Journal: General dentistry
Acellular dermal matrix allograft (ADMA) is an alternative to a free gingival graft for keratinized tissue augmentation and root coverage. Soft tissue dehiscence is one of the major complications that can occur after replacing a missing tooth with a dental implant; it can lead to esthetic problems and have a negative impact on the long-term success of the implant. Soft tissue dehiscence coverage is not as predictable around dental implants as it is on root surfaces. This article describes a case involving soft tissue dehiscence, in which an ADMA was used to increase the width of keratinized mucosa around an implant-supported prosthesis, resulting in complete implant surface coverage due to the phenomenon of creeping attachment.
Restoring worn anterior mandibular teeth is a challenge, especially when teeth are small, esthetics are a concern, the long-term prognosis is questionable, and/or patient finances are an issue. This article describes an alternate treatment for a patient with a collapsed bite, missing posterior mandibular teeth, an ill-fitting complete maxillary denture with poor esthetics, and irregular, worn mandibular anterior teeth.
Incidental radiopacities of the jaws are commonly identified on routine intraoral and extraoral radiographs. Dentists should be able to develop a differential diagnosis of these lesions. This article presents 2 cases in which mandibular radiopacities associated with external root resorption were identified incidentally and discusses the differential diagnosis of these lesions. Both patients were referred by their general practitioners to dental specialists for further evaluation of homogenous osteosclerotic foci surrounding and resorbing the roots of the permanent mandibular right first molar. The lesions were asymptomatic, caused no cortical expansion, and were static over time. The clinical and radiographic features were consistent with a diagnosis of idiopathic osteosclerosis (IO). External root resorption is present in 10%-12% of cases of IO and often involves the permanent mandibular first molars.
The continued growth in athletic participation among children and adults has increased the potential incidence of sports-related dental injuries. Regardless of preventive measures, damage and injury to the oral cavity can occur during participation in sports. Luxations, root fractures, bony fractures, and avulsions involving 1 or more teeth are a possibility. Many of these injuries require specific protocols for splinting of the traumatized tooth or teeth to allow the best possible outcomes. This article identifies luxation and avulsion injuries, explains the rationale for splinting, reviews guidelines for splint duration, and discusses contemporary material options available to stabilize affected permanent dentition.
This article outlines a comprehensive, multidisciplinary strategy for treatment of patients with anorexia and bulimia nervosa. In this approach, primary medical intervention and emergency dental care are followed by the staging of treatment phases that integrate medical care, psychotherapy, nutritional counseling, and dental management, which may encompass various treatment options for repair of damaged dentition. Emphasis is placed on prevention of further tissue damage during all phases of management and following completion of the treatment course.
There is continued speculation on the value of mouthguards (MGs) in preventing mild traumatic brain injury (MTBI)/concussion injuries. The purpose of this randomized prospective study was to compare the impact of pressure-laminated (LM), custom-made, properly fitted MGs to over-the-counter (OTC) MGs on the MTBI/concussion incidence in high school football athletes over a season of play. Four hundred twelve players from 6 high school football teams were included in the study. Twenty-four MTBI/concussion injuries (5.8%) were recorded. When examining the MTBI/concussion injury rate by MG type, there was a significant difference (P = 0.0423) with incidence rates of 3.6% and 8.3% in the LM MG and OTC MG groups, respectively.
Dental care providers are likely to see patients who take bisphosphonates for various medical conditions, including osteoporosis, bony metastatic tumors, multiple myeloma, breast cancer, and prostate cancer. Bisphosphonates accumulate in areas of high bone turnover, leading to suppression of bone turnover and the aging of keratocytes. These adverse effects predispose the maxillary and mandibular bone to development of medication-related osteonecrosis of the jaw (MRONJ), specifically among oncology patients treated with intravenous bisphosphonate therapy. Studies have shown that stopping bisphosphonate therapy, temporarily (drug holiday) or permanently, is not significantly effective. The effectiveness of a drug holiday is likely limited due to the pharmacologic activity of bisphosphonates and their persistent, long-term effect on bone. Therefore, patients should not be discouraged from taking bisphosphonates for an existing medical condition. A dental health assessment by an oral surgeon, a dental specialist, or a well-trained general dental practitioner is highly recommended prior to treatment with bisphosphonate. The evaluating clinician must attempt to eliminate or mitigate risk factors to prevent the development of MRONJ. It is crucial for dental care providers to recognize the clinical signs and symptoms of MRONJ, including its radiographic appearance. In cases of any suspicious oral lesion, early referral to an oral surgeon is crucial. It is better to avoid dental extractions during the active period of treatment and to treat the tooth carefully with nonsurgical root canal treatment instead. This review provides brief clinical guidance for dental care providers regarding management of patients prescribed bisphosphonates and ways to help minimize patients' risk of developing MRONJ.
Endodontic management of 3-rooted maxillary premolars is a challenge due to their complex anatomy and narrow root canal walls. This study aimed to evaluate, by microcomputed tomography (μCT), the apical enlargement and centering ability promoted by hand, rotary, and reciprocating instrumentation in 3-rooted maxillary premolars. Eighteen teeth were divided into 3 groups (n = 6) according to the preparation technique: crown-down hand, rotary, and reciprocating instrumentation. Instruments with similar apical diameters were used (25 and 40 mm for buccal and palatal canals, respectively). Centering ability and canal enlargement were evaluated through the comparison of μCT images obtained before and after instrumentation. Distances of 0, 2, 4, and 6 mm from the apical stop were considered. Differences between canal areas before and after instrumentation were calculated. In addition, distances between the original canal center and the prepared canal center at the apical stop were measured in both the mesiodistal and buccopalatal directions. Significant differences in enlargement areas and centering ability among the techniques were determined using 2-way analysis of variance and Tukey post hoc test (P > 0.05). Root canal enlargement was similar for all techniques. Excessive enlargement was observed in only a few specimens, and root perforation did not occur. Some specimens presented untreated canal areas. In mesiobuccal and distobuccal roots, reciprocating instrumentation promoted more centered preparations than hand instrumentation when measured in the mesiodistal direction (P > 0.05). There were no other statistically significant differences. The results established that hand, rotary, and reciprocating techniques presented similar safety margins for instrumentation of the apical third of 3-rooted maxillary premolars. Reciprocating instrumentation presented some advantages over hand preparation regarding centering ability.
This in vitro study evaluated the marginal microleakage of a bioactive restorative with other restorative materials in standard Class V preparations. Sixty previously extracted, noncarious human molars were randomly assigned to 3 experimental groups (n = 20): a bioactive composite resin, a universal hybrid composite resin, and a resin-modified glass ionomer restorative. Class V cavities were prepared on the facial or lingual surface of each tooth so that coronal margins were located in enamel and apical margins in cementum (dentin). After the cavity preparations were restored with the appropriate material, the specimens were artificially aged in water baths. The root apices were sealed with utility wax, the tooth surfaces were coated with nail varnish to within 1 mm of the restoration, and specimens were immersed in 1% methylene dye solution for 8 hours. The teeth were invested in clear polymer resin, sectioned longitudinally, and examined under a stereomicroscope to assess dye penetration. Nonparametric scores indicated that microleakage was significantly greater at the apical margins than the coronal margins for all groups (P > 0.0001). The specimens restored with the bioactive material exhibited greater microleakage at both the coronal and apical margins than did specimens restored with the composite resin or resin-modified glass ionomer material, although the differences were not statistically significant (P > 0.05). Based on the results of the present study, the type of restorative material did not appear to have a significant influence on microleakage. Rather, the marginal position (coronal versus apical) of the restoration was the determining factor in microleakage.
To avoid complications, the intimate relation between the maxillary sinus and dental roots deserves attention during surgical procedures. Accidental introduction of foreign bodies, such as dental implants, may irritate the maxillary sinus mucosa, causing sinusitis. Cone beam computed tomography (CBCT) has been proven to be suitable for diagnosis in these cases by providing the exact location of the foreign body. The present article reports 3 cases of foreign bodies inside the maxillary sinus associated with inflammatory processes. Imaging examinations, such as CBCT, are an important tool to assist dentists in diagnosing the presence of foreign bodies in the interior of the maxillary sinus.