Esthetic treatment of buccal exostoses: a case report.

Buccal exostoses are benign bony protuberances that may grow over time but rarely result in functional alterations. The diagnosis is established by a combination of medical history and clinical and radiographic features of the affected region. This case report describes the surgical treatment of bilateral bone projections on the buccal surface of the maxilla that represented an undesirable esthetic alteration to the patient. The surgical procedures, which were performed at separate appointments for the left and right sides, involved reflection of full-thickness flaps and careful osteotomy with a carbide spherical drill and a Rhodes chisel. At completion of the procedures, flat buccal bone ridges with a clear esthetic improvement were observed. At the follow-up examination (3 months postsurgery on the left side and 1 month on the right), the presence of stable periodontal tissue-positioned where it was located during the immediately postoperative period-indicated a satisfactory clinical result.

Effect of hydrogen peroxide on color and whiteness of resin-based composites.

OBJECTIVE: To evaluate the influence of a 35% hydrogen peroxide gel on color and whiteness changes of resin-based composites (RBC). MATERIALS AND METHODS: Discs (n = 10; shade A3.5 enamel; and 8 mm diameter and 2 mm thick) were fabricated from three RBC (DF- Durafill, Heraeus Kulzer; ED- IPS Empress Direct, Ivoclar Vivadent; and AP- Amelogen Plus, Ultradent Products). Three subgroups were obtained for each RBC: before bleaching (T0 ) and after first (T1 ) and second (T2 ) bleaching applications. A dental spectrophotometer (VITA Easyshade, Vita Zahnfabrik) was used to obtain CIELAB color coordinates and whiteness index for dentistry (WID ) in all periods. CIELAB ( ΔEab* ) and CIEDE2000 (ΔE00 ) color differences were also obtained. Perceptibility (PT) and acceptability (AT) thresholds were used to analyze values of ΔEab* , ΔE00 , and ΔWID . Two-way analysis of variance (ANOVA; for L*, a*, b*, and WID ) and one-way ANOVA and Tukey tests (for ΔEab* and ΔE00 ) were used to analyzed the results (α = 0.05). RESULTS: L* and WID values from all RBC did not change after bleaching applications (T1 and T2 ) (P > .05). There were no significant differences in color differences ( ΔEab* and ΔE00 ) among all RBC evaluated after bleaching applications (T1 -T0 and T2 -T0 ; P > .05). Regardless of the RBC, mean values of ΔE00 between all different periods were always below 50%:50% PT value. CONCLUSIONS: The 35% hydrogen peroxide bleaching gel influences on color and whiteness of resin-based composites. However, color changes were not clinically perceived and whiteness variations were clinically acceptable. CLINICAL SIGNIFICANCE: Patients should be advised that existing composite restorations might not match the natural tooth color after bleaching, and their replacement may be required.

Clinical treatment of necrotizing ulcerative gingivitis: a case report with 10-year follow-up.

The aim of this case report is to describe the diagnosis and treatment of a patient with necrotizing ulcerative gingivitis. An 18-year-old man with no systemic problems reported with chief complaints of gingival bleeding during toothbrushing and spontaneous pain. Clinical examination revealed significant plaque accumulation on the surfaces of all teeth as well as papillary necrosis involving mainly the anterior teeth. Treatment included an initial phase of supragingival plaque and calculus removal along with at-home use of 0.12% chlorhexidine gluconate mouthrinse twice a day for 30 days. After the initial phase, subgingival scaling was performed, and regular oral hygiene methods were resumed by the patient. After active therapy was completed, a periodontal maintenance regimen was established, and the patient was recalled for periodontal maintenance therapy. Follow-up occurred weekly throughout treatment, monthly for the first 6 months posttreatment, and 2-3 times a year during the periodontal maintenance therapy. Clinical results after 10 years showed that this approach controlled the acute phase and maintained the patient's periodontal health over time.

Diversity, frequency and antifungal resistance of Candida species in patients with type 2 diabetes mellitus.

OBJECTIVE: To determine number, species of Candida and Candida resistance to antifungal therapy according to the metabolic control state and the associated salivary changes in patients with type 2 diabetes mellitus (DM2). MATERIALS AND METHODS: Samples of non-stimulated saliva were collected from 52 patients with DM2. Salivary pH was measured and cultured on Sabouraud glucose agar and the values of CFU/ml were calculated. The species were presumptively identified using CHROMagar Candida® plates, and identification was confirmed by polymerase chain reaction (PCR). C. albicans isolates were cultured on SGA tetracycline agar with nystatin and fluconazole diffusion disks to measure susceptibility. RESULTS: Sixty six percent of the yeasts isolated were Candida albicans, followed by C. glabrata (20.7%). In patients with decompensated DM2, there was an inverse association between HbA1c value and salivary pH. At higher levels of salivary acidification, a greater diversity and quantity of yeasts of the genus Candida were observed. With nystatin, higher inhibition was observed at lower pH. CONCLUSIONS: The antifungal therapies could be more effective if it consider, qualitative salivary characteristics as pH, that could determine the susceptibility of species of Candida to at least to nystatin, which is the most used antifungal for treatment to oral candidiasis in patients with DM2.

Management of an uncomplicated crown fracture by reattaching the fractured fragment-Case report.

Coronal fractures of the anterior teeth are common sequelae of traumatic dental injuries. Reattachment of fractured tooth fragments using dental adhesive techniques offers some advantages, including restoration of the function, esthetics, shape, texture, and brightness of the surface. The present report describes a clinical case of reattachment with a 4-year clinical and radiographic follow up in a permanent maxillary central incisor with an uncomplicated crown fracture. Fragment reattachment is a conservative procedure, preserving esthetics and functionality, and it can provide an immediate positive emotional response from the patient.

Changing the gingival color discrepancy induced by pigmented root using subepithelial connective tissue graft: a case report.

Metallic alloys can suffer corrosion, and metallic posts and cores used for restorative procedures may develop a blue-gray pigmentation in root dentin, which in turn changes the color of gingival tissues. Removing posts and cores may lead to root fracture, and bleaching agents have a limited effect on staining from alloy corrosion. Surgical techniques for correcting undesirable esthetic deficiencies have been investigated in the literature. This article describes the case of a patient with gingival discoloration caused by root pigmentation in the maxillary area. A subepithelial connective graft harvested from the palate was used to treat the gingival color discrepancy.

Location and negotiability of second mesiobuccal canal in upper molar by tomographic and anatomical macroscopic analysis.

PURPOSE: The aim of this study was to assess the presence and negotiability of second mesiobuccal (MB2) canal at pulp chamber, cervical, medium and apical levels comparing the findings obtained by anatomical evaluation with cone-beam computed tomography (CBCT) images. METHODS: 56 and 43 human maxillary first and second upper molars, respectively, were assessed. The specimens were placed on an acrylic platform in a stationary position to identify the presence of MB2 canal at the pulp chamber floor, cervical, medium, and apical level. The samples were analyzed using two image acquisition softwares (XoranCat and DentalSlice) and subsequently by macroscopic anatomical analysis with a 4× magnifying glass. All data were summarized, and mean values, frequencies, and percentage values were calculated for each group of specimens. RESULTS: DentalSlice and XoranCat images of first molars showed a rate concordance index (CI) of present MB2 canals in comparison to anatomic evaluations of 65.2 and 70.1%, respectively. On the second molars, the rate of CI reached about 80 % in both sets of images. In the first molars, 29.9% of canals localized by XoranCat images did not display anatomical negotiability; 34.8% of canals localized by DentalSlice images did not display anatomical negotiability. Among second molars, 18.6% of canals localized by XoranCat did not display anatomical negotiability; 19.8% of canals localized by DentalSlice did not display anatomical negotiability. On the first molars with anatomical negotiability, errors not identified by XoranCat and DentalSlice reached rates of 22.3 and 25.4%, respectively. Among second molars, error rates were 8.7% (XoranCat) and 11.6% (DentalSlice). CONCLUSION: Our study indicated that (1) the tomographic image is an auxiliary way to detection and mapping of the MB2 canal in maxillary molars, (2) the tomographic image is ineffective in determining negotiability. Both image software packages used in this study showed similar results.

Mandibular molar rehabilitation using orthodontic extrusion associated with odontoplasty.

The aim of this clinical report is to describe the successful treatment of a mandibular first molar presenting an extensive fracture at the buccal aspect in a young patient. The extension of the fracture was a negative prognostic factor for tooth maintenance. An alternative clinical treatment was proposed since the patient was young and presented with good oral hygiene and periodontal health. The treatment was based on orthodontic forced eruption associated with odontoplasty. A 3-year follow-up after the surgical procedure demonstrated the maintenance of periodontal health and good plaque control. It can be concluded that orthodontic forced eruption associated with odontoplasty promoted favorable conditions for prosthetic rehabilitation and is a feasible procedure in the treatment of tooth fracture extended below the cementoenamel junction.

Interdisciplinary esthetic approach in clinical dental rehabilitation.

During the esthetic evaluation of smile, the presence of diastemas, tooth color, size and shape, and the amount of gingival exposure are important factors to be considered. A 23-year-old female patient was referred to us with a dissatisfaction with her smile. After clinical examination revealed esthetic alterations as generalized tooth yellowish discoloration, a slight diastema in the upper anterior region, and a shortened appearance of maxillary dental crowns, providing a gingival smile. The proposed treatment consisted of an esthetic rehabilitation for resolution of gummy smile and closure of diastema in anterior teeth by the use of digital planning as a guide for the accomplishment of integrated procedures. The result obtained by the multidisciplinary treatment associating periodontal surgical procedure for esthetic crown lengthening with in-office bleaching and direct restorations with composite resin, by digital planning, provided evident harmonization between tooth color and shape and gingival contour, enabling more harmonious smile esthetics.

Retentive efficacy, antimicrobial and cytotoxicity comparisons between different types of commercial and experimental denture adhesives with antifungal action.

The effect of the addition of nystatin and an alternative antifungal derived from pyrazoles in different commercial denture adhesives on their retentive efficacy, cytotoxicity and antimicrobial activity against Candida albicans was evaluated. Commercial denture adhesives were prepared with the inclusion of nystatin and 3,5-diaryl-4,5-dihydro-1H-pyrazole-1-carboximidamide (pyrazole) in three concentrations: 23.78 %w/w, 3.02 %w/w, and 0.31 %w/w (0.015 g, 0.0015 g, and 0.00015 g, respectively). The retentive efficacy was tested observing the influence of the medium, type of commercial denture type and the test condition (dipping). The antifungal action through disk diffusion and direct contact tests at 1, 4, 8 and 12 h and cytotoxic activity was evaluated in mouse fibroblasts (NIH/3T3) by the MTT reduction colorimetric assay. The addition of pyrazole and nystatin in commercial denture adhesives did not affect retentive efficacy rates and enhanced antifungal actions against Candida albicans. Results show a possibility of using denture adhesives as a delivery system for commercial antifungals (Nystatin) or pyrazole, with the second concentration (1,560 µg-3.02 %w/w) as the most efficient.