Nonsurgical periodontal treatment and prosthetic rehabilitation of a renal transplant patient with gingival enlargement: a case report with 2-year follow-up.

BACKGROUND: Drug-induced gingival enlargement is a common condition which can be observed in patients taking immunosuppressive medications following organ transplant surgery. The disfiguring excessive tissue often hinders proper oral hygiene practices, therefore accompanied by periodontitis, tooth mobility, and even pathological tooth migration in extreme cases. This case report presents a conservative treatment protocol for a patient with the aforementioned conditions involving neither surgical nor orthodontic intervention. Few related studies have reported such a noninvasive protocol for managing these kinds of conditions. CASE PRESENTATION: A 51-year-old woman presented with bleeding gingiva, mobile teeth and complained of chewing difficulties. She had undergone renal transplant surgery 16 years prior to this dental visit and had been taking immunosuppressive drugs including cyclosporine ever since. After clinical and radiographic examinations, the patient was diagnosed with drug-induced gingival enlargement, pathological tooth migration, severe periodontitis, and missing teeth. Through careful and meticulous nonsurgical debridement, oral hygiene instruction, tooth extraction, and occlusal adjustment, the patient's periodontium was restored to a healthy state without surgical intervention. Moreover, the patient's chewing function was restored by means of removable partial dentures. Good adaptation of prostheses and satisfaction with overall treatment outcomes were reported. CONCLUSIONS: Through proper diagnosis, treatment, and with good patient cooperation, complex systemic and dental problems can be managed conservatively without invasive surgeries to attain a stable periodontium and eventually, occlusal function could be restored.

Effect of Luting Agents on Retention of Dental Implant-Supported Prostheses.

To evaluate the retentive strength of 7 different luting agents in cement-retained implant abutment/analog assemblies. Fifty-six externally hexed dental implant abutment/analog assemblies and cast superstructures were divided randomly into 7 groups for cementation with each of the 7 luting agents. Five definitive cements tested were zinc phosphate cement, All-Bond 2, Maxcem, RelyX Luting cement, HY-Bond, and two provisional cements, ImProv and Premier. Cast superstructures were cemented onto the implant abutments and exposed to 1000 thermal cycles (0°C-55°C) and 100 000 cycles on a chewing simulator (75 N load). A universal testing machine was used to measure cement failure load of the assembled specimens. Cement failure load was evaluated with 1-way ANOVA and Duncan's multiple range analysis. Significant differences in cement failure loads were measured (P < .0001). Post hoc testing with Duncan's multiple range indicated 4 separate groupings. Maxcem and All-Bond 2 were comparable, having the greatest load failure. RelyX and zinc phosphate cement were analogous, and higher than HY-Bond. Improv and Premier constituted a pair, which demonstrated the lowest retentive values. Within the limitations of this in vitro study, Maxcem and All-Bond 2 are good candidates for cement-retained implant prostheses while concerning retention.

Comparison of patient's satisfaction with implant-supported mandibular overdentures and complete dentures.

BACKGROUND: The purpose of this study was to compare patients' subjective experiences with respect to long-term satisfaction with mandibular implant-retained overdentures versus conventional complete dentures. METHODS: Among 85 completely edentulous patients, 60 were treated with four one-stage titanium implants and overdentures retained by a cast bar with extracoronal attachments. These patients constituted the experimental group, and were subsequently evaluated clinically over a period of up to 6 years. The other 25 patients constituted the control group and were treated with conventional complete dentures without implant retained. All the patients (n = 60) in the experimental group responded to questions on their experiences before and after treatment with the implant-retained overdentures. Sixty percent (n = 15) of the 25 patients in the control group responded to the questionnaire. RESULTS: No implants or restorations failed during the observation period. The experimental group, however, showed significant differences with the control group in terms of their responses to the questionnaire. CONCLUSION: The use of implants to retain and support the overdenture improved comfort and gave the experimental patients greater self-confidence in social interactions, in addition to more effective oral rehabilitation. The results demonstrate that the effects of rehabilitation of the mandibular arch with an implant-retained overdenture are predictable.

Fracture resistance and marginal discrepancy of porcelain laminate veneers influenced by preparation design and restorative material in vitro.

OBJECTIVES: The purpose of this investigation is to evaluate marginal discrepancy and fracture resistance of two veneering materials using two preparation designs. METHODS: Two veneer preparation designs (full and traditional) were restored with leucite-reinforced ceramic (ProCAD, Ivoclar Vivadent, Amherst, NY) milled by CAD/CAM (Cerec 3D milling system, Serona Dental Systems), and conventional sintered feldspathic porcelain (Noritake Super Porcelain EX3, Noritake Dental Supply Co). Forty-eight specimens were analysed with a sample size of n=12 per group. The thickness of each veneer was measured on four specific surfaces. Marginal discrepancy was evaluated with a replica technique and cross-sectional view using a digital microscope. The fracture resistance of veneers cemented on standardised composite resin dies was evaluated using a universal testing machine. Results were analysed with ANOVA, Tukey-Kramer post hoc testing, and linear regression. RESULTS: The results of this investigation revealed no correlation between the thickness and marginal discrepancy of the veneers. The full preparation design with ProCAD and the traditional preparation design with feldspathic porcelain manifested smaller gap. Fracture resistance was decreased for the full preparation design with feldspathic porcelain. CONCLUSIONS: In terms of marginal discrepancy and fracture resistance, the most favourable combination was a traditional veneer preparation design with conventional sintered feldspathic porcelain. For the full veneer preparation, a stronger ceramic material such as ProCAD is suggested.