Dental Tribune International
Clinical
New perspectives in periapical surgery: Hemostasis

October 22, 2018

The aim of the current investigation was to review techniques and materials available to achieve bleeding control during periapical surgery. An adequate bleeding control is crucial, since it improves vision in the surgical site, minimizes surgical time, enhances the root-end resection and filling, and reduces surgical blood loss, postsurgical hemorrhage and postsurgical swelling.

Condylar retrusion on the horizontal plane associated with retrusive lateral excursion

October 20, 2018

The objective of this article was to describe the relationship between the movement of the interincisive point and the working temporomandibular joint condyle with regard to the horizontal plane during laterality movements.

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Efficacy of a adhesive on the strength of a luting cement to leucite-reinforced glass-ceramic

October 17, 2018

The present study compared the efficacy of a universal adhesive containing silane, bis-GMA and 10-methacryloyloxydecyl dihydrogen phosphate (10-MDP) monomer with that of silane applied alone or combined with bis-GMA or 10-MDP, but in separate steps, on the microtensile bond strength of a CAD/CAM leucite-reinforced glass-ceramic to a resin cement.

Direct pulp capping as a conservative procedure to maintain pulp vitality

October 15, 2018

From a completely optimistic point of view, the ultimate goal for every dentist performing a restorative and/or endodontic procedure should be to maintain the pulp vitality and functionality of the tooth without any discomfort for the patient. The pulp tissue is needed to provide nutrition, innervation and immunocompetence, with these acting as a defence mechanism and alerting to the presence of any external aggression.(1)

Orthograde apical application of an MTA plug in a tooth without constriction

October 8, 2018

The minor apical foramen should be maintained at its initial position and size after chemomechanical endodontic procedures. If the apical constriction is breached and transported, cleaning procedures will be compromised and obturation significantly difficult to carry out well.

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Chairside CAD/CAM immediate restorations

October 5, 2018

No-preparation ultrathin veneer is one of the most minimally invasive restorations. Its thickness ranges from 0.3 to 0.5 mm. In the right circumstances (Figs. 1 & 2) it can show excellent aesthetic appearance and provide long-term stability and health of soft- and hard-tissue.

Dynamic navigation for reliable and predictable flapless implant placement

August 20, 2018

A 52-year-old female patient was concerned about the appearance of her smile. Her upper right first molar and second premolar had been missing for several years (Figs. 1 and 2). She was otherwise a fit and healthy non-smoker. The patient was unwilling to consider a denture and was not keen for the symptomless adjacent teeth to be prepared for bridgework, particularly the upper right first premolar, which was unfilled. She did not wish to have any form of removable prosthesis. She chose to have implant-supported crowns, as she wanted the final restoration to be as close as possible to having natural teeth.

Combined CAD/CAM-assisted treatment, for a new, beautiful smile

June 6, 2018

CEREC has become part of everyday life at our practice where I and three other general dentists work. We treat not only patients from the direct vicinity, but also patients from some 600 km away; indeed, these make up around 25 per cent of our client base today. Treatment in a single session is thus an important “added value” service for our patients. And that is reflected in our system’s take-up rate. As a practitioner, it is important to me not to have to compromise when it comes to restorations and, in particular, to have full control over the process at all times. That may sound trivial, but it has a major impact on the treatment itself, including the dental technology aspect, on my time management, as I can treat another patient during CAD/CAM production, and also on the cost-effectiveness of my practice. And, of course, one should not forget the high levels of patient satisfaction. Our patients couldn’t be more impressed with CEREC, especially when they realise the indications for which it can be used in implantology and orthodontics.

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Implant restoration with CEREC

May 23, 2018

Dental implants are a fantastic addition to the repertoire of any restorative dentist and allow us to provide a tooth replacement in a way that minimises damage to remaining dentition. The restoration of dental implants requires a sound knowledge of restorative dentistry, prosthodontics and periodontology. Traditionally, this has been carried out with an analogue impression taken with an impression coping either via an open or closed tray impression technique. A skilled technician then fabricates this restoration over a 2- to 3-week period. The time and skill required for these restorations both from the clinician and technician command high fees for the patient.

The use of CBCT and CAD/CAM techniques in implant-supported rehabilitation of maxilla—Part II

May 18, 2018

In the first part of this article (published in CAD/CAM 1/2017) the different phases of diagnostics, planning and implantological treatment were presented. In the process of planning, the necessity of creating temporary restorations in order to increase the patient’s comfort was taken into consideration, keeping in mind the fact that augmentative procedures must be performed.

Using CAD/CAM for a combination approach to full mouth reconstruction

May 9, 2018

Now more than ever, it behoves dentists and laboratories to work together as part of an interdisciplinary and collaborative team to coordinate treatment, select ideal restorative material(s), and plan cases, particularly those involving full-mouth reconstructions. Fortunately, a number of digitally based technologies can be incorporated into the treatment thorough diagnostic and treatment planning processes, as well as used for fabricating various components of treatments. When used in combination with a systematic and collaborative plan for preparing and executing treatment, these tools can enable the team to achieve success when restoring a patient’s smile to proper form, function, and health.

Brain-guided implant reconstruction: Who makes the decisions?

May 5, 2018

It appears that there is still a great divide between those who utilise 3-D technology for dental implant planning and surgical placement of dental implants and those who do not. Clearly, decisions as to how to diagnose and treatment plan our patients may be the difference between success and failure. Recently an internet advertisement promoting an educational programme stated that ‘Implant surgery is not complicated, easier than most other dentistry, and every dentist has the skills to surgically place implants. If you can take teeth out, you can put a dental implant in! You don’t need expensive equipment for brain-guided surgery, you can learn it with no initial investment!’ Implant dentistry has become one of the most predictable and successful treatment modalities in all of dentistry. If the only imaging modality utilised is a two-dimensional panoramic or periapical radiograph how can a clinician really know if a procedure will be complicated?

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Digitising your implant practice

May 3, 2018

Undoubtedly, digital dentistry is the current topic. Over the last five years, the entire digital workflow has progressed in leaps and bounds. There are so many different digital applications that it is sometimes difficult to keep up with all the advances. Many dentists are excited about the advantages of new technologies, but there are an equal number who doubt that the improved clinical workflow justifies the expense.

Success evaluation of N2 treated teeth with open apical foramen—A retrospective study

April 26, 2018

95 teeth with open foramen were identified in a general dentist practice during the years 1985—2006, 75 of which could be followed-up by X-ray after an average time of 70 months (follow-up X-ray). 40 teeth were subject to vital extirpation (VitE), 28 teeth to vital amputation (VitA), and seven teeth with necrotic pulp underwent conservative root canal treatment (RT). Apexification success rate amounted to 85.3 percent (VitE 90 percent, VitA 85.7 percent, non-vital RT 57.1 percent). Another 12 percent could be judged as partial success in molars, as a certain number of the molar roots showed apexification, however, others not yet. The percentaged difference of a successful apexification between vitally extirpated teeth and root canal treatment of non-vital teeth was significant (p = 0.0243). Apexification result was irrespective of the filling level of root canal treated teeth as well as of endodontic success.

3D Endo Software, glide path management and WaveOne Gold

April 26, 2018

Radiographic imaging forms an essential part of the diagnosis, treatment planning and follow-up, in modern endodontics. 1 Cone beam computer tomography (CBCT) allows for the visualisation of root canal systems in three dimensions without the superimposition of anatomic structures that occurs with conventional radiographs. 2–4 CBCT units reconstruct the projection data to produce interrelational images in the axial, sagittal and coronal planes. 5 Due to the higher resolution of limited field of view CBCT units (Fig. 1) their application in endodontics has been expanded. High-resolution CBCT images are ideal for diagnosis of periapical lesions, identification of root fractures and resorption lesions and for the evaluation of root canal morphology, root length and root curvatures .

Use of diode laser in the treatment of gingival enlargement during orthodontic treatment

April 25, 2018

In recent decades, we have witnessed the substantial development and expansion of the use of fixed orthodontic appliances. While their application has many advantages, several problems related to the health of the soft tissue may sometimes appear during treatment. In fact, the use of fixed orthodontic appliances may provoke labial desquamation, erythema multiforme, gingivitis and gingival enlargement.

The effect of partial vacuum on the chemical preparation of the root canal system

April 14, 2018

From the early 20th century, when Walter Hess and Ernest Zürcher demonstrated root canal anatomy with an unprecedented visual clarity, its complexity has fascinated researchers armed with ever better imaging tools—from blue dyes to CT, from CBCT to confocal microscopy, from clear tooth preparations to micro-CT , to name just a few. Thanks to rigorous research and discussion, the diverse intricacy of root canal morphology is well understood and accepted today. However, the question of how to best prepare this space to restore homeostasis remains open to debate, which is conducted both in the scientific and, unfortunately, commercial domains. Our task as scholars and clinicians is to investigate which approaches would be practical and applicable to bring teeth and periodontium back to health in accordance with evidence-based endodontics and principles of minimally-invasive dentistry.

Orthodontic management of maxillary lateral incisors agenesis

March 21, 2018

The purpose of this article is to show the diferent modalities of treatment for upper lateral incisors agenesis. In daily practice, orthodontists often meet cases of upper lateral incisors agenesis. The two common treatment options are: space closure, using canines to substitute the missing lateral incisors, or space opening for future restorations.

MTA placement with the Produits Dentaires MAP System

March 14, 2018

More than 20 years ago, Torabinejad et al. first described a new root-end filling material called mineral trioxide aggregate (MTA). MTA showed in vitro better sealing ability than amalgam or Super EBA when used as a root-end filling material. Later, several in vivo and in vitro studies demonstrated more applications for MTA. Pulp capping, apexification, repair of root perforations and root-end filling are commonly described clinical procedures to seal the pathway of communication between the root canal system and the external surface of the tooth. The application of MTA was first described as being achieved with aid of plastic or metal spatulas. Unfortunately, proper placement was not possible in this manner.

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Getting to grips with general dental practitioner orthodontics

March 6, 2018

My learning pathway with the IAS Academy was slightly different from the normal route in that I took the ClearSmile Aligner course first, then the ClearSmile Inman Aligner one and then the ClearSmile Brace course. I trained with aligners first by shadowing my former principal, who used a different clear aligner system to great effect.

Dentinal defects after root canal preparation

February 14, 2018

Vertical root fractures are one of the most frequent complications seen on teeth having endodontic treatment, and generally result in the extraction of tooth (Haueisen et al. 2013). The root canal treatment procedures may cause dentinal stress and consequently dentinal cracks. The emerging dentinal fractures may transform into vertical root fractures under functional loads (Barreto et al. 2012).

Photodamage of dental pulpa stem cells during 700 fs laser exposure

February 14, 2018

Material and methods Cells Human stem cells from the dental pulp of adults (given by S. Gronthos, NIH, Bethesda, USA) were cultivated in α-modified Eagle’s Medium (MEM) by Gibco BRL Life Technologies (Paisley, Scotland) while adding 20 % FCS, 2 mM L-glutamine, 100 μM L-ascorbate-2-phosphate, 100 μ Penicillin and 100 μg/ml Streptomycin at 5 % CO2 and 37 °C in 25 ml and 75 ml cell culture flasks (Greiner, Frickenhausen, Germany). The cells were treated for experiments and cultivation with 0.25 % trypsin, 5 mM glucose, 0.05% EDTA in PBS for 5 minutes at 37 °C. After having been thus detached from the base of the culture flasks, the cells were incubated in cell chambers (MiniCeM, JenLab GmbH, Jena, Germany) for laser microscopy. Comparative studies were conducted on Chinese hamster ovary (CHO) cells, which are available in many international laboratories as reference cells. The CHO cells were incubated in Dulbeccos HAM-F12 Medium (Gibco BRL) with 10 % FCS, L-glutamine and an antibiotic mix of Penicillin, Streptomycin and Amphotericin B at 5 % CO2 and 37 °C. Trypsinisation corresponded to that of the stem cells.

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Successful communication in your daily practice Part I: Grumbling patients

February 14, 2018

Imagine getting to your clinic every day and feeling confident that whatever happens to you, you will be able to resolve it. Resolve a problem easily—in a way that not only you will feel happy with yourself but also your patients and staff will stay loyal to you, because they will also be happy with the service and solutions you provide them!

Mastering the implant digital workflow

January 30, 2018

Whether we like it or not, we are embracing the digital era in our brave new world. Many dental practices are now becoming paper-free—a digital innovation—and even using tablet computers to record patient details and medical histories. We are continually surprised by the rising age of the technologically savvy patient, particularly those of a certain generation who perhaps we assume would be less so than the perceived iPhone generation.

Irrigating the root canal: A case report

January 22, 2018

The patient reported on in this article is a student in dentistry and his parents are both dentists. They referred their son to a good endodontist, who then referred the case to me. As always, peers are more than welcome in either of my practices, in Rome and London, so when I treated this case, I had three dentists watching me, a future dentist on the chair, placing a great deal of pressure on me.

Facebook & Co.: Could 2018 be the death of digital advertising?

January 4, 2018

In an article by business author Jaron Lanier in the Jan/Feb 2018 edition of Wired UK magazine, he reminds us that Facebook and Google now account for 75 per cent of online advertising spend, globally. In the same article, there is also a fascinating quote about the current problems with the Internet.

The role of 3-D imaging systems in present orthodontics

August 15, 2017

Traditionally, the diagnosis in orthodontics gives a lot of importance to cephalometry and the analysis of the dental casts. The development of new technologies does not intend to discard traditional concepts, in fact, it intends to provide more information allowing a wider approach of our patients and resulting in a more thorough diagnosis.

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Widening the scope of aligner application: A case report

August 11, 2017

Over the last two decades, extensive research has been carried out to alleviate the two major shortcomings of orthodontic treatment: visibility and duration.

Removable prosthesis in digital times

August 9, 2017

The main problem that brings patients to our surgery is an edentulous maxilla, which motivates the patient to want a functional restoration, with particular attention to the aesthetic result. The evaluation of the soft tissues of the face, from front and side view, shows a big reduction of the labial support induced by a centripetal bone retraction. More than that, the lack of sagittal and vertical bone support reduces the degree of dental- gingival exposure in case of peri-prosthetic crestal design (Figs. 1 & 2).

Treatment options for the edentulous arch

August 9, 2017

Historically, when a patient’s dental condition reached a state of total tooth loss, treatment was limited to a complete denture with no hope of improving that status. The greatest challenge, particularly when working with a lower jaw, was providing a denture with reasonable stability and retention. Success was greatly dependent upon the skill of the practitioner but also on the neuromuscular ability of the patient, their supporting structures and a philosophical attitude toward their condition. Treatment for patients suffering complete edentulism has been revolutionised by the ongoing success of dental implants so that the standard of care for the mandible is an implant overdenture.

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