Journal of Clinical and Experimental Dentistry. 2011. Vol. 3, no. 4

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    Central Odontogenic Fibroma combined with Central Giant Cell lesion of the mandible. Immunohistochemical profile.
    (2011) Bologna-Molina, Ronell; Pacheco Ruiz, Laura; Mosqueda Taylor, Adalberto; Huesca Ramirez, Héctor Gustavo; Ponce Lonato, José Angel; González González, Rogelio
    Central Odontogenic Fibroma is a benign neoplasm of mesenchymal origin that makes up less than 5% of odontogenic tumors. There is a variation of this lesion that includes a zone of giant cells. This neoplasm is characterized by fibroblast proliferation, a component of apparently inactive odontogenic epithelium within a mature connective tissue stroma and multinucleated osteoclast-like giant cells. Clinically, it manifests as a slow-growing central lesion, which causes painless cortical expansion and may occasionally cause the displacement of adjacent dental organs or resorption. We present a new case of this combined lesion that was revealed radiographically as a well-defined radiolucent area in the left mandibular body. Histologically, we identified a mesenchymal lesion composed of mature fibrocellular tissue, where islands and cords of odontogenic epithelium and fibrocellular areas with numerous giant cells can be distinguished. The immunohistochemical examination was positive for giant cells with the marker CD68 and positive for epithelium cords with the marker CK19, which indicates that this an odontogenic lesion.
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    A Literature Review of Different Criterias for Selecting and Cementing a post: a review
    (2011) Grewal, Partapjot Singh; Grewal, Kanu Priya; Grover, Deepak
    The primary function of a corono-radicular post is to provide retention for a core, which replaces lost coronal tooth structure and retains the final restoration without compromising the apical seal of the endodontic filling. Therefore, it is important to select a post system that provides maximum retention, yet removes as little as possible of the remaining subgingival tooth structure. Several new esthetic dowel systems are available for the restoration of endodontically treated teeth, but little is known about how effectively these dowels seal the restored teeth. These post and core restorations are subjected to repeated tension, compression and torquing forces. Most forces clinically manifest themselves as tensile forces or shear stress on the post-cement-dentin interfaces. Recently, various endodontic dowel systems have been made available for restoring endodontic treated or mutilated teeth, making the choice difficult for the practitioner. In light of this, the current paper provides an insight into the various post and core systems available, the criteria and methods for their selection and cementation.
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    Effect of ozone therapy upon clinical and bacteriological parameters of the oral cavity: an update
    (2011) González Muñoz, L.; Flichy Fernández, Antonio; Ata-Ali Mahmud, Francisco Javier; Pascual Moscardó, Agustín; Peñarrocha Diago, María
    Objective: To review the literature on ozone therapy in oral health, as assessed by different clinical and bacteriological parameters. Material and methods: A PubMed literature search was made using the key words “ozone dental”, and establishing as limits “randomized controlled trial” and “dental journal”. Thirteen articles were identified, with access to only 6 of them. Results: Four studies used ozone for the treatment of caries. One study examined its effect upon dental hypersensitivity, while another evaluated the efficacy of ozone as a tooth whitening technique. Five studies explored the bacteriological actions of ozone therapy in reference to different types of bacteria. Conclusion: The reviewed literature yields a number of studies describing a high antimicrobial potential of ozone therapy in different dental areas, though very few in vivo studies have evidenced the success of such treatment. Further studies are therefore needed in this field.
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    The diagnostic role of saliva: a review
    (2011) Mittal, Sanjeev; Bansal, Vikram; Garg, Shushant K.; Atreja, Gaurav; Bansal, Sanjay
    As a diagnostic fluid, saliva offers distinctive advantages over serum because it can be collected non-invasively by individuals, even by patient. Does not require special equipment for collection and storage as unlike blood saliva does not clot. Advantageous for person in whom blood drawing is difficult as in obese and haemophilic patient. Whole saliva used for diagnosis of systemic diseases, because it contains serum constituents. These constituents are derived from the local vasculature of the salivary glands and gingival cervicular fluid.This review examines the diagnostic application of saliva for hereditary disorders, autoimmune diseases, malignant and infectious diseases, and endocrine disorders, as well as in the assessment of therapeutic levels of drugs and the monitoring of illicit drug use, and also for forensic evidence and others. . In future we are likely to see the increased utilization of saliva as a diagnostic fluid. As we enter the era of genomic medicine, sialochemistry will play an increasingly important role in the early detection, the monitoring and progression of the systemic and oral diseases.
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    Extreme ameloblastoma of the mandible with hypoproteinemia: a case report and review of clinicopathological features
    (2011) Acharya, Swetha; Joshi, Abhijit; Tayaar, Amsavardani S.; Gopalakrishna, Kodyalamoole
    Ameloblastoma is a tumor of odontogenic epithelium. It has an intermediate malignant potential, thus positioning it in a gray zone between benign and malignant neoplasms. Invasive ameloblastomas of excessive size are rarely confronted. Although these ameloblastomas are benign, they are life threatening. Many have eventuated in death due to airway obstruction, starvation from restriction of feeding, and complications of hypoproteinemia. These tumors cause significant expansion of skin and lips [tissue expanders]. Due to its metabolic demands, a tumor of enormous size will have numerous feeding vessels. Patients with extreme ameloblastomas are usually from rural areas of developing countries who delay the treatment due to fear of surgery. We present a case of extreme ameloblastoma in a 35 year old female which was a consequence of patient negligence. The tumor reached an enormous size over 10 years causing gross facial deformities and posed considerable problems in management.
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    Skillful management of exodontia complication to prevent dreadful sequelae
    (2011) Bansal, P.; Rohatgi, S.; Sheokand, N.
    Successful surgical treatments depend upon accurate diagnosis, judicious treatment planning, selection and execution of an appropriate surgical technique, and on a well monitored post-operative period. However, despite these precautions, extraction of teeth (particularly third molar) is exposed to the accidents and complications common to all buccomaxillary and facial interventions. A maxillary third molar may be displaced in maxillary sinus, nearby soft tissue, or may migrate in a superioposterior direction towards paraphyrangeal space, or infratemporal fossa. Dislocating the maxillary third molar in infratemporal fossa is one of the worst nightmare as this area has complex anatomy consisting of vital neurovascular tissues and complex fascial spaces. The extent of displacement depends upon anatomical conditions as well as direction and amount of force applied. Complication arises from error in judgment, improper use of instruments, the application of extreme force or failure to obtain full visualization before acting. Various researchers have given their opinion regarding immediate or delayed removal of tooth pushed in infratemporal fossa but almost all agree that each case should be weighed independently for risk and reward before attempting. Here we present a case in which intraoral approach was taken to retrieve the displaced tooth thus preventing potentially dreadful complications.
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    Fibro-osseous lesion of maxilla. Report of two cases in a family with review of literature
    (2011) Kaur, Bhawandeep; Sheikh, Soheyl; Shambulingappa, P.
    Fibrous dysplasia is a disturbance of bone metabolism that is classified as a benign fibro-osseous lesion. Fibrous connective tissue containing abnormal bone, replaces normal bone. The etiology of fibrous dysplasia is unknown. The radiographic appearance of the irregularly shaped trabeculae aids in the differential diagnosis. Occurring most commonly in the second decade of life, the lesions of fibrous dysplasia can be surgically recontoured for esthetic or functional purposes once they become dormant.
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    Vanishing (Disappearing) Bone Disease in children: a review
    (2011) Nagaveni, N.B.; Radhika, N.B.; Umashankara, K.V.; Satisha, T.S.
    Vanishing bone disease is a very rare, peculiar destructive condition of the skeletal system resulting in spontaneous and progressive resorption and disappearance of osseous structures with replacement by vascular, fibrous connective tissue. Children and adolescents are most commonly affected, although patients ranging in age from 18 months to 40 years have been reported. Its clinical presentation is highly variable largely depending upon the site of skeletal involvement. The maxillofacial territory and upper extremity bones are the predominant sites affected by this ailment. The etio-pathogenesis of this condition still remains poorly understood, the natural history and prognosis is unpredictable. Radiographic findings associated with vanishing bone disorder are particularly dramatic and characterized by complete resorption and disappearance of the affected bone leading to the definition of “vanishing bone” or “disappearing bone disease.” Although various treatment options have been suggested, in general, no single treatment modality has proven effective in arresting this rare clinical entity. The present article provides an insight into the in-depth comprehensive review of literature pertaining to this fascinating musculoskeletal disorder in children.
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    Differences in clinical variables and risk factors between patients with osteoarthritis and osteoarthrosis of the temporomandibular joint (TMJ)
    (2011) Poveda Roda, Rafael; Bagán Sebastián, José Vicente; Sanchís Bielsa, José María
    Objective: To study differences in risk factors and clinical variables between a group of patients with osteoarthritis and a group with osteoarthrosis of the temporomandibular joint. Material and methods: Thirty-five patients (32 women and 3 men) (mean age 53±18 years), 21 (60%) with a diagnosis of osteoarthrosis (mean age 54.7±20.2 years) and 14 (40%) with a diagnosis of osteoarthritis (mean age 51.7±16.9 years), were studied. The two groups were compared with each other and also with the group of 164 patients with temporomandibular joint pathology from which they were drawn. An evaluation was made of the demographic variables, risk factors (parafunctions, posterior occlusal contacts, sleep disturbances and psychoactive medication), clinical manifestations (pain, joint sounds, limitation of mandibular movements) and panoramic X-ray and magnetic resonance imaging alterations. Results: None of the studied variables showed statistically significant differences between osteoarthritis and osteoarthrosis. Age was significantly older among the patients with osteoarthritis/osteoarthrosis than in the general group of patients with temporomandibular joint pathology (36.9±17.2) (F=20.1; p=0.000). The time from appearance of the symptoms to medical consultation (35.9±41.8 months) was significantly longer in patients with osteoarthritis (F=3.95; p=0.049). The number of posterior occlusal contacts (5.2±3.0), maximum aperture (32.5±6.5 mm), and the frequency of parafunctions (42.9%) were significantly lower in the group of patient with osteoarthritis (F=6.2 p=0.01; F=4.45 p=0.04; χ2 =4.85 p=0.03) than in the group of patients with temporomandibular joint pathology from which they were drawn. Conclusions: No epidemiological or clinical differences were observed between osteoarthritis and osteoarthrosis, though both processes - particularly osteoarthritis - showed differences with respect to the group of patients with temporomandibular joint pathology from which they were drawn.
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    Fibrous Dysplasia and Ossifying Fibroma-an advent in their diagnosis
    (2011) Gulati, Anubha; Rao, Nirmala; Radhakrishnan, Raghu A.
    Objectives: Fibro-osseous lesions of the craniofacial complex comprise of a diverse, interesting and challenging group of conditions that pose difficulties in classification and treatment. The two most confused benign fibro-osseous lesions are fibrous dysplasia and ossifying fibroma. Sometimes, the classic clinical, radiologic or pathologic features of fibrous dysplasia or ossifying fibroma may not be evident, but overlapping features of both may be seen. The dilemma in diagnosis of these lesions rests in the bony trabeculae as well as in the fibrous stroma. Cases of fibrous dysplasia showing lamellated bony trabeculae and osteoblastic rimming have been reported which may confound diagnosis because of resemblance with ossifying fibroma. In the present study, an attempt has been made to demonstrate the fibrous element of these two lesions using histochemical stains. Study design: The sections of fibrous dysplasia & ossifying fibroma were stained with Haematoxylin and Eosin, Trichrome stain and Peracetic acid-aldehyde fuschin-modified Halmi stain. Result: The study revealed that the oxytalan fibers were more numerous in ossifying fibroma (seen with both Trichrome and modified Halmi stains). Conclusion: Although the ultimate diagnosis of fibrous dysplasia and ossifying fibroma is arrived at by correlating clinical, radiographic and routine histopathologic examination, the differences in the configuration of the stroma using histochemical stains may help in the diagnosis of these two lesions.
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    Hemostatic agents used in apical surgery: a review
    (2011) Maestre Ferrín, Laura; Peñarrocha Diago, María
    Objective: A review was made of the current literature on hemostatic agents used in apical surgery in order to determine their effectiveness and adverse effects. Material and methods: The main search terms used were: endodontic surgery, apicoectomy, apical surgery, periradicular surgery, hemostasis, hemostatic agents, and bleeding control. The authors searched the Medline database for articles published up to 1 September 2010. Experimental and clinical studies comparing the effectiveness and/ or adverse effects of two or more hemostatic agents and published between 2000 and 2010 were included in the review. Results: Four studies were analyzed: two clinical studies and two experimental studies. According to the clinical studies, epinephrine produces no changes in blood pressure or heart rate when used to control bleeding in periapical surgery. Aluminum chloride alone or in combination with ferric sulfate was found to be the most effective agent in the experimental studies, and the tissue damage it causes was not observed when the superficial bone layer was eliminated with rotary instruments. Conclusion: Additional controlled clinical trials are needed to not only assess the efficacy of the different hemostatic agents but also to investigate their influence upon healing and the outcome of periapical sur gery.
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    Two-year sealant survival in a high caries cohort at a graduate pedodontic clinic
    (2011) Samara, Suad A.; Haidar, Ziyad
    Objectives: To assess the efficacy of resin sealants in children aged 6-12 years referred to one graduate pedodontic program located in the Middle East (2009-2010). Study Design: Data from a cohort of 110 patients with at least 2 erupted first permanent molars were included in this study. Dental health status was evaluated using the DMFs/t index. UltraSeal XT® Plus sealants (n=253 applications) were performed in presence of rubber dam isolation and survival carefully inspected and scored at 1 and 2 years. Cross-sectional examination of descriptives and bi/multivariate analysis followed. Results: Majority (63%) were males. Caries were diagnosed in 77.9% of children with only 1% deemed caries-free. Hence, mean DMFs/t was 9.3±6.1/7.2±5.1, respectively. At 2 years, 66% of sealants were completely retained and 11% completely lost. Analysis revealed higher sealant survival in mandibular teeth. Conclusions: Fluoride-releasing resin sealant is an effectual preventive tool especially in such a high carious population.
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    The Frequency of taurodontism in the Turkish population
    (2011) Topcuoglu, H. Sinan; Karata, Ertuğrul; Arslan, Hakan; Koseoglu, Mustafa; Evcil, M. Sinan
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    Toxicity test of a dental commercial composite in rats.
    (2011) Ponce Bravo, Santa; Ledesma Montes, Constantino; Martinez-Rivera, Jorge I.; Morales-Sanchez, Israel
    Objective: The aim of this study was to determine the 90-day subchronic toxicity of one triethylene glycol dimethacrylate containing composite (MEDENTAL Light-Cure Composite™) orally administered to rats according to OECD no. 48 guidelines and the requirements specified in the International Organization for Standardization 10993-11. Study design: The composite was administered orally to Wistar rats during 90 days and they were observed to determine changes in their behavior, eye and skin signs and other attitudes such as aggressiveness, posture, walking and response to handling. After 90 days they were sacrificed to determine blood alterations, special hematological tests were done and histopathological changes in 33 different organs were assessed. Results: Under the experimental conditions, our results showed that the composite tested in this study did not produce significant changes in clinical behavior of the animals. Microscopic review of the Hematoxilin and Eosin stained slides obtained from 33 analyzed organs showed no abnormal inflammatory or cytological changes and all hematological special tests were within normal limits. Conclusions: The results of this study show that under our experimental conditions the MEDENTAL Light-Cure Composite™ does not produce inflammatory or cytological changes suggestive of toxicity.
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    Effectiveness of a recent topical sialogogue in the management of drug-induced xerostomia
    (2011) Martin-Piedra, M.A.; Aguilar Salvatierra, Antonio; Herrera, David; Gómez Moreno, Gerardo
    Objectives: Use of certain drugs is the most common aetiology of xerostomia. Systemic sialogogues provide a longer effect than topic ones, but also induce relevant side effects. Topical sialogogues, as malic acid, allow a safe use as they induce no systemic side-effects or pharmacological interactions, being especially interesting in cases of mild hyposalivation and oral dryness, mainly the chronic use of xerostomizing drugs. The aim of this study was to evaluate the clinical effect of 1% malic acid in patients affected by xerostomia due to antihypertensives or antidepressants. Study Design: 10 patients with drug-induced xerostomia were prospectively evaluated before and after using malic acid spray during three weeks. Xerostomia Inventory (XI) was used to evaluate subjective improvement. Unstimulated and stimulated salivary flow rates were determinated. Results: Severity significantly decreased, from 38.22 to 31.00 points (p = 0.011) after using the product. 77.8% of subjects did not complain about xerostomia at the end and 66.6% achieved an improvement > 6 points. Unstimulated flow rate singnificantly increased, from 0.163 to 0.226 mL/min (p = 0.021) at the third week. Conclusions: 1% malic acid spray induces some improvement in the management of mild and reversible xerostomia. Carrying out of randomized controlled trials is justified according to this study.
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    Acculturation and oral health status among Tibetan immigrants residing in Bangalore City, India
    (2011) Radha, G.; Pushpanjali, K.; Aruna, C. N.
    Background: This study is the first of its kind conducted among Tibetans immigrants to Bangalore City, India to study the effects of acculturation on the oral health outcomes of less established group of individuals. Objectives: To determine the Acculturation and oral health status among Tibetan immigrants in Bangalore city and to assess the relationship between them. Materials and Methods: A random sample of 560 immigrants aged 18 years and above from different Tibetan centre of Bangalore city were included for the study. Acculturation was measured using modified Psychological-behavioral acculturation scale. Dental caries experience and periodontal status were recorded. Results: 49.1% of females and 50.9% of males were in highly accultured group. Bivariate analysis using Chi-square test was performed using 5% significance level. Logistic regression analysis demonstrated a strong association between DMFT and Ethnic factors, and periodontal status with language barrier and utilization of health care. Discussion: Reducing disparities in oral health status and in the use of dental services among Tibetan immigrants require attention to cultural factors such as language barrier and age at migration and immigrant’s degree of acculturation.