CBCT Post-Processing Tools to Manage the Progression of Invasive Cervical Resorption: A Case Report

Abstract This case report aimed to highlight the usefulness of cone beam computed tomography (CBCT) and its post-processing tools for the diagnosis, follow-up and treatment planning of invasive cervical resorption (ICR). A 16-year-old female patient was referred for periapical radiographic examination, which revealed an irregular but well demarcated radiolucency in the mandibular right central incisor. In addition, CBCT scanning was performed to distinguish between ICR and internal root resorption. After the diagnosis of ICR, the patient was advised to return shortly but did so only six years later. At that time, another CBCT scan was performed and CBCT registration and subtraction were done to document lesion progress. These imaging tools were able to show lesion progress and extent clearly and were fundamental for differential diagnosis and treatment decision.

Resumo Com este relato de caso clínico objetiva-se enfatizar a contribuição das ferramentas de pós-processamento aplicadas às imagens de tomografia computadorizada de feixe cônico (TCFC) no diagnóstico, acompanhamento e decisão do tratamento de reabsorção cervical invasiva (ICR). Paciente do sexo feminino, com 16 anos de idade foi encaminhada para realização de radiografia periapical e foi observada radiolucência irregular, na raiz do incisivo central inferior direito. A TCFC foi realizada no intuito de se obter diagnóstico diferencial entre ICR e reabsorção radicular interna. Após o diagnóstico de ICR, o paciente foi orientado a retornar em breve, mas o fez somente seis anos mais tarde. Fez-se assim outra tomografia e registro e subtração foram realizados para documentar a progressão da lesão. Essas ferramentas foram capazes de revelar claramente o progresso da lesão, sua real extensão e foram fundamentais para o diagnóstico diferencial e decisão de tratamento.

Absence of Non-Carious Cervical Lesions (NCCLs) in a Chilean Pre-Columbian Sample with Severe Occlusal Tooth Wear / Ausencia de Lesiones Cervicales no Cariosas (NCCLs) en una Muestra Chilena Precolombina con Severo Desgaste Oclusal

This study evaluates the non-carious cervical lesions (NCCLs) and the occlusal tooth wear in a pre-Columbian sample (n= 67, adults) from San Pedro de Atacama (North of Chile, 400-1300 BCE). The cervical regions of tooth were observed for loss of enamel and/or dentine in order to identify them as NCCLs and the tooth wear was characterized by the Basic Erosive Wear Examination (BEWE) index. None of the individuals analyzed presented NCCLs, whereas the 98.5% (66/67) of them showed occlusal wear. The mean BEWE index was 2.5, indicating severe dental wear (3 being the highest possible score of BEWE). This lack of relation among severe tooth wear and NCCLs gives support to the idea of loss of crown height reduces cervical stress and develop of NCCLs in archaeological populations.

Este estudio evalúa las lesiones cervicales no cariosas (NCCLs) y el desgaste dental oclusal en una muestra precolombina (n= 67, adultos) de San Pedro de Atacama (Norte de Chile, 400-1300 AEC). Se analizó la perdida de esmalte y/o dentina en las áreas cervicales de los dientes con el propósito de identificarlas como NCCLs y el desgaste dental fue evaluado según el índice Basic Erosive Wear Examination (BEWE). Ninguno de los individuos analizados presentó NCCLs, mientras el 98,5% (66/67) de ellos mostró desgaste oclusal. El promedio del índice BEWE fue de 2,5, indicando severo desgaste dental (siendo 3 el puntaje más alto posible). La falta de relación entre severo desgaste dental y NCCLs apoya la idea que la pérdida de altura de las coronas reduce el estrés cervical y el desarrollo de NCCLs en poblaciones arqueológicas.

Comparative photoelastic study of dental and skeletal anchorages in the canine retraction

OBJECTIVE: To compare dental and skeletal anchorages in mandibular canine retraction by means of a stress distribution analysis. METHODS: A photoelastic model was produced from second molar to canine, without the first premolar, and mandibular canine retraction was simulated by a rubber band tied to two types of anchorage: dental anchorage, in the first molar attached to adjacent teeth, and skeletal anchorage with a hook simulating the mini-implant. The forces were applied 10 times and observed in a circular polariscope. The stresses located in the mandibular canine were recorded in 7 regions. The Mann-Whitney test was employed to compare the stress in each region and between both anchorage systems. The stresses in the mandibular canine periradicular regions were compared by the Kruskal-Wallis test. RESULTS: Stresses were similar in the cervical region and the middle third. In the apical third, the stresses associated with skeletal anchorage were higher than the stresses associated with dental anchorage. The results of the Kruskal-Wallis test showed that the highest stresses were identified in the cervical-distal, apical-distal, and apex regions with the use of dental anchorage, and in the apical-distal, apical-mesial, cervical-distal, and apex regions with the use of skeletal anchorage. CONCLUSIONS: The use of skeletal anchorage in canine retraction caused greater stress in the apical third than the use of dental anchorage, which indicates an intrusive component resulting from the direction of the force due to the position of the mini-implant and the bracket hook of the canine. .

OBJETIVO: comparar as ancoragens dentária e esquelética na retração do canino inferior, por meio do estudo da distribuição de tensões. MÉTODOS: foi confeccionado um modelo fotoelástico de segundo molar a canino, sem o primeiro pré-molar, e simulada a retração do canino inferior com elástico preso a dois tipos de ancoragem: dentária, no primeiro molar conjugado aos dentes adjacentes; e ancoragem esquelética, em gancho simulando o mini-implante. As forças foram aplicadas 10 vezes e observadas no polariscópio circular. As tensões no canino inferior foram registradas em 7 regiões. O teste de Mann-Whitney foi aplicado para comparar as tensões em cada região, considerando os dois sistemas de ancoragem. As tensões nas regiões perirradiculares do canino foram comparadas pelo teste de Kruskal-Wallis. RESULTADOS: as tensões foram similares tanto na região cervical quanto no terço médio. No terço apical, as tensões associadas à ancoragem esquelética foram maiores que as tensões associadas à ancoragem dentária. Os resultados do teste de Kruskal-Wallis mostraram que as maiores tensões foram identificadas nas regiões cervicodistal, apicodistal e na região do ápice com o uso da ancoragem dentária; e com o uso da ancoragem esquelética, as maiores tensões se localizaram nas regiões apicodistal, apicomesial, cervicodistal e no ápice. CONCLUSÃO: o uso de ancoragem esquelética na retração promoveu maior tensão no terço apical do que o uso da ancoragem dentária, indicando um componente intrusivo devido à direção da força decorrente da posição do mini-implante e do gancho do braquete do canino. .

Force distribution is more important than its intensity!

A common question about root resorption is raised in orthodontic practice: What is more important, the intensity of force or its distribution along the root, periodontal and alveolar structures? Diffuse distribution of forces applied to periodontal tissues during tooth movement tends not to promote neither extensive areas of cell matrix hyalinization nor significant death of cementoblasts that lead to root resorption. However, focal distribution or concentration of forces within a restricted area - as it occurs in tipping movements, even with forces of lower intensity - tend to induce extensive areas of hyalinization and focal death of cementoblasts, which is commonly associated with root resorption. In tipping movements, the apical regions tend to concentrate more forces in addition to wounding the cementoblasts due to the smaller dimension of their root structure as well as their cone shape. For this reason, there is an increase in root resorption. In the cervical region, on the other hand, the large area resulting from a large diameter and bone crown deflection tends to reduce the effects of forces, even when they are more concentrated, thus rarely inducing death of cementoblasts and root resorption.

Um questionamento comum sobre as reabsorções radiculares na prática ortodôntica: "O que é mais importante? A intensidade das forças aplicadas ou sua distribuição ao longo das estruturas radiculares, periodontais e alveolares?" A distribuição difusa das forças aplicadas sobre os tecidos periodontais durante o movimento dentário de corpo tende a não promover extensas áreas de hialinização da matriz extracelular, nem morte significativa de cementoblastos que levariam à reabsorção radicular. Porém, a distribuição focal ou concentração de forças - como nas inclinações, mesmo nas de menor intensidade - em uma área restrita tende a induzir áreas extensas de hialinização e morte focal de cementoblastos, associando-se mais comumente à reabsorção radicular. Nos movimentos de inclinação, as áreas apicais, por sua menor dimensão da estrutura radicular e sua forma cônica, tendem a concentrar mais ainda as forças e lesar cementoblastos, aumentando a frequência das reabsorções radiculares. Na região cervical, a maior área decorrente do maior diâmetro e a deflexão óssea da crista óssea tendem a reduzir os efeitos das forças, mesmo quando mais concentradas, muito raramente induzindo a morte de cementoblastos e reabsorções radiculares.

Evaluation of the vertical alterations of the upper second molars after the alignment and leveling phase using the MBT technique

OBJECTIVE: This study aimed at comparing the distocervical angulations of upper second molars crowns of groups with normal occlusion and with Angle Class I and II malocclusions. Additionally, it aimed to analyze the changes occurring after alignment and leveling performed with MBT technique. METHODS: The sample of normal occlusions comprised 32 lateral teleradiographs, while the sample of malocclusions comprised 38 initial and post-leveling lateral teleradiographs. RESULTS: The results did not show statistically significant differences between morphological characteristics of the normal occlusion group and the malocclusion group. On the other hand, after alignment and leveling, statistically significant reduction was observed in distocervical inclinations with extrusion of the distal portion of upper second molars.

OBJETIVO: a proposta do presente trabalho foi comparar as angulações distocervicais das coroas dos segundos molares superiores de um grupo com oclusão normal e outro composto de más oclusões de Classes I e II de Angle, e analisar as modificações ocorridas após o alinhamento e nivelamento com a técnica MBT. MÉTODOS: a amostra de oclusão normal foi composta por 32 telerradiografias laterais; e a amostra de má oclusão constituiu-se de 38 telerradiografias laterais iniciais e pós-nivelamento. RESULTADOS: os resultados não mostraram diferença estatisticamente significativa entre as características morfológicas dos grupos com oclusão normal e com má oclusão; porém, após o alinhamento e nivelamento, observamos redução estatisticamente significativa nas inclinações distocervicais, com extrusão da porção distal dos segundos molares superiores.

Effect of andiroba oil on periodontitis in Wistar rats

PURPOSE: To evaluate the effects of andiroba oil on the periodontitis in rats. METHODS: The periodontitis was induced by the placement of cotton ligatures around the cervix of the second upper molars on fifteen rats, and waiting fifty days. The animals were randomly distributed into three groups: saline group, andiroba oil group and meloxican group, differentiated by substance used in the treatment of periodontitis. The groups received the respective substance by gavage for seven days, after the periodontitis induced. It was analyzed the score of inflammatory cells and the measurement from the cemento-enamel junction to the bone crest. RESULTS: The andiroba oil group (p=0.008) and meloxican group (p=0.0347) show a less score of inflammatory cells than saline group, however there weren't difference between them (p=0.2754). Regarding the analysis of measurement from the cemento-enamel junction to the bone crest, there was no difference between groups studied (p=0.3451). CONCLUSION: Andiroba oil decreased the quantity of inflammatory cells, however, it didn't have an effect on the measurement of alveolar bone loss, like the treatment with Meloxican®.

One-Year Evaluation of a Simplified Ethanol-Wet Bonding Technique: A Randomized Clinical Trial

The objective of this randomized clinical trial was to evaluate the clinical performance of adhesive restorations using a three-step etch-and-rinse adhesive (TSER), a one-step self-etching adhesive (OSSE), and a simplified ethanol-wet bonding technique (EWBT) prior to the application of a composite resin in non-carious cervical lesions. Ninety-three restorations (31 for each group) were placed in 17 patients by a single operator. No cavity preparation was performed. After 6 and 12 months, the restorations were assessed by two previously trained examiners using modified Ryge criteria for retention (kappa=1.00) and marginal adaptation/staining (kappa=0.81), and the results were analyzed by Fisher's exact and Kruskal-Wallis tests, respectively. No significant differences were observed among groups at the 6- and 12-month time points for any of the assessed criteria (p≥0.05). The intra-group analysis performed by Cochran's test (for retention) and Wilcoxon test (for marginal adaptation/staining) revealed significant differences between the baseline/12-month time intervals in marginal adaptation in OSSE (p=0.0180) and in marginal staining in TSER (p=0.0117). The survival analysis for retention criteria performed using a log-rank test did not show significant differences (p>0.05). The restorations placed using the simplified EWBT performed equally well as the other adhesive strategies employed.

O objetivo deste ensaio clínico randomizado foi avaliar o comportamento clínico das restaurações adesivas, usando um adesivo convencional de três passos (CTP), um adesivo autocondicionante de um passo (AUP) e uma técnica simplificada da adesão úmida por etanol (AUET) antes da aplicação de uma resina composta em lesões cervicais não-cariosas. Noventa e três restaurações (31 para cada grupo) foram realizadas em 17 pacientes por um único operador. Nenhum preparo cavitário foi realizado. Depois de 6 e 12 meses, as restaurações foram avaliadas por 2 examinadores previamente treinados, utilizando critérios de Ryge modificados para retenção (kappa=1,00) e adaptação/manchamento marginal (kappa=0,81), e os resultados foram analisados pelos testes Exato de Fisher e Kruskal-Wallis, respectivamente. Não foram observadas diferenças significativas entre os grupos aos 6 e 12 meses para qualquer um dos critérios avaliados (p≥0,05). A análise intra-grupo feita pelos testes Q de Cochran (para retenção) e Wilcoxon (para adaptação/manchamento marginal) revelou diferenças significativas entre os intervalos de tempo baseline/12 meses para a adaptação marginal no AUP (p=0,0180) e manchamento marginal no CTP (p=0,0117). A análise de sobrevivência para o critério retenção realizada utilizando o teste de log-rank não apresentou diferenças significantes (p≥0,05). As restaurações feitas utilizando a técnica simplificada da adesão úmida por etanol comportaram-se igualmente às outras estratégias adesivas empregadas.

Role of delayed light polymerization of a dual-cured composite base on marginal adaptation of class II posterior composite open-sandwich restoration.

Objective: To determine the effect of delayed light polymerization of a dual-cured composite base material on the marginal adaptation of class II composite restoration. Materials and Methods: 35 extracted human molar teeth were used to prepare class II mesio-occlusal or disto-occlusal slot preparations with gingival margins at the CEJ. The teeth were restored using an open-sandwich technique with a 2mm base increment of dual-cured composite, and divided into 5 groups based on the mode of the polymerization of the dual-cured composite base: Group A - self-cured after placement (5 mins), Group B - light-cured immediately after placement, Group C - light-cured 30 seconds after placement, Group D - light-cured 60 seconds after placement, Group E - light-cured 120 seconds after placement. Then a top layer of a light-cured composite resin is placed to complete the restoration. The teeth were thermocycled and immersed in 1% aqueous solution of methylene blue for 24 hours. Sectioning of the teeth and scoring under stereomicroscope was done. Data will be statistically evaluated using the kruskal wallis 1-way ANOVA. Results: Statistical analysis using kruskal wallis 1-way ANOVA showed that the dual-cured composite light polymerized 1 minute after placement exhibited the least microleakage. Conclusion: Delayed light polymerization of the dual-cured composite base reduced the microleakage in class II open-sandwich restorations.

Influence of lateral excursion on vestibular cervical dental abfractions

Se realizó una investigación para evaluar la influencia de los movimientos excursivos laterales mandibulares; función de grupo y guía canina sobre abfracción dentaria cervico vestibular(ADCV). Se seleccionaron 36 individuos de ambos sexos entre 20 a 45 años de edad, con dentición natural completaque presentan como mínimo un diente con ADCV, en la Clínica Universitaria de la UNMSM. Se evaluó el número de dientes con ADCV por cada lado (derecho e izquierdo), tipo de diente,y movimiento excursivo lateral (guia canina o función en grupo) que lo influye. Los resultados denotaron no significancia estadísticas (p>0,05), el tipo de diente con mayor frecuencia a presentar ADCV fue el primer premolar inferior, 30,8 por ciento del lado derecho y 36,4 por ciento del lado izquierdo. Se encontró correlación positiva moderada entre edad y ADCV(r=0,40). Se concluye que la excursion lateral función en grupo puede contribuir a la presencia de ADCV.

Use of enamel matrix protein derivative with minimally invasive surgical approach in intra-bony periodontal defects: clinical and patient-centered outcomes

This case series evaluated the clinical performance and patient-centered outcomes after a minimally invasive surgical technique (MIST) associated with enamel matrix protein derivative (EMD), for the treatment of intra-bony defects. Twelve patients presenting teeth with probing depth >5 mm and bleeding on probing associated with radiographic evidence of intra-bony defect were treated by MIST associated with EMD. Clinical parameters were measured at baseline, 3 and 6 months. Patient perception during the intraoperative period and during the first postoperative week was evaluated. The use of MIST with EDM promoted significant improvements in clinical parameters, minimal pain/discomfort and maximum esthetics satisfaction. Within of limits of the present study, it could be shown that MIST combined with EMD for the treatment of intra-bony defects promotes satisfactory clinical and patient-centered outcomes.

O objetivo deste estudo foi avaliar os resultados clínicos e centrados no paciente após abordagem cirúrgica minimamente invasiva (CMI) associada à aplicação das proteínas derivadas da matriz do esmalte (PDE) no tratamento de defeitos infra-ósseos. Doze pacientes apresentando um sítio com profundidade de sondagem >5 mm e sangramento à sondagem , associado à evidência radiográfica de defeito infra-ósseo, foram tratados com CMI e aplicação das PDE. Os parâmetros clínicos foram avaliados imediatamente antes do procedimento e após 3 e 6 meses. A percepção de dor e desconforto do paciente durante o período trans-cirúrgico e ao longo da primeira semana de pós-operatório, bem como a satisfação estética 6 meses após o tratamento, foram avaliadas por meio de questionários. Os resultados mostraram que o uso da CMI associada à aplicação de PDE promoveu melhoras estatisticamente significantes nos parâmetros clínicos, mínima dor e desconforto e máxima satisfação estética aos pacientes. Dentro dos limites do estudo, foi demonstrado que a associação de CMI e PDE, no tratamento de defeitos infra-ósseos, é capaz de promover satisfatórios resultados clínicos e centrados no paciente.

Two-year clinical evaluation of resinous restorative systems in non-carious cervical lesions

This controlled clinical trial evaluated the 2-year clinical performance of a one-bottle etch-and-rinse adhesive and resin composite system (Excite/Tetric Ceram) compared to a resin-modified glass ionomer cement (RMGIC) (Vitremer/3M) in non-carious cervical lesions. Seventy cervical restorations (35 resin composite - RC- restorations and 35 RMGIC restorations) were placed by a single operator in 30 patients under rubber dam isolation without mechanical preparation. All restorations were evaluated blindly by 2 independent examiners using the modified USPHS criteria at baseline, and after 6, 12 and 24 months. Data were analyzed statistically by Fisher's exact and McNemar tests. After 2 years, 59 out of 70 restorations were evaluated. As much as 78.8 percent retention rate was recorded for RC restorations, while 100 percent retention was obtained for RMGIC restorations. Fisher's exact test showed significant differences (p=0.011) for retention. However, there were no significant differences for marginal integrity, marginal discoloration, anatomic form and secondary caries between the RC and RMGIC restorations. The McNemar test detected significant differences for Excite/TC between baseline and the 2-year recall for retention (p=0.02), marginal integrity (p=0.002) and anatomic form (p=0.04). Therefore, the one-bottle etch-and-rinse bonding system/resin composite showed an inferior clinical performance compared to the RMGIC.

Esse estudo avaliou o desempenho clínico de restaurações de lesões cervicais não-cariosas por um período de 2 anos empregando um sistema adesivo de condicionamento total (Excite/Tetric Ceram) e um cimento de ionômero de vidro modificado por resina (Vitremer). Setenta restaurações (35 por material) foram realizadas por um único operador. Todas as lesões cervicais não-cariosas foram restauradas sem a execução de preparo cavitário e sob isolamento absoluto. As restaurações foram avaliadas por 2 examinadores independentes usando os critérios USPHS modificados nos períodos inicial, 6, 12 e 24 meses. A análise estatística foi realizada pelos testes de Fisher e McNemar. Cinquenta e nove restaurações foram avaliadas após 2 anos, obtendo-se um índice de retenção de 78,8 por cento para resina composta e 100 por cento para o cimento de ionômero de vidro modificado por resina. O teste exato de Fischer detectou diferença significante (p=0,011) para retenção entre os dois materiais. Contudo, não houve diferença significante para integridade marginal, descoloração marginal, forma anatômica e cárie secundária. O teste de McNemar detectou diferença estatística para o sistema Excite/Tetric Ceram entre o período inicial e 2 anos para os critérios de retenção (p=0,02), integridade marginal (p=0,002) e forma anatômica (p=0,04). Portanto, o sistema adesivo de condicionamento total apresentou um desempenho clínico inferior comparado ao cimento de ionômero de vidro modificado por resina.

Glass ionomer cements and their role in the restoration of non-carious cervical lesions

Glass ionomer based materials are clinically popular in several areas of restorative dentistry, but restoration of cervical lesions has proven particularly successful. Various etiologies, conformations, locations and structural characteristics make non-carious cervical lesions more challenging to adhesive restorative procedures and marginal seal in the long run. Due to their characteristics, glass ionomer cements (GICs) have precise indication for these cases. Moreover, the use of a GIC base underneath composite resin, the so-called "sandwich" or mixed technique, allows associating the good characteristics of composite resins and GICs, and has been considered quite useful in the restoration of non-carious cervical defects. The aim of this paper is to critically review the literature and discuss peculiar features of GICs regarding their role in the restoration of non-carious cervical lesions.

Influence of flowable materials on microleakage of nanofilled and hybrid Class II composite restorations with LED and QTH LCUs.

Background: Class II composite restorations are more frequently being placed with margins apical to the cementoenamel junction (CEJ) and margins within the dentin are prone to microleakage. Aims: This in vitro study was used to evaluate the influence of flowable composite and flowable compomer as gingival liner on microleakage in Class II composite restorations and compare a light-emitting diode (LED) unit with a quartz tungsten halogen (QTH) unit for light-activating composite resins. Materials and Methods: Mesioocclusal and distoocclusal Class II cavity preparations were made in 72 sound extracted premolars. The buccolingual width was 2.5 mm and the gingival margins of all the cavities were placed 1.0 mm apical to the CEJ. The boxes were prepared 1.5 mm deep axially, making 144 slot cavities. Teeth were randomly divided into the following two groups (n = 72): (I) Universal Filtek Supreme XT; Universal Filtek Supreme XT + Flwable Filtek XT and Universal Filtek Supreme XT + Dyract Flow and (II) Filtek Z250; Filtek Z250 + Flwable Filtek XT and Filtek Z250 + Dyract Flow. Flowable materials were injected into the gingival floor of the cavity to a thickness of 1.0 mm. Each increment was cured for 20 s. One-half of the subgroups in each group were cured with QTH and the other half with LED light curing units (LCUs). After 1 week of incubation at 37°C, the specimens were thermocycled (5-55°C, x1500), immersed in 0.5% basic fuchsine dye for 24 h and sectioned and microleakage was evaluated at the gingival margin by two examiners using a 0-3 score scale. The data were analyzed using the Kruskal-Wallis and Mann-Whitney U tests. Results: The groups utilizing flowable liners had significantly less microleakage (P < 0.05). No significant difference was identified between Universal Filtek Supreme XT and Filtek Z250 composites with and without flowable materials. There was no significant between utilizing flowable composite or flowable compomer and between each similar subgroup when polymerized with either the LED or the QTH LCUs. Conclusions: A layer of flowable materials at the gingival floor of Class II composite restorations may be recommended to improve the marginal seal of a restoration.

Cementum analysis in cleidocranial dysostosis.

OBJECTIVE: Cleidocranial dysostosis (CCD) is a skeletal disorder associated with dental anomalies such as failure or delayed eruption of permanent teeth and multiple impacted supernumerary or permanent teeth. Absence of cellular cementum at the root apex is presumed to be one of the factors for failure or delayed eruption. The aim of this study was to analyze the root cementum of supernumerary(S) and permanent teeth (P) of a CCD patient and to compare the findings with those of normal individuals with special emphasis on delayed eruption. MATERIALS AND METHODS: Ground sections of 12 extracted teeth (9S + 3P) of a CCD patient and 12 teeth of normal individuals (5S + 7P) were taken for the study. The sections were longitudinal and 50 microm thick. Root characteristics were recorded with the aid of a light microscope. RESULTS: The absence of apical cellular cementum, increased root resorption and increased percentage of the gap type of cemento-enamel (C-E) junctions were significant findings noted both in the supernumerary and permanent teeth of the CCD patient. CONCLUSION: The presumption of cellular cementum is essential for tooth eruption is not supported by the findings of the present study. Delayed exception could be attributed to various other factors like mechanical obstruction, reduced serum alkaline phosphatase levels etc. Also, the significance of the increased percentage of the gap type of C-E junctions and its role in tooth eruption has to be further evaluated.

Free gingival graft in the treatment of class III gingival recession.

AIM: The purpose of this study was to assess the success and predictability of root coverage and esthetics obtained with free gingival grafts (FGGs) in the treatment of early class III gingival recessions for a period of 12 months. MATERIALS AND METHODS: Ten patients contributed to 12 sites, each with early class III recession with interdental bone loss < or = 4 mm from cemento enamel junction(CEJ). Clinical parameters recorded at baseline and at 1, 6, and 12 months were probing depth (PD), recession depth (RD), recession width (RW), and clinical attachment level (CAL). RESULTS: Reduction of recession resulted in a significant gain in CAL and PD at the end of 12 months. A statistically significant mean root coverage of 41.25 +/- 21.07% was obtained at the end of 12 months. A statistically significant improvement in Visual Analog Scale score was seen after a 12-month follow-up period. CONCLUSION: In a south Indian population, early class III gingival recessions treated with FGG procedures resulted in 40-50% root coverage with fairly acceptable esthetics.

Assessment in vitro of brushing on dental surface roughness alteration by laser interferometry

Noncarious cervical lesions (NCCLs) are considered to be of multifactorial origin, normally associated with inadequate brushing. This study assessed the influence in vitro of simulated brushing on NCCL formation. Fifteen human premolars were submitted to brushing in the cementoenamel junction region, using hard-, medium- and soft-bristled brushes associated with a toothpaste of medium abrasiveness under a 200 g load, at a speed of 356 rpm for 100 minutes. The surface topography of the region was analyzed before and after brushing, by means of a laser interferometer, using "cut-off" values of 0.25 and considering roughness values in mm. The initial roughness (mm) results for dentin (D / bristle consistency: 1 - soft, 2 - medium and 3 - hard) were as follows: (D1) 1.25 ± 0.45; (D2) 1.12 ± 0.44; (D3) 1.05 ± 0.41. For enamel (E / bristle consistency: 1 - soft, 2 - medium and 3 - hard), the initial results were: (E1) 1.18 ± 0.35; (E2) 1.32 ± 0.25; (E3) 1.50 ± 0.38. After brushing, the following were the values for dentin: (D1) 2.32 ± 1.99; (D2) 3.30 ± 0.96; (D3) Over 500. For enamel, the values after brushing were: (E1) 1.37 ± 0.31; (E2) 2.15 ± 0.90; (E3) 1.22 ± 0.47. Based on the results of the ANOVA and Tukey statistical analyses (a = .05) it was concluded that soft, medium and hard brushes are not capable of abrading enamel, whereas dentin showed changes in surface roughness by the action of medium- and hard-bristled brushes.

Root coverage with free gingival autografts--a clinical study.

AIM: To assess the percentage of root coverage with autogenous free gingival grafts. MATERIALS & METHODS: Ten non-smoking patients with Miller's class I or class II recessions were included in the study. The clinical parameters such as recession depth, recession width, probing pocket depth, clinical attachment level and width of the keratinized gingiva were recorded at the baseline, at the end of 1 month, 3 months, and 6 months after the surgical procedure. Autogenous free gingival grafts harvested from the palatal mucosa were used to cover the denuded roots. RESULTS: Four out of ten sites showed 100% root coverage. A mean percentage of 80.3% of root coverage was achieved.

Prevalência de projeção cervical de esmalte em molares inferiores: avaliação da possibilidade de diagnóstico utilizando RX convencional e digital e tomografia / Prevalence of enamel cervical projections in mandibular molars: evaluation of possible diagnosis with conventional and digital RX and tomograph

Para a realização de um correto diagnóstico e adequado tratamento da bifurcação radicular de molares inferiores envolvidos pela doença periodontal inflamatória, é necessário o conhecimento pleno da anatomia cervical dos dentes. Uma das complexidades anatômicas encontradas é a projeção cervical de esmalte (PCE). Avaliou-se a presença da PCE em 462 molares inferiores, e a possibilidade de diagnóstico destas projeções por meio de radiografia convencional, digital e tomográfica. As PCE foram classificadas em Grau 0 (ausência de projeção), Grau I (pequena), Grau II (próxima da furca, sem atigi-la) e Grau III (atingindo a furca). No primeiro molar foi observado, nas faces vestibular e lingual, respectivamente,que 45,3 por cento e 70,9 por cento apresentaram Grau 0, 42,6 por cento e 26,4 por cento Grau I, 5,4 por cento e 2,7 por cento Grau II e 6,7 por cento e 0 por cento Grau III. No segundo molar foi observado, nas faces vestibular e lingual, respectivamente, que 44,5 por cento e 84,9 por cento apresentaram Grau 0, 35,6 por cento e 14,3 por cento Grau I, 12,3 por cento e 0,68 por cento Grau II e 7,5 por cento e 0 por cento Grau III. No terceiro molar foi observado, nas faces vestibular e lingual, respectivamente, que 61,9 por cento e 92,2 por cento apresentaram Grau 0, 20,8 por cento e 5,9 por cento Grau I, 8,3 por cento e 1,7 por cento Grau II 8,9 por cento e 0 por cento Grau III . Nenhum dente apresentou PCE nas faces proximais. Concluiu-se que houve maior prevalência de PCE na face vestibular e que a de Grau I foi a mais encontrada nos dentes estudados. Nenhum dos métodos de diagnóstico utilizados foi capaz de evidenciar a projeção cervical de esmalte

A comparative study of microleakage below cemento-enamel junction using light cure and chemically cured glass ionomer cement liners.

Posterior composite resins have gained considerable importance over last few years. However, improper placement techniques continue to be a prime cause of failure of these restorations. This study was done to compare the microleakage at the tooth restoration interface extending below cementoenamel junction when posterior composite restorations were placed directly in the cavity or when placed over a glass ionomer cement liner, both chemically cured and light cured. The results have shown that light cured glass ionomer when used as a liner under a composite restoration used below gingival cementum/dentin margin has the best sealing capability.