exodoncia y se realiza el diagnóstico intraoperatorio de RCI. Tratada la causa, se realiza el reimplante intencional (RI). Conclusión: La técnica de RI se presenta como una alternativa a la cirugía periradicular, siendo una herramienta valiosa en la conservación de dientes con pronóstico comprometido

No disponible

Chemical Interaction and Interface Analysis of Self-Etch Adhesives Containing 10-MDP and Methacrylamide With the Dentin in Noncarious Cervical Lesions.

OBJECTIVES: To characterize the chemical interactions and analyze the interface of adhesive systems containing 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) and N-methacryloyl glycine (methacrylamide) functional monomers with the dentin in noncarious cervical lesions (NCCLs) compared with artificial defects (ADs). METHODS AND MATERIALS: Twenty human teeth with natural NCCLs on the buccal surface were used. Class V cavities, similar to NCCLs, were created on the lingual surface to serve as controls. Teeth were randomly allocated to two groups according to the functional monomer in the adhesive (N=10): G1, 10-MDP; and G2, methacrylamide. NCCLs and ADs were characterized by their mineral composition (MC) and degree of demineralization (DD) using micro-Raman spectroscopy, adhesive/dentin chemical interactions (CIs) were assessed with infrared photoacoustic spectroscopy, and interface morphology was evaluated with scanning electron and light microscopy. MC, CI, and DD data were submitted to Shapiro-Wilk and Student t-tests ( p<0.05). RESULTS: Compared with ADs, dentin in NCCLs was hypermineralized ( p<0.05). In G1, CI, and DD in the first 2 µm, and adhesive projections in NCCLs and ADs interfaces were similar. Additionally, a thin layer of dentin collagen was observed in ADs, while it was hardly present in NCCLs. In G2, although CI could not be identified, changes in the mineral components were observed. The DD in the ADs and NCCLs were statistically similar, while SEM showed a lack of adhesion at NCCLs interface. DD and collagen exposure in the ADs and NCCLs were more pronounced than in G1. CONCLUSIONS: Results suggest that the G1 adhesive could be applied directly on the superficial sclerotic layer in NCCLs. In contrast, previous cavity preparation should be conducted to improve the micromechanical interaction of G2 with the dentin.

Periodontal Evaluation in Noncarious Cervical Lesions Restored with Resin-modified Glass-Ionomer Cement and Resin Composite: A Randomised Controlled Study.

PURPOSE: To assess periodontal parameters of noncarious cervical lesions (NCCLs) restored with glass-ionomer cement (RM-GIC) and composite resin at baseline, three and six months. MATERIALS AND METHODS: Eighteen patients with bilateral lesions were included in the study. Lesions (1 mm in depth) were randomly restored with each type of restorative material. Probing depth (PD), relative gingival recession (rGR), relative clinical attachment level (rCAL), visible plaque index (VPI) and gingival bleeding index (GBI) were measured. RESULTS: No statistically significant differences were found when comparing within groups (p > 0.05). However, the intergroup analysis demonstrated a decrease in GR and rCAL gain for teeth restored with the resin-modified glass-ionomer cement (RM-GIC). CONCLUSION: Both materials behaved similarly when in close contact with periodontal tissues and did not influence periodontal parameters.

Anatomic assessment of the mandibular buccal shelf for miniscrew insertion in white patients.

INTRODUCTION: Cortical bone thickness, bone width, insertion depth, and proximity to nerves are important factors when planning and placing orthodontic miniscrews. The objective of this study was to anatomically assess the mandibular buccal shelf in a white patient population as the insertion site for orthodontic miniscrews by investigating these 4 variables. METHODS: Measurements were made on cone-beam computed tomography scans of 30 white patients (18 girls, 12 boys; mean age, 14.5 ± 2 years). All measurements were taken adjacent to the distobuccal cusp of the first molar, and the mesiobuccal and distobuccal cusps of the second molar. Additionally, bone depth was measured at 2 height levels, 4 and 8 mm from the cementoenamel junction. Stereolithographic models of patients were superimposed on the cone-beam computed tomography volumes to virtually create an outline of the soft tissue on the cone-beam computed tomography image to allow identification of the purchase point height (mucogingival junction). The inferior alveolar nerve was digitally traced. Miniscrews (1.6 × 10 mm) were virtually placed at the buccal shelf, and their insertion depths and relationships to the nerve were assessed. Analysis of variance with post hoc analysis was used for data analysis. RESULTS: Insertion sites and measurement levels had significant impacts on both cortical bone thickness and bone width. Cortical bone thickness was typically greatest at the distobuccal cusp of the second molar. Bone width was also greatest at the distobuccal cusp of the second molar 8 mm from the cementoenamel junction. The greatest insertion depth was found again at the distobuccal cusp to the second molar, whereas the miniscrews had the greatest proximity to the nerve at this site also. CONCLUSIONS: The distobuccal cusp level of the mandibular second molar is the most appropriate site for miniscrew insertion at the buccal shelf in white patients.

Compliance of Randomized Clinical Trials in Noncarious Cervical Lesions With the CONSORT Statement: A Systematic Review of Methodology.

The literature was reviewed to evaluate the compliance of randomized clinical trials (RCTs) with the CONsolidated Standards of Reporting Trials (CONSORT ) and the risk of bias of these studies through the Cochrane Collaboration risk of bias tool (CCRT). RCTs were searched at Cochrane Library, PubMed, and other electronic databases to find studies about adhesive systems for cervical lesions. The compliance of the articles with CONSORT was evaluated using the following scale: 0 = no description, 1 = poor description, and 2 = adequate description. Descriptive analyses about the number of studies by journal, follow-up period, country, and quality assessments were performed with CCRT for assessing risk of bias in RCTs. One hundred thirty-eight RCTs were left for assessment. More than 30% of the studies received scores of 0 or 1. Flow chart, effect size, allocation concealment, and sample size were more critical items, with 80% receiving a score of 0. The overall CONSORT score for the included studies was 15.0 ± 4.8 points, which represents 46.9% of the maximum CONSORT score. A significant difference among countries was observed ( p<0.001), as well as range of year ( p<0.001). Only 4.3% of the studies were judged as at low risk; 36.2% were classified as having unclear risk and 59.4% as having high risk of bias. The adherence of RCTs evaluating adhesive systems to the CONSORT is low with unclear/high risk of bias.

Eighteen-month Clinical Study of Universal Adhesives in Noncarious Cervical Lesions.

OBJECTIVE: To evaluate the clinical performance of Scotchbond Universal (3M Oral Care) and Prime & Bond Elect (Dentsply Sirona) in the restoration of noncarious cervical lesions (NCCLs). METHODS AND MATERIALS: This was a randomized controlled clinical trial involving 63 subjects. Two hundred and three NCCLs were restored using Scotchbond Universal and Prime & Bond Elect using both an etch-and-rinse and a self-etch technique. Lesions were notch-shaped NCCLs, and the restorations were placed without any mechanical retention. Restorations were finished immediately after placement and scored with regard to retention, marginal discoloration, marginal adaptation, and secondary caries. Similar assessment of the restorations was performed 18 months after placement. Logistic regression was performed for each outcome separately with a compound symmetric variance-covariance structure assumed to consider a correlation of restorations within subjects. All analyses were conducted using SAS version 9.4 (SAS Inc). RESULTS: One hundred and fifty-eight teeth (77.8% of the restorations placed) in 46 subjects (73% of subjects enrolled) were available for the 18-month follow-up. A statistically significant difference was reached only for the comparison Scotchbond Universal/self-etch (SU_SE) and Prime & Bond Elect/etch-and-rinse (PBE_E&R) groups ( p=0.01), where a restoration with SU_SE was 66% less likely to maintain a score of Alpha for marginal discoloration than a restoration performed with PBE_E&R. CONCLUSIONS: Scotchbond Universal and Prime & Bond Elect presented acceptable clinical performance after 18 months of clinical service. However, Scotchbond Universal, when applied with a self-etch approach, did demonstrate a relatively high level of marginal discoloration when compared to the other groups.

Minimally Invasive Treatment of Class 4 Invasive Cervical Resorption with Internal Approach: A Case Series.

Invasive cervical resorption (ICR) is a type of external resorption that can involve the coronal, middle, and apical parts of the root in its advanced stages. The diagnosis and treatment of ICR depend on the extent of the resorption into the dentin. The treatment of advanced ICR is challenging, and these teeth have poor prognoses. This article describes 4 cases of class 4 ICR diagnosed by using cone-beam computed tomography and treated with a minimally invasive internal approach with sodium hypochlorite irrigation and calcium hydroxide dressing. All cases were followed for at least 3 years.

Bone and cortical bone thickness of mandibular buccal shelf for mini-screw insertion in adults.

OBJECTIVE: To analyze the buccal bone thickness, bone depth, and cortical bone depth of the mandibular buccal shelf (MBS) to determine the most suitable sites of the MBS for mini-screw insertion. MATERIALS AND METHODS: The sample included cone-beam computed tomographic (CBCT) records of 30 adult subjects (mean age 30.9 ± 7.0 years) evaluated retrospectively. All CBCT examinations were performed with the i-CAT CBCT scanner. Each exam was converted into DICOM format and processed with OsiriX Medical Imaging software. Proper view sections of the MBS were obtained for quantitative and qualitative evaluation of bone characteristics. RESULTS: Mesial and distal second molar root scan sections showed enough buccal bone for mini-screw insertion. The evaluation of bone depth was performed at 4 and 6 mm buccally to the cementoenamel junction. The mesial root of the mandibular second molar at 4 and 6 mm showed average bone depths of 18.51 mm and 14.14 mm, respectively. The distal root of the mandibular second molar showed average bone depths of 19.91 mm and 16.5 mm, respectively. All sites showed cortical bone depth thickness greater than 2 mm. CONCLUSIONS: Specific sites of the MBS offer enough bone quantity and adequate bone quality for mini-screw insertion. The insertion site with the optimal anatomic characteristics is the buccal bone corresponding to the distal root of second molar, with screw insertion 4 mm buccal to the cementoenamel junction. Considering the cortical bone thickness of optimal insertion sites, pre-drilling is always recommended in order to avoid high insertion torque.

Effectiveness on oral pain of 808-nm diode laser used prior to composite restoration for symptomatic non-carious cervical lesions unresponsive to desensitizing agents.

This study compares sensitivity reduction after dental restoration with and without prior diode laser (DL) irradiation for cervical dentine hypersensitivity (CDH) from non-carious cervical lesions (NCCLs) unresponsive to desensitizing agents. Eighty-eight teeth of 28 subjects (21 females; age 23-64 years), with CDH from NCCL were included in this study. NCCLs of each oral quadrant were randomized in two groups (study group (SG)) to estimate the sensitivity reduction after dental restoration (SG-1) compared with the DL irradiation used prior to restoration placement (SG-2). The subjects were asked to rate the sensitivity experienced during air stimulation using a visual analog scale before (baseline), immediately after, and at 6 and 12 months from restoration. The outcomes showed a significant reduction of discomfort compared to baseline for NCCLs of SG-2 with the decrease of 78.5, 78.9, and 78.1 % immediately and at 6 and 12 months after restoration, respectively; in comparison with the decrease of 70.1, 67, and 65.3 % for NCCLs of SG-1 immediately and at 6 and 12 months after restoration, respectively; and compared to baseline. The DL irradiation prior to dental restoration can further improve the painful symptomatology of CDH from NCCL unresponsive to desensitizing agents.

Surgical repair of invasive cervical root resorption with calcium-enriched mixture cement: a case report.

Invasive cervical resorption (ICR) occurs in the cervical area of the teeth due to the formation of a soft tissue that progressively resorbs dentin. The disease is asymptomatic unless the pulp is exposed. This article presents a case involving a mandibular canine that was treated with a calcium-enriched mixture (CEM) cement. After a full mucoperiosteal flap was performed, the soft tissue was curetted away and the cavity filled with CEM biomaterial. One week later, the supragingival surface of the CEM was polished and covered with composite resin. At a 1-year follow-up visit, the pulp was healthy and the gingival probing depth decreased from >3 mm to 1 mm, showing attachment gain. As a biocompatible material, CEM has proven its ability in dentinogenesis, cementogenesis, and osteogenesis; it may prove to be a suitable biomaterial for treating ICR cases.

Surgical management of invasive cervical resorption using resin-modified glass ionomer cement.

Invasive cervical resorption is an external resorption that begins below the epithelial attachment. It is caused primarily by dental trauma, orthodontic treatment, or dental bleaching. This case report involved an invasive Class III cervical resorption resulting from trauma to the superior right central incisor. Root canal treatment was followed by surgical intervention. The resorptive defect was debrided, and part of the tooth was restored with resin-modified glass ionomer cement. Postoperative follow-up revealed complete healing and healthy gingival attachment.

Subepithelial connective tissue graft for treatment of gingival recessions with and without enamel matrix derivative: a multicenter, randomized controlled clinical trial.

The aim of this multicenter, randomized controlled trial was to compare the clinical outcomes of a connective tissue graft (CTG) alone or in combination with enamel matrix derivative (CTG + EMD) in the treatment of Miller Class I and II gingival recessions. The 56 selected defects were evaluated for probing depth, recession depth, keratinized tissue width, and probing attachment level, and were measured at baseline and 12 months after treatment. The mean recession reduction was 3.9 ± 0.8 mm for EMD-treated sites (test) and 3.6 ± 1.5 mm for the control group (P = .22), corresponding to a mean root coverage of 90% and 80% for test and control groups, respectively (P = .05). Complete root coverage was obtained in 62% of test sites compared to 47% in the control group (P = .27). Both procedures provided good soft tissue coverage. The better results of the test group did not achieve a statistically significant level.

Fracture resistance of amalgam/glass-polyalkenoate open sandwich Class II restorations: an in vitro study.

OBJECTIVE: To investigate the effect of two glass-polyalkenoate restorative materials used as root-dentin replacements on the fracture strength of Class II amalgam restorations. MATERIALS AND METHODS: Class II slot preparations extending 2mm apical to the cemento-enamel junction were made in 30 teeth and randomly assigned to three groups. Group 1 (Control): restored entirely with amalgam (Tytin, Sybron Kerr, Orange, CA, USA). Group 2: The root-dentin area was restored with a viscous conventional glass-polyalkenoate restorative material (Fuji IX GP, GC America, Alsip, IL, USA), and the remainder of the preparation restored with amalgam. Group 3: The root-dentin area was restored with a resin-modified glass-polyalkenoate restorative material (Fuji II LC, GC America) and the remainder restored with amalgam. The amalgam restorations were loaded in compression to failure and the data analyzed using one-way ANOVA (alpha=0.05). RESULTS: No significant differences in fracture strength were found. CONCLUSION: Root-dentin replacement with the tested glass-polyalkenoate materials did not affect the fracture strength of Class II amalgam restorations.

Endodontic and periodontal treatment of an external cervical resorption.

External root resorption can be divided into 3 categories: 1) progressive inflammatory resorption; 2) cervical resorption; and 3) replacement resorption. Cervical resorption is a not well recognized type of progressive external inflammatory resorption. It occurs after injury to the cervical attachment apparatus, mostly in the area of the cervical root surface (precementum) below the epithelial attachment. The present article describes an abnormal case of cervical resorption in a vital lateral maxillary incisor of a 27-year-old male patient. Endodontic treatment and subsequent periodontal plastic-esthetic surgery were performed. Reconstruction of the defect was achieved using mineral trioxide aggregate cement. After 2 years, the tooth showed no pathologic symptoms. The present case demonstrates a novel combined endodontic and periodontal treatment of an external root resorption.

Coronally repositioning the cemento-enamel junction to address gingival margin discrepancies.

BACKGROUND: Gingival margin discrepancies, especially in the esthetic zone, can pose a challenge for the restorative dentist. Surgical clinical crown lengthening and orthodontic tooth movement are most often used to treat these situations. In this report, an additional surgical technique will be discussed with its indications for use. METHODS: Three cases are presented, each with a different type of gingival margin discrepancy. The surgical technique used was the same for all cases. It involved establishing a new, more coronally positioned cemento-enamel junction (CEJ) through the use of a finishing bur and curets. The newly exposed root surface was then covered with connective tissue, thus effecting a movement of the gingival margin in a coronal position. RESULTS: Clinical outcomes resulted in a more natural soft tissue relationship between the treated tooth and the adjacent dentition. The three cases presented did not appear to have any negative periodontal or restorative consequences following the procedure. CONCLUSIONS: This report presents another technique which can be considered when the clinician is faced with the need to move the gingival margin in a coronal direction. Within the guidelines presented, this technique appears to be predictable, less complicated, and less time consuming to carry out when compared with other available options.

Immunohistochemical study on pulpal response in rat molars after cavity preparation by Er:YAG laser.

While Er:YAG laser systems are in extensive use for caries removal and cavity preparation, the effects of such treatment on pulp tissue remain unclear. This study evaluates these systems using immunohistochemical methods and compares the results with information gained from treatment using conventional burs. Cervical cavities were prepared in the upper first molars of rats, using either an Er:YAG laser or a conventional tungsten-carbide bur. At intervals of 5 min, 6 h, 12 h, 1 d, 3 d and 7 d after cavity preparation, the teeth were processed for immunohistochemical analyses of tissue non-specific alkaline phosphatase, OX6-positive major histocompatibility complex class II antigen-expressing cells and PGP 9.5-immunoreactive nerve fibers. DNA fragmentation was detected by the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling (TUNEL) method. Tissue non-specific alkaline phosphatase was observed mainly in the subodontoblastic layer under the cavity lesion, from 5 min, in both groups. The immunoreactivity was more pronounced in the laser group, but by 7 d no significant differences were recognizable. At 12 h, TUNEL-positive cells were detected around the odontoblastic layer in both groups. From 3 d to 7 d, a limited number of positive cells were still visible in the group that underwent standard treatment. Clear similarities in the distribution patterns of OX6-immunopositive cells and PGP 9.5-immunoreactive nerve fibers were also noted. From 12 h to 1 d, OX6-positive cells accumulated along the pulp-dentin border, extending their processes into the dentinal tubules. Numerous bead-like PGP 9.5-immunoreactive nerve fibers were observed under the odontoblastic layer at 7 d. These results demonstrated that there was no appreciable difference in the manner in which pulp tissue responded to treatment with either Er:YAG laser or a conventional drill. This would seem to indicate the usefulness of the Er:YAG laser system in the removal of caries and cavity preparation.

Modification of col shape and interproximal area after periodontal surgery associated with the restorative alveolar interface (RAI) technique. Histological study in dogs.

The modification of the col shape and position by the restorative alveolar interface technique (RAI) was studied in the interproximal areas between the mandibular first molars and fourth premolars of 10 dogs. Full thickness flaps were raised to expose the interproximal root surface and alveolar bone crest. The RAI procedure was performed only on the experimental sides and the control areas were the opposite side of the same animal. The animals were sacrificed at zero hour, 7, 14, 21 and 28 days for histological analyses. Approximately 6.0-micron-thick sections were made in buccolingual and mesiodistal directions and stained with hematoxylin-eosin and Mallory for light microscopy analysis. A satisfactory healing process was observed up to the 14th and 21st days which showed a modified col shape. At this time, an inflammatory reaction developed affecting the evolution of the healing. The surgery had probably created conditions for the installation of an inflammatory process resulting from the modified anatomy of the interdental area.

Soft tissue root coverage as treatment for cervical abrasion and caries.

Root exposure caused by gingival recession may result in cervical abrasion, root caries, root sensitivity, and compromised esthetics. Although cervical root lesions can be treated with Class V restorations, there may be advantages in treating them with soft tissue grafts for root coverage since they restore the dento-gingival unit to its prerecession condition. The rationale for root coverage with soft tissue grafts is reviewed and two cases are presented of successful root coverage procedures in which gingival recession associated with cervical abrasion and caries was present.