Evaluation of the Injection Pain with the Use of Vibraject during Local Anesthesia Injection for Children: A Randomized Clinical Trial

AIM

To compare the outcomes of the conventional syringe and the outcomes of the vibraject-assisted injection (VAI) in terms of the pain of the needle insertion during various intraoral injections of local anesthesia in children aged 6-9 years.

MATERIALS AND METHODS

A total number of 75 children aged 6-9 years were selected from patients visiting the pediatric dental clinic at Damascus University. The children were assigned into three equal groups (25 children each) according to the type of intraoral injection needed for the treatment: Groups [Group I: received upper buccal infiltrations (UBI), Group II: received posterior palatal infiltrations (PPI), and Group III: received inferior alveolar nerve block (IANB)]. This study was conducted considering the split-mouth design. Each child was subjected to both anesthetic injections: the conventional and the vibration-assisted in two separate dental visits 2 weeks apart. At each clinic visit, subjective and objective pain levels were assessed using the visual analog scale (VAS) and Face, Leg, Activity, Cry, Consolability (FLACC) scale.

RESULTS

Children who received local anesthesia using the Vibraject method had lower VAS and FLACC scores than those who received local anesthesia using the conventional method.

CONCLUSION

Vibraject was more effective in reducing the pain with local anesthetic injection compared to the conventional injection technique in clinical dental procedures for children.

CLINICAL SIGNIFICANCE

In a pediatric dental clinic, pain management is considered a pillar that influences actions. Using the VAI may achieve the ease, cooperation, and compliance during the dental care session.

Assessment of the readiness of restorations manufactured by CAD/CAM in terms of marginal fit (Part I)

Background

The master cast is the gold standard for the control and eventual adjustment of restorations produced by conventional procedures. Some digital workflow bypasses the master cast and relies completely on the precision of the CAD/CAM restoration.

Aim

To examine the reproducibility of the margins of CAD/CAM restorations generated from a single digital scan. Also, to check the readiness of these restorations for delivery directly after fabrication without adjustment on a master cast and thereby eliminate the need for the master cast.

Methods

A total of 18 metal substructures made from cobalt chrome alloy were fabricated utilizing a single STL file. The circumference was divided into eight zones. The vertical marginal discrepancy (VMD) was measured at each zone of each metal substructure, with optical microscopy at ×200 magnification.

Results

Measurements of vertical marginal discrepancy were in a range of (-94: 300) with a mean of 62 ± 60 μm. A one-way ANOVA test revealed that the mean VMD is significantly different among the 18 substructures (F17, 1,134 = 63.948, p < 0.001).

Conclusion

Although all the received substructures were fabricated from the same scan file, they were not identical and varied widely, and they were going outside the acceptable range in some zones. Within the limitations of this study, the marginal fit can be improved by extraoral adjustments on the master cast. Thus, skipping the master cast deprives the dentist of delivering a restoration of higher quality.

Effectiveness of dentin pre-treatment on bond strength of two self-adhesive resin cements compared to an etch-and-rinse system: an in vitro study

Statement of problem

It has been shown that selective etching improves the bond strength of some self-adhesive resin cements to enamel. The same has yet to be determined with dentin pre-treatment.

Purpose

To evaluate the tensile bond strength of two self-adhesive resin cements after two dentin surface pre-treatments, and also to analyze the cement/dentin interface.

Material and Methods

One hundred and twelve human third molars were extracted. The teeth were distributed into seven groups (n = 16). Maxcem Elite Chroma (MAX) (Kerr, Scafati, Italy) and Relyx U200 (RLX) (3M ESPE, Neuss, Germany) were used without pre-treatment or with two dentin pre-treatments (polyacrylic acid or phosphoric acid). A conventional etch-and-rinse (EAR) luting cement, NX3 Nexus (NX3) (Kerr, Scafati, Italy), was used as an external control group. Before testing, all specimens were stored in distilled water for 24 hours. Three specimens from each group were prepared for scanning electron microscopy observation (SEM). A tensile bond strength test (TBS) was performed for the remaining samples. The data were statistically analyzed using the Kruskal–Wallis test and Pairwise comparisons using the Wilcoxon rank sum test.

Results

MAX without pre-treatment and with phosphoric acid etching attained statistically similar bond strengths to NX3 (P > 0.05). There was a statistical difference (P = 0.00488) between RLX without pre-treatment (5.62 MPa) and NX3 (10.88 MPa). Phosphoric acid pre-treatment increases the bond strength values of RLX to a strength that is comparable to NX3 (P > 0.05). The lowest tensile bond strength (TBS) was attained after the application of polyacrylic acid with MAX (1.98 MPa). No statistical differences were found between the RLX bond strength values after polyacrylic acid treatment and RLX without pre-treatment or NX3 (P > 0.05). SEM observations disclosed an enhanced potential of the self-adhesive cements to infiltrate into dentin tubules and form resin tags when applied after phosphoric acid pre-treatment. The failure mode was dominantly adhesive.

Conclusions

On dentin, the self-adhesive resin cement MAX might be an effective alternative to conventional resin cement. Etching the dentin with phosphoric acid does not have a negative effect on the bond strength of MAX to dentin. On the other hand, phosphoric acid improved the bond strength of RLX when compared to EAR cement.

A comparison between modified and conventional surgical techniques for surgical lip repositioning in the management of the gummy smile

AIM

The aim of this study was to evaluate and compare conventional and modified lip repositioning surgical techniques used for management of gummy smile involving hyperactive lip elevator muscles.

METHODS AND MATERIALS

A prospective study was conducted between April 2016 and May 2017. Twenty two adult patients aged 18-38 years with gummy smile ranging from 4 to 6 mm because of soft tissue disorders were included in the study. All patients were treated in the oral and maxillofacial department at Damascus University. The sample was divided into two groups of 11 patients. The first group was treated by the conventional standard technique, and the second group treated by a modified study technique. The amount of gingival display in full smile was evaluated in both groups following each intervention.

RESULTS

Both groups exhibited a statistically significant reduction in the measurement of gummy smile at month 1 and 6 postoperatively (P < .05), but there was no significant difference in gingival display at 3 months in either group postoperatively (P > .05). The recent study showed a significant difference in gingival display between 3 and 6 months postoperatively in group 1, but no significant difference in group 2.

CONCLUSION

This study showed that the modified technique utilized in treating gummy smile has less relapse after surgery, shows excellent cosmesis and compared to the conventional technique, greater sustainability.

CLINICAL SIGNIFICANCE

The recent increase in demand for an esthetic smile has led to the development a modification of conventional lip repositioning for correcting gummy smile by myotomy of lip elevator muscles. This modified technique offers less relapse and greater stability post-operatively than the conventional technique.

The marginal fit of lithium disilicate crowns: Press vs. CAD/CAM

This study aimed to compare the vertical marginal gap of teeth restored with lithium disilicate crowns fabricated using CAD/CAM or by pressed ceramic approach. Twenty mandibular third molar teeth were collected after surgical extractions and prepared to receive full veneer crowns. Teeth were optically scanned and lithium disilicate blocks were used to fabricate crowns using CAD/CAM technique. Polyvinyl siloxane impressions of the prepared teeth were made and monolithic pressed lithium disilicate crowns were fabricated. The marginal gap was measured using optical microscope at 200× magnification (Keyence VHX-5000, Japan). Statistical analysis was performed using Wilcoxon test. The lithium disilicate pressed crowns had significantly smaller (p = 0.006) marginal gaps (38 ± 12 μm) than the lithium disilicate CAD/CAM crowns (45 ± 12 μm). This research indicates that lithium disilicate crowns fabricated with the press technique have measurably smaller marginal gaps compared with those fabricated with CAD/CAM technique within in vitro environments. The marginal gaps achieved by the crowns across all groups were within a clinically acceptable range.

The marginal fit of E.max Press and E.max CAD lithium disilicate restorations: A critical review

This critical review aimed to assess the vertical marginal gap that was present when E.max lithium disilicate-based restoration (Press and CAD) are fabricated in-vitro. Published articles reporting vertical marginal gap measurements of in-vitro restorations that had been fabricated from E.Max lithium disilicate were sought with an electronic search of MEDLINE (PubMed) and hand search of selected dental journals. The outcomes were reviewed qualitatively. The majority of studies that compared the marginal fit of E.max press and E.max CAD restorations, found that the E.max lithium disilicate restorations fabricated with the press technique had significantly smaller marginal gaps than those fabricated with CAD technique. This research indicates that E.max lithium disilicate restorations fabricated with the press technique have measurably smaller marginal gaps when compared with those fabricated with CAD techniques within in-vitro environments. The marginal gaps achieved by the restorations across all groups were within a clinically acceptable range.

Two ways of immediate rehabilitation of edentulous mandible with dental implants and prostheses--critical view on Brånemark System Novum

With appropriate stabilization and occlusal loading, mandibular implants can be immediately loaded in a complete-arch configuration with no apparent detrimental effect on the rates of osseointegration. Ten patients were treated with the immediate loading protocols in completely edentulous mandible either with conventional one-stage implants and a provisional denture or with the Brånemark System Novum and a definite restoration. A total of 42 implants were placed. One Novum implant was lost 1 month after placement. The clinical success rate of the immediately loaded implants at the time of the 6-month check-up was 97.6%. Radiographic surveys completed by panoramic radiographs 6 months after the surgery revealed good healing of bone at implant interface. After the period, mean marginal bone loss was 0.4 mm (ranged from 0 mm to 1.5 mm). The results of this short-term clinical and radiographic study indicate that the precise surgical and prosthetic protocol allows successful prosthetic rehabilitation of mandibular edentulism and that the provisional or permanent fixed reconstruction can be provided to a patient on a day of fixture surgery. Finally, authors consider critical comments on Brånemark System Novum.

Evaluation of stability of titanium and hydroxyapatite-coated osseointegrated dental implants: a pilot study

An endosseous implant is described as osseointegrated when it is immobile in function. Objective measures of stability testing have been described. The Periotest is a commercially available device that is used for this purpose. This study was designed to measure stability of endosseous implants placed in the mandible. Implants were placed in the mandibular canine or first premolar area to support an overdenture prosthesis. Stability was evaluated through the use of a Periotest device at the time of implant placement and following one year of functional loading. Implant designs were either a screw-shaped titanium alloy or a hydroxyapatite-coated cylinder. A total of 54 implants were placed, 37 were titanium screw-shaped implants, while the remaining 17 were hydroxyapatite cylinders. Initial measurements of stability showed no difference due to implant type. Following one year of functional loading, titanium screw-shaped implants were more stable than hydroxyapatite implants (P < 0.05). The difference in implant rigidity following a period of functional loading may be an indication of a difference in osseointegration between the two implants used in this study.