Overdenture Prostheses with Metal Copings: A Retrospective Analysis of Survival and Prosthodontic Complications.

PURPOSE: To retrospectively evaluate complications associated with overdentures and abutment teeth restored with metal copings, including post-procedural and prosthetic problems; also to analyze the frequency and influencing factors associated with these problems. MATERIALS AND METHODS: A total of 80 subjects (48 females, 32 males, mean age 62 years) wearing root-supported overdentures were enrolled in the study. All participants were thoroughly examined by a single examiner, and appropriate maintenance care was performed. The 80 subjects had 270 abutments, which were endodontically treated teeth. All 80 subjects were carefully interviewed, inspected, and evaluated for post-procedural and clinical problems with their overdentures for an observation period of up to 5 years. RESULTS: Of the post-procedural problems evaluated, the most common problems were gingival inflammation (69%) and root caries (36%) because of poor oral hygiene (41%) and loss of metal copings (34%), followed by overdenture base fracture over abutment teeth (34%). Other post-procedural problems reported were loss of overdenture stability (23%), incidence of overdenture repair (20%), poor retention (18%), incidental finding of root fragments (unplanned) in the jaws (15%), and up to two grade net change in the mobility of overdenture abutments (8%). All prostheses were in use at the time of data collection and observation up to 5 years. CONCLUSIONS: Overdenture therapy was satisfactory; however, post-procedural and prosthetic complications and aftercare maintenance must not be underestimated.

Severe periodontitis associated with chronic kidney disease.

The data on Indian population with regard to severity/prevalence of chronic periodontitis in association with chronic kidney disease (CKD) is scarce. We are describing an interesting case of severe periodontitis associated with CKD. The patient had unusual inflammatory gingival overgrowth which persisted even after treatment. By describing this case we want to highlight our current lack of understanding with regard to etiopathogenesis of periodontal disease in CKD patients and need for further research in this area.

In vitro evaluation of effect of various endodontic solutions on selected physical properties of white mineral trioxide aggregate.

During endodontic therapy various irrigating solutions at different concentrations and duration are used. These chemical solutions may affect the setting reaction of mineral trioxide aggregate (MTA). The aim of this study was to evaluate the effect of sodium hypochlorite (NaOCl) (5.25%), chlorhexidine gluconate (CHX) (2%), ethylenediaminetetraacetic acid (EDTA) solution (17%) and BioPure MTAD on surface micro-hardness and flexural strength of white MTA. Twenty-five disk-shaped and 25 bar-shaped specimens were divided into five groups and were stored under distilled water, NaOCl (5.25%), chlorhexidine CHX (2%), EDTA solution (17%) and BioPure MTAD for 7 days. The micro-hardness of disk specimens was measured while the flexural strength was tested on bar specimens. EDTA and BioPure MTAD significantly reduced the hardness and flexural strength as compared with other groups. Under distilled water strength remained high; therefore, a final flush with distilled water before placement of MTA is advocated, especially if decalcifying agents are used during the clinical procedure.

An in vitro evaluation of performance of two electronic root canal length measurement devices during retreatment of different obturating materials.

INTRODUCTION: The purpose of this in vitro evaluation was to study the accuracy of Root ZX and ProPex system during retreatment of canals obturated with different obturating materials (gutta-percha + zinc oxide-eugenol sealer, gutta-percha + AH plus sealer, and Resilon + Epiphany sealer). METHODS: Sixty human mandibular premolar roots were instrumented with Rotary ProTaper until size F4 under copious irrigation. After instrumentation, actual working length was directly measured by using #15 FlexoFile. Electronic working length was taken with the help of Root ZX and ProPex. Teeth were divided into 3 groups and obturated by using lateral condensation of gutta-percha + zinc oxide-eugenol sealer (group I), gutta-percha + AH plus sealer (group II), and Resilon + Epiphany sealer (group III). After 7 days, the obturating materials were removed by using Gates-Glidden burs and K-files. A new electronic working length was taken. Original and post-treatment electronic working lengths were compared with actual working length. Accuracy of both electronic root canal length measurement devices was calculated for tolerance limits of +/-0.5 mm and +/-1.0 mm. Accuracy was compared by using chi(2) tests, and difference between actual working length and original and post-treatment electronic working lengths was compared by using Student t test. RESULTS: The accuracy of electronic root canal length measurement devices before root canal obturation was 83.3% and 93.3% for Root ZX and ProPex, respectively, for a tolerance limit of +/-0.5 mm and 100% for a tolerance limit of +/-1.0 mm. There was no statistically significant effect of different obturating materials tested in this study on the accuracy of Root ZX and ProPex for tolerance limits of +/-0.5 mm and +/-1.0 mm. Student t test revealed insignificant differences between the mean of actual working length and original and post-treatment electronic working lengths. CONCLUSIONS: Root ZX and ProPex can be a useful adjunct with a high accuracy rate during root canal preparation and retreatment.

Comparative evaluation of anesthetic efficacy of Gow-Gates mandibular conduction anesthesia, Vazirani-Akinosi technique, buccal-plus-lingual infiltrations, and conventional inferior alveolar nerve anesthesia in patients with irreversible pulpitis.

OBJECTIVE: Conventional inferior alveolar nerve block (IANB) has a poor success rate in inflamed pulps. Three alternative techniques of providing anesthesia to mandibular molars were evaluated and compared with conventional IANB. STUDY DESIGN: Ninety-seven adult volunteer subjects, actively experiencing pain, participated in this prospective, randomized, double-blinded study. Twenty-five patients received Gow-Gates mandibular conduction block anesthesia, 24 patients received "high" Vazirani-Akinosi inferior alveolar nerve block, 26 received only buccal-plus-lingual infiltrations, and 22 patients (control) received conventional IANB anesthesia. Endodontic access preparation was initiated after 15 minutes of anesthesia. Pain during treatment was recorded using a Heft-Parker visual analog scale. Success was recorded for "none" or "mild" pain. RESULTS: Statistical analysis using nonparametric McNemer tests showed that Gow-Gates gave a success rate of 52%, which was statistically higher than control IANB (36%) (P < .05). Vazirani-Akinosi and infiltrations gave 41% and 27% success rates, respectively, with no statistically significant differences from control IANB. CONCLUSIONS: Gow-Gates mandibular conduction anesthesia may increase the success rates in patients with irreversible pulpitis compared with conventional IANB. None of the techniques provided acceptable success rates.

Comparative evaluation of effect of preoperative oral medication of ibuprofen and ketorolac on anesthetic efficacy of inferior alveolar nerve block with lidocaine in patients with irreversible pulpitis: a prospective, double-blind, randomized clinical trial.

INTRODUCTION: Anesthetic efficacy of inferior alveolar nerve block decreases in patients with irreversible pulpitis. It was hypothesized that premedication with nonsteroidal anti-inflammatory drugs might improve the success rates in patients with inflamed pulps. METHODS: Sixty-nine adult volunteers who were actively experiencing pain participated in this prospective, randomized, double-blind study. The patients were divided into 3 groups on a random basis and were randomly given 1 of the 3 drugs including ibuprofen, ketorolac, and placebo 1 hour before anesthesia. All patients received standard inferior alveolar nerve block of 2% lidocaine with 1:200,000 epinephrine. Endodontic access preparation was initiated after 15 minutes of initial inferior alveolar nerve block. Pain during treatment was recorded by using a Heft Parker visual analog scale. Success was recorded as none or mild pain. RESULTS: Statistical analysis with nonparametric chi2 tests showed that placebo gave 29% success rate. Premedication with ibuprofen gave 27%, and premedication with ketorolac gave 39% success rate. There was no significant difference between the 3 groups. CONCLUSIONS: Preoperative administration of ibuprofen or ketorolac has no significant effect on success rate of inferior alveolar nerve block in patients with irreversible pulpitis.

Oral lichenoid reaction associated with tin component of amalgam restorations: a case report.

Amalgam or its components may cause type IV hypersensitivity reactions on the oral mucosa. Majority of the reported cases involved a delayed hypersensitivity to mercury. A case of bilateral oral lichenoid reaction is presented, which was present in relation to amalgam restorations. Histopathological features were compatible with lichenoid mucositis. Patch test was positive with pulverized amalgam and tin. The lesion healed up after replacement of restorations with an intermediate restorative material. The clinician should be aware of all possible pathological etiologies of white lesions. If there is any doubt about the nature or management of an unusual oral lesion, referral to appropriate specialists is mandatory.

Anesthetic efficacy of supplemental buccal and lingual infiltrations of articaine and lidocaine after an inferior alveolar nerve block in patients with irreversible pulpitis.

INTRODUCTION: The success rate of inferior alveolar nerve block (IANB) decreases in patients with irreversible pulpitis. It was hypothesized that supplemental infiltration of lidocaine and articaine may improve the success rates. METHODS: Eighty-four adult volunteers, actively experiencing pain, participated in this prospective, randomized, double-blinded study. All patients received standard IANB of 2% lidocaine with 1:200,000 epinephrine. Twenty-four patients did not receive supplemental infiltrations (control). Thirty patients received supplemental buccal and lingual infiltrations of 2% articaine with 1:200,000 epinephrine, and 30 patients received buccal and lingual infiltrations of 2% lidocaine with 1:200,000 epinephrine at 2 minutes after the IANB. Endodontic access preparation was initiated after 15 minutes of initial IANB. Pain during treatment was recorded by using a Heft Parker visual analog scale. Success was recorded as "none" or "mild" pain. RESULTS: Statistical analysis using nonparametric McNemer tests showed that supplemental buccal and lingual infiltration of 2% lidocaine with 1:200,000 epinephrine or 4% articaine with 1:200,000 epinephrine improved the success rate from 33% to 47% and 67%, respectively. Also the success rate with 4% articaine with 1:200,000 epinephrine was significantly more than 2% lidocaine with 1:200,000 epinephrine (p < 0.05). CONCLUSIONS: Although supplemental buccal and lingual infiltrations of 4% articaine or 2% lidocaine increased the success rate of the inferior alveolar nerve block in patients with irreversible pulpitis, none of the techniques provided acceptable success rates.