Clinical evaluation of the use of fiber posts and direct resin restorations for endodontically treated teeth

PURPOSE: Restoration of root-treated teeth is routinely performed in clinical practice with a choice of therapeutic options, considering many factors to provide optimal mechanical properties, esthetics, and longevity. The aim of the present work was to present a preliminary clinical report on the use of fiber posts and direct resin composites for restoring root-treated teeth. MATERIALS AND METHODS: Thirty-eight anterior and 62 posterior endodontically treated teeth were selected from 3 private prosthodontic offices. The protocol used included endodontic treatment, with translucent fiber posts (DT post) bonded to the post-space using a '1-bottle' adhesive (One-Step, Bisco) and a dual-cure resin cement (DuoLink, Bisco). Direct resin restorations were performed using a micro-hybrid resin composite (Gradia Direct, GC) and a layering technique. Both opaque dentin and enamel and translucent enamel shades were used. RESULTS: Patients were recalled after 6, 12, 24, and 30 months, and the restorations assessed according to predetermined clinical and radiographic criteria. These clinician-mediated evaluation methods confirmed the good clinical performance of the restorations. CONCLUSION: Restoration of endodontically treated teeth with fiber posts and direct resin composites is a treatment option, that in the short term conserves remaining tooth structure and results in good patient compliance.     

Cellular profile of the peritumoral inflammatory infiltrate in squamous cells carcinoma of oral mucosa: Correlation with the expression of Ki67 and histologic grading

Background  

Squamous cells carcinoma is the most important malignant tumor with primary site in the oral cavity and, given the great exposure of mucosa and lips to the etiologic factors of this neoplasm, its incidence is high. Investigation of the prognostic determinants is significant for the expectations of treatment proposal and cure of the patient. The local immune response represented by peritumoral inflammatory infiltrate is a possible prognostic factor.     

Revascularization of autogenous block grafts with or without an e-PTFE membrane

PURPOSE: The aim of this study was to describe the revascularization process of autogenous bone block grafts placed with or without an expanded polytetrafluoroethylene (e-PTFE) membrane. MATERIALS AND METHODS: Thirty Wistar male rats had their mandibles augmented by either an autogenous bone block graft (group A) or an autogenous bone block graft covered with an e-PTFE membrane (group B). The animals were sacrificed by perfusion at baseline, 3, 7, 14, and 21 days after surgery. RESULTS: After 3 days, the presence of vascular sprouts derived from the recipient bed was observed in group A; more discrete sprouts were also observed in group B. After 7 days, revascularization continued, with vessels derived from both the recipient bed and the surrounding connective tissue in group A but only from the recipient bed in group B. At 14 days, group A showed penetration of vessels at the periphery of the graft; the vessels reached varying distances inside it. In group B, revascularization of the graft occurred mainly near its perforation, its borders, and at the recipient bed-graft interface. After 21 days, graft vascular penetration could be observed throughout the extent of the graft in group A but only approximately halfway through the graft in group B. DISCUSSION: The results emphasized the importance of the vascular network and of the revascularization process of the autogenous bone graft in new bone formation. Early vascular penetration and nutrition of the graft are key factors in its integration with the recipient bed. CONCLUSIONS: Revascularization of the bone graft occurred in both A and B. However, vascular sprouts originated only from the recipient bed in group A, while in group B the graft was penetrated by vessels from both the recipient bed and the surrounding connective tissue. The revascularization took place more promptly and was more intense and extensive in group A than in group B for all periods.     

Dental implants placed in grafted maxillary sinuses: a retrospective analysis of clinical outcome according to the initial clinical situation and a proposal of defect classification

Objective of the study: To present a classification of maxillary defects necessitating sinus floor elevation procedures (SFEPs) with two objectives: (a) to propose a standardization of surgical procedures according to initial type of atrophy and (b) to allow the evaluation of the success/survival rates of implants placed in the grafted areas according to the initial situation. Materials and methods: Nine‐hundred and fifty‐two consecutive SFEP were performed on 692 patients. Initial defects were classified according to a new classification, which considered not only residual bone height below the sinus but also the width of the alveolar crest and horizontal/vertical intermaxillary relationship. Results were evaluated according to the different classes. The sinuses were grafted with autogenous bone taken from intra‐oral or extra‐oral sites: 579 SFEP were associated with vertical and/or horizontal onlay grafts to correct concomitant alveolar ridge deficits. A total of 2037 implants were inserted into the grafted sinuses either immediately or 4–6 months later. Three to 6 months afterwards, implants were loaded. The mean follow‐up was 59 months (range: 12–144 months). Results: The success rate of the reconstructive procedures varied between 93.2% and 100%, according to class of atrophy; the overall survival and success rates of implants were 95.8% and 92.5%, respectively, whereas the survival and success rates according to class of atrophy varied between 90% and 97.6%, and between 85.4% and 95.5%, respectively. Lower success rates were found in classes presenting with more severe atrophy. Conclusion: The results obtained demonstrated that sinus floor elevation, alone or in association with reconstructive procedures with autogenous bone grafts, is a reliable procedure to allow implant placement in atrophic edentulous maxillae, irrespective of the initial clinical situation. However, it must be underlined that the success rates of reconstructive procedures and implants differ according to class of atrophy, showing lower success rates in classes presenting with more severe atrophy.     

Marginal integrity of ceramic inlays luted with a self-curing resin system.

OBJECTIVE: Aim of this study was to observe the efficacy of two different composite cements on the prevention of marginal deterioration around adhesive ceramic inlay restorations, under laboratory conditions, and to test the null hypothesis that different luting procedures cannot affect sealing ability of luted inlays. METHODS: Twenty-six standardized mesio-occlusal Class II cavities were prepared in extracted posterior teeth. Class II inlays were fabricated with IPS Empress II system following the manufacturer's instructions. The samples were divided into two groups of 13 teeth each at random. Group 1: The ceramic inlays of Group 1 were luted using Excite DSC and an experimental self-curing resin cement (Multilink, Vivadent); in this group, Excite DSC was self-activated and not light-cured. Group 2: Excite DSC in combination with a dual-curing resin cement (Variolink II, Vivadent) was used (as control). In this group Excite DSC was light-cured for 20s separately, before resin cement application. The 'wet' bonding technique was followed. Three samples of each group were selected at random for SEM observations, while the other 10 samples were processed for marginal leakage. The bonding mechanism to dentin and resin cement thickness was evaluated. RESULTS: Samples of both groups showed resin tag and adhesive lateral branch formation. In Group 1 the hybrid layer was mainly uniform along the interface between dental substrates and adhesive material, and resin cement thickness was between 20 and 85 microm. At the cervical margin no gap was detected. In Group 2 the cement thickness was between 30 and 110 microm and hybrid layer formation was observed along the interface but at the cervical margin it was not always uniform and continuous. Resin tag formation was uniform in both groups. At cervical margins, 80% of Group 1 samples showed a perfect seal at the dentin-cementum margins, and 90% at enamel margins. Group 2 samples showed only 50% of cervical margins free from leakage and 80% at the occlusal enamel margins. Statistically significant differences were found at cervical margins between the two groups, while no significant differences were found at enamel site.CONCLUSIONS: It can be concluded that the self-curing adhesive-resin cement combination can properly seal Class II porcelain inlays.     

Immediately loaded bar-connected implants with an anodized surface inserted in the anterior mandible in a patient treated with diphosphonates for osteoporosis: a case report with a 12-month follow-up

Background: It has been suggested that tooth loss is greater in the osteoporotic patient population. Only a few cases have been reported in the literature about the use of dental implants in patients with osteoporosis. Diphosphonates are stable analogs of pyrophosphate, a physiologic regulator of calcification and bone resorption. Multiple implant failures have been reported in a patient undergoing treatment with diphosphonates. Recently, several clinical and experimental reports have shown that immediate loading of dental implants is possible in selected situations. Purpose: The aim of this case report was to present the clinical outcome of immediate loading of implants in a patient undergoing diphosphonate treatment for osteoporosis. Materials and Methods: In a 65‐year‐old patient undergoing diphosphonate treatment for osteoporosis, four implants were inserted in the anterior mandible. The implants were connected with a bar supporting an overdenture and were then loaded the same day. Results: No problems occurred in the postoperative period. At 1‐year follow‐up, all four of the implants appeared to be clinically osseointegrated, and no mobility was present. Minimal bone resorption was present around all implants. Conclusions: Our case report points to the fact that, contrary to what has been reported in the literature, it is possible to successfully insert and load immediately after surgery dental implants in a patient undergoing diphosphonate treatment for osteoporosis     

Immunolocalization of PTCH protein in odontogenic cysts and tumors

The human patched gene (PTCH) functions in both embryologic development and tumor suppression. PTCH mutations have been found in odontogenic keratocysts. However, the expression and localization of the protein product of the gene have not been determined in odontogenic tumors and cysts. We investigated 68 odontogenic lesions by immunohistochemistry, and compared their PTCH expression with that in basal cell carcinomas. All odontogenic lesions, including two keratocysts with truncating mutations, were positive for PTCH. Different types of lesions had different amounts of staining. Lack of staining was noted in the majority of basal cell carcinomas. Taken together, these data suggest that odontogenic keratocysts arise with heterozygous mutations of the PTCH gene.     

The number of implants required to support a maxillary overdenture: a systematic review and meta-analysis

Purpose

The number of implants needed to support a maxillary overdenture is still a controversial issue. The aim of this systematic review was to investigate the number of implants required to support a maxillary overdenture in order to obtain optimal treatment outcomes in terms of implant survival, overdenture longevity and patient satisfaction.

A study of the septa in the maxillary sinuses and the subantral alveolar processes in 30 patients

The objective of this paper is to study the incidence of septa in the maxillary sinus and measure the height of the underlying alveolar process using panoramic radiography and computerized tomography (CT scans). Thirty patients who were going to be treated with dental implants were submitted to panoramic radiographs and CT scans. Sixty maxillary sinuses were analysed and divided into 2 groups: group 1 (totally edentulous) and group 2 (partially edentulous). The sinuses were divided into 3 regions (anterior, middle, and posterior), the septa were analysed, and the heights of the alveolar processes were calculated in these 3 areas. Of the 30 patients, 36.5% had maxillary sinuses, and 25% of these sinuses had septa, and 11.8% of the panoramic radiographs were false-negatives. In the panoramic radiographs of 10 patients, 3 had bilateral septa, 5 had a septum in only one sinus, and 2 patients had 2 unilateral septa. In the CT scans of 11 patients, 4 patients had a bilateral septa, 5 had a septum in only 1 sinus, and 2 patients had 2 unilateral septa. Therefore, 2 more septa were observed in the CT scans. In the study of the height of the subantral alveolar process, the least amount of difference between both techniques occurred in the middle region of the sinus. The CT scan is more reliable than the panoramic radiograph in diagnosing maxillary septa because of its greater accuracy. In the panoramic radiograph, the middle portion of the alveolar process in the posterior subantral segment was the least distorted of the three portions measured.