Four single implant-supported crowns replacing the maxillary incisors: A retrospective report of 10 cases with 2-9 years of follow-up.

OBJECTIVE: This retrospective case series aimed to assess the stability of the papilla around four single crowns supported by narrow-diameter implants replacing all maxillary incisors. Secondary objectives included assessment of marginal bone level stability, incidence of technical and biological complications, and patient satisfaction. MATERIALS AND METHODS: Individuals with four adjacent implants in maxillary incisor sites, placed with a 3 mm inter-implant distance and rehabilitated with single crowns were included. Retrospective data were obtained from photographs and radiographs taken at the delivery of the prosthesis (baseline-T0). Patients were then recalled (≥2 years after T0) for clinical and radiographic examination (follow-up-T1). Photographs were obtained and patient satisfaction was assessed using a visual analogue scale. Papilla height and marginal bone level were compared over time. RESULTS: Data from 10 patients with medium-low smile lines and rehabilitated with 40 implants, in function for 5.4 ± 1.9 years, were analyzed. The papilla height between implants (T0: 2.3 ± 0.9 mm; T1: 2.6 ± 0.7 mm; p = .011) and between tooth and implant (T0: 3.4 ± 0.9 mm; T1: 3.8 ± 0.8 mm; p = .025) increased significantly over the years. The marginal bone level remained stable over time (T0: 0.88 ± 0.57 mm; T1: 0.71 ± 0.67 mm; p = .007). Patients were highly satisfied (97.7 ± 0.3%) with the treatment outcome. CONCLUSION: Within its limitations, this study demonstrated that four single implant-supported crowns placed at maxillary incisor sites may exhibit soft tissue and marginal bone stability over a long period of time. This treatment approach, however, should be restricted to few patients as it requires a proper case selection and skillful execution of all surgical and prosthetic steps.

Accuracy of High-resolution Small-volume Cone-Beam Computed Tomography in the Diagnosis of Vertical Root Fracture: An In Vivo Analysis.

INTRODUCTION: The purpose of this in vivo study was to evaluate the accuracy of small-volume cone-beam computed tomographic (CBCT) imaging compared with conventional periapical radiography (CPR) in the diagnosis of vertical root fractures (VRFs) using exploratory surgery as the reference standard. METHODS: Eighty-two dental records of 85 teeth with suspected VRFs that underwent CPR, CBCT imaging, and exploratory surgery were included. Two observers assessed CPR and CBCT images independently for the presence or absence of root fractures, and findings from the exploratory surgery were considered the reference standard. Diagnostic sensitivity, specificity, accuracy, and the receiver operating characteristic curve values were obtained. The effect of single- and multirooted teeth on diagnostic accuracy as well as the association between clinical symptoms and the presence of VRFs were also assessed. RESULTS: VRFs were surgically detected in 64 of the 85 teeth (75.3%), of which 62.5% were multirooted and 76.6% had intracanal posts. CBCT imaging was more sensitive and accurate (65.6% and 64%) than CPR (27.3% and 40.5%). Both CPR and CBCT diagnostic accuracies were higher in single- than multirooted teeth. Pain on percussion, a localized periodontal pocket, and tooth mobility were associated with the presence of VRFs (P < .05; odds ratio = 4.15, 13.5 and 4.1, respectively). CONCLUSIONS: The accuracy of CBCT imaging for the diagnosis of VRFs was poor, although it was higher than with CPR. Multirooted teeth in the presence of intracanal posts may limit its diagnostic value.

Evaluation of three soft manual toothbrushes in relation to gingival abrasion: a crossover randomized clinical trial / Avaliação de três escovas de dentes manuais macias em relação à abrasão gengival: um ensaio clínico randomizado cruzado

Purpose: The aim of this study was to evaluate gingival abrasion of soft toothbrushes. Material and Methods: This randomized, crossover, blind study tested three commercially available manual soft toothbrushes: CURAPROX® 5460 (CPX), Colgate Slim Soft (COG) and ORAL-B® Indicator 30 Plus (ORB). Fifteen men and 15 women were randomly divided into 3 groups (N=10), who used all the brushes in three consecutive stages of 14 days each. Plaque index (PI), gingival index (GI), and gingival abrasion (GA) were assessed at the end of each experimental stage. Participants were also scored their perception of brush comfort, trauma, and cleanliness with visual analog scales (VAS). Friedman nonparametric test was used to analyze the data (p≤0.05). Results: No statistically significant differences were found among the tested brushes for any of the studied variables. When present, gingival abrasion lesions were mostly small (<2 mm). There was no difference between PI and GI between the 3 brushes. However, in patients' perception, CPX had significantly higher scores for comfort, while COG presented higher scores for trauma and ORB for cleanliness. Conclusion: The results indicate that all the tested brushes were similar concerning gingival abrasion and plaque control. However, patients reported different levels of satisfaction concerning their use. When recommending a soft toothbrush, clinicians should take into consideration individual patient requirements, and provide instructions of use based on the specific characteristics of each brush. (AU)

Objetivo: O objetivo deste estudo foi avaliar a abrasão gengival de escovas dentais macias. Material e Métodos: Este estudo randomizado, cruzado e cego testou três escovas manuais macias comercialmente disponíveis: CURAPROX® 5460 (CPX), Colgate® Slim Soft (COG) e ORAL-B® Indicator 30 Plus (ORB). Quinze homens e 15 mulheres foram aleatoriamente divididos em 3 grupos (N = 10), que utilizaram todas as escovas em três estágios consecutivos de 14 dias cada. Índice de placa (IP), índice gengival (IG) e abrasão gengival foram avaliados no final de cada estágio experimental. Os participantes também pontuaram quanto à sua percepção de conforto, trauma e limpeza das escovas com escalas analógicas visuais (EVA). Os dados foram analisados com o teste não paramétrico de Friedman (p≤0,05). Resultados: Não foram encontradas diferenças estatisticamente significativas entre as escovas testadas em relação à abrasão gengival. Quando presentes, as lesões de abrasão gengivais eram em sua maioria pequenas (<2 mm). Não houve diferença entre o IP e IG apresentados pelas 3 escovas. Porém, na percepção dos pacientes, a CPX apresentou escores significativamente maiores para conforto, enquanto a COG apresentou maior trauma e a ORB maior sensação de limpeza. Conclusão: Os resultados indicam que as escovas testadas foram semelhantes quanto à abrasão gengival e controle de placa. No entanto, os pacientes relataram diferentes níveis de satisfação em relação ao seu uso. Ao recomendar uma escova de dentes macia, os dentistas devem levar em consideração os requisitos individuais do paciente e fornecer instruções de uso com base nas características específicas de cada escova. (AU)

Periodontal parameters of two types of 3 x 3 orthodontic retainer: a longitudinal study.

INTRODUCTION: bonded fixed retainers are often used to stabilize the results obtained with the orthodontic treatment. It is important that they do not prejudice dental health, as they will be used for a long period. OBJECTIVE: The purpose of the present study was to compare periodontal indexes between two types of bonded fixed retainers, conventional 3 x 3 plain retainer (0.8-mm orthodontic wire, bonded to the canines only) and a manufactured braided retainer (0.2 x 0.7-mm stainless steel wire, bonded to all anterior teeth) after use. METHODS: a test group of 15 volunteers (aged from 18 to 25 years) used both the conventional retainer and braided retainer for six months. A randomized longitudinal study design, with a two week washout interval, was applied. The dental plaque index, gingival index and dental calculus index were evaluated. Furthermore, the calculus accumulated along the retainer wire was measured and all patients answered a questionnaire about the use, acceptance and comfort of both types of retainers. RESULTS: the scores for plaque and gingival indexes were higher for the braided retainer (p< 0.05) on the lingual and proximal surfaces. The same occurred with the calculus index on the lingual surfaces (p< 0.05). The calculus index along wire was higher for the braided retainer (p< 0.05). All patients preferred the conventional retainer, and said that it was also more comfortable to use. CONCLUSION: it was concluded that the conventional retainer showed better periodontal indexes than the braided type.

Periodontal parameters of two types of 3 x 3 orthodontic retainer: a longitudinal study

ABSTRACT Introduction: bonded fixed retainers are often used to stabilize the results obtained with the orthodontic treatment. It is important that they do not prejudice dental health, as they will be used for a long period. Objective: The purpose of the present study was to compare periodontal indexes between two types of bonded fixed retainers, conventional 3 x 3 plain retainer (0.8-mm orthodontic wire, bonded to the canines only) and a manufactured braided retainer (0.2 x 0.7-mm stainless steel wire, bonded to all anterior teeth) after use. Methods: a test group of 15 volunteers (aged from 18 to 25 years) used both the conventional retainer and braided retainer for six months. A randomized longitudinal study design, with a two week washout interval, was applied. The dental plaque index, gingival index and dental calculus index were evaluated. Furthermore, the calculus accumulated along the retainer wire was measured and all patients answered a questionnaire about the use, acceptance and comfort of both types of retainers. Results: the scores for plaque and gingival indexes were higher for the braided retainer (p< 0.05) on the lingual and proximal surfaces. The same occurred with the calculus index on the lingual surfaces (p< 0.05). The calculus index along wire was higher for the braided retainer (p< 0.05). All patients preferred the conventional retainer, and said that it was also more comfortable to use. Conclusion: it was concluded that the conventional retainer showed better periodontal indexes than the braided type.

RESUMO Introdução: as contenções ortodônticas fixas são amplamente utilizadas após o tratamento ortodôntico, sendo fundamental que esses dispositivos não se tornem prejudiciais à saúde dentária, já que serão usados por um longo período. Objetivo: o presente estudo teve como objetivo a avaliação periodontal da região da arcada inferior, comparando as condições de acúmulo de placa e cálculo ao longo do fio e na margem gengival, em decorrência do uso da contenção convencional (fio 0,8 mm de aço inoxidável colado apenas nos caninos) ou de uma contenção pré-fabricada com fio trançado (0,2 x 0,7 mm colado em todos os dentes anteroinferiores) após exposição ao meio bucal. Métodos: participaram do estudo 15 voluntários adultos jovens (idades entre 18 e 25 anos) que utilizaram dois tipos de contenções, por seis meses cada. Foi utilizado um modelo de estudo longitudinal, randomizado, com washout de 15 dias. Os parâmetros periodontais utilizados foram: índice gengival, índice de placa e índice de cálculo. O cálculo acumulado ao longo da contenção foi avaliado e todos os pacientes responderam a um questionário sobre o uso, aceitação e conforto de ambos os tipos de contenção. Resultados: observou-se que o índice de placa foi maior para a contenção com fio trançado (p<0,05), assim como o índice gengival (p<0,05). O mesmo ocorreu para o índice de cálculo nas faces proximais e lingual (p<0,05). O índice de cálculo ao longo do fio também foi significativamente maior para a contenção com fio trançado (p<0,05). Em relação ao questionário aplicado, 60% dos voluntários consideraram que a contenção com fio trançado foi mais desconfortável, e todos eles preferiram a contenção convencional. Conclusão: concluiu-se que a contenção convencional apresentou melhores resultados periodontais, quando comparada à contenção pré-fabricada com fio trançado.

The success rate of immediate implant placement of mandibular molars: a clinical and radiographic retrospective evaluation between 2 and 8 years.

BACKGROUND: Dental implants, indicated for re-establishing both mastigatory and aesthetic functions, can be placed in the sockets immediately after tooth extraction. Most studies investigate the anterior and upper regions of the dental arch, whereas few examine longitudinal appraisal of immediate implant installation in the mandibular molar region. OBJECTIVE: The aim of this retrospective study was to evaluate the success rate of immediate dental implants placement in mandibular molars within a follow-up period as long as 8 years. MATERIALS AND METHODS: Seventy-four mandibular molar implants after non-traumatic tooth extraction between 2002 and 2008 were examined in the study. All implants were evaluated radiographically immediately after prosthesis placement, 1 year after implantation, and by the end of the experimental period, in 2010. Clinical evaluation was done according to [Albrektsson et al. (1986) The International Journal of Oral & Maxillofacial Implants, 1, 11-25] success criteria for marginal bone loss. The mean bone losses, calculated as the difference between the final evaluation measures and those taken by the end of the first year of implant, were compared using Kruskal-Wallis test with a significance level of 5%. RESULTS: All implants presented clinical and radiographic stable conditions, that is, 100% success rate. Significant bone loss was not found between final evaluation and that of the first functional year (P > 0.05). CONCLUSION: Immediate implant placement of mandibular molars proved to be a viable surgical treatment given the high success rate up to 8 years after implantation.

Interdisciplinary treatment for a patient with open-bite malocclusion and amelogenesis imperfecta.

Amelogenesis imperfecta (AI) comprises a clinically and genetically heterogeneous group of conditions that affect the dental enamel, occasionally in conjunction with other dental, oral, and extraoral tissues. The aim of this case report is to describe an interdisciplinary treatment of hypoplastic AI associated with a severe open bite. The treatment consisted of surgical, orthodontic, periodontal, prosthetic and restorative management, establishing good chewing function, dental esthetics and facial harmony.

Periodontal parameters and BANA test in patients with chronic renal failure undergoing hemodialysis.

OBJECTIVES: The aim of this study was to analyze the periodontal parameters of patients with chronic renal failure. MATERIAL AND METHODS: The periodontal status of 16 Brazilian patients aged 29 to 53 (41.7 ± 7.2) years with chronic renal failure (CRF) and another matched group of 14 healthy controls with periodontitis was assessed clinically and microbiologically. Probing pocket depth (PPD), gingival recession (GR), dental plaque index (PLI), gingival index (GI), and dental calculus index (CI) were the clinical parameters recorded for the entire dentition (at least 19 teeth), while the anaerobic periodontopathogen colonization in four sites with the highest PPD was evaluated using the BANA test ("PerioScan"; Oral B). RESULTS: The results for the CRF group and control group, respectively were: PPD: 1.77 ± 0.32 and 2.65 ± 0.53; GR: 0.58 ± 0.56 and 0.51 ± 0.36; PLI: 1.64 ± 0.56 and 1.24 ± 0.67; GI: 0.64 ± 0.42 and 0.93 ± 0.50; CI: 1.17 ± 0.54 and 0.87 ± 0.52. Comparison between groups using the "t" test revealed a significantly increased PPD (p<0.001) in the control group. Comparison of the other clinicial parameters by the Mann-Whitney test showed differences only for PLI, which was significantly higher (p<0.05) in the CRF group. Spearman's test applied to each group showed a positive correlation among all clinical parameters, except for GR (p<0.05). None of the groups showed any correlation between GR and GI, while a significant negative correlation between GR and PPD was observed for the CRF group. The percentage of BANA-positive sites was 35.9% for the CRF group and 35.7% for the control group. The BANA test correlated positively with PPD only in the control group and with GR only in the CRF group. CONCLUSIONS: In spite of a higher PLI and dense anaerobic microbial population even in shallow PPD, patients with CRF exhibited better periodontal conditions than periodontitis patients, which is an evidence of altered response to local irritants.

Periodontal parameters and BANA test in patents with chronic renal failure undergoing hemodialysis

OBJECTIVES: The aim of this study was to analyze the periodontal parameters of patients with chronic renal failure. MATERIAL AND METHODS: The periodontal status of 16 Brazilian patients aged 29 to 53 (41.7±7.2) years with chronic renal failure (CRF) and another matched group of 14 healthy controls with periodontitis was assessed clinically and microbiologically. Probing pocket depth (PPD), gingival recession (GR), dental plaque index (PLI), gingival index (GI), and dental calculus index (CI) were the clinical parameters recorded for the entire dentition (at least 19 teeth), while the anaerobic periodontopathogen colonization in four sites with the highest PPD was evaluated using the BANA test ("PerioScan"; Oral B). RESULTS: The results for the CRF group and control group, respectively were: PPD: 1.77±0.32 and 2.65±0.53; GR: 0.58±0.56 and 0.51±0.36; PLI: 1.64±0.56 and 1.24±0.67; GI: 0.64±0.42 and 0.93±0.50; CI: 1.17±0.54 and 0.87±0.52. Comparison between groups using the "t" test revealed a significantly increased PPD (p<0.001) in the control group. Comparison of the other clincial parameters by the Mann-Whitney test showed differences only for PLI, which was significantly higher (p<0.05) in the CRF group. Spearman's test applied to each group showed a positive correlation among all clinical parameters, except for GR (p<0.05). None of the groups showed any correlation between GR and GI, while a significant negative correlation between GR and PPD was observed for the CRF group. The percentage of BANA-positive sites was 35.9 percent for the CRF group and 35.7 percent for the control group. The BANA test correlated positively with PPD only in the control group and with GR only in the CRF group. CONCLUSIONS: In spite of a higher PLI and dense anaerobic microbial population even in shallow PPD, patients with CRF exhibited better periodontal conditions than periodontitis patients, which is an evidence of altered response to local irritants.

A cross-over study on the effect of various therapeutic approaches to morning breath odour.

OBJECTIVE: The aim of this study was to investigate the effect of tongue scraping and inter-dental flossing on morning bad breath in periodontally healthy subjects. METHODS: A four-step blind, cross-over study was conducted in 19 volunteers, divided into four groups: Group I: tooth brushing; Group II: tooth brushing and inter-dental flossing; Group III: tooth brushing and tongue scraping; and Group IV: tooth brushing, inter-dental flossing and tongue scraping. The volunteers performed these oral hygiene procedures three times a day for 7 days. Seven-day wash-out intervals were observed. Morning mouth breath was assessed organoleptically and by volatile sulphur compound concentrations. RESULTS: The highest mean organoleptic and volatile sulphur compound measurement values were found in the treatment groups in which tongue scraping was not performed and there were statistical differences between the two groups (p < 0.05). In the organoleptic evaluation (p > 0.05), inter-dental flossing did not show any statistical improvement in the effect of tongue hygiene on morning bad breath, but it significantly reduced the concentration of volatile sulphur compounds (p < 0.05). CONCLUSION: The findings suggest that tongue scraping appears to be the most important hygienic procedure to reduce morning bad breath in periodontally healthy subjects.