Journal of Clinical and Experimental Dentistry. 2012. Vol. 4, no. 1

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    Papillon- Lefèvre Syndrome: report of a case and its management
    (2012) Sachdeva, Shabina; Kalra, Namita; Kapoor, Pranav
    Papillon-Lefèvre Syndrome (PLS) is a rare autosomal recessive disorder first described by two French physicians, Papillon and Lefèvre in 1924. The disorder is characterized by diffuse palmoplantar keratoderma and precocious aggressively progressing periodontitis, leading to the premature loss of deciduous and permanent teeth at a very young age. The cutaneous lesions are usually manifested simultaneously with the intra-oral presentations and include keratotic plaques on the palms and soles varying from mild psoriasiform scaly skin to overt hyperkeratosis. The etiopathogenesis of the syndrome is relatively obscure and immunologic, genetic or possible bacterial etiologies have been proposed. Due to the vast degree of periodontal breakdown involved at such an early age, the dental surgeon is often the first to diagnose the syndrome. This paper presents a clinical presentation a 15 year old male diagnosed with Papillon- Lefèvre Syndrome.
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    Evaluation of periimplant bone neoformation using different scanning electron microscope methods for measuring BIC.: a dog study
    (2012) Calvo Guirado, José Luis; Aguilar Salvatierra, Antonio; Guardia Muñoz, Javier; Delgado Ruiz, Rafael Arcesio; Ramírez Fernández, Piedad; Pérez Sánchez, Cristina; Gómez Moreno, Gerardo
    Objetives: The aim of this study was to determine which of three methods for measuring BIC (bone-to-implant contact), using vestibular and lingual scanning electron microscopy (SEM) for different implant systems at 15, 30 and 90 days post-surgery was the most precise. An elemental analysis with SEM was used to evaluate neoformed bone composition for three implant systems at the same study times. Material and Methods: 36 implants were placed in eighteen Beagle dogs mandible about one year old and weighing approximately 12-13 kg in order to evaluate bone apposition to three different implant surfaces. It was used the third and fourth premolar and first molar distal sockets in both quadrants of the mandible (3P3, 4P4 and 1M1). Teeth were hemi-sected and the distal roots were removed. The specimens were prepared for histological examination and each section surface was stained using Masson's trichrome and hematoxylin and eosin stains. BIC evaluations were performed by the three methods, BIC I (the quantity of mineralized bone in direct contact with the implant's titanium surface across the entire threaded area); BIC II (along a line that passes from apex to apex of the implant threads); BIC III (both in areas around and above the threads and in between threads). Results: Both BIC and bone content were analyzed for all implants placed in P3, P4 y M1 alveoli on both, the buccal and palatine sides (elemental analysis quantified Ca, P, O and C). It was seen it was only at the ninety-day mark that high percentages of calcium were present. Conclusions: This study suggest that BIC III evaluation is the most certain method for establishing the quantity of bone formed as the BIC area.
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    Osteonecrosis of the jaws in patients treated with bisphosphonates
    (2012) Ata-Ali Mahmud, Fadi; Ata-Ali Mahmud, Francisco Javier; Flichy Fernández, Antonio; Bagán Sebastián, José Vicente
    The literature describes an increasing presence of bisphosphonate-induced osteonecrosis of the jaws (ONJ), characterized by the exposure for over 8 weeks of necrotic bone in the maxillofacial region, after bisphosphonate therapy, in the absence of prior maxillary radiotherapy. The present literature review examines the etiopathogenesis, risk factors, clinical forms, diagnosis, treatment and prevention of bisphosphonate-induced ONJ. In addition, a review is made of all the series involving over 15 patients diagnosed with this disorder between 1 January 2011 and 15 May 2011. A PubMed-Medline search was carried out with the following key words: 'bisphosphonates' and 'osteonecrosis'. The appearance of osteonecrosis is a serious complication, with an increasing incidence, that affects patient quality of life and causes important morbidity. All patients treated with bisphosphonates are at risk of developing osteonecrosis as a result of such medication. This potential complication therefore should be explained to the patient by both the prescribing physician and the dental surgeon in charge of oral treatment, with the obtainment of informed consent in all cases.
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    From Stem to Roots: tissue engineering in Endodontics
    (2012) Chandki, Rita; Kala, M.; Banthia, Priyank; Banthia, Ruchi
    The vitality of dentin-pulp complex is fundamental to the life of tooth and is a priority for targeting clinical management strategies. Loss of the tooth, jawbone or both, due to periodontal disease, dental caries, trauma or some genetic disorders, affects not only basic mouth functions but aesthetic appearance and quality of life. One novel approach to restore tooth structure is based on biology: regenerative endodontic procedure by application of tissue engineering. Regenerative endodontics is an exciting new concept that seeks to apply the advances in tissue engineering to the regeneration of the pulp-dentin complex. The basic logic behind this approach is that patient-specific tissue-derived cell populations can be used to functionally replace integral tooth tissues. The development of such 'test tube teeth' requires precise regulation of the regenerative events in order to achieve proper tooth size and shape, as well as the development of new technologies to facilitate these processes. This article provides an extensive review of literature on the concept of tissue engineering and its application in endodontics, providing an insight into the new developmental approaches on the horizon.
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    Comparison of Radiovisiography and Digital volume tomography to direct surgical measurements in the detection of infrabony defects
    (2012) Raichur, Preeti Satyabodh; Setty, Swati B; Thakur, Srinath L; Naikmasur, Venkatesh G
    Objectives: To compare the linear measurements of Radiovisiography (RVG) and Digital volume tomography (DVT) to direct surgical measurements in the detection of periodontal infrabony defects. Study design: RVG and DVT images were taken prior to periodontal surgery for 28 infrabony periodontal defects. After defect debridement, direct bony defect measurements were made from the cemento enamel junction (CEJ) to the base of the defect (CEJ-BD) and to the alveolar crest (CEJ-AC) with a periodontal probe. These same measurements were made on the RVG and DVT images and then compared to the direct surgical values. Results: DVT correlated strongly with surgical measurements, whereas RVG correlated less favorably (P=0.0109, P=0.0193 respectively).No significant difference for CEJ-AC (P=0.0599) was seen between DVT and surgical measurements; however, there was a significant difference for the distance CEJ-BD (P=0.0105). Conclusion: DVT technique is significantly more accurate than RVG in the detection of infrabony periodontal defects.
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    Clinical measurement of tooth wear: tooth Wear Indices
    (2012) López Frías, Francisco Javier; Castellanos Cosano, Lizett; Martín González, Jenifer; Llamas Carreras, José María; Segura-Egea, Juan J.
    Attrition, erosion, and abrasion result in alterations to the tooth and manifest as tooth wear. Each classification corresponds to a different process with specific clinical features. Classifications made so far have no accurate prevalence data because the indexes do not necessarily measure a specific etiology, or because the study populations can be diverse in age and characteristics. Tooth wears (attrition, erosion and abrasion) is perceived internationally as a growing problem. However, the interpretation and comparison of clinical and epidemiological studies, it is increasingly difficult because of differences in terminology and the large number of indicators/indices that have been developed for the diagnosis, classification and monitoring of the loss of dental hard tissue. These indices have been designed to identify increasing severity and are usually numerical, none have universal acceptance, complicating the evaluation of the true increase in prevalence reported. This article considers the ideal requirements for an erosion index. A literature review is conducted with the aim of analyzing the evolution of the indices used today and discuss whether they meet the clinical needs and research in dentistry
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    Evaluation of the Clinical Efficacy of Potassium nitrate Desensitizing Mouthwash and a Toothpaste in the Treatment of Dentinal Hypersensitivity
    (2012) Sharma, Sunita; Shetty, Neetha J.; Uppoor, Ashita
    Potassium Nitrate has been used as a desensitizing agent to treat dentinal hypersensitivity. The effectiveness of a potassium nitrate is evaluated both in the form of a toothpaste and a mouthwash in a clinical study. Thirty patients were assessed using evaporative stimuli and thermal stimuli and response was evaluated using Visual Analogue Scale at baseline, at 2 weeks and 4 weeks. The patients were divided into group I: fifteen patients who used toothpaste containing 5% potassium nitrate, sodium fluoride, xylitol and triclosan, group II: Fifteen patients who used mouthwash containing 3% potassium nitrate, sodium fluoride, xylitol and triclosan . The results of both the assessment methods indicated that potassium nitrate toothpaste as well as mouthwash showed statistically significant decrease in the sensitivity score on a Visual Analogue Scale. This was effective in reducing the symptoms of dentinal hypersensitivity when used either as toothpaste or as a mouthwash. But, there were no statistically significant differences between the groups, although both were effective in the treatment of hypersensitivity.
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    Evaluation of knowledge, experience and perceptions about medical emergencies amongst dental graduates (Interns) of Belgaum City, India
    (2012) Jodalli, Praveen S.; Ankola, Anil V.
    Introduction: Medical emergencies can occur frequently in dental setting. Effective management of an emergency situation in the dental office is ultimately the dentist's responsibility. The lack of training and inability to cope with medical emergencies can lead to tragic consequences and sometimes legal action. For this reason, all health professionals including dentists must be well prepared to attend to medical emergencies. Providing basic life support [BLS] is dentist's most important contribution until definitive treatment for a medical emergency can be given. Hence the study is aimed to assess the dental graduates (Interns) knowledge, skills and competency regarding dentistry-medical emergency interface. Methodology: Data were collected from 105 Interns of two dental colleges of Belgaum City using a structured questionnaire consisting of 7 item questionnaire (6 closed and 1 open ended). Results: Overall in all the years, syncope / faint was seen by 40.9% of the respondents, 37.1% with hypoglycemic attacks, allergic reactions by 17.1%, epileptic attacks by 7.6%, asthmatic attacks by 4.5% and angina 0.9%. The frequencies of the emergencies encountered were once or even more. Knowledge of the presence of drugs and equipments in the emergency drug kit and the confidence in regard to use them was low. Medical emergencies training were undertaken by 42% respondents, but in varying degrees. There was a desire for further medical emergencies training by majority of respondents. Conclusion: The study showed that syncope is the commonest medical emergency event. Dental graduates had a superficial knowledge of medical emergencies, drugs and equipments. Emphasis is placed on the need for more medical emergencies training to be offered, to increase knowledge and confidence of dental graduates (Interns) in the management of medical emergencies
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    Osteomyelitis affecting mandible in tuberculosis patients
    (2012) Karjodkar, Freny; Saxena, Vasu Siddhartha; Maideo, Anuradha; Sontakke, Subodh
    Tuberculosis (TB) is a frequent health problem in developing nations. It has two forms pulmonary and secondary causing other kinds of TB, collectively denoted extra pulmonary tuberculosis. The prevalence of extra pulmonary TB has increased in the last couple of years. Maxillofacial manifestations of tuberculosis form nearly 10% of all extra pulmonary manifestations of the disease. Extra pulmonary TB involving maxillofacial region is our prime concern. Very few cases of TB of the temporomandibular joint (TMJ) and mandible have been reported in literature. The clinical appearance of TB infection of the TMJ has been described as unspecific, resembling arthritis, osteomyelitis, cancer or any kind of chronic joint diseases. This article describes two cases where the bone, namely TMJ. and angle of mandible are affected by tuberculosis. In addition to conventional radiographs we used Cone Beam Computed tomography (CBCT) to explore the third dimension of the lesion
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    Prevalence of Talon cusp in Indian population
    (2012) Prabhu, Rachana V; Rao, Prasanna Kumar; Veena, KM; Shetty, Prathima; Chatra, Laxmikanth; Shenai, Prashanth
    Aim: To investigate the prevalence of the talon cusps in a sample of Indian dental patients and their distribution among different types of teeth. To determine the presence of other dental anomalies associated with the talon cusps. Methodology: 2740 out patients (1523 males and 1217 females) attending Oral Medicine department from November 2010 to January 2011 were screened for the presence of talon cusps and were subjected to Intra Oral Peri-apical (IOPA) radiograph to rule out any associated anomalies or peri-apical changes. Results: Talon cusps were detected in 16 out of 2740 patients (person prevalence 0.58%). Thirty one teeth were found to have talon cusp. Maxillary lateral incisors were the most commonly affected teeth (54.8%, 17 teeth), followed by maxillary central incisors and canines (16.12%, 5 teeth).Talon cusp was found in two mandibular central incisors (6.45%) and one each in mandibular second and third molar (3.22% each). Seventeen teeth in 7 patients (54.83%) were found to be associated with anomalies like dens invagination (6 teeth, 19.35%), impacted 13, 23 (6 teeth, 19.35%), partial anodontia (3 teeth, 9.67%), geographic and fissured tongue (2 teeth, 6.45%). Peri-apical granuloma was found in one tooth with talon cusp associated with dens invaginatus. None of the patients were found to be associated with any syndromes. Conclusion: Attention should be paid to the presence of the talon cusp and the associated anomalies. Early diagnosis of the talon cusp can help the clinician in preventing the further complications.
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    Polymerase chain reaction of enterococcus faecalis and candida albicans in apical periodontitis from Turkish patients
    (2012) Dumani, Aysin; Yoldas, Oguz; Yilmaz, Sehnaz; Koksal, Fatih; Kayar, Begum; Akcimen, Beril; Seydaoglu, Gulsah
    Aim: The aim of this study was to determine the frequency of two important pathogenic microorganisms associated with endodontic infections, Enterococcus faecalis and Candida albicans, in root canal samples from patients with necrotic pulps or failed canal therapy by polymerase chain reaction method. Methodology: Microbial samples were obtained from 117 teeth with necrotic pulp tissues and 114 teeth with failed endodontic treatment. Results: E.faecalis were identified in 16% of the necrotic and 10% of the retreated root canal infections by PCR. C.albicans genome were identified in 20% and 11% of the necrotic and retreated root canal infections, respectively, by PCR. The frequencies of microbiota were not statistically different between necrotic and retreatment groups (p > 0.05, chi squared test). Conclusions: PCR analysis of teeth with periapical lesions revealed that E.faecalis was found in fewer patients than in previous studies. The C.albicans prevelance was consistent with previous reports. No statistical difference was found between primary and secondary root canal infections for C.albicans or E.faecalis.
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    Utility of Periodontal exploration in patients with Fibromyalgia
    (2012) Santos García, Rocío; Sánchez Domínguez, Benito; Cordero, Mario David; Ríos Santos, José Vicente; Jaramillo Santos, Reyes; Herrero Climent, Mariano; Bullón, Pedro
    Objetive: Fibromyalgia (FM) is a chronic pain syndrome with unknown etiology, which affects predominantly women. Mitochondrial alteration could have a role in the pathophysilogical mechanisms of inflammatory conditions as FM and periodontitis. The aim of the present study was assay the relationship between both diseases and mitochondrial dysfunction. Patients and methods: We study the presence of periodontitis in twelve patients diagnosed of FM and mitochondrial dysfunction described. The diagnosis of FM was established according to ACR criteria and clinical symptoms were evaluated using the Fibromyalgia Impact Questionnaire (FIQ) and Beck Depression Inventory (BDI). Results: Only one patients of twelve included and agreed to participate in the study were diagnosed with periodontitis. Conclusions: Pending studies with larger numbers of patients, we can conclude that mitochondrial dysfunction in FM is a itself event not related with periodontitis. Periodontitis could be considered a exclusion criterion in all studies about mitochondrial dysfunction in patients
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    Bone necrosis around dental implants: a patient treated with oral bisphosphonates, drug holiday and no risk according to serum CTX
    (2012) Flichy, Patrice; González Lemonnier, Sandra; Balaguer Martínez, José; Peñarrocha Oltra, David; Peñarrocha Diago, Miguel; Bagán Sebastián, José Vicente
    Osteonecrosis of the jaw (ONJ) may appear following certain oral surgery procedures in patients treated with oral bisphosphonates (OB). Guidelines for the treatment of these patients were set out in the American Association of Oral and Maxillofacial Surgeons (AAOMS) Position Paper on Bisphosphonate-Related Osteonecrosis of The Jaws (Position Paper) and Approved by the Board of Trustees in September 2006. For the AAOMS the placement of implants in these patients is not contraindicated. In addition, the serum C-terminal telopeptide bone suppressor marker (CTX) test is available to determine the risk of ONJ. A case is presented of ONJ in a patient with 6 months of OB discontinuation ('drug holiday') before dental implant placement (following the guidelines of the AAOMS) and with no risk of osteonecrosis according to the serum CTX value (340 pg/ml). The wound healed favorably with complete healing at 7 months. In this case, the serum CTX test must be questioned as to its predictive value of ONJ, and more reliable markers of this risk are needed.
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    In vitro susceptibility of e.faecalis and c.albicans isolates from apical periodontitis to common antimicrobial agents, antibiotics and antifungal medicaments
    (2012) Dumani, Aysin; Yoldas, Oguz; Yilmaz, Sehnaz; Akcimen, Beril; Seydaoglu, Gulsah; Kipalev, Arzu; Koksal, Fatih
    The aim of this study was to evaluate in vitro antimicrobial activity of 4 antibiotic agents (for E.faecalis) and 4 antifungal agents (for C.albicans) by agar dilution method. Additionally, modified strip diffusion method was used for detection of in vitro antimicrobial activities of 5% NaOCl, 2.5% NaOCl, 17% EDTA and 2% CHX and agar diffusion method for detection of in vitro susceptibilities of three intracanal medicaments for 18 E.faecalis and 18 C.albicans isolates from primary and secondary root canal infection. Isolates were recovered from 231 endodontic samples of patients, with the need of root canal treatment and retreatment. All tested E.faecalis isolates showed resistance to antibiotics. For irrigation solutions, 2% CHX was more effective in eliminating E.faecalis but 5% NaOCl showed larger inhibition zone than 2.5% NaOCl, 17% EDTA and 2% CHX. For intracanal medication, Ca(OH)2-CHX worked efficiently in killing E.faecalis isolates compared to Ca(OH)2-Steril saline solution, Ca(OH)2-Glycerin. For C.albicans, 18 isolates were susceptible to amphotericin B, nistatin, fluconazole but showed resistance to ketoconazole. 5% NaOCl was more effective in eliminating and produced larger inhibition zone compared to 2.5% NaOCl, 17% EDTA and 2% CHX. Ca(OH)2-Glycerin intracanal medication was better in eliminating C.albicans isolates and produced larger inhibition zone compared to other Ca(OH)2 medicaments.
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    Corticotomy-assisted orthodontics
    (2012) Cano, J.; Campo, Julián; Bonilla, Elena; Colmenero Ruiz, César
    The use of orthodontic treatment in adult patients is becoming more common and these patients have different requirements specially regarding duration of treatment and facial and dental aesthetics. Alveolar corticotomy is an effective means of accelerating orthodontic treatment. This literature revision include an historical background, biological and orthodontic fundamentals and the most significant clinical applications of this technique. Orthodontic treatment time is reduced with this technique to one-third of that in conventional orthodontics. Alveolar bone grafting of labial and palatal/lingual surfaces ensures root coverage as the dental arch is expanded. Corticotomyassisted orthodontics has been reported in a few clinical cases, and seems to be a promising adjuvant technique, indicated for many situations in the orthodontic treatment of adults without active periodontal pathology. Its main advantages are reduction of treatment time and postorthodontic stability. Further controlled prospective and histological studies are needed to study tooth movement, post-retention stability, and microstructural features of teeth, periodontium, and regenerated bone after using this procedure.
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    Can Orthopantomography be used as a tool for screening of carotid atheromatous pathology and thus be used to help reduce the prevalence of ischemic stroke within the population?
    (2012) Veiga Abecasis, Pedro; Chimenos Küstner, Eduardo
    Objective: To assess the possibility of Dentists being able to screen patients with higher risk of vascular diseases. Materials: Kodak 8000C Orthopantomographer, eco-Doppler Logiq-500 General Electric at the Lisbon Hospital Particular. Methods: Assessment of orthopantomographies made to 142 patients aged 50 or more, as well as the existing risk factors. Conduction of carotid eco-Doppler to patients who appear to have calcified plaques of the atheroma. Results: Strong dependence between dichotomised age and having the pathology (p = 0.02).Smokers are twice more likely to present plaques (OR= 2). Being hypertensive increases in about 1.4 the likelihood of having a stroke (OR= 1.4). Of the 27 individuals who presented calcifications in the Orthopantomography, they were all submitted to an eco-Doppler and 21 had the pathology confirmed. 27 individuals, who did not show any plaques in the Orthopantomography, were randomly selected to be the control group. They were submitted to an eco-Doppler. And 23 confirmed the non-existence of plaques. Conclusions: Orthopantomography used for assessing the oral cavity reveals more information which should be the object of the Dentist's attention