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Language Medicina oral, patología oral y cirugía bucal. Ed inglesa. 2013. Vol. 18, no. 5
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- Microleakage in Class II composite restorations with margins below the CEJ: in vitro evaluation of different restorative techniques(2013) Poggio, Claudio; Chiesa, Marco; Scribante, Andrea; Mekler, Jenia; Colombo, MarcoObjectives: The purpose of this in vitro study was to evaluate the microleakage in "deep" Class II composite restorations with gingival cavosurface margin below the CEJ (cemento-enamel junction) and restored with different techniques. Study Design: Fifty human teeth were used. In each tooth two standardized Class II slot cavities (on mesial and on distal surfaces) were prepared: the buccolingual extension of the cavities was 4 mm; the gingival wall was located in dentin/cementum (2 mm beyond the CEJ). The prepared teeth were randomly assigned to 5 experimental groups (of 10 specimens and 20 cavities each) and restored. Group 1: Filtek TM Supreme XTE Flowable (3MESPE) + Universal Filtek Supreme XTE (3MESPE), Group 2: GrandioSO Heavy Flow (Voco) + GrandioSo (Voco), Group 3: SDRTm (Dentsply Caulk) + Esthet-X® HD (Dentsply Caulk), Group 4: SonicFill (Kerr), Group 5: Grandio (Voco). After thermocycling, the specimens were immersed in a 0.5% basic fuchsine dye solution and incubated at 37°C for 24 hours. The teeth were subsequently sectioned mesiodistally. All specimens were examined at 25× in a stereomicroscope and standardized digital images were obtained. Dye penetration was measured from gingival margins. Results: The results demonstrated no significant leakage differences between Group 4 and Group 5, that both showed significantly higher frequency distribution of Score 0. Group 2 and Group 3 showed a significant prevalence of Score 1, whereas Group 1 showed significantly higher frequency of Score 2. Conclusions: None of the restorative techniques tested completely eliminated microleakage dye penetration in dentin margins; marginal adaptation in Class II composite restorations with gingival wall below the CEJ varied in both substrates and from different restorative techniques used.
- Luting of ceramic crowns with a self-adhesive cement: effect of contamination on marginal adaptation and fracture strength(2013) Slavcheva, Slavena; Krejci, Ivo; Bortolotto, TissianaObjectives: This study evaluated the percentages of continuous margins (%CM) and fracture strength (FS) of crowns made out from blocs of leucite-reinforced ceramic (IPS Empress CAD) and luted with a representative self-adhesive cement (RelyX Unicem) under four contaminating agents: saliva, water, blood, a haemostatic solution containing aluminium chloride (pH= 0.8) and a control group with no contamination. Study Design: %CM at both tooth-cement (TC) and cement-crown (CC) interfaces were determined before and after a fatigue test consisting of 600'000 chewing loads and 1'500 temperature cycles changing from 5º C to 50º C. Load to fracture was recorded on fatigued specimens. Kruskal-Wallis test was used to compare %CM and FS between the five groups with a level of confidence of 95%. Results: At the TC interface, no significant differences in marginal adaptation before loading could be detected between groups. After loading, a significant marginal degradation was observed in the group contaminated with aluminium chloride (52 ± 22 %CM) in respect to the other groups. No significant differences in %CM could be detected between the groups contaminated with saliva, water, blood and the control. At the CC interface, no significant differences in marginal adaptation were observed between the groups. The FS on loaded specimens was around 1637N, with no significant differences between groups as well. Conclusions: An adverse interaction of the highly acidic haemostatic agent with either dentin or the self-adhesive cement could explain the specimens' marginal degradation. The self-adhesive cement tested in this study was no sensitive to moisture contamination either with saliva, water or blood.
- Immediate implants placed in fresh sockets associated to periapical infectious processes: a systematic review(2013) Alvarez Camino, JC; Valmaseda Castellón, E.; Gay Escoda, CosmeObjetives: The development of treated implant surfaces, added to the increase of the aesthetic requirements by the patients has led to a change in the treatment protocols as well as the development of techniques such as the onefase implants and the immediate prosthetic loading. One of the usual contraindications of the implant treatment is the presence of periapical disease associated to the tooth to be replaced. The aim of this paper is to review the published literature on immediate implant placement in extraction sockets of teeth with periapical pathology, considering the level of scientific evidence, and following the principles of medicine and evidence-based Dentistry. Material and Methods: A search of articles published between 1982 and 2012 was conducted. The search terms immediate, dental implant, extraction, infected, periapical pathology were used. Search was limited to studies in animals and humans, published in english language. Results: 16 articles were selected from a total of 438, which were stratified according to their level of scientific evidence using the SORT criteria (Strength of Recommendation Taxonomy). Studies in both animals and humans presented high rates of implant survival, but human studies are limited to a small number of cases. Discussion and Conclusions: There is a limited evidence regarding implant placement immediately to the extraction of teeth affected by chronic periapical pathology. Following analysis of the articles, and in function of their scientific quality, a type B recommendation is given in favor of the immediate implant placement in fresh sockets associated to periapical infectious processes.
- The morbidity of oral mucosal lesions in an adult swedish population(2013) Robledo Sierra, Jairo; Mattsson, Ulf; Svedensten, Tage; Jontell, MatsObjectives: To study the severity of symptoms and estimate the prevalence of oral mucosal lesions in a non-referral adult Swedish population, as registered by general dental practitioners. This study also aims to evaluate the possibility of dental practitioners collecting large quantities of reliable and accurate clinical data on oral mucosal lesions. Study Design: Data from 6,448 adult Swedish patients were collected by general dental practitioners using a standardized registration method. A correlation analysis between a group with oral mucosal lesions and a control group, with no oral mucosal lesions, was performed for various parameters such as symptoms from the oral mucosa, systemic diseases, medication, allergy history, tobacco habits and the patient's own assessment of their general health. In addition, clinical photos were taken of all oral mucosal lesions in order to determine the degree of agreement between the diagnoses made by general dental practitioners and those made by oral medicine specialists. Results: A total of 950 patients (14.7%) presented with some type of oral mucosal lesion and of these, 141 patients (14.8%) reported subjective symptoms. On a visual analogue scale, 43 patients (4.5%) scored their symptoms <30, 65 patients (6.8%) scored their symptoms >=30, and 28 patients (2.6%) scored their symptoms >=60. The most debilitating condition was aphthous stomatitis and the most common oral mucosal lesion was snuff dipper's lesion (4.8%), followed by lichenoid lesions (2.4%) and geographic tongue (2.2%). There was agreement between the oral medicine specialists and the general practitioners over the diagnosis of oral mucosal lesions on the basis of a clinical photograph in 85% of the cases (n=803). Conclusions: Nearly 15% of the patients with oral mucosal lesions reported symptoms. General practitioners could contribute significantly to the collection of large quantities of reliable and accurate clinical data, although there is a risk that the prevalence of oral mucosal lesions may be underestimated.
- Malignancy Risk Models for Oral Lesions(2013) Zarate, Ana María; Brezzo, María Magdalena; Secchi, Dante Gustavo; Barra, José Luis; Brunotto, MabelObjectives: The aim of this work was to assess risk habits, clinical and cellular phenotypes and TP53 DNA changes in oral mucosa samples from patients with Oral Potentially Malignant Disorders (OPMD), in order to create models that enable genotypic and phenotypic patterns to be obtained that determine the risk of lesions becoming malignant. Study Design: Clinical phenotypes, family history of cancer and risk habits were collected in clinical histories. TP53 gene mutation and morphometric-morphological features were studied, and multivariate models were applied. Three groups were estabished: a) oral cancer (OC) group (n=10), b) OPMD group (n=10), and c) control group (n=8). Results: An average of 50% of patients with malignancy were found to have smoking and drinking habits. A high percentage of TP53 mutations were observed in OC (30%) and OPMD (average 20%) lesions (p=0.000). The majority of these mutations were GC ? TA transversion mutations (60%). However, patients with OC presented mutations in all the exons and introns studied. Highest diagnostic accuracy (p=0.0001) was observed when incorporating alcohol and tobacco habits variables with TP53 mutations. Conclusions: Our results prove to be statistically reliable, with parameter estimates that are nearly unbiased even for small sample sizes. Models 2 and 3 were the most accurate for assessing the risk of an OPMD becoming cancerous. However, in a public health context, model 3 is the most recommended because the characteristics considered are easier and less costly to evaluate.
- Bisphosphonate-related osteonecrosis of the jaws (Bronj)(2013) Beninatio, Francesco; Pruneti, Riccardo; Ficarra, GiuseppeBisphosphonate-related osteonecrosis of the jaws (BRONJ) is an extremely therapy resistant osteomyelitis-like disease exclusively involving the jaw bones of patients in treatment with bisphosphonates (BPs). Objectives: The aim of this study was to evaluate the radiological and clinical findings and management of 51 patients with BRONJ diagnosed from 2004 to 2009 in our Reference Center. Study Design: A prospective study was performed. The patients were examined every 2-6 months, depending on their clinical conditions. Outcome variables were the resolution of symptoms, persistence of bone exposure and / or fistula and the status of the lesional mucosa. Results: The higher prevalence of the disease was noted in 2006 and 2007 and at the time of diagnosis 90% of patients had been treated with iv BPs. The main precipitating event leading to BRONJ was an invasive dental procedure in 61% of patients while no traumatic event could be identified in 16% of patients. The median time of follow-up was 19 months (range: 2-57), during which 31% of patients healed and 39% succumbed. In 78% of patients the therapy was medical, in 16% it consisted in surgical deep curettage and only in 6% it was necessary to perform an osteotomy to avoid a mandibular pathological fracture. All the patients in treatment with oral BPs healed from BRONJ with a median time of conservative treatment of 19 months. Conclusions: Prevention has lead to a progressive reduction in the prevalence of BRONJ. In our experience medical treatment is often sufficient to keep the disease under control and to lead to the healing of the lesions by spontaneous loss of the sequestrum. This approach seems to be very effective in patients who were in treatment with oral Bps preparations; BRONJ seems to have a more benign clinical behaviour in these patients.
- Prevalence of apical periodontitis and frequency of root canal treatments in liver transplant candidates(2013) Castellanos Cosano, Lizett; Machuca Portillo, Guillermo; Segura Sampedro, Juan José; Torres Lagares, Daniel; López López, José; Velasco Ortega, Eugenio; Segura-Egea, Juan J.Aim: The purpose of this study was to investigate the prevalence of apical periodontitis (AP) and endodontic treatment in liver transplant candidates and control healthy subjects. Material and Methods: A descriptive cross-sectional study. Forty two liver transplant candidates (LTC) (study group) and 42 control subjects. Digital panoramic radiographs where used. Periapical status was scored according to the periapical index (PAI). Results were analysed statistically using the Chi-squared test and logistic regression. Results: Radiographic signs of AP in one or more teeth was found in 79% of patients in the study group and in 50% of control subjects (p = 0.008; OR = 3.7; C. I. 95% = 1.4 - 9.5). One or more root-filled teeth (RFT) were found in 19% and 62% of study and control subjects, respectively (p = 0.0001; OR = 0.14; 95% C. I. = 0.05 - 0.38). Among LTC patients 14.7% of the teeth had AP, whereas in the control subjects 4.2% of teeth were affected (p= 0.0002). The percentage of RFT in the study and control groups was 1.5% and 6.8%, respectively (p = 0.0002). Conclusions: Liver transplant candidates have significantly higher prevalence of radiographic periapical lesions and lower frequency of RFT than controls healthy subjects.
- Design characteristics, primary stability and risk of fracture of orthodontic mini-implants: pilot scan electron microscope and mechanical studies(2013) Walter, André; Winsauer, Heinz; Marcé Nogué, Jordi; Mojal, Sergi; Puigdollers Pérez, AndreuObjectives: Orthodontic mini-implants (OMIs) are increasingly used in orthodontics but can fail for various reasons. This study investigates the effects of OMI design characteristics on the mechanical properties in artificial bone. Material and Methods: Twelve self-drilling OMIs (2 small, 6 medium, 4 large) from 8 manufacturers were tested for their primary stability in simulated medium-high cancellous bone and the risk to fracture in high-density methacrylate blocks. For the assessments of the maximum insertion torque (IT) and torsional fracture (TF) 5 of each OMI were used and for the pull-out strength (POS) 10. The OMIs were inserted with a torque screwdriver (12 sec/360°) until the bottom at 8 mm depth was reached. OMI designs were analyzed with a scan electron mi - croscope (SEM). Results: SEM images revealed a great variation in product refinement. In the whole sample, a cylindrical OMI shape was associated with higher POS (p<0.001) but lower IT (p=0.002) values. The outer and inner OMI di - ameters were design characteristics well correlated with POS, IT and TF values (ranging from 0.601 to 0.961). Greater thread depth was related to greater POS values (r= 0.628), although OMIs with similar POS values may have different IT values. Thread depth and pitch had some impact on POS. TF depended mainly on the OMI inner (r= 0.961) and outer diameters (r=0.892). A thread depth to outer diameter ratio close to 40% increased TF risk. Conclusions: Although at the same insertion depth the OMI outer and inner diameters are the most important fac - tors for primary stability, other OMI design characteristics (cylindrical vs. conical, thread design) may significantly affect primary stability and torsional fracture. This needs to be considered when selecting the appropriate OMI for the desired orthodontic procedures.
- Interferometric microscopy study of the surface roughness of Portland cement under the action of different irrigants(2013) Ballester Palacios, Maria L.; Berástegui Jimeno, Esther María; Parellada Esquius, Neus; Canalda Sahli, CarlosObjectives: Some investigations suggested common Portland cement (PC) as a substitute material for MTA for endodontic use; both MTA and PC have a similar composition. The aim of this study was to determine the surface roughness of common PC before and after the exposition to different endodontic irrigating solutions: 10% and 20% citric acid, 17% ethylenediaminetetraacetic (EDTA) and 5% sodium hypochlorite. Study Design: Fifty PC samples in the form of cubes were prepared. PC was mixed with distilled water (powder/ liquid ratio 3:1 by weight). The samples were immersed for one minute in 10% and 20% citric acid, 17% EDTA and 5% sodium hypochlorite. After gold coating, PC samples were examined using the New View 100 Zygo interferometric microscope. It was used to examine and register the surface roughness and the profile of two different areas of each sample. Analysis of variance (ANOVA) was carried out, and as the requirements were not met, use was made of the Kruskal-Wallis test for analysis of the results obtained, followed by contrasts using Tukey's contrast tests. Results: Sodium hypochlorite at a concentration of 5% significantly reduced the surface roughness of PC, while 20% citric acid significantly increased surface roughness. The other evaluated citric acid concentration (10%) slightly increased the surface roughness of PC, though statistical significance was not reached. EDTA at a concentration of 17% failed to modify PC surface roughness. Irrigation with 5% sodium hypochlorite and 20% citric acid lowered and raised the roughness values, respectively. Conclusions: The surface texture of PC is modified as the result of treatment with different irrigating solutions commonly used in endodontics, depending on their chemical composition and concentration.
- Detection of human cytomegalovirus and Epstein-Barr virus in symptomatic and asymptomatic apical periodontitis lesions by real-time PCR(2013) Ozbek, Selcuk M.; Ozbek, Ahmet; Yavuz, Muhammed SelimObjectives: Recent studies have investigated the occurrence of human cytomegalovirus and Epstein-Barr Virus in samples from apical periodontitis lesions and a role in the pathogenesis of this disease has been suggested. Because genotype distribution and seroprevalence of EBV and HCMV differ among populations, it is important to determine the presence of these viruses in endodontic periapical lesions of different populations. The aims of this study were to determine the presence of HCMV and EBV DNAs in samples from Turkish patients with symptomatic and asymptomatic apical periodontitis lesions using real-time polymerase chain reaction method and to evaluate their presence in both symptomatic and asymptomatic apical periodontitis lesions. Study Design: Periapical samples were collected from 12 asymptomatic and 16 symptomatic periapical lesions in conjunction with apicectomy. HCMV and EBV DNAs were identified in the samples by real-time PCR. The chi- squared test with Yates's correction or the Fisher's exact test was used to analyse the significance of differences. Results: HCMV DNA was detected in 10 of the 16 (62.5%) symptomatic and in five of the 12 (41.7 %) asymptomatic periapical study lesions. The EBV DNA was identified in seven of the 16 (43.7 %) symptomatic and three of the 12 (25 %) asymptomatic periapical lesions. The difference in occurrence of HCMV and EBV DNA between symptomatic and asymptomatic periapical lesions was not statistically significant. (All comparisons have p > 0.05). Conclusions: Our findings suggest that HCMV and EBV is a frequent inhabitant of both symptomatic and asymptomatic apical periodontitis lesions of endodontic origin in Turkish population.
- Supportive periodontal therapy and periodontal biotype as prognostic factors in implants placed in patients with a history of periodontitis(2013) Aguirre Zorzano, Luis Antonio; Vallejo Aisa, Francisco Javier; Estefanía Fresco, RuthObjectives: To evaluate bone loss around implants placed in patients with a history of treated chronic periodontitis and who did or did not attend supportive periodontal therapy, after one year in function. Furthermore, the influence of periodontal biotype and level of plaque was also evaluated. Material and Methods: Forty-nine patients participated voluntarily in the study. All subjects had a history of chronic periodontitis, which had been previously treated. After the active treatment, 27 patients attended supportive periodontal therapy (SPT) and the rest did not (No SPT). The O'Leary plaque index and periodontal biotype were recorded for each subject and 246 Astra Tech® OsseospeedTM implants were radiographically analysed (123 placed in SPT patients and 123 in No SPT patients) at the time of loading and one year later, measuring marginal bone loss with the program Dental Studio NX 6.0®. The statistical analysis was performed with Windows SPSS, applying Pearson's correlation index and the Kruskal- Wallis and U-Mann Whitney non-parametric tests. Results: Six patients were found to have periimplantitis and sixteen mucositis. The survival rate was 99.59% (100% SPT and 99.18% No SPT). Mean bone loss was 0.39 mm (range [-0.71 - 8.05]). Among SPT patients, 95% of the implants had losses less than or equal to the mean (mean bone loss of 0.16 mm) compared to 53.7% for the No SPT group (mean bone loss of 0.62 mm). A statistically significant relationship was demonstrated between bone loss around the implant and the patient's periodontal biotype and plaque index. Conclusions: The marginal bone loss around implants in patients with treated chronic periodontitis is minimal if they are in a controlled SPT programme and there is individual control of plaque index. Moreover, the presence of a thin periodontal biotype represents a risk factor for additional bone loss.
