Cement-enamel Junction Research Articles

Association of different antidepressant classes with clinical attachment level and alveolar bone loss in patients with periodontitis: A retrospective study.

Our study aimed to determine the relationship of antidepressant medicine use with periodontal diseases, exploring the association of different pharmacological classes of antidepressant with observations of clinical attachment loss (CAL) and alveolar bone level (BL) in patients with periodontitis. Existing evidence on the impact of antidepressant medication on periodontal tissues has focused on some classes only and is still unclear. Therefore, this retrospective study evaluated the association of different antidepressant classes with clinical attachment loss (CAL) and alveolar bone level (BL). This study was carried out in a population of patients aged≥30years old with periodontitis who sought treatment at the University of Florida from 2014 to 2018. The following variables were obtained from patients' records; usage of antidepressant medications and their pharmacological classes (selective serotonin reuptake inhibitors [SSRI], serotonin-norepinephrine reuptake inhibitors [SNRI], tricyclic, atypical, and monoamine oxidase inhibitors [MAO]), age, gender, smoking habit, mild systemic diseases, CAL, and cement-enamel junction (CEJ) and alveolar bone crest (BC) distance, defined as BL, in the Ramfjord index teeth. Five hundred and eighty-two periodontitis patients were evaluated, of which 113 (19.4%) were antidepressant users. Antidepressant users exhibited significantly lower BL and fewer sites with severe CAL (≥5mm), than non-users (p<.05). Among all single-class antidepressant users, the SSRI users showed significantly less CAL and lower BL than non-users (p<.05). Patients taking combinations of the different classes of antidepressants also showed better CAL and BL than non-users. Generalized linear models, including variables such as gender, age, systemic diseases, and smoking, demonstrated that antidepressant users were more likely to have lower mean BL and fewer sites with severe bone loss (i.e. BL>3 and >5mm) than non-users (p<.05). Antidepressant medications were associated with higher alveolar bone level and less clinical attachment loss in patients with periodontitis. When the different classes of antidepressants were analyzed individually, only the SSRI class users and the multiple-class users showed significantly less periodontal breakdown than non-users.

The influence of different CAD/CAM materials on the marginal fit of endocrown with different cavity depths (A comparative in-vitro study)

To evaluate and compare the influence of dissimilar CAD-CAM material on the marginal fitness of endocrown with different cavity depths. Freshly extracted human maxillary first premolar teeth (n = 40) were selected for this study. Teeth were decapitated 2 mm above the cement-enamel junction from proximal surface and endodontic treatment were performed for all teeth. Samples were allocated at two main groups (n = 20), according to cavity depth. Group A: 2 mm cavity depth; Group B: 4 mm cavity depth; and further subdivided into two sub-groups according to material used (n = 10): (A1 and B1) resin-based material; (A2 and B2) ceramic-based material. Teeth were prepared with butt joint margin and 10° internal axial wall divergence. Afterwards, samples scanning was performed using InLab digital scanner. Endocrown restoration fabricated by Sirona Cerec InLab MCXL milling device and adhesively luted with a resin cement (RelyX™ Ultimate ClickerTM, 3 M ESPE). All samples were subjected to thermocycling. After thermocycling, marginal gaps were measured using stereomicroscope at a magnification of 45X. The recorded measurements were collected, scaled and statistically analyzed. A resin-based endocrown showed significantly a smaller vertical marginal gap than ceramic-based, an endocrown with 2-mm cavity depth showed significantly lower marginal gap than one with 4-mm cavity depth. Increasing the cavity depth of endocrown preparation negatively affect the marginal fit. Resin-nanoceramic endocrown showed better marginal fit than glass ceramic endocrown. Both tested CAD/CAM materials showed clinically acceptable vertical marginal gap.

Assessment of the Potential Ability to Penetrate into the Hard Tissues of the Root of an Experimental Preparation with the Characteristics of a Dental Infiltratant, Enriched with an Antimicrobial Component-Preliminary Study.

Infiltration is a method of penetration with a low viscosity resin that penetrates deep into demineralised tooth tissue and fills the intergranular spaces, hence reducing porosity. Carious lesions initially located at the enamel–cement junction are usually found in elderly patients. Those spots are predisposed to bacterial adhesion originating both from biofilm and from gingival pocket bacteria. The aim of this study was to evaluate the penetration of an experimental preparation, which has the characteristics of a dental infiltrant, enriched with an antibacterial component, into the decalcified root cement tissues of extracted human teeth in elderly patients. An experimental preparation with the characteristics of a dental infiltrant was prepared, applied, and polymerised on the surface of extracted, previously decalcified human teeth. The control sample was Icon (DMG, Hamburg, Germany). The ability of the preparations to penetrate deep into the root cement was evaluated using scanning electron and light microscopy. The study showed that an experimental preparation could potentially be used for treatment of early carious lesions within the tooth root in elderly patients, among others, as it penetrates deep into demineralised tissues. More research is needed.

Occlusal problems, mental health issues and non-carious cervical lesions.

Non-carious cervical lesions (NCCLs) are characterized by a loss of hard dental tissue near the cement-enamel junction with multifactorial etiology. The aim of this study was to demonstrate that occlusal factors as attrition, malocclusion, and bruxism, and mental disorders as depression, stress, and anxiety are involved in the etiology of NCCLs. Salivary samples and clinical data of 340 individuals selected from 6,112 participants were obtained from the University of Pittsburgh School of Dental Medicine Dental Registry and DNA Repository project. The affected group was formed by individuals with NCCL (34 females, 34 males, mean age 55.34years). In addition, the comparison group was formed by individuals without NCCL (136 females, 136 males, mean age 55.14years). Eleven single-nucleotide polymorphisms (SNPs) previously associated with mental disorders were genotyped and tested for association with NCCLs. When all occlusal factors were combined there was found a significant association with NCCL (p = 0.000001/adjusted OR 4.38, 95% CI 2.50-7.69). Attrition (OR 3.56, 95% CI 2.00-6.32) and malocclusion (OR 5.09, 95% CI 1.65-15.68) as separate variables showed statistically significant associations with NCCL. There was a significant difference in stress history between the two groups (OR 2.17, 95% CI 1.08-4.39). No associations between NCCLs and the SNPs selected were found. However, when the occlusal factors were analyzed as covariates, associations were found between bruxism and seven of the selected SNPs. Our results suggest that occlusal factors might be associated with NCCLs.

Microleakage of three different combinations of adhesive and composite resins

Aim The aim of the present study was to evaluate the influence of 3 adhesive systems on microleakage of direct composite restorations with proximal margins under the cement-enamel junction (CEJ) and in the enamel. Materials and methods In 30 extracted molars standardized MOD (mesio-occlusal-distal) cavities were prepared with a proximal margin located 1 mm under the cement-enamel junction and another one in the enamel, and subsequently randomly divided in 3 groups of 10 using 3 different adhesives and the same composite: Flowable (G-aenial Universal Injectable, GC) + universal adhesive (G2-Bond universal, GC) with selective-etch technique (Group 1); Flowable (G-aenial Universal Injectable, GC) + self-etch adhesive (Clearfil SE Bond 2, Kuraray) with 2-step technique (Group 2); Flowable (G-aenial Universal Injectable, GC) + total-etch adhesive (Optibond FL, Kerr) with 3-step technique (Group 3). Samples were tested for microleakage using silver nitrate and infiltration was classified in 5 levels. The differences in microleakage were statistically evaluated with significance set at P<0.05. Results In the margin located in the enamel, group 1 showed an average of 0 microleakage, group 2 an average of 0.2 and group 3 an average of 0.1. In the margin located in the dentin, group 1 showed an average score of 1.1, group 2 of 2.15 ang group 3 of 1.25. No statistically significant difference was found in the enamel. Conclusion The combination of adhesive G2-Bond universal and Optibond FL showed the highest sealing ability both in margins located in the enamel and margins located in the dentin. The adhesive interface in the enamel produced a very good seal, while the adhesive interface in the dentin showed varying degrees of microleakage in all groups.

Regeneration of rat periodontium by cementum protein 1-derived peptide.

Cementum protein 1 (CEMP1) has the capacity to promote differentiation of periodontal ligament (PDL) cells toward a cementoblastic phenotype in vitro and bone regeneration in vivo. In this study, we tested the capabilities of a synthetic cementum protein 1-derived peptide, MGTSSTDSQQAGHRRCSTSN (CEMP1-p1), to promote regeneration of periodontal structures in a periodontal fenestration defect in rats. Fenestration defects were created using an extra-oral approach in the buccal aspect of the mandibular first molar roots. Eighteen male Wistar rats were divided into three groups. Two controls (defects non-treated or defects treated with a gelatin matrix scaffold [GMS] only) and the experimental group treated with 5µg/dose of CEMP1-p1 embedded in GMS. After 28days, the animals were sacrificed, and the mandibles processed for histopathological examination. Expression of cementum proteins, cementum attachment protein (CAP), CEMP1, integrin binding sialoprotein (IBSP), and osteocalcin (OCN), was assessed using immunofluorescence. The formation of new cementum, bone, and PDL fibers were compared between control and experimental groups. The histological analysis revealed that the control group without any treatment new cementum or oriented PDL fibers were not observed. However, the presence of newly bone was detected. In the control group treated with GMS, new cementum formation was not detectable, the PDL fibers were oriented parallel to the longitudinal root axis, and new bone formation was observed. The experimental group showed deposit of acellular extrinsic fiber cementum (AEFC) in a lamellae-like feature with inserted Sharpey's fibers, formation of cellular mixed stratified cementum (CMSC) with the presence of cementocytes, and newly formed bone close to the cementum-enamel junction. Cementoblast cells adjacent to new cementum expressed CAP, CEMP1, IBSP, and OCN. These studies show that CEMP1-p1 promotes the formation of AEFC, CMSC, new PDL with Sharpey's fibers inserted in cementum and bone, thus providing strong evidence that the synthetic peptide CEMP1-p1 promotes periodontal regeneration in a rat fenestration model.

Assessment of Microleakage under Stainless Steel Orthodontic Brackets Bonded with Various Adhesive Systems: An In Vitro Study

The aim of this study was to evaluate the extent of microleakage beneath stainless steel orthodontic brackets bonded with different adhesive systems. Freshly extracted 60 human premolar teeth from mandibular arch were included in this study. After sterilizing all teeth, they were stored in thymol solution of 1% for further preparation. Acrylic blocks were used to mount the teeth in a way their roots were totally implanted up to the cement enamel junction in acrylic with crown being visible. A 0.022 slot, stainless steel preadjusted edgewise premolar brackets were taken. Sixty premolars were categorized randomly into three groups (20 premolars in each group) as follows: group I: flowable composite, group II: Fuji Ortho LC, group III: Transbond XT. Later, all the samples were subjected to thermocycling and tested immediately and 24 hours after water storage. The samples were submerged for 24 hours in methylene blue solution (2%) at room temperature. A ×20 magnification stereomicroscope was used to examine all samples. The lowest microleakage (1.34 ± 0.20) was shown by Transbond XT restored teeth, followed by flowable composite group (1.79 ± 0.32) and Fuji Ortho LC group (2.98 ± 0.13). An analysis of variance showed statistically significant differences among various adhesive systems. A statistically significant difference (p <0.05) among groups I and II, and groups II and III adhesive materials was seen. This study demonstrated microleakage in all the examined adhesive groups but the lowest microleakage was found with Transbond XT group followed next by Filtek Z350 XT group and Fuji Ortho LC group. Due to microleakage, the bacteria and fluids present intraorally penetrate through the gaps along the enamel-adhesive boundary. This penetration results in significant esthetic and clinical complications. Such problems related to microleakage can be addressed with the use of an appropriate adhesive agent.

Prevalência de perda de inserção periodontal em adolescentes de 12 a 16 anos em uma escola pública de Porto Alegre

The aim of this study was to verify prevalence of loss of attachment in 12-16 years old adolescents of a public school in Porto Alegre. The prevalence of loss of attachment was determined by means of periodontal probing a mesial, distal, buccal and lingual surfaces of incisors and first permanent molars. A trainer examiner performed the examination with Williams periodontal probe, odontoscope are standard illumination. The level of attachmet was defined as thc distance in millimeters from the cementum-enamel junction to the most apically probable portion, close to thc bottom of the sulcus/pocket. For cach site, two measurements were performed, the distance from the gingival margin to the cementure enamel junction, and the distance from the gingival margin to the bottom of the sulcus pocket. The level of attachment for a site was calculated subtracting the first and the second or, in case of gingival recession, adding both. Loss of attachment was considered when this measure exceeded 2 mm in buccal-lingual surfaces and 3 mm in proximal surfaces. 3048 sites were examined, showing a prevalence of 4.82% of loss of attachment. From these, 36.77% bled on probing and 61.22% did not. The buccal surface was the one with the highest prevalence of loss of attachment.

Comparison of shear stress acting on the severely worn anterior canine restored with 2 different restorations

Aim: To compare fracture resistance of severely destructed mandibular canine under oblique loading restored with Richmond crown verses zirconia endocrown. Materials and method: 10 mandibular canine were endodontically treated and divided into 2 group of 5 each both the group were cut 2mm above the cement enamel junction one group received endo crown and second group received cast metal post and core, both the group were subjected shear force on UTM at cross head speed of 1 mm/min the results obtained were calculated in newton’s and statistical analysis was carried out. Results: Cast metal post and core (972.4±217.51N) showed better resistance to fracture than Richmond crown group (1180.6±168.87N).statistical analysis done using unpaired t test (P value =0.1818) which was which was statistically insignificant. Conclusion: endocrown showed better resistance to fracture from shear forces than cast metal post and core.

Senescence-accelerated mouse prone 8 (SAMP8) mice exhibit reduced entoconid in the lower second molar

ObjectiveThe position and size of the major cusps in mammalian molars are arranged in a characteristic pattern that depends on taxonomy. In humans, the cusp which locates distally within each molar is smaller than the mesially located cusp, which is referred to as “distal reduction”. Although this concept has been well-recognized, it is still unclear how this reduction occurs. Current study examined whether senescence-accelerating mouse prone 8 (SAMP8) mice could be a possible animal model for studying how the mammalian molar cusp size is determined. DesignSAMP8 mice were compared with parental control (SAMR1) mice. Microcomputed tomography images of young and aged mice were captured to observe molar cusp morphologies. Cusp height from cement-enamel junction and mesio-distal length of molars were measured. The statistical comparison of the measurements was performed by Mann-Whitney U test. ResultsSAMP8 mice showed reduced development of the disto-lingual cusp (entoconid) of lower second molar when compared with SAMR1 mice. The enamel thickness and structure was disturbed at entoconid, and aged SAMP8 mice displayed severe wear of the entoconid in lower second molar. These phenotypes were observed on both sides of the lower second molar. ConclusionsIn addition to the general senescence phenotype observed in SAMP8 mice, this strain may genetically possess molar cusp phenotypes which is determined prenatally. Further, SAMP8 mice would be a potential model strain to study the genetic causes of the distal reduction of molar cusp size.

The Effects of Different Antioxidant Agents on the Microtensile Bond Strength of Composite Resin to Bleached Enamel

Objective: The objective of this in vitro study is to examine the effect of antioxidants on the bonding strength of composite resin to bleached enamel. Materials and Methods: One hundred twenty non decay teeth were used in this study. Specimens were cut from the enamel cement junction. Then the specimens were randomly assigned into two groups-office bleaching and home bleaching. Bleaching antioxidants were applied to the first 12 subgroups. The specimens in the remaining 12 groups were kept in artificial saliva for 14 days and antioxidants were applied. Composite resin restoration was applied to all specimens. A cutting device was employed to obtain six specimens (0.9mm) from each tooth, and the microtensile bond strength (μTBS) test was performed. Data were analyzed using one-way ANOVA, the paired t-test, and Duncan’s post hoc test (p=0.05). Results: In office bleaching specimens, immediate antioxidant application increased the μTBS values (p&lt;0.05). Comparisons of the antioxidants individually revealed that bonding values increased after two weeks in specimens subjected to antioxidant application (p&lt;0.05). In office bleaching specimens, immediate antioxidant application increased the μTBS values (p&gt;0.05). Mean μTBS values in the groups to which antioxidants were applied two weeks after home bleaching were higher than those in the groups in which antioxidants were applied immediately. Conclusion: The use of antioxidants after bleaching may increase the MTBS value. The clinician should take this into account especially in immediate restoration applications after bleaching.

Minimally invasive free gingival graft technique prior-to orthodontic therapy: case report

Introduction: A gingival recession (GR) is an affection in which the gingiva displaces apical to the cement-enamel junction causing exposure of the root surface. A thin gingival phenotype can be associated to GR, especially when exposed to orthodontic movements. To solve this condition, several mucogingival techniques have been proposed. Free gingival grafts taken from the palate are the gold standard; however, they are related to poor esthetical results and postoperative complications. In order to reduce those disadvantages, a «Minimally Invasive Esthetic Free Gingival Graft» (MIEFGG) technique is proposed, which involves a donor site placed on the buccal aspect of upper molars to modify the phenotype or regain attachment in the recipient site. Aim: To describe a new graft technique, used in mucogingival surgery, which is both esthetic and minimally invasive. Material and methods: A 24-year-old female patient who requested a periodontal evaluation before orthodontic treatment. Diagnosis: Cairo’s RT3 along with thin phenotype, type II mobility, and extrusion associated to teeth 4.1 and 4.2. Treatment plan: thicken the gingival phenotype surrounding teeth 4.1 and 4.2 before orthodontic therapy. Since the patient expressed esthetical concerns, the MIEFGG technique was selected. Results: Postsurgical follow-ups were performed 7, 14, 30, and 150 days. Both the width and the height of the keratinized gingiva around teeth 4.1 and 4.2 increased by 1 mm. The esthetic outcome was satisfactory, according to the patient. No complications or postoperative pain was reported. Conclusion: MIEFGG is a technique that presents good results in terms of gingival augmentation, little discomfort to the patient, and esthetic results. Concerning the clinical case presented here, those advantages were achieved. However, more research is needed in order to prove its effectiveness

Differential diagnosis between calcifying odontogenic cyst and adenomatoid odontogenic tumor by computed tomography images.

Calcifying odontogenic cysts (COC) and adenomatoid odontogenic tumors (AOT) have similar radiographic findings. We examined the radiographic and computed tomography (CT) images of patients histologically diagnosed with COC or AOT and identified their characteristic findings. The subjects included 12 patients histologically diagnosed with COC or AOT (one female and five males per group), who underwent CT at our hospital between Nov 1998 and Jun 2019. The location of the lesion, impacted tooth, bone expansion, root resorption, tooth migration, calcified body, and presence or absence of a high-intensity zone in the marginal area of the lesion were examined. In patients with COC, five patients with COC exhibited bone expansion toward the buccal side. The lesion encompassing the crown was attached to the cement-enamel junction and contained a radiopaque lesion with a calcified body. In 6 patients with COC, irregularly shaped calcified bodies were observed with small tooth-like structures. In patients with AOT, all six patients with AOT exhibited bone expansion toward the buccal and lingual sides. The lesion encompasses a part of the tooth root or the entire tooth. Punctate calcification was observed within the lesion and the marginal area in three patients, and a high-intensity zone was observed in the marginal area of the lesion in two patients. We report imaging findings that may be characteristic of COC and AOT, suggesting that CT findings may be useful for differentiating between COC and AOT.

Deposition of Immune Complexes in Gingival Tissues in the Presence of Periodontitis and Systemic Lupus Erythematosus.

Systemic lupus erythematosus (SLE) is a complex chronic autoimmune disease characterized by tissue damage and widespread inflammation in response to environmental challenges. Deposition of immune complexes in kidneys glomeruli are associated with lupus nephritis, determining SLE diagnosis. Periodontitis is a chronic inflammatory disease characterized by clinical attachment and bone loss, caused by a microbial challenge – host response interaction. Deposition of immune complex at gingival tissues is a common finding in the course of the disease. Considering that, the primary aim of this study is to investigate the deposition of immune complexes at gingival tissues of SLE patients compared to systemically healthy ones, correlating it to periodontal and systemic parameters. Twenty-five women diagnosed with SLE (SLE+) and 25 age-matched systemically healthy (SLE–) women were included in the study. Detailed information on overall patient's health were obtained from file records. Participants were screened for probing depth (PD), clinical attachment loss (CAL), gingival recession (REC), full-mouth bleeding score (FMBS) and plaque scores (FMPS). Bone loss was determined at panoramic X-ray images as the distance from cementenamel junction to alveolar crest (CEJ-AC). Gingival biopsies were obtained from the first 15 patients submitted to surgical periodontal therapy of each group, and were analyzed by optical microscopy and direct immunofluorescence to investigate the deposition of antigen-antibody complexes. Eleven (44%) patients were diagnosed with active SLE (SLE-A) and 14 (56%) with inactive SLE (LES-I). Mean PD, CAL and FMBS were significantly lower in SLE+ than SLE–(p < 0.05; Mann Whitney). The chronic use of low doses of immunosuppressants was associated with lower prevalence of CAL >3 mm. Immunofluorescence staining of markers of lupus nephritis and/or proteinuria was significantly increased in SLE+ compared to SLE–, even in the presence of periodontitis. These findings suggest that immunomodulatory drugs in SLE improves periodontal parameters. The greater deposition of antigen-antibody complexes in the gingival tissues of patients diagnosed with SLE may be a marker of disease activity, possibly complementing their diagnosis.

Immediate Implant Placement with Buccal Bone Augmentation in the Anterior Maxilla with Thin Buccal Plate: A One-Year Follow-Up Case Series.

To evaluate the buccal bone thickness of immediate implant placement with buccal bone augmentation in patients with a thin buccal plate in the esthetic zone. Eighteen consecutive patients requiring a single tooth replacement in the anterior maxillary zone with a thin plate (<1 mm) were included and received immediate implant placement with narrow-diameter implants. Patients received buccal bone augmentation (both internal and external socket bone grafting) with deproteinized bovine bone mineral (DBBM) and an absorbable membrane. The final restoration was delivered after 8 months. Cone-beam CT scans were performed before surgery (CBCT0), immediately after surgery (CBCT1), at final restoration delivery (CBCT2), and at 1-year follow-up after the final restoration (CBCT3) to evaluate the buccal bone thickness and ridge width. A repeated measures ANOVA and Bonferroni correction for multiple comparisons were applied for statistical analysis of changes within different time points (α = 0.05). Fifteen of the 18 enrolled patients were available for analysis at the 1-year follow-up after final restoration. The mean buccal bone thickness at 2 mm apical to the implant-abutment junction (IAJ-2) were 3.59 mm (range: 3.04-4.58 mm), 2.79 mm (range: 2.25-3.78 mm), and 2.52 mm (range: 1.72-3.36 mm), respectively, at CBCT1, CBCT2, and CBCT3. A statistical significance was observed for buccal bone thickness change between CBCT1 and CBCT2 at IAJ-2 (F = 17.948, p = 0.001). The net gains of the ridge width from CBCT0 to CBCT1, CBCT1 to CBCT2, and CBCT2 to CBCT3 were 1.08 mm, -0.94 mm and -0.04 mm at 4 mm apical to the cementum-enamel junction, respectively. No statistical significance was observed for the change in ridge width from CBCT0 to CBCT3 (F = 10.518, p = 1.000). Simultaneous buccal bone augmentation may maintain a predictable buccal bone thickness for immediate implant placement in the maxillary anterior sites with a thin buccal plate (<1 mm) at 1-year follow-up after final restoration.

English

Restoration of traumatic teeth with complicated crown root fracture poses many challenges to the clinicians. When the fracture line is below the level of gingiva, the prognosis of such fractured tooth is considered questionable or hopeless. Treating such cases is also challenging as they are associated with loss of ferrule and compromised biological width. Preservation of such diseased natural teeth usually involves a multi-disciplinary approach involving endodontic therapy, periodontal crown lengthening and / or orthodontic extrusion followed by prosthetic rehabilitation. Tooth injuries and complicated tooth fractures especially in the aesthetic region pose a great challenge to the clinician.1 When the fracture line extends at or below the level of cement enamel junction, the prognosis of such tooth is considered questionable or hopeless; they are usually associated with the loss of ferrule and compromised biological width, and therefore restoration of such teeth becomes a great challenge. To ensure functional longevity, endodontically treated teeth with less coronal structure must have at least 5 mm of tooth structure coronal to the crestal bone. Three milli meters of tooth structure is needed to maintain a healthy soft tissue complex, and 2 mm of coronal tooth structure incisal to the preparation finish line is necessary to ensure structural integrity.2 There are mainly two reasons why a tooth extraction should be avoided: Structural reasons and psychological stress associated with extraction. Psychological stress can be in the form of financial stresses associated with extraction and rehabilitation of the same and fear of post-traumatic pain. Extraction of tooth is also followed by aesthetic challenges as it may lead to hard and soft tissue resorption as the healing architecture is unpredictable. In this case report a simple yet effective treatment is presented for a 21-year-old female patient with a chief complaint of clinical tooth fracture in relation to 44. After thorough clinical and radiographic examination, it was decided to reinforce the use of flexible glass fibre post and incorporate the same as tags to engage E chain to facilitate orthodontic tooth extrusion followed by prosthetic rehabilitation. The purpose of this case report is to describe the use of a simple chair side technique for a tooth fractured at the level of cementoenamel junction (CEJ) with forced tooth eruption.

Vertical eruption of anterior maxillary teeth adjacent to single-implant–supported crowns: An assessment after a 3-year follow-up period

Statement of problemVertical eruption of teeth adjacent to an implant has been reported clinically and might affect the esthetic outcome over time. The prevalence of the problem is unclear. PurposeThe purpose of this prospective clinical trial was to evaluate the vertical eruption of anterior maxillary teeth adjacent to single-implant crowns after a 3-year follow-up period. Material and methodsThirty single dental implants were inserted in maxillary anterior sites including the first premolar. The mean age of the participants at implant-supported crown insertion was 48.4 years (range 23 to 79 years). Each implant was restored with a 1-piece screw-retained ceramic single crown. The vertical changes of 60 adjacent anterior maxillary teeth were evaluated from periapical radiographs and casts at baseline, 6, 12, and 36 months. ResultsA global ANOVA test showed statistically significant differences for the outcomes of the distance-implant platform and cement-enamel junction (DPC) (P<.001), crown length distal (P=.021) and mesial (P=.035), implant crown length (P=.022), and incisal edge to edge (P<.001). ConclusionsContinuous vertical tooth eruption next to a single dental implant was observed in adult participants.

Evaluation of facial and palatal alveolar bone thickness and sagittal root position of maxillary anterior teeth on cone beam computerized tomograms.

Amount of bone covering the facial and palatal surface of the root and the sagittal root position are important parameters while considering an immediate implant placement. This study measures the distance from cement-enamel junction (CEJ) to alveolar crest and thickness of alveolar bone of maxillary anterior teeth facially and palatally at 5 different points. CBCT scans of 79 systemically healthy patients were evaluated by two calibrated and independent examiners. Measurements like: 1) distance from CEJ to Crest. 2) Thickness of facial and palatal alveolar bone at five different points a) Crest, b) 2 mm from the crest, c) mid root level, d) apical 3rd, e) apex. 3) Sagittal root position. 4) Labiopalatal distance at the apex. 5) Length of the bone from apex to the nasal floor for incisors. 6) Presence of fenestrations and dehiscences were assessed. Healthy maxillary anteriors were evaluated and less than 2 mm bone was seen at all five points, 0.5 to 1 mm bone is seen in all anteriors at crest, 2 mm from crest, midroot, apical 3rd level. 1 to 2 mm is seen at apex. Labiopalatal width at apex ranged from 3 mm to 13 mm with a mean of 7.45 ± 2.24 mm for centrals, 7.69 ± 2.14 mm for lateral incisors, and 6.76 ± 2.42 mm for canines. The present study supports the finding of very thin facial bone over maxillary anteriors and frequent occurrence of fenestrations and dehiscences. Pre-treatment evaluation of alveolar bone surrounding the maxillary anteriors is important to avoid complications during implant placement.

Dental health indicators of the Chernyakhov population from Shyshaki (Ukraine)

Odontological studies of ancient populations represent different indicators related to health state, lifestyle and human diet. The aim of this paper is to determine the dental health indicators in the Chernyakhov population (the end of the IVth c. AD) from Ukraine. The paper also attempts to identify the relationship between sex and these indicators in the studied population. The sample analysed consisted of the dental remains of 25 adult individuals (11 males and 14 females) and 8 children individuals excavated from the cemetery at the archaeological site of Shyshaki (Poltava region of Ukraine). A total of 760 teeth were examined for caries, tooth wear and calculus clinically, and 647 teeth of adults were observed radiographically. The studied population presents frequency of caries in individuals of 12.5%. This indicator in adult male and female dentition is 42.86% and 14.0% respectively, and 25% in children. The presented population frequency of caries teeth was 0.88%. Females presented higher caries rate than males (2.72 % females vs. 0.36 % males) (p&lt;0.05). The most frequent were caries lesions of cementum-enamel junction (40%) and combined lesions of crown and root (40%) with no difference in terms of sex. Frequency of dental wear in adult individuals and 8-10 year-old individuals was 100%. The studied population represented TWI (tooth wear index) in adults (2.26), which increased with aging, but the difference in terms of sex is insignificant. Calculus was observed in 64.28% of the females and 63.33% of the males, showing no statistical difference (p&gt;0.5). These findings confirm a very low rate of caries teeth in the territory of Shyshaki during the Late Roman period, which could be related to regional diet and concentration of fluorine in drinking water. The Chernyakhov population presents high dental wear and similar frequency of dental calculus when compared to the population from Roman Britain. Females presented significantly higher frequency of caries than males, whereas no significant sex differences were found regarding dental wear, calculus, and localisation of caries lesions. The authors presume that dental health indicators in the Chernyakhov culture need to be studied more with bigger sample size and data of the populations from other regions of Ukraine.

Data on the push-out bond strength of three different root canal treatment sealers.

It is of interest to document data on the push – out bond strength of three different root canal treatment sealers such as MTA Fillapex (MTA based), AH plus (Epoxy Resin based) and Apexit plus (Calcium hydroxide based). Forty-five freshly extracted human maxillary central incisors with closed apices were selected randomly. All the teeth were sectioned at cement-enamel junction using a diamond disc before starting the root canal preparation to obtain root length of 12 mm. All teeth were instrumented using ProTaper rotary instruments. 5.25% sodium hypochlorite was used for irrigation between instrumentation followed by 17% EDTA, and final rinse by saline. Obturation procedures were done using the gutta-percha single cone technique. 45 roots were randomly assigned to 3 groups of 15 for obturation with gutta-percha cones and 1 of the 3 sealers (n=15). Group 1 = MTA Fillapex sealer + gutta-percha: Group 2 = AH plus sealer + gutta-percha:Group 3 = Apexit plus sealer + gutta-percha. The roots were sectioned horizontally to its canal into 3 sections: Coronal, Mid-root and Apical-thirds using a precision cutting machine, with a thickness of 3 mm. The specimens were subjected to push-out test using a universal testing machine that carried a plunger. The loading speed was 1mm/min until the dislodgment of the material occurred. The independent t- test was used to compare the mean scores among the study groups. The level of significance was set at 5% for all tests. After the push-out bond strength test, each sample was evaluated under stereomicroscope (40x) to determine the mode of failure and recorded as one of the following categories: adhesive, cohesive or mixed. The observations thus obtained were subjected to statistical analysis using Student - t test. AH Plus showed significantly higher values than MTA Fillapex and Apexit plus (p < 0.05). Amongst the push-out bond strength AH Plus sealer showed significant difference from MTA Fillapex and Apexit plus groups. There was no significant difference between MTA Fillapex and Apexit plus however (p>0.05). Microscopic analysis displayed that the majority of the modes were cohesive failures for AH Plus, adhesive failures for MTA Fillapex and mixed failures for Apexit Plus. . Thus, AH Plus had the highest bond strength and MTA Fillapex had the lowest bond strength to root dentin. Mean push-out bond strength values were ranked as follows; AH Plus >Apexit Plus > MTA Fillapex. Microscopic analysis displayed that the majority of the modes were cohesive failures of AH Plus, adhesive failures for MTA Fillapex and mixed failures for Apexit Plus.