Modern Research in Dentistry

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EISSN : 2637-7764
Current Publisher: Crimson Publishers (10.31031)
Total articles ≅ 95
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Published: 31 October 2020
Modern Research in Dentistry; doi:10.31031/mrd

I-Ping Chen, Do Hyeon Kim, Bruce Cha, Jin Jiang
Published: 19 August 2020
Modern Research in Dentistry, Volume 5, pp 506-512; doi:10.31031/mrd.2020.05.000614

Abstract:
Do Hyeon Kim1, Bruce Cha2, Jin Jiang2 and I-Ping Chen2* 1Private Practice, Bridgeport, CT, USA 2Department of Oral Health and Diagnostic Sciences, School of Dental Medicine, University of Connecticut Health, Farmington, CT, USA *Corresponding author: I-Ping Chen, D.D.S., Ph.D., Associate Professor, University of Connecticut Health Division of Endodontology, Department of Oral Health and Diagnostic Sciences, 263 Farmington Avenue Farmington, CT 06030-3705, USA Submission: July 28, 2020;Published: August 19, 2020 DOI: 10.31031/MRD.2020.05.000614 ISSN:2637-7764Volume5 Issue3 Thorough understanding of root canal anatomy is a prerequisite for successful endodontic treatment. The failure of root canal treatment of maxillary molars is highly associated with missing the second mesiobuccal (MB2) canals. Aim: we aim to assess the prevalence and morphology of MB2 canals of first (1st) and second (2nd) maxillary molars based on CBCT images. We further compared the treatment rate of MB2 canals to the rate identified from CBCT imaging analysis. Methodology: Pre-operative CBCT images of 400 maxillary 1st molars and 264 maxillary 2nd molars in a cohort of 661 subjects were examined. Parameters studied were: Result: 99% of maxillary 1st and 89.77% of 2nd molars had three separate roots with 2nd molars showing higher morphological variability. MB2 canals were found in 77% of maxillary 1st molars and 46.9% of 2nd In 3-rooted molars, the most common Vertucci classifications for MB canals in 1st molars were Type II (37.63%) and in 2nd molars Type I (47.26%). When MB2 orifices were not at the pulpal floor level (~50% of cases), the average distance below the pulp floor was 0.94mm in maxillary 1st molars and 0.92mm in 2nd molars. Clinically, the rates of MB2 canals being treated of 1st and 2nd molars were 67% and 37.8%, respectively. With MB2 identified in CBCT images, 86.6% were obturated in maxillary 1st and 80.64% in maxillary 2nd molars. Conclusion: Despite the resolution limit, CBCT remains a widely accepted non-destructive tool to study canal morphology and is readily available to many endodontists. When it is beneficial to patients and cost or radiation exposure is not a concern, pre-operative CBCT images should be thoroughly analyzed before treatment to ensure treatment quality and to limit iatrogenic complications. Keywords: CBCT imaging; MB2 canals; Maxillary molars; Fused roots The morphology of maxillary molars has been extensively studied, particularly the prevalence of a second mesiobuccal (MB2) root canal. Despite of this effort, the high failure rate of root canal treated maxillary molars remains tightly associated with untreated MB2 canals. There is a significant increase in the incidence of MB2 canals in retreatment cases, suggesting that these canals are frequently missed in the initial treatment [1]. Moreover, maxillary 1st molars with missed MB2 canals were 4.38 times more likely to be associated with a periapical lesion and, surprisingly, MB2 canals were unfilled in almost half of endodontic cases (46.5%) [2]. To maximize the success rate of root canal treatment, it is important for endodontists to be aware of anatomic variations. Since the first report of MB2 canals in maxillary molars in 1925 [3], the prevalence of MB2 canals has been examined by many techniques, which may explain the variable results between studies. Some commonly used methods include clearing and staining of extracted teeth [4], various sectioning techniques [5,6], conventional/digital radiographs [7,8], root canal treatment under microscope in vitro [9], and micro-computed tomographic imaging [10]. The incidence of MB2 canals in the literature ranges from 18-96% [11]. Studies using clearing and staining techniques of extracted teeth revealed that more than 90% of maxillary molars have multiple canals in MB roots [12,13]. On the other hand, clinical studies reported lower incidence (18-73%) of MB2 canals [14-16]. Such discrepancies could also be attributed to different selection criteria of sample population, such as ethnic background or age. Numerous studies have been conducted to establish a reliable and efficient clinical method to help locate MB2 canals [16-18]. In recent years, 3-dimensional cone-beam computed tomography (CBCT) has been used for identifying root canal configurations [10,19,20]. It can confirm the presence of MB2 canals as well as locate and orient a canal in relation to MB1, distobuccal, and palatal canals [19,21]. As a non-destructive tool, CBCT imaging offers not only high-resolution images in all spatial planes with minimal distortion but also reconstructs the volumetric images [22,23]. The aim of this study is to investigate the root and canal morphology of maxillary 1st and 2nd molars based on pre-operative CBCT images and associate the MB2 detection rate of CBCT with those being treated in clinic. Subjects The protocol of this study was approved by the Pearl Institutional Review Board, Indiana, USA (19-KIM- 101). The study included pre-operative CBCT images of 400 maxillary 1st and 264 maxillary 2nd molars taken from 661 subjects between August 2014 and March 2019 for diagnostic purposes. The number of CBCT scans to be included in the study was determined by a power analysis using a sample size calculator (www.qualtrics.com) with a significant level of 0.05 and 99% power. Inclusion criteria for CBCT images were as follows: Pre-operative evaluation of CBCT images CBCT images were taken with a Carestream CS 9000 3D (Carestream Dental, Atlanta, GA) using the following parameters: 70kVp, 10mA, 10.8 second exposure time, 76mm voxel size, and 50mm x37mm scan field of view. Images were viewed with a 27-inch monitor (Samsung T27B350ND) at a screen resolution of 1920x1080 and luminance of 300cd/m². Serial sagittal, coronal, and axial views of CBCT images were evaluated. In axial view, the axis of slicing was rotated to intersect with the long axis of the root. The presence of additional...
Anuradha G, Arvind Muthukrishnan, Vishnupriya Veeraraghavan, Gautham Kumar N
Published: 12 August 2020
Modern Research in Dentistry, Volume 5, pp 504-505; doi:10.31031/mrd.2020.05.000613

Abstract:
Anuradha G1*, Arvind Muthukrishnan2, Vishnupriya Veeraraghavan3 and Gautham Kumar N4 1Prof & Head, Dept of Oral Medicine & Radiology, Madha Dental College, Chennai, India 2Prof & Head, Dept of Oral Medicine & Radiology, Saveetha Dental College, Chennai, India 3Prof, Dept of Biochemistry, Sabetha Dental College, Chennai, India 4Prof, Dept of Periodontics & Implantology, Madha Dental College & Hospital, Chennai, India *Corresponding author: Anuradha G, Prof & Head, Dept of Oral Medicine & Radiology, Madha Dental College, Chennai, India Submission: June 08, 2020;Published: August 12, 2020 DOI: 10.31031/MRD.2020.05.000613 ISSN:2637-7764Volume5 Issue3 Diabetes mellitus is a metabolic disorder characterized by hyperglycemia due to insulin deficiency or its ineffectiveness. Successful management of diabetes involves constant monitoring of the glycemic status of the patient which is usually done by estimating the glucose concentration in blood. However, drawing blood is always an invasive procedure which has prompted researchers to look at alternative biofluids as a reliable substitute to blood for glucose estimation. This mini review examines various biofluids including urine, tears, sweat, and saliva as possible candidates for glucose estimation in diabetic patients. Diabetes mellitus is a group of metabolic diseases characterized by hyperglycemia resulting from an absolute deficiency of insulin secretion and/or reduction in the biological effectiveness of insulin or both [1]. Due to the burden of this disease across the globe, diabetes mellitus is considered as one of the priority non communicable diseases and various measures have been put forward for an effective screening, diagnosing and monitoring the diabetic status in patients [2]. The classic symptoms of untreated diabetes are unintended weight loss, polyuria, polydipsia, polyphagia and other symptoms of diabetes include tiredness, blurred vision, fatigue, headache, slow healing of wounds and itchy skin. Diabetic retinopathy, neuropathy, nephropathy and microvascular angiopathy leading to cardiovascular diseases are long term complications [3]. The estimation of blood sugar levels have always been the gold standard in estimating the diabetic status of individuals. Since blood testing is invasive, painful and also leads to anxiety, risk of infection and also needs a skilled phlebotomist to withdraw blood, blood testing may result in noncompliance with healthcare services to perform a blood test to diagnose or monitor the glycaemia status in patients [4]. So recent advances focus on various biological fluids other than blood in diagnosing and monitoring the blood glucose level in patients [5]. Since 1841, urine has been used as a diagnostic fluid for diabetes assessment. It has been extensively studied as it is very easy to collect and is composed of metabolites such as glucose, proteins and other dissolved salts [6]. Glucose can be found in urine when it is excreted from blood in elevated levels and as a result, this fluid has been investigated for the diagnosis of diabetes [7]. But the main disadvantage of using urinary glucose in diagnosis and screening of diabetes mellitus includes marked individual variations in the renal threshold for glucose, poor reflection of changing levels of hyperglycemia and lack of specificity and sensitivity of various qualitative and semi quantitative procedures [8]. The other physiological fluid used in monitoring glucose levels is the interstitial fluid, Blood and surrounding vascularized tissue readily exchange biological analytes and small molecules by diffusion with the interstitial fluid. Methods of monitoring glucose via the skin has become popular and counteract the challenges associated with patient compliance and invasive monitoring. The Glucowatch was developed as a wearable device which used reverse iontophoresis to extract interstitial fluid through skin and measure glucose levels [9]. Although Glucowatch was a considerable advancement towards noninvasive and continuous glucose monitoring, the approach was hampered by the need of periodic recalibration, thereby resulting in increase in cost for testing equipment and patient care. Other drawbacks include long warm up times, sweating and skin rash with irritation which subsequently resulted in product removal from the market [10]. Sweat was also tried for diagnostic purposes in diabetes mellitus but the analytes contained in sweat varied significantly between basal and exercising states as well as between individuals [11]. There are various researches including eye glasses bio sensor system, watch sensing platform for glucose sensing in sweat, glucose sensor integrated into a wearable wrist band for monitoring glucose levels using sweat. Although sweat sensing for diagnosis is very promising there are also some concerns associated with this sensing fluid [12]. The main challenges include limited fundamental knowledge about this sensing fluid compared to blood, sampling issues associated with sweat production by exercising, surface contamination due to skin impurities and variability in the rate of sweat production. Ocular fluids have also been analysed and this fluid is excreted from the body in the form of tears. Analytes found in this fluid includes glucose, ascorbic lactate, proteins, hormones and can offer great insight into individuals health status [13]. As a result, ocular fluid was investigated for noninvasive and continuous glucose monitoring. A smart contact lens was created and was correlated with the blood glucose levels in diabetic patients. Using contact lens as a sensing platform had many advantages including real time continuous and noninvasive glucose monitoring. However, the disadvantages include production of corrosive hydrogen peroxide as a bi product in the electrochemical sensing approach used in the smart lens and blinking causing artefact in the sensor signal. The human saliva, an exocrine fluid secretion has high...
Tzanakakis Emmanouil-Georgios
Modern Research in Dentistry, Volume 5, pp 496-503; doi:10.31031/mrd.2020.05.000612

Abstract:
Dr.Tzanakakis Emmanouil-Georgios* Department of Operative Dentistry, Dental School of Athens, National and Kapodistrian University of Athens, Greece *Corresponding author: Dr.Tzanakakis Emmanouil-Georgios, Department of Operative Dentistry, Dental School of Athens, National and Kapodistrian University of Athens, Greece Submission: June 25, 2020;Published: July 22, 2020 DOI: 10.31031/MRD.2020.05.000612 ISSN:2637-7764Volume5 Issue3 Restoring extremely abraded dentition is considered as one of the most demanding and time consuming clinical challenges. Patients are often unaware of the complexity of these treatment plans and are usually reluctant to accept major prosthetic interventions. Proper coordination of the clinicians involved in the treatment plan is essential and saves valuable clinical time. This clinical report describes thoroughly a complicated treatment plan that involves periodontic and endodontic treatment, dental implants, orthodontic extrusion and a full-mouth rehabilitation with a combination of all-ceramic and metal-ceramic restorations. In this case report the role of temporary restorations in increased VDO is emphasized and with an extended discussion on clinical steps. Keywords: Abraded dentition; VDO; Bruxism; Metal-ceramic; All-ceramic Abbreviations: TMJ: Temporomandibular Joint; VDO: Vertical Dimension of Occlusion; RPD: Removable Partial Denture The management of complicated cases of extremely abraded dentition is a difficult task for the clinician. It has a negative impact on quality of life comparable with that of edentulousness [1]. The reconstruction of dental arches requires extensive restorative treatment [2,3]. Every patient requires unique treatment, however most of them at the beginning of treatment are not aware of the cost and time that is necessary for a proper and long term treatment plan and postpone the therapeutic interventions. Moreover they are usually confused because specialized clinicians may propose different treatment plans. A team of experienced clinicians can suggest an appropriate treatment planning [2]. Nowadays, the increase of mechanical strength and adhesive potential of new dental materials may offer new possibilities in reconstructive techniques and digital workflow can minimize invasive tooth preparations [4,5]. Bruxism is a repetitive parafunctional activity and the main cause for temporo-mandibular disorders (TMD) [6]. Wear facets along with masseter muscle hypertrophy other clinical are common findings that indicate the presence of bruxism [6]. Masticatory forces in bruxing patients are much higher than maximum biting forces measured during chewing cycles, which partially explains the catastrophic impact to dental restorative materials. It is widely considered that bruxism has also a negative impact on the periodontal tissues and is a main cause of loss of osseointegration of dental implants [7-9]. Loss of posterior support causes difficulty in mastication especially in young and middle aged population. In these patients, anterior teeth are overloaded. The results are either tooth mobility or extensive wear of the clinical crown. Restoration of posterior support is necessary as early as possible with provisional restorations to restore periodontic and mechanical overload of the remaining dentition [2]. Fixed implants restorations are more attractive for the patients especially when the alternative treatment plan includes a removable device. If a patient can afford the increased cost and accepts the minor surgical procedure, implants are a reliable solution to partial edentulism [10]. The aim of this case report was to analyze the therapeutic management of a patient presenting generalized excessive tooth wear in the mandibular dentition involving decreased VDO and loss of posterior support. The treatment included a combination of periodontic and endodontic therapies, implants placement, minor orthodontic treatment and optimum prosthodontic rehabilitation with fixed dental prostheses, cast posts and all ceramic veneers in increased VDO. Patient presentation The Caucasian 53-year-old male patient was seeking treatment. His chief complaint was difficulty in chewing and his anticipation for a fixed restoration (Figure 1). Figure 1: Preoperative intraoral frontal view. Initial clinical situation, radiographic examination Figure 2: Preoperative panoramic radiograph. The patient reported a free medical history, but admitted smoking habit (20+cig/day). He was not taking any medication and reported pain in facial muscles during stressful periods. The patient was subjected to thorough clinical and radiographic examination (panoramic x-ray) (Figure 2). Intraorally, he presented severe abrasion most observed in mandibulary dentition, reduced VDO, and several missing mandibular teeth (#44,45,46,47 and 36,37). In the maxilla, a 4-unit metal ceramic bridge with a cantilever was found on the incisors {12-11-21-(22)}, and one 4-unit metal-acrylic bridge in the posterior segment {23-(24)-(26)-27}. The visible diastemmas between #12,#13 and #13,#14 were due to a missing premolar #15 which probably caused distal migration of #14 and 13 (Figure 3-5). The smile line was evaluated as medium (Figure 6). Secondary caries was visible in amalgam restorations in #14 and #16 and was inspected under the abutment #12. A significant change in the occlusal plane was obvious, defined by significant protrusion of #13, #14 and #16. In the mandible acrylic crowns were positioned in #44, 33, 34. Initial radiographic examination revealed endodontic therapies in #12, 34, 35, 42 and #43 and it was estimated that the bone level averaged at 70%. Clinical examination of the stomatognathic system revealed bilateral myalgia of the lateral pterygoid muscles on palpation, unilateral clicking on the left TMJ and limitation in mouth opening. All other masseter muscles were free of symptoms. Figure 3: Preoperative occlusal view of the maxilla. Figure 4: Preoperative intraoral...
Elodie Terrer, Oumarou Hama H, Gouriet F, Habib G, Catherine Jh, Raskin A, Lan R, Hadj Said M, Aboudharam G, Terrer E, et al.
Modern Research in Dentistry, Volume 5, pp 486-489; doi:10.31031/mrd.2020.05.000610

Abstract:
Oumarou Hama H1,2, Gouriet F1,5, Catherine JH3,4,5, Habib G1,5, Raskin A3,4,5, Hadj Said M3,5, Lan R3,4,5, Aboudharam G2,3,5, Drancourt M1,2,5 and Terrer E2,3,5* 1IHU Méditerranée Infection, Marseille, France 2Aix-Marseille Université, IRD, MEPHI, IHU Méditerranée Infection, Marseille, France 3Aix-Marseille Université, UFR Odontologie, Marseille, France 4Aix-Marseille Université, Anthropologie bioculturelle Droit Ethique Santé, Marseille, France 5APHM, Hôpital Timone, Marseille, France *Corresponding author: Elodie Terrer, Aix-Marseille University, MEPHI, IHU Méditerranée-Infection 19-21 Boulevard Jean Moulin, 13005 Marseille, France Submission: July 08, 2020;Published: July 20, 2020 DOI: 10.31031/MRD.2020.05.000610 ISSN:2637-7764Volume5 Issue2 Objective: Dental pulp is acknowledged to be an organic tissue sample on which the microbiological diagnosis of blood-borne pathogens, including those responsible for infectious endocarditis, can be based. Method: Molecular detection of aureus was performed in the dental pulp extracted from one tooth collected in a patient firmly diagnosed with S. aureus infectious endocarditis. Result: We report on one patient diagnosed with Staphylococcus aureus endocarditis in whom aureus DNA was further detected by PCR in the dental pulp. We advocate not throwing away extracted teeth, appropriate microbial investigations of which may reveal bacteraemic pathogens not otherwise detectable. Keywords: Bacteremia; Tooth; MALDI TOF MS; Microbiology; Diagnosis; Cardiology Dental pulp is acknowledged to be a suitable organic tissue upon which to base the microbiological diagnosis of blood-borne pathogens, including those responsible for infectious endocarditis [1,2]. Non-exposed dental pulp can be invaded by bacteria with predominance of aero-intolerant bacteria of the genera Eubacterium, Propionibacterium and Actinomyces [3]. Furthermore, molecular approaches have made it possible to detect the DNA of Coxiella burnetii, a pathogen responsible for endocarditis [4] in the dental pulp of experimentally-infected guinea pigs [5], as well as HIV DNA in a seropositive patient [6]. In addition, one case of Bartonella quintana bacteraemia has been detected by PCR in the dental pulp sample collected from a patient who had been diagnosed with B. quintana bacteraemia six months previously but who was not longer bacteraemic when the tooth was extracted [1]. Infectious endocarditis (IE) is mainly caused by streptococci, staphylococci and enterococci and, rarely, by fungi [7,8]. Staphylococcus aureus (S. aureus) is one of the pathogens most frequently involved in blood-borne infections, including IE [9,10]. In this paper, we report on one patient diagnosed with S. aureus endocarditis in whom S. aureus DNA was further detected by PCR in the dental pulp. In April 2019, a 54-year-old patient was admitted to the emergency department of the Timone hospital (Marseille, France) with fever, confusion and tetraparesia. A cerebral scan found multiple left hypodense fronto-parietal and left occipital lesions. Blood and the cerebrospinal fluid cultured methicillin-susceptible S. aureus. Empiric antibiotic therapy combining amoxicillin, gentamycin and acyclovir was then changed for cefazolin, 12g/day and clindamycin 600mg four times/day. A transthoracic echocardiography found vegetation on the native bicuspid aortic valve and a moderate aortic insufficiency. The patient was then diagnosed with S. aureus infectious endocarditis. A total body scan found bilateral renal, splenic and hepatic embolisms. Brain magnetic resonance imaging found several right frontal, left occipital, temporal, thalamic and bilateral cerebellar hyper signals with haemorrhagic organisation in the right frontal and occipital lesion. Five days later, the patient presented with septic shock and was admitted to the cardiologic intensive care unit. Antibiotic therapy was changed for intravenous sulfamethoxazole 4,800mg/day, clindamycin 1,800mg/day, gentamycin 160mg/day and rifampicin 1,800mg/day. Laboratory tests showed leucocytosis at 19G/L, haemoglobin at 10.4g/dL, platelets at 180G/L, and protein C-reactive at 95.5mg/L. 18fluorodeoxyglucose-positron emission tomography/computed tomography showed multiple hypermetabolic foci in the lymph nodes, liver, muscles and bones. Spinal magnetic resonance imaging showed a lumbar L4-L5 and cervical C5-C6 spondylodiscitis. Initial clinical and biological evolution was favourable, however, three weeks later the cardiac lesion worsened with severe aortic valve insufficiency. Cardiac surgery was performed and the patient underwent an aortic bio prosthesis. Culture of the explanted cardiac valve remained sterile and PCR-based tests for the pan bacterial 16S RNA gene, Enterococcus faecalis, Enterococcus faecium, S. aureus, Coxiella burnetii and Bartonella spp. were negative. Histological examination of the explanted valve showed a valvular tissue largely destroyed by a dense, non-specific and polymorphic inflammatory reaction, with many neutrophils. As part of the routine management of patients with IE, 13 teeth with infectious foci of endodontic or periodontal origin were extracted using amoxicillin antibiotic prophylaxis according to the recommendations of the Haute Autorité de Santé (HAS) and the Agence Nationale de Sécurité du Médicament (ANSM). After obtaining the patient’s informed consent, the teeth were microbiologically investigated in line with advice from the IHU Mediterranean Infection Ethics Committee (Advice, 05/29/2018). The evolution of the patient was favourable at the six-month follow-up consultation. Six of the 13 extracted teeth (n°13, n°24, n°25, n°35, n°36, n°37) were used for bacteriology investigation. Teeth were decontaminated with 1% chlorhexidine (MP Biomedicals, Illkirch, France), washed with UltraPure™...
Eric Z Shapira
Modern Research in Dentistry, Volume 5, pp 490-495; doi:10.31031/mrd.2020.05.000611

Abstract:
Eric Z Shapira* Professor of Geriatric Medicine and Dentistry *Corresponding author: Eric Z Shapira, Professor of Geriatric Medicine and Dentistry, USA Submission: February 17, 2020;Published: July 20, 2020 DOI: 10.31031/MRD.2020.05.000611 ISSN:2637-7764Volume5 Issue3 Today, people are living longer and hopefully keeping their teeth longer. There are modalities of dental treatment that can correct tooth loss and bone loss with adequate substitutes that emulate “the real thing.” Bone loss, a disease symptom which can occur from multi-variants, can lead to subsequent tooth loss and an inability to replace these lost teeth. Dentists have long attempted to find ways of replacing missing teeth with endosseous, as well as subperiosteal implant techniques. Blade implants were the treatment of the 1950’s; whereby a small length-wise slit was made on the edentulous ridge to a depth conducive to “tapping” a stainless steel, flat fixture into the bone. Depending upon the width and depth of the surrounding bone, the blade implant could be used to hold single and/or multiple crowns. Trial and error led to the advent of the cylindrical, square, peg-shaped or rounded and oblong implants made of titanium and other osseo-integrative materials. Eventually, hydroxyl-appetite coated implants came into use and proved more successful than the standard blade type implant. The “coated” implants were more predictable and lasted longer, especially when coated with “plasma spray”. Older individuals with more discretionary income, who may have been conditioned and committed to saving their teeth, were the more obvious patients opting for implant tooth replacement. Many factors that figured into the equation of whether the implant would “take” or not had to be considered before an implant could be delivered as the treatment of choice. Today, in conjunction with these various factors of viability and disease, considerations for recommending an implant as a replacement for a missing tooth should be given the highest and priority as it has become the Standard of Care. Aging brings change to everything. Therefore, the human body is subject to many stressors, including stress itself, disease, time, the normal aging process, and physical injury of one kind or another. All of these aforementioned entities potentiate change and either allows the human body to adapt physiologically or forcibly exerts this change unconsciously or consciously depending upon the type of insult one is trying to cope with at the time. The older one gets, the more difficult this process is and the slower the process becomes. Patients on multiple drug therapies, patients with various systemic disease states, patients with emotional stress, one Dementia of another, personality disorders and various metabolic problems should be examined thoroughly, both dentally and medically, prior to any implant placement. One should go as far as getting a Medical Clearance for an elderly, medically compromised patient to have the surgical placement of an implant. The human body is susceptible to rapid changes that may be slow to expose symptoms which may be indicative of subliminal disease states. Many diseases today can and should preclude one from having a dental implant due to the high risk of potential failure. Some of these disease states might include: osteopenia, osteoporosis, diabetes, auto-immune diseases, diseases related to material allergies, xerostomia, stressrelated bruxism, chronic advanced periodontal disease and the loss of mental cognition, which would limit eventual home care and recall visits post implant placement; ultimately leading to failure. This author believes that our greatest challenge as dental practitioners is to get the patient, especially the older patient, who needs implant therapy to want an implant procedure; and for that matter, anything else that demands a choice in restoring a patients’ mouth to optimum health. That is: Our greatest challenge in dental practice is to get the patient to want what “we” think they need. All too often there remains a plethora of variables that can confound the choices we all make as patients. However, from experience, the biggest stopgap seems to be their abilities to afford implant therapy. There is no question in the mind of a person who for all their life has taken care of their mouth and the rest of their body, using self-efficacy as their guide, to want the best possible options to keep their dentition working in an ideal manner. There is no “hard sell” for the patient who knows what is best for themselves; but, for those patients who have difficulty making a decision for implant care, education seems to be at the core of this process. The question remains: Is it necessity, financial ability, rationalization through education or desire that helps in the process of getting to “yes?” Clinical examples can show how the prospective implant therapy for an elder can enhance their ability to function with embellished ability, a minimum of sideeffects and unnecessary angst about discomfort, ability to eat and other concerns (Table 1). Table 1: A step-wise system of learning. From Geriatric lectures of Eric Shapira, D.D.S. Avram King circa 1980’s©. In the 1980’s, a psychologist by the name of Avram [1] developed the Step-Wise System of Learning [1]. This table shows how one comes to making a decision given information that they did not have before. The persons’ ability to choose is influenced by how the message is delivered of course, what kind of message it is e.g. didactive or guilt-inducing with judgment injected into the equation by the receiver. With the mixing of information, emotions, judgment and empathic or sympathetic words, a persons’ level of commitment is born. The commitment can be getting to “yes” or ending in “no.” This...
Foti Vincenzo
Modern Research in Dentistry, Volume 5, pp 476-485; doi:10.31031/mrd.2020.05.000609

Abstract:
Foti Vincenzo* and Rossi Roberto Private practice, Genova, Italy *Corresponding author: Foti Vincenzo, Private practice, Piazza Borgo Pila 40, Genova, Italy Submission: June 09, 2020;Published: July 08, 2020 DOI: 10.31031/MRD.2020.05.000609 ISSN:2637-7764Volume5 Issue2 Guided bone regeneration is a technique widely known, clinicians know very well indications and limitations of this technique. One of the principles to achieve bone augmentation and formation resides in the stability of the blood clot forming under a barrier membrane. The technique proposed in this article has the goal of providing stabilization to the bone graft by adding fibrin sealant (FS) to the bone graft and also using the fibrin sealant to attach a bone membrane (cortical lamina) to the recipient site. This simple modification of the technique of guided bone regeneration is presented in two successful cases. Keywords: Cortical lamina; Fibrinogen; Fibrin sealant; Guided bone regeneration; Implants Fibrin Sealant Fibrin sealant (FS) is a medical device derived from human blood, used in surgery and in specialties since 1975 for his hemostatic and ahesive properties. The first application in the dental field dates to the 80’, in oral surgery for those patients with disorders of hemostasis [1]. In periodontology Pini Prato GP et al [1]. in 1988 treated infra-bony defects by using FS to stabilize membranes in guided tissue regeneration procedures [2]. The first application in guided bone regeneration was reported by Wittkampf in 1989. He described a simple way to handle granules of HA in the reconstruction of narrow alveolar ridges using the FS to keep the particles together [3]. Hotz [4] used FS as a biological resorbable glue (thrombin was diluted to 1U/ml) in socket preservation. The glue would keep the granules of HA in solid form until keratinized gingiva had sealed the socket [4]. Three years of clinical experience demonstrated the efficacy of the complex HA/FS in pre-prosthetic and reconstructive surgery [5]. The clinical study that demonstrated and a new peri-implant regenerative technique by adding the FS was the one of Corrente et al. [6]. The authors achieved supra-crestal regeneration without the use of a barrier membrane. The average vertical gain was 2.05mm and histology showed newly formed trabecular bone [6]. Cardaropoli D et al. [7] 2013 modified the technique of Corrente by adding a collagen membrane, with this addition they reported a mean vertical gain of 3.95mm [7]. In regenerative procedures, FS adds an excellent physical quality to the bone grafts, making them sticky, moldable and easy to adapt to local anathomy, without any waste of granules [8]. FS demonstrates an osteoinductive capacity when mixed with osteoconductive bio-materials [9-11]. Furthermore favors angiogenesis, thanks to the link of fibrinogen with VEGF growth factor, stimulating proliferation of endothelial cells [12]. Fibrinogen also induces formation of extracellular matrix to support blood supply, connective tissue and bone [13]. Linsley in 2012 demonstrated that fibrinogen induces growth of mesenchimal cells and their differentiation into osteoblasts [14]. One last effect of FS is to enhance and accelerate wound healing and closure [15]. Cortical Lamina The cortical lamina (Cortical Lamina Osteobiol, by Tecnoss, Coazze, Italy) is a membrane used in GBR made of collagenated porcine bone. This membrane is very versatile because is produced in three different versions, curved, soft and bone layer. These three version satisfy all the different applications in GBR whether we are dealing with horizontal, vertical or three-dimensional defects [16]. Rossi et al. [17] carried out a clinical and histological study on humans, a series of patients with severely resorbed mandibles were first treated by means of the cortical lamina associated with collagenated porcine bone xenograft (GenOs Osteobiol By Tecnoss, Coazze, Italy) mixed with the patient’s own blood clot. The lamina was positioned on top of the grafted edentulous ridge in the attempt of increasing the width and height. After healing periods of 6/8 months implants were inserted in the areas where the ridge augmentation took place, and careful biopsies were taken before inserting the fixtures. All implants achieved osseointegration and up to one year after final restoration did not show any modification of the crestal level. Biopsies showed that all areas augmented had live mineralized bone [17]. If curved lamina because of its stiffness and flexibility can be adjusted to local anatomy just by means of sutures, the soft lamina behaves like any resorbable membrane but, being made of bone, maintains a certain elasticity and needs to be fixed by pins or tacks. Same can be said for the bone layer that needs screws to keep it in place. Cortical lamina proves to be a reliable device to perform ridge augmentation, the application of FS to the soft lamina became crucial in the development of the F.I.R.S.T. technique. I.R.S.T In 2016 authors found in the FS the ideal material to achieve a perfect fixation of the cortical lamina, preventing the use of screws. The objective was to create a system where the bone graft and the cortical lamina become one whole complex. Stability of the graft represents one of the key factors in GBR [18]. Aside from that the hypothesis was that FS would improve regeneration through the osteoinductive activity of fibrinogen. The name “Fibrinogen-Induced Regeneration Sealing Technique” object of this paper generated from this thought. The patient was a woman 64-year-old with history of periodontal disease. Non-smoker, in good general health, she did not report allergies or intolerances to anesthetics and drugs. She presented with stage IV periodontitis and partial edentulism in the second quadrant with a horizontal bony deficiency. The first step represented full-mouth disinfection and systemic therapy with Metronidazole and Amoxicillin for...
Youjian Peng
Modern Research in Dentistry, Volume 5, pp 473-475; doi:10.31031/mrd.2020.05.000608

Abstract:
Jiehua Zhang and Youjian Peng* Department of Stomatology, Renmin Hospital of Wuhan University, China *Corresponding author: Youjian Peng, Department of Stomatology, Renmin Hospital of Wuhan University, No.238 Jiefang Road, Wuchang District, Wuhan, Hubei, China Submission: May 25, 2020;Published: July 02, 2020 DOI: 10.31031/MRD.2020.05.000608 ISSN:2637-7764Volume5 Issue2 The objective of this article is to describe the treatment of an 8-year-old boy with anterior crossbite and premature loss of the second primary molar due to the ectopic eruption of the maxillary first permanent molar. A modified Nance appliance was used to distalize the maxillary first permanent molar. And the crossbite of the anterior region was corrected by two-by-four (2×4) appliance. Satisfactory function was achieved for this patient, which greatly simplified the subsequent treatment in the permanent teeth. Keywords: Ectopic Eruption; Crossbite; Modified Nance appliance The prevalence of ectopic maxillary first permanent molars in children has been reported as 3%-4% [1-3]. The etiology of ectopic eruption is related to genetic and environmental factors. The latter ones include small arches or a short maxillary length, significantly larger maxillary first permanent molars and maxillary second primary molars, a more mesial eruptive path of the permanent molar, and abnormal angulation of eruption of the maxillary first permanent molars. The ectopic eruption of a maxillary first permanent molar is frequently ignored and extremely challenging in dental practice. However, as the key to occlusion, the first permanent molars play a vital role in balanced occlusion. Failure to treat ectopic eruption could result in a local malocclusion. So early diagnosis and treatment can prevent a more complicated malocclusion. Figure 1: Pretreatment intraoral photographs. An 8-year-old boy sought orthodontic treatment at the office of our hospital in Wuhan, China. His chief complaint was to correct his anterior crossbite. He had a symmetrical face with a slightly concave profile. His facial midline was coincident with the dental midline. He was in a period of mixed dentition. The first maxillary molars presented a Class II molar relationship on both sides, with a crossbite of lateral incisors. He had a space of 2mm between the right permanent maxillary first molar and premolar resulted from the early loss of the second primary premolar (Figure 1&2A). The panoramic radiograph that was taken at the age of 5 years showed that atypical resorption of the second primary molar was caused by the mesial ectopic eruption of his right permanent maxillary first molar (Figure 2B). Figure 2: A. Pretreatment panoramic radiograph at the age of 8; B. Pretreatment panoramic radiograph at the age of 5. Figure 3: Treatment progress: A. 2 months after the start of orthodontic treatment; B. 5 months after the start of orthodontic treatment. Figure 4: Posttreatment intraoral photographs. 0.012NiTi (NIC, Suhang, China) were placed and bonded on maxillary arch for alignment and crossbite correction in the anterior region. To reopen the space for the maxillary right second premolar, a modified Nance appliance was placed on the maxillary first permanent molars and the first premolars (Figure 3A). The crossbite was corrected after two months of treatment. At the end of the third month, 7mm space was opened for the second premolar. The maxillary right second premolar erupted after a 5-month treatment (Figure 3B). The results maintained for 3 months and the active treatment ended. The posttreatment records showed that the treatment objectives were achieved (Figure 4). The facial photographs showed acceptable overbite and overjet were achieved. A Class I molar relationship was established. Abnormal mesial eruption of a maxillary first permanent molar may result in early loss of the second primary molar and incidence of the impaction in the second premolar. Except for allowing the selfcorrect and erupt into occlusion [3,4], possible treatment options include extraction of the second primary molar, a sectional fixed appliance, orthodontic separators (elastomeric, brass wire and pre-fabricated clip separators), or custom-made appliances [5,6]. In this case, a modified Nance appliance was used to regain lost space, upright the maxillary first permanent molar, and preserve arch length. Successful early intervention in the mixed dentition ensures proper full eruption of the permanent second premolar, which simplifies or even avoids comprehensive treatment of the malocclusion. © 2020 Youjian Peng. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.
Jurandi Nery Pereira
Modern Research in Dentistry, Volume 5, pp 470-472; doi:10.31031/mrd.2020.05.000607

Abstract:
Jurandi Nery Pereira* and Thaís Brito Oliveira Filho State Universty of Feira de Santana, Feira de Santana, Bahia, Brasil Federal Universty of Bahia, Salvador, Bahia, Brasil *Corresponding author: Jurandi Nery Pereira, Filho State Universty of Feira de Santana, Feira de Santana, Bahia, Brasil Submission: May 05, 2020;Published: June 23, 2020 DOI: 10.31031/MRD.2020.05.000607 ISSN:2637-7764Volume5 Issue2 As a chemical control, 0.12% chlorhexidine digluconate is the most widespread in the lineage of mouthwashes. In addition to the effective action of chlorhexidine in dental biofilm, its use is also indicated for oral mucositis, as it acts in reducing the severity of injuries, providing more comfort and avoiding secondary infections. However, the use of chlorhexidine for prolonged periods is contraindicated, as it induces side effects such as discoloration of the teeth, peeling of the mucosa, altered taste and unpleasant taste. In our literature review work, we concluded that 0.12% chlorhexidine digluconate is an excellent antimicrobial agent, but its use should be done with discretion, as it has significant adverse effects. In times of pandemic, health and hygiene care must be doubled. A healthy body helps the immune system to prevent infections. Therefore, the concern of health authorities regarding the new coronavirus (Sars-Cov-2) is justified. In this sense, attention to oral hygiene is of fundamental importance since the mouth is the gateway for numerous infectious agents. The use of chemical adjuvants is recommended, as it reduces the microbial load to which the organism is subjected. However, the use of such substances can cause some undesired effects, which we will see below in relation to 0.12% chlorhexidine digluconate, considered the “gold standard” of mouthwashes [1]. As a chemical control, 0.12% chlorhexidine digluconate is the most widespread in the lineage of mouthwashes [1]. In addition to the effective action of chlorhexidine on dental biofilm, its use is also indicated for oral mucositis, as it acts in reducing the severity of injuries, providing more comfort and avoiding secondary infections [2]. Chlorhexidine has a substantivity in the oral cavity for approximately 12 hours, inhibiting the adhesion and colonization of microorganisms to dental elements. Thus, it can be emphasized that it exerts bactericidal action when used in high concentrations and bacteriostatic in low doses, paralyzing and killing bacteria [1-3]. However, even with numerous beneficial effects, some adverse effects have been observed in the literature regarding its use, such as: alteration in the coloration of dental elements, restorations, prostheses and tongue, formation of supragingival calculus, loss of taste, burns in tissue soft, pain, dry mouth, and unpleasant aftertaste in the mouth. Mucosal ulcerations, reversible swelling of the lips and parotid glands, scaly lesions, urticaria, dyspnea and anaphylactic shock can rarely occur [4-6]. Chlorhexidine is an antimicrobial and antiseptic agent widely used in the health area, however, it can cause oral changes such as: changes in the color of the dental elements, loss of taste, soft tissue burns, pain, dry mouth, scaly lesions, mucosal ulcerations and unpleasant aftertaste in the mouth [4]. According to Zanatta & Rösing [4], the change in dental color (Figure 1), which is reported by most users, is strongly associated with its prolonged use, concentration and high volume, affecting mainly the cervical face of the crown and the proximal areas of the dental elements. However, these stains are easily removed with the use of ultrasound (Figure 2). these authors also address hypotheses about the factors that lead to staining, such as the ability of chlorhexidine to denature proteins, form ferric and stony sulfite, or even with the association of colored foods, however for Bohner [7] the staining is caused by diet dyes, which react with the mouthwash, forming colored elements. Berton et al. [5] describe the clinical management of unilateral parotid edema caused by the use of chlorhexidine in a 66-year-old patient who used the substance continuously. Figure 1: Teeth stained by 0.12% chlorhexidine digluconate. Figure 2: Appearance after ultrasound treatment. According to Torres et al. [8] it is necessary for the professional to make a correct anamnesis and clinical diagnosis of the patient in order to be more careful when performing invasive procedures in patients with systemic diseases and heart valves, so avoiding compromising the patient’s health. It is necessary in the preoperative period to perform extra-oral asepsis and rinse with chlorhexidine, as well as to use it in the postoperative period to prevent the development of infections, always guiding the patient on the form and days of use to avoid effects collaterals in the oral cavity. The most widely used form of chlorhexidine at a concentration of 0.12% in dentistry is through mouthwash, the amount of which is 15ml, twice a day, rinsing for 60 seconds [1,2,4]. In a recent study, Ambhore and Padhye showed the effectiveness of using chlorhexidine in gel form [9]. On the other hand, Campos et al. [10] reported the use of chlorhexidine by the medical team three times a day and mouthwash with 10 ml of 0.12% chlorhexidine solution for 60 seconds. The use in high doses, acts in the coagulation of cytoplasmic proteins and bacterial death, in low doses, it causes a change in the cell membrane and extravasation of low molecular weight bacteria [2,4]. As emphasized by Franco et al. [11], chlorhexidine acts in two ways, when used in low concentrations, it has bacteriostatic action, paralyzing the bacterium, through the alteration of the osmotic balance and the loss of intracellular substances. Already in high concentrations it has bactericidal action, which ends up destroying the cell. Chlorhexidine is also effective in preventing and treating mucositis in patients undergoing...
Alvydas Gleiznys
Modern Research in Dentistry, Volume 5, pp 467-469; doi:10.31031/mrd.2020.05.000606

Abstract:
Alvydas Gleiznys1* and Zivile Zidonyte2 1Department of Prosthodontics, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, Lithuania 2Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, Lithuania *Corresponding author: Alvydas Gleiznys, Department of Prosthodontics, Faculty of Odontology, Medical Academy, Lithuanian University of Health Sciences, Lithuania Submission: March 19, 2020;Published: May 29, 2020 DOI: 10.31031/MRD.2020.05.000606 ISSN:2637-7764Volume5 Issue2 Bell’s palsy is an idiopathic neuropathy of the facial nerve, meaning that a cause is unknown. It is usually recognized as an acute weakness and disability to move one side of the entire face. Problems of speech, swallowing and eating occur and the chance of the quick recovery takes 6 months (85% of patients) or is impossible at all. However, it is inevitable to restore patient’s masticatory system and to return the ability to live a comprehensive life. The purpose of the work is to report a case of Bell’s Palsy, reveal advices and difficulties that were met during this treatment. Methods: A clinical and radiographic examination for the 51-year-old patient was made in accordance with neurologist, otorhinolaryngologist and general doctor. Accordingly, an electronic research was performed on databases such as The Cochrane Library, EMBASE via Science Direct, MEDLINE via PubMed in order to collect as much information as possible. All selected data was summarized and the protocol of treatment for a patient was determined. Result: A clinical case presents our findings and the protocol of the treatment, replenished with data from scientific literature. The main aspects are mentioned with our plans to continue our research how to improve prosthodontic treatment for patients with facial paralysis. Conclusion: Clinical and radiographic analysis has showed a need for a specific treatment. According to the clinical case, the main anatomical structures were marked according which a required border molding has to be reached for all types of patients and have distinguished the ones that are inherent for patients with Bell’s palsy. Keywords: Bell’s palsy; Complete dentures; Border molding; Custom trays Bell’s palsy is known as facial paralysis that has an idiopathic cause. This severe condition can appear because of unknown conditions and complicates one’s life [1]. The main features of the Bell’s palsy are: Many different treatment approaches have been offered by neurologist to the resolution for such one side paralysis and a patient was motivated to accept dental treatment to recover his masticatory system. In prosthodontics it appears indispensable to transfer the view from the mouth to the casts. Sometimes mistakes occur and collaboration between dental technician and a dentist interrupts, wherefore appropriate treatment cannot be accomplished [4-9]. Accordingly, one of the most important factors how to maintain this professional communication is taking into account the correct determination of custom tray borders, border molding and impressions [4-8]. Treatment becomes especially difficult in edentulous patients with health disorders, so that we have decided to announce our clinical case. The purpose of this case report study was to perform an objective treatment for a patient with one side facial paralysis, to determine the borders of an upper jaw custom tray and to assure impression is ready to be sent to the laboratory [7,9,10]. The case presented is of a 51-year-old male patient who came to our Clinic with a medical history of Bell’s palsy. Treatment plan was based on electronic research and the experience our doctors. The research was based on three databases (The Cochrane Library, EMBASE via Science Direct, MEDLINE via PubMed). It was performed by using keywords: “complete dentures”, “border molding”, “and custom trays”, “ Bell ’s palsy”. As inclusion criteria we have chosen clinical cases on humans, English language, articles that have proven statistically confirmed value. After screening the literature, detailed information was used for the treatment. It was decided to extract teeth that cannot be restored. After 4 weeks, preliminary impressions were made with alginate and poured in Type III dental stone (Figure 1). After fabricating primary casts, custom acrylic resin trays were made and single-step border molding was done (Figure 2). Figure 1: Primary casts. Figure 2: Upper jaw custom tray. By customizing individual trays and taking trial impressions, a few main structures have shown a need to be checked whether custom tray border molding is correct. After corrections and single-step border molding, a final impression was taken. Accordingly, an asymmetry of polyvinyl siloxane impression between both sides has shown manifesting differences between normal and paralyzed sides (Figure 3). From the photo it is clear that a deviation of the labial frenum is linked to the paralyzed side, right buccal frenum is not expressed enough and the right labial and buccal sulcus take less space than the left ones. However, other structures are similar in both sides (Figure 4). On the active side we could make functional moves in order to show off muscle and mucous membrane activity, whilst the passive one only showed us a regular anatomy without expressed amplitude of intraoral structures and soft tissues. Even though a patient was incapable of moving the right side of his face, during functional impressions his right side of the case was manipulated by a doctor in order to achieve the best retention and stability. Further treatment protocol steps were made the same as for conventional complete dentures. Denture bases and wax rims were made to record maxilla mandibular relationship. VDO (vertical dimension of occlusion) was determined to be 2-3mm less than VDR (vertical...
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