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Language Journal of Clinical and Experimental Dentistry. 2017. Vol. 9, no. 11
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- Dental implants placement in paranoid squizofrenic patient with obsessive-compulsive disorder : a case report(2017) Castellanos Cosano, Lizett; Corcuera Flores, José Ramón; Mesa-Cabrera, MarÃa; Cabrera DomÃnguez, José Javier; Torres Lagares, Daniel; Machuca Portillo, GuillermoParanoid schizophrenia is a mental illness that involves no observable anatomical alteration. Main characteristic affects the personality of the individual, as well as areas of his own psychology. A 33-year-old man with paranoid schizophrenia and obsessive-compulsive disorder in treatment with Haloperidol, Oxcarbazepine, Olanzapine and Seroquel is presented. Dental exploration showed widespread decay mostly cervical with numerous root fragments, agenesis of lateral incisors, impacted wisdom teeth, missing teeth and malocclusion. Treatment plan included restoration of teeth decay, extractions of root fragments and implant-supported prostheses in bilateral upper lateral incisors for aesthetics reason. A previous consultation with a psychiatric specialist was performed and no contraindication were observed. A preliminary radiological examination was performed previous dental treatment and implant placement. Due to patient refusal to replace dental abscenses with implants, inform consent was signed up from his parents. After local anesthesia, first implant was placed at upper right lateral positions (Straumann Bone Level Ø 3.3 mm, length 10 mm). Two weeks later a second implant was placed at upper left lateral position (Straumann Bone Level Ø 3.3 mm, length 12 mm). The patient showed no postoperative complications. After implant placement, the patient attended scheduled review appointments. The prosthesis was placed after a 3-month period of osseointegration. Implant placement can be considered a suitable option for people with mental disorders. A previous consultation with psychiatric specialists for conducting a good patient management is necessaire.
- Severe tetracycline dental discoloration : restoration with conventional feldspathic ceramic veneers. A clinical report(2017) Faus Matoses, Vicente; Faus Matoses, Ignacio; Ruiz-Bell, Esther; Faus Llácer, VicenteThe treatment of severe tetracycline discoloration is a challenge for the dentist. There are several treatment options and one of the most effective is the use of feldspathic veneers. The aim of this clinical case was to carry out the replacement with conventional feldspathic ceramic veneers on a patient with highly stained teeth (grade IV tetracycline) by a minimally invasive approach. Clinical examination revealed gingival retraction, color change of the veneers, ceramic cracked of 1.1 and 1.3 and incisal wear in lower anterior teeth. The decision was to retreat with feldspathic ceramic veneers from 1.6 to 2.6. Premolars and first molars were included because its dark color intensifies the width buccal corridors. Also, the restoration with veneers from 3.3 to 4.3 was considered. Firstly, the veneers were removed and the color was selected by the Vitapan 3D Master guide (Vita Zahnfabrick, Bad Säckingen, Germany). Mock-up was made to evaluate aesthetic, phonetic and functional parameters. Then, teeth were prepared through the mock-up in order to reduce the minimal amount of dental tissue possible. Opaque dentine mass of microhybrid composite (Esthet-X A2O, Dentsply Sirona, Konstanz, Germany) was placed to mask the most intense stains. The definitive impressions were taken with silicone (Aquasil Ultra XLV, Dentsply Sirona, Konstanz, Germany) were taken to fabricate conventional feldsphatic ceramic veneers (Noritake kisai Co, Ltd. Japan) by the parallel stratification masking technique. For cementing, an opaque cement was selected from the try-in tests (Calibra, Dentsply Sirona, Konstanz, Germany) and the composite was silicatized with an air-abrasion device. A favorable and minimally invasive result was achieved to treat grade IV tetracycline stains, surpassing the patient?s aesthetic expectations and functional needs.
- Orthodontics and veneers to restore the anterior guidance. A minimally invasive approach(2017) Faus Matoses, Vicente; Faus Matoses, Ignacio; Jorques-Zafrilla, Ana; Faus Llácer, VicenteTooth wear is defined as the progressive loss of a tooth?s surface due to actions other than those which cause tooth decay or dental trauma. It is a pathological condition with an increasing prevalence among young people. The aim of this article is to describe an alternative treatment modality to rehabilitate the anterior guidance by a minimally invasive interdisciplinary ortho-restorative treatment. Two patients came to the dental clinic for restorative treatment in order to rehabilitate the worn anterior dentition. Clinical analysis showed tooth surface loss located at the incisal edges by attrition due to an inadequate anterior guidance. In both cases the occlusal vertical dimension was reduced. First, following Dahl?s principle, resin attachments were placed in the upper canines. These attachments allowed the extrusion of posterior teeth in order to increase the occlusal vertical dimension. Furthermore, anterior teeth were intruded in order to create space for the restorative material. In the second phase, the restorative treatment was completed. Due to the characteristics of the case, feldspathic ceramic veneers were indicated. A diagnostic wax-up was performed to assist the treatment planning and a mock-up was prepared. Then, maxillary incisors were prepared through the mock-up to ensure a minimally invasive technique. Afterwards, silicone impressions were taken. Finally, veneers were cemented with a light-cured cement. In the present case, the functional and aesthetic parameters required by the patients were achieved, thus satisfying their needs.
- Preload loss of abutment screws after dynamic fatigue in single implant-supported restorations. A systematic review(2017) Pardal Peláez, Beatriz; Montero MartÃn, JavierTo carry out a systematic literature review of the causes of preload loss of the abutment screws, of internal and external connection implants, tightened to different torque values and subjected to cyclic loading. A systematic search was conducted in PubMed, EMBASE, and Cochrane Library databases with reference to in vitro studies in which internal and external connection implants were subjected to cyclic loads to determine the degree of loosening of the abutment screws after loading. The reviewed studies tested distinct implant connections (mostly externally hexed, and morse taper) subjected to diverse cycles (from 16667 to 1 million), with loads ranging from 0-400 Nw, using screws of different materials and designs that were tightened into torques between 20-45 Ncm, Accordingly after loading the percentage of torque loss ranges between 16.1% to 39%. Most of the studies indicate that the internal connection, together with the morse taper, best resists cyclic loading in terms of screw loosening in single-tooth implants.
- Implant failure and history of failed endodontic treatment : a retrospective case-control study(2017) Chatzopoulos, Georgios S.; Wolff, Larry F.Residual bacterial biofilm and/or bacteria in planktonic form may be survived in the bone following an extraction of an infected tooth that was endodontically treated unsuccessfully Failed endodontic treatment may be associated with failure of implants to osseointegrate in the same sites. Therefore, the aim of this retrospective case-control study is to examine the risk of implant failure in previous failed endodontic sites. This retrospective case-control study is based on 94 dental records of implants placed at the University of Minnesota School of Dentistry. Dental records of patients who received an implant in sites with previously failed endodontic therapy in the dental school were identified from the electronic database, while control subjects were obtained from the same pool of patients with the requirement to have received an implant in a site that was not endodontically treated. The mean age of the population was 62.89±14.17 years with 57.4% of the sample being females and 42.6% of them being males. In regards to the socio-economic status and dental insurance, 84.0% of this population was classified as low socio-economic status and 68.1% had dental insurance. Tobacco use was self-reported by 9.6% and hypercholesterolemia was the most prevalent systemic medical condition. Dental implant failure was identified in two of the included records (2.1%), both of which were placed in sites with a history of failed endodontic treatment. Within the limitations of this retrospective case-control study, further investigation with a larger population group into implant failure of sites that previously had unsuccessful endodontic treatment would be warranted. Implant failure may be associated with a history of failed endodontic treatment.
- Evaluation of changes in salivary composition in renal failure patients before and after hemodialysis(2017) Khanum, Nishath; Mysore-Shivalingu, Mahesh; Basappa, Srisha; Patil, Archana; Kanwar, SantoshSaliva plays a major role in preserving the integrity of oral tissues. The oral health of renal failure patients could be negatively affected by the underlying pathology, the dialysis treatment, or an altered salivary composition. Major systemic changes occur during hemodialysis (HD), which could affect the flow rate and biochemical composition of saliva. Therefore, the aim of this study was to evaluate the effects of HD on the salivary flow rate, pH and biochemical composition before and after completion of a dialysis session. Thirty Renal failure patients undergoing hemodialysis were selected based on the inclusion and exclusion criteria set forth for the study. Unstimulated whole saliva (UWS) was collected by the spitting method, immediately before and after a dialysis session. Salivary flow rate, pH, concentration of urea, creatinine, sodium, chloride, potassium and calcium were measured. Hemodialysis had an acute stimulating effect on the salivary flow rate. The mean pH of UWS showed no significant changes before and after dialysis. The concentrations of urea, creatinine, chloride and potassium in whole saliva changed markedly before and after a hemodialysis session; whereas no significant difference was seen in the concentration of sodium and calcium. This study shows that HD has significant acute effects on both salivary secretion and biochemical composition in saliva. We conclude that the observed changes in salivary concentrations and flow rate are mainly due to an increased watery secretion from the salivary glands and also saliva can be used as a tool for monitoring hemodialysis.
- Management of permanent teeth with necrotic pulps and open apices according to the stage of root development(2017) Plascencia, Hugo; DÃaz Haro, Ana; Gascón, Gerardo; Garduño, Susana; Guerrero Bobadilla, Carlos; Márquez-De Alba, Salvador; González-Barba, GeovaniThis paper analyzed the distribution of treatments for permanent teeth with necrotic pulps and open apices according to the stage of root development. Dental records from all root canal procedures performed in permanent teeth with necrotic pulps and open apices over a period of 14 years by residents of the Speciality of Endodontics, University of Guadalajara, Mexico, were analized. Records from 206 treatments were mainly divided into the following 3 different stages according to criteria described by Cvek: stage IV (n = 79, 38.3%), stage V (n = 66, 32%) and stage III (n = 53, 25.7%). Few cases involved the initial stages of root development (stages I and II) (n = 8, 3.8%). Such teeth were submitted to four different treatments: MTA apical barrier (n = 69), Ca(OH)2 replacements (n = 34), gutta-percha (n = 67) and a plug of Ca(OH)2/gutta-percha (n = 36). The teeth with intermediate root development (Cvek stage III) showed a predilection for the MTA apical barrier and Ca(OH)2 replacement techniques (P ? 0.001). Furthermore, the stage of root development did not influence the apical extent of the root filling. The finding of permanent teeth with necrotic pulp and open apices is not exclusive to young patients with an open apex. Moreover, teeth with fragile, irregular and divergent apical morphologies, such as Cvek?s stages´ I and II, were not common and may be considered to be unusual findings. The diverse endodontic procedures were reliable regardless of the stage of root development.
- Direct oral anticoagulants and its implications in dentistry : a review of literature(2017) Lanau, Neus; Mareque Bueno, Javier; Giner Tarrida, LluÃs; Zabalza, MichelFour novel direct oral anticoagulants (DOACs) named dabigatran, rivaroxaban, edoxaban and apixaban have been recently introduced to overcome some of the drawbacks of existing anticoagulants. They have less interactions and do not require routine monitoring. However, there is not enough scientific data about the protocol to apply in these patients on DOACs undergoing dental treatment. Thus is necessary to evaluate the potential bleeding risk of these drugs, the possibility of thromboembolic events occurring if they are withdrawn or the need to change to heparin previously. A comprehensive search of the PubMed, Scopus and ISI Web of Science databases was conducted to identify studies that evaluated the relationship between direct oral anticoagulants and dental procedures. The quality of the reported information was assessed following the PRISMA statement. Eleven studies that met the inclusion criteria were included in the review: 2 randomized clinical trials, 3 prospective studies, 3 retrospective studies, 2 case series and 1 case report. DOACs are safe drugs in terms of bleeding. The possible postoperative bleeding complications are manageable with conventional haemostasis measurements. The bridging approach with heparin does not seem to be recommended. Consensus among the professionals involved in the management of the patient is fundamental in invasive dental treatments and in complex patients.
- A case series of intraosseous hemangioma of the jaws : various presentations of a rare entity(2017) Chandra, Srinivasa R.; Chen, Eleanor; Cousin, Timothée; Oda, DolphineHemangiomas of the soft tissue are common in the head and neck area, especially in the tongue and in children under ten years of age. Intraosseous hemangiomas of the mandible and maxilla (IHM), on the other hand, are exceedingly rare and are not well characterized. This study presents six IHM cases focusing on the clinical, radiographic, and histologic characteristics. Six cases of IHM were retrieved from the archives of the Biopsy Services at the University of Washington. Clinical, radiologic, and histologic findings are described. A total of six cases of IHM were reviewed. The patient age range was 16 to 65; the group comprised three females and three males. All six cases presented as swellings, two caused tooth resorption, and one was associated with pain and numbness. Three of the six IHM were present in the body of the mandible, two in the area of the extracted right mandibular third molar, and one in the anterior maxilla between the right canine and lateral incisor. Radiographically, five were radiolucent and one was radiopaque. Of the five radiolucent, two were unilocular and three multilocular. The one radiopaque case was exophytic, simulating a large osteoma. Histologic features ranged from cavernous to a mix of venous and arterial types. Follow-up is available for all six cases ranging between one to seven years; only one case recurred within the first year post-surgery. IHM are exceedingly rare; IHM do not present in a consistent manner both clinically and radiographically. It is therefore important to recognize the wide spectrum of IHM?s clinical, radiographic, and histological presentations.
- Pigmented squamous cell carcinoma in situ : report of a new case and review of the literature(2017) Martins, Fabiana; Mistro, Florence; Kignel, Sergio; Palmieri, Michelle; do Canto, Alan-Motta; Braz Silva, Paulo HenriquePigmented squamous cell carcinoma in situ (PSCCIS) is very rare, being clinically described as a pigmented lesion with histological characteristics of an in-situ carcinoma presenting pigmentation within neoplastic cells. A 50-year-old Afro-descendant man came for clinical evaluation of a painful black and red lesion located on the right aspect of the oropharyngeal isthmus. After incisional biopsy, the resulting sample was described as a pigmented squamous cell carcinoma in situ, a diagnosis further confirmed by immunohistochemical analysis. Treatment consisted in total excision of the lesion, and no recurrence was observed after a 30-month follow-up. Clinicians and pathologists should be aware of PSCCIS as a differential diagnosis of melanoma, a lesion which significantly increases the morbidity and mortality rates among these patients.
- Determinants of maxillary canine impaction : retrospective clinical and radiographic study(2017) Laurenziello, Michele; Montaruli, Graziano; Gallo, Crescenzio; Tepedino, Michele; Guida, Laura; Perillo, Letizia; Troiano, Giuseppe; Lo Muzio, Lorenzo; Ciavarella, DomenicoThe aim of this study is to evaluate determinants of maxillary canine impaction taking into account both canine position related variables and the pattern of facial growth. A retrospective clinical and radiographic analysis was carried out on 109 patients aged between 9 and 10 years at the time of first evaluation. At baseline, SN-GoMe angle, the interincisal angle, the canine angle ? and the canine distance d were used to characterize canine location and vertical facial growth. At the end of a two years follow up period the eruption state of each canine of each patient was recorded and accordingly classified as erupted or impacted on a clinical and radiographic basis. Univariate and multivariate statistical analyses were performed, including correlation among the studied variables and principal components analysis; several machine learning methods were also used in order to built a predictive model. At the end of the two years follow up period after the first examination, 54 (24.77%) canines were classified as impacted. Except for Angle ? values, there were no statistically significant differences between impacted and erupted canines. The studied variables were not significantly correlated, except for the SN-GoMe Angle and the distance d in the impacted canine group and the angle ? and the distance d in erupted canines group. All variables, except for SN-GoMe Angle in erupted canines, have a partial communality with the first two principal components greater than 50%. Among the learning machine methods tested to classify data, the best performance was obtained by the random forest method, with an overall accuracy in predicting canine eruption of 88.3%. The studied determinants are easy to perform measurements on 2D routinely executed radiographic images; they seems independently related to canine impaction and have reliable accuracy in predicting maxillary canine eruption.
- Smear layer removal evaluation of different protocol of Bio Race file and XP- endo Finisher file in corporation with EDTA 17% and NaOCl(2017) Zand, Vahid; Mokhtari, Hadi; Frough-Reyhani, Mohammad; Nahavandizadeh, Neda; Azimi, ShahramThe aim of the present study was to compare the amount of the smear layer remaining in prepared root canals with different protocols of Bio RaCe files and XP-endo Finisher file (XPF) in association with 17% EDTA and sodium hypochlorite solution. A total of 68 extracted single-rooted teeth were randomly divided into 4 experimental groups (n=14) and two control groups (n=6). The root canals were prepared with Bio RaCe files (FKG Dentaire, Switzerland) using the crown-down technique based on manufacturer?s instructions and irrigated according to the following irrigation techniques: Group 1: XPF with 2 mL of 2.5% NaOCl for 1 minute. Group 2:, XPF with 1 mL of 17% EDTA for one minute. Group 3: XPF was used for 1 minute in association with normal saline solution. Group 4: XP-endo Finisher file for 30 seconds in association with 2.5% NaOCl and 17% EDTA for 30 seconds. The negative control group: NaOCl (2.5%) was used during root canal preparation, followed by irrigation with 17% EDTA at the end of root canal preparation. The positive control group: Normal saline solution was used for irrigation during root canal preparation. In all the groups, during preparation of the root canals with Bio RaCe file, 20 mL of 2.5% NaOCl was used for root canal irrigation and at the end of the procedural steps 20 mL of normal saline solution was used as a final irrigant. The samples were analyzed under SEM at ×1000?2000 magnification and evaluated using Torabinejad scoring system. Data were analyzed with non-parametric Kruskal-Wallis test and post hoc Mann-Whitney U test, using SPSS. Statistical significant was defined at P<0.05. The results of the study showed the least amount of the smear layer at coronal, middle and apical thirds of the root canals in groups 2, which was not significantly different from the negative control group (P<0.5). Under the limitations of the present study, use of a combination of NaOCl and EDTA in association with XPF exhibited the best efficacy for the removal of the smear layer.
- Prior oral conditions in patients undergoing heart valve surgery(2017) Silvestre Donat, Francisco Javier; Gil Raga, Irene; Martinez Herrera, Mayte; Lauritano, Dorina; Silvestre Rangil, JavierPatients scheduled for heart valve surgery should be free of any oral infectious disorders that might pose a risk in the postoperative period. Few studies have been made on the dental conditions of such patients prior to surgery. The present study describes the most frequent prior oral diseases in this population group. A prospective, observational case-control study was designed involving 60 patients (30 with heart valve disease and 30 controls, with a mean age of 71 years in both groups). A dental exploration was carried out, with calculation of the DMFT (decayed, missing and filled teeth) index and recording of the periodontal parameters (plaque index, gingival bleeding index, periodontal pocket depth, and attachment loss). The oral mucosa was also examined, and panoramic X-rays were used to identify possible intrabony lesions. Significant differences in bacterial plaque index were observed between the two groups (p<0.05), with higher scores in the patients with valve disease. Probing depth and the presence of moderate pockets were also greater in the patients with valve disease than among the controls (p<0.01). Sixty percent of the patients with valve disease presented periodontitis. Patients scheduled for heart valve surgery should be examined for possible active periodontitis before the operation. Those individuals found to have periodontal disease should receive adequate periodontal treatment before heart surgery.
- Adenomatoid odontogenic tumor : case series of 14 with wide range of clinical presentation(2017) Al-Shimari, Fatima; Chandra, Srinivasa; Oda, DolphineTo present 14 cases of adenomatoid odontogenic tumor (AOT), highlighting their clinical, radiographic, and histologic characteristics. Fourteen cases of AOT were retrieved from the archives of the Oral Pathology Biopsy Service (OPBS). Clinical, radiologic, and histologic findings are described. Fourteen AOT cases were reviewed, of which 12 were intraosseous and two were peripheral (gingiva). The cases came from eight females and six males with an age range of 11?30. Of the 12 intraosseous cases, nine were follicular (associated with impacted teeth), while three were extra-follicular (present between teeth). Six of the 12 cases were in the maxilla, and the other six were in the mandible. The two peripheral cases presented as nodules on the buccal gingiva of the anterior maxillary teeth. Radiographically, all 12 follicular and extra-follicular cases were unilocular radiolucencies; of those, only one had specks of radiopacity. Histologically, all specimens were similar in morphology, demonstrating a varied degree of duct-like structures, epithelial spheres, spindle-shaped epithelial cells, calcifications, and a thick capsule. The two peripheral cases had no capsule. AOT usually affects patients under 20 years of age, with a female to male ratio close to 2:1. Presentation in the anterior maxilla is almost twice as common as in the anterior mandible. Radiographically, AOT presents as a unilocular radiolucency more commonly associated with impacted teeth, simulating a dentigerous cyst. We present 14 new cases of AOT (nine follicular, three extra-follicular, and two peripheral) with discussions of their clinical, radiographic, and histological features.
- Color stability of CAD/CAM Zirconia ceramics following exposure to acidic and staining drinks(2017) Colombo, Marco; Cavallo, Marco; Miegge, Matteo; Dagna, Alberto; Beltrami, Riccardo; Chiesa, Marco; Poggio, ClaudioThe aim of this in vitro study was to evaluate the color stability of CAD/CAM Zirconia ceramics following exposure to acidic drink (Coca Cola) and after exposure to staining solution (coffee). All the samples were immersed in different staining solutions over a 28-day test period. A colorimetric evaluation according to the CIE L*a*b* system was performed by a blind trained operator at 7, 14, 21, 28 days of the staining process. Shapiro Wilk test and Kruskal-Wallis ANOVA were applied to assess significant differences among restorative materials. Paired t-test was applied to test which CIE L*a*b* parameters significantly changed after immersion in staining solutions. One week immersion in acidic drink did not cause a perceivable discoloration for all restorative materials (?E < 3.3). Subsequent immersion in coffee affected color stability of all Zirconia samples, even if Kruskal-Wallis ANOVA found significant differences among the various restorative materials. The ?Es of CAD/CAM Zirconia ceramics after immersion in coffee varied among the products, but color integrity is not affected by contact with acidic drinks.
- A smart rotary technique versus conventional pulpectomy for primary teeth : a randomized controlled clinical study(2017) Mokhtari, Negar; Shirazi, Alireza Sarraf; Ebrahimi, MasoumehTechniques with adequate accuracy of working length determination along with shorter duration of treatment in pulpectomy procedure seems to be essential in pediatric dentistry. The aim of the present study was to evaluate the accuracy of root canal length measurement with Root ZX II apex locator and rotary system in pulpectomy of primary teeth. In this randomized control clinical trial complete pulpectomy was performed on 80 mandibular primary molars in 80, 4-6-year-old children. The study population was randomly divided into case and control groups. In control group conventional pulpectomy was performed and in the case group working length was determined by electronic apex locator Root ZXII and instrumented with Mtwo rotary files. Statistical evaluation was performed using Mann-Whitney and Chi-Square tests (P<0.05). There were no significant differences between electronic apex locator Root ZXII and conventional method in accuracy of root canal length determination. However significantly less time was needed for instrumenting with rotary files (P=0.000). Considering the comparable results in accuracy of root canal length determination and the considerably shorter instrumentation time in Root ZXII apex locator and rotary system, it may be suggested for pulpectomy in primary molar teeth.
- Comparison of total antioxidant capacity of saliva in women with gestational diabetes mellitus and non-diabetic pregnant women(2017) Zamani-Ahari, Ulduz; Zamani-Ahari, Sahar; Fardi-Azar, Zahra; Falsafi, Parisa; Ghanizadeh, MiladPregnancy is considered a stressful event, results in higher levels of oxidative stress and considerable changes in physiological and metabolic functions such as gestational diabetes mellitus (GDM). Due to the cumulative effect of antioxidants and considering the controversies in this area, this study was undertaken to investigate the total antioxidant capacity (TAC) of saliva in pregnant women whit gestational diabetes in comparison to non-diabetic pregnant women. In this cross-sectional study (2015-16), a total of 31 women with a diagnosis of GDM and 59 non-diabetic pregnant women were included in the diabetic and control groups, respectively. Salivary samples were collected by spitting method. When all samples were collected, total antioxidant capacity (TAC) was measured with the use of a commercial kit following the manufacturer?s instructions. Data were analyzed with descriptive statistics and Mann-Whitney test using SPSS 18. Average TAC level in the saliva of women with gestational diabetes was 0.10 ± 0.14, with 0.04 ± 0.11 in non-diabetic pregnant women. Nonparametric Mann-Whitney test showed that this difference was statistically significant (P=0.024). Under the limitations of the present study it can be concluded that there is an increase in oxidative stresses during pregnancy, followed by an increase in the total levels of salivary antioxidants to counteract such stresses. Therefore, it is expected that determining the salivary antioxidant levels during pregnancy can be an alternative technique for the early diagnosis of diabetes.
