Oral lichenoid lesion: A review of the literature

The oral lichenoid lesion (OLL) is response that occurs on the oral mucosa. The OLL include allergic response to the dental materials, drugs, and on graft-vs-host disease (GVHD). OLL to dental material happen when restorative materials, most commonly amalgam, are in direct contact with the mucosa in sensitized individuals. Medications that produce OLL are oral hypoglycemic agents, angiotensin-converting enzyme inhibitors, and nonsteroidal anti-inflammatory agents. GVHD is a complication in bone marrow transplantation and OLL is a common lesion observed in this disease especially in chronic GVHD. The clinical and histological aspects of OLL are similar to oral lichen planus and turn it difficult to make a differential diagnosis. The purpose of this paper is review about OLL related to the dental materials, drug use and GVHD.

Unraveling the role of epidermal growth factor receptor in oral lesions: Key to non surgical treatment modes

Epidermal growth factor receptor (EGFR) is a transmembrane receptor with tyrosine kinase activity, mediating actions of various growth factors including EGF, transforming growth factor-α, and neuregulins. Protein binding to ligand induces receptor modification, tyrosine autophosphorylation leading to cell signaling resulting in cellular proliferation. This receptor plays diverse roles in maintaining homeostasis and recent molecular advances identify that EGFR mutations are linked to several carcinomas. EGFR plays important roles in the development and maintenance of various oral structures, tooth development, eruption and morphogenesis. EGFR expression has also been studied in diverse oral pathologies like squamous cell carcinomas, potentially malignant lesions, lichen planus, salivary gland tumors and odontogenic cysts and tumours. The present review delves into the various general features of EGFR with an insight into its physiological and pathological role in the oral cavity. The clinical implications and upcoming role of EGFR inhibitors in the nonsurgical treatment of oral lesions has also been discussed.

Angina bullosa hemorrhagica an enigmatic oral disease

Angina bullosa hemorrhagica (ABH) is an enigmatic oral disorder described for the first time by Badham in 1967 to define blisters with a hematic content in the oral cavity and oropharynx unrelated to any hematological, dermatological or systemic disease. The ABH is an uncommon disease of the oral cavity distinctively affecting adults, with the highest incidence over the 5^th decade of life. This process is considered nowadays to have a multifactorial etiopathogenesis, where mild oral traumatisms can trigger the blisters in susceptible individuals. Certain association on the onset of the lesion with the chronic use of inhaled steroids and, more controversially, with triggering systemic disorders, such as, diabetes or hypertension has been described. Characteristically, the ABH blisters are acute and are located on the lining mucosa, more frequently on the soft palate. Usually, the lesions are solitary and rupture easily, resulting in a superficial ulceration that heals quickly without scarring. The histopathological analysis shows a subepithelial blister containing blood and direct immunofluorescence on the epithelium is negative. The differential diagnosis should consider all oral vesiculo-bullous disorders with hematic content, including mucocutaneos, hematological or cystic pathology. The diagnosis of ABH is clearly clinical, although the biopsy might be helpful on atypical or abnormally recurrent cases. The general prognosis of ABH is good and the treatment is symptomatic.

Oral lichenplanus: Etiology, pathogenesis, diagnosis, and management

Oral Lichen planus (OLP) is a common chronic mucocutaneous disorder with an immune mediated pathogenesis. Its appearance may vary from presence of keratotic to erythematous areas. Etiology of OLP is unknown, but it is thought to be the result of an autoimmune process with an unknown predisposing factor. Oral lichen planus is a complex and poorly understood clinical condition with periods of remissions and exacerbations. Management of the OLP is diversified with few lesions requiring treatment for years and few others are mild, requiring no treatment.

Melkersson-Rosenthal syndrome

Melkersson-Rosenthal syndrome (MRS) is a rare, non-caseating granulomatous disorder of unknown etiology and undefined diagnostic criteria. The classical triad of recurrent orofacial edema, relapsing facial paralysis, and fissured tongue, is not frequently seen in its complete form, and many patients remain misdiagnosed or undiagnosed for years. The purpose of this study is to review the findings in the literature describing the Melkersson-Rosenthal syndrome with aim to identify its clinical and histopathological characteristics and correlate them with definitive diagnostic criteria and effective treatment modalities. A systematic review and analysis of more than 100 publications met eligibility criteria performed by the authors. Orofacial edema of unknown etiology is the most typical clinical feature of the Melkersson-Rosenthal syndrome. Its coexistence with of facial nerve palsy or fissured tongue could be characterized as an oligosymptomatic MRS. Many investigators suggest cheilitis granulomatosa as a monosymptomatic form of MRS, while patients with facial palsy and fissured tongue, without orofacial edema, should not be considered having MRS. Histological evidence is not necessary. Corticosteroids are generally accepted as the mainstay treatment.

Unusual aggressive behavior of central giant cell granuloma following tooth extraction

Central giant cell granuloma (CGCG) is found exclusively in jaws. Its etiopathogenesis is unclear; however it is suggested that it can arise as a reactive response to trauma. This report describes an aggressive variety of CGCG which raises a question; can extraction of tooth modify the behavior of CGCG? A 46 years old male had reported with a rapidly increasing intraoral and extraoral swelling of lower jaw following tooth extraction. Radiographic examination revealed a large multilocular lesion involving the body and ramus of mandible which had been proved to be aggressive CGCG on histopathological examination. The importance of radiographic examination prior to extraction of teeth and importance of inclusion of CGCG in jaw swellings associated with mobility of teeth or failure of healing sockets is emphasized.

Non-surgical periodontal therapy: An update on current evidence

Periodontal disease is an inflammatory condition that involves a complex interaction between pathogenic bacteria, environmental and acquired factors and host related factors. Till recently periodontal treatment was directed primarily towards reduction of bacterial load by subgingival debridement of root surfaces and modification of environmental risk factors. The current paradigm of periodontal disease stresses greater role of host-mediated inflammatory response in tissue destruction characteristic of periodontal disease. Various therapeutic modalities have been developed adjuvant to mechanical periodontal therapy. The use of laser and photodynamic therapy show great promise but their effectiveness has still not been conclusively proven. Chemotherapeutic agents, either systemic and local antimicrobials or host modulating drugs, played pivotal role in better and more predictable management of periodontal disease. The present review focuses on the best available evidence, for the current management of the chronic periodontal patients, gathered from systematic reviews and meta-analysis of mechanical non surgical periodontal therapy (NSPT) (subgingival debridement, laser therapy and photodynamic therapy) and the adjunctive chemotherapeutic approaches such as systematic and local antibiotics and antiseptics, subgingival pocket irrigation and host modulation therapies. The review also attempts to briefly introduce future developments in some of these modalities. At the end, the review summarizes the analysis of the current evidence that suggests that thorough subgingival debridement remains the mainstay of NSPT and that adjunct use of chemotherapeutic agents may offer better management of clinical parameters in periodontitis patients.

Pierre Robin sequence from orthodontic and surgical perspective

Pierre Robin sequence (PRS) is a triad of micrognathia, glossoptosis, and cleft palate that results in an obstruction of the airway on inspiration and impeding feeding. The tongue of infants with PRS fall back toward the posterior pharyngeal wall (glossoptosis) due to receding chin produced by mandibular micrognathia (small jaw) or retrognathia. This causes a serious condition with potentially severe, life-threatening airway obstruction. If untreated, this problem can lead to exhaustion, cardiac failure, and ultimately death, especially during the early months of life. Actually, in the majority of PRS infants, these symptoms can be managed by placing the infant in the prone position until adequate growth of the jaw occurs. If this type of treatment fails, the infant then should be considered for other conservative therapies or surgical interventions. This paper reviews surgical interventions such as tongue-lip adhesion, mandibular traction, mandibular distraction, tracheotomy and conservative orthodontic approaches, and presents a baby treated successfully with an orthodontic appliance.

Tissue restoration after improper laser gingivectomy: A case report

We report the case of 27-year-old female patient applied to our clinic with several pain at her upper teeth and weakness complaints. Anamnesis revealed that she experienced laser gingivectomy to have remarkable teeth. Clinical examination showed that maxillar alveolar bone was partially uncovered with gingivae and periosteum. Interproximal necrosed area was observed. She had sensitivity at her maxillar anterior teeth. Furthermore, she was so anxious and depressed. In order to ensure more blood supply and clot formation, perforations on uncovered cortical bone was prepared. Avoiding from infection antibiotic, antiseptic gel and for epithelization vitamin E gel were prescribed. During one month she was recalled every third day. Recall times diminished periodically, as new tissue evolves. Although laser’s irreversible photothermal effects on soft and hard tissue, after a year all denuded areas were covered with healthy tissues without any surgical procedures. Histopathologic comparing showed severe lymphocyte infiltration and increased fibrosis and kollagenization in restored gingiva, additionally epithelial loss was observed. Since there is not a case report about the complications of laser gingivectomy in literature, we tried to represent a treatment plan that may be elucidative for clinicians.

Host-derived biomarkers in gingival crevicular fluid for complementary diagnosis of apical periodontitis

Apical periodontitis (AP) develops as a result of the host’s immune inflammatory response to pulpal infection of the dental root canals that leads to the generation of an apical lesion of endodontic origin (ALEO) and potentially to systemic metabolic alterations. Misdiagnosed ALEO is not infrequent due to the lack of diagnostic tools to differentiate apical lesions of different natures. Despite the conservative endodontic treatment shows a high success rate, there are refractory cases that can not be identified early enough during follow up. This evidences the need to develop complementary diagnostic tools, such as oral fluid biomarker analysis. Gingival crevicular fluid (GCF) is a serum transudate that becomes an exudate under inflammatory conditions, carrying molecules from local periodontal tissues and general circulation than can be harvested non-invasively. We aimed to review the available literature analyzing GCF composition in AP patients to evaluate whether GCF has any potential for complementary diagnosis. To the date, only few studies addressing changes of GCF components in AP are available. Most studies support GCF modifications in specific components in AP-affected teeth, suggesting that it might reflect periapical inflammation. GCF has potential for diagnostic tool, treatment follow-up and eventually to assess systemic comprise.

Relationship between periodontitis and cardiovascular diseases: A literature review

Periodontitis and cardiovascular disease have a complex etiology and genetics and share some common risk factors (i.e., smoking, age, diabetes, etc.). In recent years, the relationship between periodontal disease and cardiovascular disease has been investigated extensively. This research mostly focused on the fact that periodontitis is an independent risk factor for cardiovascular disease. Our aim in this article is to investigate the etiological relationship between periodontal disease and cardiovascular disease and the mechanisms involved in this association. According to the current literature, it is concluded that there is a strong relationship between these chronic disorders.

Subconscious temporomandibular dysfunction therapy: A new therapeutic approach for temporomandibular disorders

AIM: To evaluate a new therapeutic approach that may permanently address excessive involuntary muscle activity which causes temporomandibular disorders (TMD).

METHODS: A cohort of 69 TMD patients (33 men and 36 women, age range 14-71 years) was treated with Subconscious Temporomandibular Dysfunction (STeDy) therapy. A thick awareness splint assisted patients to gradually recognize the interdependence between psychological pressure and subconscious muscle activity. The STeDy therapy lasted for one year and involved three stages: (1) data collection including medical history, clinical examination and psychological evaluation; (2) application of the awareness splint and consultation on a monthly basis; and (3) final evaluation.

RESULTS: About 10% of patients (3 men and 4 women) quit the STeDy therapy within the first 3-6 mo due to severe health problems or psychosocial reasons. Based on the absence of objective and subjective clinical symptoms as well as on radiographic findings, the temporomandibular dysfunction treatment was successful in all remaining 62 patients that completed the year-long therapy. Symptoms, including recurrent headache, morning fatigue, clicking sound or painful temporomandibular joint disorders, were eliminated in all patients within the first six months. By completion of the STeDy therapy, all patients had learned to recognize stressful conditions and cognitively avoided displaying excessive bruxism or other subconscious activity of the stomatognathic muscles. A follow-up after at least one year indicated the permanent nature of the cognitive treatment in all patients, illustrating the fact that subconscious muscle activity due to stress plays a principal role in the great majority of TMD, at least in adults.

CONCLUSION: The STeDy therapy successfully and permanently resolved TMD problems of all patients that completed the year-long treatment.

Stomatological management of head and neck cancer patients treated with chemotherapy and radiotherapy

Treatment of head and neck cancer with radiotherapy and/or chemotherapy can cause oral damage. Long-term treatment can damage the salivary glands, the oral mucosa, and the maxilla, leading to altered production of saliva and to multiple infections. These lesions can be prevented, limited or avoided by thorough evaluation prior to treatment and by therapeutic follow-up and preventive measures. The dentist must have strong medical knowledge of the possible short-, medium-, and long-term oral complications of the cancer treatment, and must have knowledge of the protocols for oral management of cancer patients. The availability of a multidisciplinary medical team together with a dentist to attend to the patient prior to the cancer treatment, as well as close communication between team members during and after treatment, is crucial. The aim of the present study was review the stomatological management of head and neck cancer patients treated with chemotherapy and radiotherapy and summarizing current treatments, therapeutic innovation and tissue regeneration perspectives.

Accuracy of linear vs spiral tomography: Alveolar crest to sinus/nasal floor height

AIM: To determine the accuracy of tomography in the linear measurement of alveolar bone at maxillary sinus/nose location.

METHODS: Two dry skulls each marked with 10 pairs of guttaperchas placed on buccal and lingual sides of the maxillary ridge were used in this in vitro study. The distance between the alveolar crest and the sinus/nasal floor was measured on tomographic views, prepared by linear and spiral techniques. The ridges were then sectioned so that each section would include one pair of buccal and lingual guttaperchas. The actual distances directly measured on the sections were compared to those of the equivalent tomographic sections (the magnification co-efficient was applied). Paired t-test was used to statistically analyze the data.

RESULTS: The measurement error with the application of linear tomography and spiral tomography was shown to be 0.455 ± 0.838 mm (P = 0.029) and 0.17 ± 0.78 mm (P = 0.347), respectively. There was a statistically significant difference between the liner tomography values and actual values (P = 0.029). This difference was representative of underestimation. McNamara’s test was used to assess the ± 1 mm error; 73.7% of the linear values and 84.2% of the spiral values were within the ± 1 mm error limit. McNamara’s test did not show any significant differences between the 2 methods in this regard (P = 0.625). The linear values were significantly different to the actual values (P = 0.029) but not to the spiral values (P = 0.185).

CONCLUSION: Spiral tomography has enough accuracy for the measurement of alveolar ridge height. Although linear tomography somewhat underestimates the actual values it provides satisfactory accuracy.

Soft tissue aneurysmal bone cyst of the mandible: Report of a case

We report the case of a 17-year-old boy with a soft tissue aneurysmal bone cyst (STABC) located in the posterior aspect of the right mandible. Conventional radiography revealed no positive findings. On the computed tomography scan, the lesion appeared to have a non-uniform intralesional density. Magnetic resonance imaging revealed an abnormal soft tissue masses with cystic component in the superficial part of right mandibular body and angle with intact cortex. Following histopathological examination, fibro-histiocytic proliferation, blood-filled spaces and multinucleated giant cells were seen and the lesion was diagnosed as a STABC. The mass together with underlying bone and periosteum on its periphery was surgically resected under general anesthesia. Thirty-six months after surgery the patient was assessed at outpatient clinic and found no sign of recurrence This may be only the first reported case of the mandible in the English literature of this extremely rare benign tumor occurring in soft tissue.

Surgical obturator duplicating original tissue-form restores esthetics and function in oral cancer

Oral cancer treatment primarily focused on the surgical removal of cancer tissues followed by surgical/prosthetic reconstruction. Restoration of the missing structures immediately after surgery shortens recovery time and allows patient to return to community as a functioning member. The most practiced surgical obturators are simple resin prosthetic bases without incorporation of the teeth. This article highlights a technique to fabricate a surgical obturator that duplicates patient’s original tissue form including teeth, alveolus and palatal tissues. The obturator is placed immediately after surgery and make patient feel unaware of surgical deformity. The obturator prosthesis fabricated with this technique supports soft tissues and minimizes the scar contracture. We have clinically tried this technique in 11 patients. Patients’ satisfaction level was recorded on visual analogue scale (VAS) and it ranges between 74% and 94% (with average of 87%). Four different prosthodontists have visually evaluated facial asymmetry of patients at 6 mo recall and their average perception on VAS varies between 71% and 93% (with average of 84%).

Pharmacogenomics in oral diseases

The availability of newer technologies for identification and characterization of the human genome has enabled our understanding of the genetic variations in a majority of human diseases. Human genomic sequence varies in less than 1% among the different population group and these differences known as gene polymorphisms are the primary reasons for differences in individuals’ response to various drug therapy. Also understanding the genetic changes may enable implementation of targeted therapy, thus providing for effective treatment strategies and minimizing the adverse side effects. Pharmacogenomics is a recent development in the field of personalized medicine which focuses on the genetic determinants of drug response at the levels of entire human genome. It primarily deals with tailoring of drug therapy for every individual based on their genetic make-up and identifying new target in various diseases for drug therapy. While the application of pharmacogenomics in systemic illness is well researched, its role in oral diseases needs documentation. Identifying specific targets in periodontitis, head and neck cancer, infections and genetic disorders can be beneficial in discovery of new drugs. This editorial provides an overview of basics of pharmacogenomics, its current role in disease management and its potential role in various head and neck diseases.

Cytotoxicity of a silorane-based dental composite on human gingival fibroblasts

AIM: To evaluate the direct and indirect biocompatibility of Filtek Silorane on human gingival fibroblastic cells.

METHODS: Sixty-three standardized cylindrical specimens (8 mm diameter and 2 mm thickness) of restorative material were prepared using a light emitting diode-curing unit. The sample were built up in one increment and divided in 2 groups. In the first group, 21 samples (unpolished samples) were left without a specific polishing procedure; in the second one, 42 samples (polished samples) were polished with 4 different grains of discs. Fibroblast cultures, obtained from gingiva of 2 subjects without systemic and oral disease, were used to assess the direct and indirect biocompatibility. Cells cultured for 48 h in normal culture medium were used as a control.

RESULTS: The scanning electron microscope observations of fibroblasts cultured on the silorane samples, either polished or unpolished, confirmed the good biocompatibility of the material, favouring the cellular spreading. 3-dimethylthiazol-2, 5-diphenyltetrazolium bromide tests showed a significant reduction (P < 0.01) of gingival fibroblasts viability cultured both in polished samples (90.05% ± 19.00%) and unpolished samples (78.15% ± 11.00%) compared with the control. Cells growth in medium conditioned with the samples for 1 wk showed a significant viability reduction (P < 0.01) compared to the control. A reduction of cell viability was observed even in the groups containing the material for 3 wk (polished: 89.45% ± 10.00%; unpolished: 65.97% ± 10.00%), even if the cytotoxicity was reduced after this long time exposure.

CONCLUSION: Although the poor chromatic availability of this material remains a big limit that restricts its use to posterior sectors, the silorane-based material can be considered an option to perform restorations when aesthetic demands are not the priority, such as the class II restorations

Molecular biomarkers of cell proliferation in ameloblastomas

Cell proliferation is a vital biological process that is important for all living organisms because of its role in growth and the maintenance of tissue homeostasis. The control of this important process differs greatly among benign and malignant neoplasms, and the evaluation of cell proliferation in neoplasms has become a common tool used by pathologists to provide useful information pertaining to diagnosis, clinical behavior, and treatment. The usefulness of information regarding cell proliferation has led to numerous studies on the value of these methods for diagnosing different types of tumors and for clinical decision making. Ameloblastomas are no exception. This review discusses the use of several classical molecular proliferation markers, including Ki-67, proliferating cell nuclear antigen, cyclin D1 and DNA topoisomerase II alpha, to characterize ameloblastomas and proposes the use of new proliferation markers used previously to characterize other neoplasms. The use of these biomarkers offers valuable opportunities to evaluate the biological behavior of this type of odontogenic tumor.

Evaluation of factors affecting the success rate of orthodontic mini-implants by survival analysis

AIM: To investigate the success rate of mini-implants and its characteristics and risk factors by survival analyses.

METHODS: Three hundred and ninety-four mini-implants of the same type were placed by a single clinician. Age, gender, treatment duration, time of failure, side and jaw of implantation and the soft tissue at placement site were recorded. Odds ratio, survival curves, and Cox proportional hazard model were applied to evaluate the factors influencing the mini-implants’ success rate.

RESULTS: The cumulative success rate was 88.1%. The maxilla had a significantly higher success rate than that of the mandible (91.7% vs 83.7%, respectively, P = 0.019). Placement of mini-implants in the attached gingiva (AG) showed a higher success rate than that of the mucogingival junction (MGJ) and mucous membrane (MM) (AG, 94.3%; MGJ, 85.8%; MM, 79.4%; P < 0.001). Significant association was found between the jaw and the gingival tissue type (P < 0.001). There were no significant differences between maxilla and mandible when compared within each placement site.

CONCLUSION: The gingival tissue type had the most significant effect on the success rate of the mini-implant with higher success rate in the attached gingiva.

Dental stem cells: Progress and perspectives

Dental pulp stem cells (DPSCs) are thought to contribute to reparative dentin formation, and that they may correspond to heterogenous populations of precursor cells or represent distinct differentiation stages along the odontoblastic lineage. DPSCs share many similarities with mesenchymal stem cells of the bone marrow (BMSCs). It appears that the distribution of tissue stem cells is not random and, within the dental pulp, there are potentially several distinct niches of stem/progenitor cells. In addition to DPSCs, other dental stem cell populations have been isolated. As for DPSCs, further studies are still needed to evaluate their potential of differentiation and their regenerative activity. Up today, (1) the formal demonstration that pulpal resident stem cells are actually the reparative dentin-forming cells recruited in response to injury is still lacking; and (2) the origin, localization and precise identity of odontogenic stem cells remain largely unknown. Dental clonal cell lines may represent valuable tool to answer some fontamental questions concerning the dental stem cell biology. Altogether, the presence of dental cell populations displaying stem cell properties has opened new paths for considering regenerative therapies. This might be a prerequisite to design alternative strategies for capping and endodontic treatment, using stem cells.

Management of missile injuries to the maxillofacial region: A case series

AIM: To assess our management of patients suffering from missile injuries to the maxillofacial region.

METHODS: From December 2009 to September 2012, 40 patients with missile injuries (high velocity gunshot and bullet wounds, explosive injuries and shrapnel etc.) affecting the maxillofacial region were treated. All except for 2 patients were males. All had soft tissue injuries with or without bone injuries. These patients were referred to the plastic and maxillofacial surgery ward of our hospital. The patients were 19 to 65 years of age (mean 45 years). In 19 cases, there were missile injuries to other parts of the body, especially the lower extremities. All of the patients were managed by early soft tissue debridement, comprehensive reconstruction and antibiotics. This retrospective study was approved by the IRB and ethical committees.

RESULTS: The majority of injuries were caused by high velocity projectiles (88%) and the remaining by car explosions or dynamite blasts (12%). 40 patients were treated surgically. Thirty patients had soft tissue loss (75%) and 20 patients (50%) had bone loss; there was combined soft tissue and bone loss in 10 (25%) patients. Facial fractures were in the orbital bones in 10 cases, maxillary in 7, nasal in 5 and the mandible in 3 cases. We used primary repair in the majority of soft tissue defects (25 of 40 cases). Bone repair was done primarily at the same stage using miniplates, titanium screws or wires. In some cases with a bone defect, iliac bone grafts were used simultaneously or in the later stages (mandibular defects). There was no failure of bone reconstruction in our cases. Infections occurred in two cases and were treated with systemic antibiotics and dressing changes, without any long term sequelae.

CONCLUSION: Our principles for soft tissue reconstructions were according to the reconstructive ladder and included primary repair, local flaps, skin grafts and regional flaps depending on the extent of damage. Primary repair in facial missile defects was not associated with increased morbidity or complications in this series. We recommend this approach when feasible.

Basic properties and types of zirconia: An overview

This paper describes types and characteristics of zirconia materials in relation to their applications in dentistry. The zirconia material typically used today by most manufacturers is a tetragonal polycrystalline zirconia, partially stabilized with yttrium oxide. The mechanical properties of zirconia have been extensively investigated in the scientific literature and zirconia clearly measures up to any other equivalent manufactured material. The biocompatibility of zirconia has also been extensively evaluated and no local or systemic adverse reactions or cytotoxic effects have been found in relation to it. However, ceramic bonding, ageing, light transmission and manufacturing processes are all factors that need to be further evaluated in order to guide the successful use of zirconia as a prosthetic restorative material. Milling zirconia to full-contour might be an alternative to traditionally veneered restorations. A potential adhesion mechanism appears to be the combination of air abrasion with aluminum oxide particles (silanated or not), followed by sintering with materials containing special reactive monomers. Changes in zirconia properties before and after the sintering process have also been investigated. It was found that after sintering, surface roughness was greater, and micro hardness was slightly reduced; however, accurate precision of fit was not affected by the sintering process. Currently, zirconia restorations are manufactured by either soft or hard-milling processes, with the manufacturer of each claiming advantages over the other. Chipping of the veneering porcelain is reported as a common problem and has been labeled as its main clinical setback. As zirconia has demonstrated good mechanical and biological performance, future technology is attempting to improve esthetics and minimize veneer fracture, aiming to create confidence in the dental community towards this all-ceramic system. Milling zirconia to full-contour might be an alternative to traditionally veneered restorations. Finally, implications are drawn for manufacturing, machining, and widespread use of these materials.

Clinical evaluation of implants in patients with maxillofacial defects

AIM: To show the efficacy of reconstruction and rehabilitation of large acquired maxillofacial defects due to tumor resections and firearm injuries.

METHODS: The study group comprised of 16 patients (10 men and 6 women) who were operated on because of their maxillofacial defects under local and general anesthesia between June 2007 and June 2011. Prosthetic treatment with the aid of dental implants was performed for all of the patients. Eight patients received an implant supported fixed prosthesis; six patients received implant supported overdentures and two patients received both. Patients were followed up postoperatively for 1 to 4 years. Implant success and survival rates were recorded. Panoramic radiographs were taken preoperatively, immediately after surgery, immediately after loading and at every recall session. Peri-implant and prosthetic complications were recorded. Subjects were asked to grade their oral health satisfaction after treatment according to 100 mm visual analog scale (VAS) and the oral health related quality of life of the patients was measured with the short-form Oral Health Impact Profile.

RESULTS: Five implants (3 in the mandible, 2 in the maxilla) in five patients were lost, while the other 53 survived, which brings an overall survival rate of 91.37% on the implant basis, but 68.75% on patient basis. All the failed implants were lost before abutment connection and were therefore regarded as early failures. For all failed implants, new implants were placed after a 2 mo period and the planning was maintained. The mean marginal bone loss (MBL) was 1.4 mm on the mesial side and 1.6 mm on the distal side of the implants. Five of the implants showed MBL > 2 mm (mean MBL = 2.3 mm) but less than 1/2 of the implant bodies and therefore were regarded as not successful but surviving implants. The VAS General Comfort mean score was 85.07, the VAS Speech mean score was 75.25 and the VAS Esthetics mean score was 82.74. No patient reported low scores (score lower than 50) of satisfaction in any of the evaluated factors. The mean of OHIP-14 scores was 5.5.

CONCLUSION: Although further follow up and larger case numbers will give more information about the success of dental implants as a treatment modality in maxillofacial defects patients, the actual results are encouraging and can be recommended for similar cases.

Quantitative scintigraphic analysis of the apical seal in Thermafil/Topseal and RealSeal 1/Realseal filled root canals

AIM: To investigate the microleakage of two different root canal obturation systems, using the nuclear medicine approach.

METHODS: Twenty-six single-rooted extracted teeth were selected. The crowns were sectioned to obtain 15-mm long root segments and each tooth was prepared using rotary ProFile^® instruments. The roots were divided into 2 experimental groups using RealSeal 1 and RealSeal sealer or Thermafil and TopSeal sealer as well as two control groups. On the 7^th and the 28^th day the apices were submersed in a solution of ^99mTc-Pertechnetate during 3 h. The radioactivity was counted using a γ camera.

RESULTS: The present study showed that none of the root canal-filled teeth was leakage free. The statistical analyses were made using Kruskal-Wallis and statistical significance was assessed using α = 0.05. Although apical leakage measured in counts per minute (cpm) in the Thermafil/TopSeal group was lower than in the RealSeal/RealSeal group (363 916 ± 180 707.7 cpm vs 533 427 ± 414 020.6 cpm) on 7^th day and (1 678 200 ± 567 217.4 cpm vs 2 240 518 ± 383 356.7 cpm) on 28^th day, there was no statistical difference (P > 0.05). In the Thermafil/TopSeal group and RealSeal 1/RealSeal group it was found that over time, the number of counts increased between 7 d and 28 d (363 916 ± 180 707.7 cpm vs 1 678 200 ± 567 217.4 cpm) and (533 427 ± 414 020.6 cpm vs 2 240 518 ± 383 356.7 cpm), respectively, with statistically significant differences (Thermafil/TopSeal group, P = 0.015 and RealSeal 1/RealSeal group, P = 0.036).

CONCLUSION: Both carrier-based Realseal 1 and Thermafil techniques showed a similar sealing effect, but none of the materials was leakage free.