Volume 1, Issue 1, June 2018

Jun 13

Prosthodontic rehabilitation of a patient with osteoporosis and bisphosphonates treatment

Ciprian-Emanuel Rusu 1, Serfözö Norbert Erich 1, Andrei Petruț 1, Carmen Biriș 1, Claudiu Horga 1
1 Faculty of Dental Medicine, University of Medicine and Pharmacy of Tirgu Mures, Romania

Teeth are fundamental to the quality of life throughout the human existence [1]. An association between tooth loss and osteoporosis has been reported in the literature. Women with osteoporosis are three times more likely to experience tooth loss than those who do not have the disease [2,3].
Osteoporosis as described by World Health Organization (WHO) is a progressive systemic skeletal disease characterised by low bone mass and micro architectural deterioration of the bone tissue, with a consequent increase in bone fragility and susceptibility to fracture. The main treatment of osteoporosis involves the use of Bisphosphonates (BPs) to improve bone density and new bone growth. BPs act on macrophages in the blood reducing their life span and causing morphological alterations and changes in differentiation of monocytes into macrophages. This reduces the body’s ability to defend against pathogens [4].
The action mechanism of BP is based on the inhibition of the farnesyl diphosphate synthase enzyme (FPPS), which in turn stimulates isoprenylation of small guanosine-5′-triphosphatases (GTPases), which signals proteins that activate and regulate changes in osteoclast morphology [5].
There have been studies with a low level of specificity and many of them with a small number of clinical cases or a poorly defined control group that cannot suggest a direct link between BPs and implant failure. Therefore, the BPs effect on implant ostointegration is not well established [6].
Subclinical hypothyroidism (SCH) is defined by the presence of serum free thyroxine levels (FT4) and triiodothyronine (FT3), within reference limits, in the presence of thyroid stimulating hormone (TSH) levels [7]. There is evidence to suggest that subclinical hypothyroidism is also linked to dyslipidemia and osteoporosis [8]. It is diagnosed based on symptoms and clinical signs associated with low thyroid stimulating hormone (TSH) levels [9]. There are studies that confirm the association of low levels of TSH with bone demineralization and alteration of trabecular bone structure. [10,11].
Patients with SCH can present with anxiety, irritability, poor concentration, slow information processing, and poor learning in comparison to healthy subjects [12].
Psychiatric illnesses such as anxiety, bipolar disorder or depression, as well as the medication associated with these diseases can reduce salivary secretion to the appearance of xerostomia [13].

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This entry was posted in Case report, Volume 1, Issue 1, June 2018 on June 13, 2018
Jun 13

Possibilities in alleviation of dentin sensitivity in vital abutments

Anamaria Bechir 1, Violeta Hancu 1, Gabriela Ciavoi 2, Doina Lucia Ghergic 1, Valentin Pribac 3, Cherana Gioga 1, Claudia Florina Andreescu 1, Farah Curt-Mola 3
1 Faculty of Dental Medicine, Titu Maiorescu University of Bucharest, Romania
2 Faculty of Dental Medicine, University of Medicine and Pharmacy of Tirgu Mures, Romania
3 Faculty of Medicine and Pharmacy, University of Oradea, Romania

After the preparation of vital abutments, by opening the dentinal tubules the apparition of different degrees of dentin sensibility (DS) can be induced.
Preparation of the teeth for full crowns can induce drying of the dentin, pulpal inflammation or even burn lesions after the reduction of the odontoblastic layer. Clinical researches demonstrated that the preparation of vital teeth for full coverage fixed prosthetic restorations can determine sharp, transient pain as a result of DS [1].
The hydrodynamic theory of dentin hypersensitivity (DHS) suggests that external stimuli determine movements in the fluid of dentin tubules, which induce nociceptive transduction in adjacent pulpal nerve fibers [2-4]. Dentinal tubules contain the odontoblastic processes, which may extend from the pulp to the dentino-enamel junction. The odontoblastic processes are the extensions of odontoblasts and they are surrounded by dentinal fluid inside the dentin tubules. The dentinal fluid is an ultrafiltrate of blood from the dental pulp and represents the communication between the dental pulp through the odontoblastic layer and the outer regions of the dentin [5,6]. DS is characterized by a short and sharp pain, with a rapid onset. DS occurs after the removal of the protective smear layer, which determines the opening of dentinal tubules and the exposure of the odontoblastic processes to chemical, thermal, tactile or osmotic stimuli [6,7,8]. Great variations were observed in the prevalence of DS, which varies from 4% to 57% [9,11]. Sealing the dentinal tubules represents a current method in decreasing DS [11]. The therapeutic approach of closing the dentinal tubules, in order to impede the fluid shifts from the dentinal tubules, is represented by the application of chemical and mechanical methods in dentin desensitization. Significant advancement in the understanding and in treatment of DH, have been developed, respectively in the use of various methods and desensitizing agents [8,12].

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This entry was posted in Original paper, Volume 1, Issue 1, June 2018 on June 13, 2018
Jun 12

The influence of cervical finish line and type of cement on microleakage

Adriana Elena Crăciun 1, Roxana Vodă 2, Janosi Kinga 3, Cerghizan Diana 3
1 Tirgu Mureș Emergency Clinical County Hospital
2 Private practice
3 Faculty of Dental Medicine, University of Medicine and Pharmacy of Tirgu Mures, Romania

The fixed dentures are commonly used in the daily practice to restore and preserve the hard dental tissues. The appropriate marginal fit of these restorations is required in all the cases, but the appearance of marginal deficiencies is inevitable at the tooth-restoration interface. The different luting agents used at the cementation of the fixed restorations pretended to seal the gap at the restoration margins and avoid the infiltration of the fluids from the oral cavity followed by microbial invasion into the dental structures. [1]
The inappropriate use of these luting agents in vital teeth results inflammation and necrosis of the pulp, which affects the longevity of the restorations. [1, 2] The microleakage is detected by clinical signs of the chronic dental hypersensitivity and color changes of the abutment at the restoration margins. [3 The water-based cements with a high degree of solubility in the oral cavity, used in the past, served only to “fill” the space between the restoration and the abutment. The two-component, powder-liquid systems, were traditionally used to fill the gaps between the tooth and restoration. However, due to their high solubility in the oral fluids, the sealing capacity of these cements depends on the precision of the marginal fit. [4] Numerous studies demonstrated that 100-500 μm is the acceptable gap at the tooth-restoration interface regarding the protection against microleakage. [5-7]
Besides the improvement of the technological processes, different cements with adequate sealing capacity had been developed in order to minimalize the marginal discrepancies. The glass ionomer cements are effective, due to their ability to continuously release fluoride ions and also the resin cements through their ability to establish chemical bonds with dental tissues. [4, 8]
The most important features of an ideal cement are biocompatibility, sealing capability and caries prevention. Microbial infiltration may be the most critical factor influencing the long-term success of a fixed prosthetic restoration. [3]
The aim of this study was to measure the rate of microleakage between tooth and restoration according to the type of finish line and luting agent.

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This entry was posted in Original paper, Volume 1, Issue 1, June 2018 on June 12, 2018
Jun 12

Efficacy of periodontal debridement using an Erbium YAG laser: A scanning electron microscopic study

Alexandra Stoica 1, Soos Reka 2, Tudor Hănțoiu 1
1 Faculty of Dental Medicine, University of Medicine and Pharmacy of Tirgu Mures, Romania
2 Postgraduate student, Faculty of Dental Medicine, University of Medicine and Pharmacy of Tirgu Mures, Romania

Current scientific research has focused on the incorporation of lasers as part of the therapy of periodontal disease. It was proved that the wavelength of different types of units might have a positive effect on both soft and hard tissues healing process consecutive periodontal treatment. Periodontal disease is a multifactorial condition characterized by a microbial etiology and also a host inflammatory component. The contribution of lasers to periodontal health is determined by their antimicrobial, debridement capacity and biostimulation effect [1-3]. The lasers were introduced in periodontology more than 50 years ago, based on the evidence that wounds heal more quickly after irradiation with low-intensity lasers, a process that might be influenced by the stimulation of growth factors. High-intensity lasers were used as part of the nonsurgical periodontal procedures, in comparison with the conventional therapy for cement and soft tissue debridement, especially in order to reduce dentinal hypersensitivity [4]. Laser light has three main characteristics: is monochromatic, directional and coherent. It can be delivered to a tissue area as continuous wave, running pulse mode or gated-pulse mode. The action of lasers on hard and soft dental tissues as well as microorganisms is influenced by the absorption of the laser by tissue chromophore as apatite minerals, water or pigmented substances found at the targeted site [5-7]. Soft tissue lasers proved to give good results in bacterial reduction and coagulation, with erbium group showing a bactericidal effect on Porphyromonas gingivalis and Aggregatibacter actinomycetem comitans. The aim of our study was to evaluate the effectiveness of an Er:YAG laser used during scaling and root planning. It will be compared with the conventional periodontal debridement methods, represented by sonic, ultrasonic and manual instruments and based on images obtained with the scanning electron microscopy, we intend to measure the in vitro effects of Er:YAG laser on the root cement.

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This entry was posted in Original paper, Volume 1, Issue 1, June 2018 on June 12, 2018
Jun 12

Comparative effectiveness of alternative medication in minor aphtous stomatitis

Farah Curt-Mola 1, Mircea Suciu 1, Ilinca Suciu 1, Anamaria Bechir 2, Lelia Laurenta Mihai 2, Alexandru Burcea 2, Edwin Sever Bechir 1
1 Faculty of Dental Medicine, University of Medicine and Pharmacy of Tirgu Mureş, Romania
2 Faculty of Dental Medicine, Titu Maiorescu University, Bucharest, Romania

Common superficial oral lesions include recurrent aphthous stomatitis, candidiasis, recurrent labial herpes, erythema migrants, hairy tongue, and lichen planus [1,2].
The recognition and the classification of oral lesions have a considerable significance in the process of diagnosis. The correct diagnosis is accomplished through the knowledge of the various lesions, a thorough history and a comprehensive clinical oral examination for the precise diagnosis in the process of differentiating between the specific conditions, management, as well as counselling [3-5]. Ulceration due to aphthous stomatitis (AS) represents the most common oral mucosal inflammatory disease, most frequently starts during the second decade of life, affects about 20% of the population and has a female predilection [6,7]. The etiology of AS is varied and is due to the perturbation of the oral ecosystem. The oral environment is unique, and is able to induce reactivity of products from the prosthetic restoration materials. The biological reactivity of dental materials in the oral cavity can induce reactions of the oral tissues against the bacteria’s adhesion, reactions to the mechanical irritation, to the direct toxic effect, and to the allergens [8]. Habitually, AS lesions begin with prodromal burning sensation, 2-48 hours before the appearance of an ulceration. AS debut is painful. It has the appearance of a rounded ulceration masked by fibrin, with erythematous margins, located especially on the nonkeratinized oral mucosa [9,10].

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This entry was posted in Original paper, Volume 1, Issue 1, June 2018 on June 12, 2018
Jun 12

Clinical-statistical analysis of correlations between caries risk indicators and the prevalence of maxillary dental anomalies in a group of children from Tirgu Mures

Mariana Păcurar 1, Eugen Bud 1, Haj Alexandra 2, Manuela Chibelean 1, Maria Cristina Figueiredo Pollmann 3
1 Faculty of Dental Medicine, University of Medicine and Pharmacy of Tirgu Mures, Romania
2 Psihiatric Clinical, Emergency Mures Hospital, Tirgu Mures, Romania
3 Faculdade de Medicina Dentária da Universidade do Porto, Portugal

Although oral health has improved worldwide, oral diseases still continue to pose a major public health problem, especially within communities belonging to socially disadvantaged groups who still face increased levels of carious lesions and periodontal diseases. Currently, the distribution and severity of oral diseases vary greatly from one country to another as well as among the different areas of the same country.
There are several studies published that have attempted to establish the correlation between the indicator of dental caries in mixed dentition and the risk of maxillary dental anomalies, as well as the way in which intra-arch and inter-arch modifications occur. Premature loss of temporary teeth, as a consequence of untreated dental caries, can cause severe three-dimensional disorders of the dental arches and implicitly of dental occlusion, interfering with the harmonious development of the physiological dentition.

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This entry was posted in Original paper, Volume 1, Issue 1, June 2018 on June 12, 2018
Jun 12

Efficacy of associated therapy in the treatment of temporomandibular disorders

Edwin Sever Bechir 1, Farah Curt-Mola 1, Mircea Suciu 1, Claudiu Horga 1, Carmen Biriș 1, Anamaria Bechir 2, Liran Levin 3
1 Faculty of Dental Medicine, University of Medicine and Pharmacy of Tirgu Mures, Romania
2 Faculty of Dental Medicine, Titu Maiorescu University of Bucharest, Romania
3 Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada

Orofacial pain is manifested in the face or oral cavity area, and includes the disorders of TMJ [1]. Between 5-12% of adult people in the United States [2], 33% of the adult Chinese population in Hong Kong [3], and 33.3% of 2005 individuals in Italy [4], experience pain associated with disorders of the TMJ. The usual symptoms of myogenic temporomandibular disorders (TMDs) are represented by the facial pain, earaches or ringing of the ears, dull, chronic headaches, jaw locking, clicking or popping sounds in the jaw joint, a bite that feels uncomfortable or “off”, neck, shoulder and back pain, and swelling on the side of the face [5-7]. The classical treatment used were injections, physical therapy, splints, anti-inflammatory medications (that could have side effects when used over long periods of time), to which have been added self-management strategies, laser therapies and interventions based on cognitive behavioral approaches [8-10].
At present, a conservative treatment approach prevails over surgery, given it is less aggressive and usually results in satisfactory clinical outcomes in mild-moderate temporomandibular disorder (TMDs).
Nocturnal grinding is a detrimental motor activity, a self-destructive parafunction, characterized by „the consequences of a normal function used in abnormal condition”. Differential diagnosis in nocturnal or day-grinding patients is realized according to the frequency of phenomenon, the destruction degree, the social discomfort and the manifested symptomatology.

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This entry was posted in Original paper, Volume 1, Issue 1, June 2018 on June 12, 2018
Jun 12

Thermal regime effect on the structure of metal component in metal-ceramic prosthesis

Raluca Monica Comăneanu 1, Costin Coman 1, Oana Botoacă 1, Adi Lorean 1
1 Faculty of Dental Medicine, Titu Maiorescu University, Bucharest, Romania

The metal-ceramic fixed prosthetic restoration which reestablish the continuity of dental arches [1] are widely used in dentistry.
The alloys features needed for in metal-ceramic technology [2-4] are:

  • high temperature resistance, which allow for no deformation during ceramics firing;
  • melting temperature must be lower than 1300°C for an easy processing, and should be higher with about 150…200°C than sintering temperature interval of the ceramics which is in the range 850…1100°C;
  • thermal expansion coefficient should be closed to the one of ceramic mass, to avoid share stress appearance in the interface alloy-ceramic durring prosthetic piece cooling;
  • solidification shrinkage should be less than 2.5%;
  • yield strength should be as high as possible;
  • should allow on optimal adherence of the ceramics mass.

Dental materials interact with living tissues they come in contact with and generate local or systemic responses [5]. The biocompatibility of dental alloys is important and is considered a controversial problem for practitioner physicians [6].
Among the causes of metal-ceramic restorations failure are cited in literature: degradation by corrosion of alloys, mechanical wear and fatigue fracture [7-9].
Corrosion is described as the destruction or damage of the material under the action of aggressive environment (atmosphere and oral fluids) [10].
Metal alloys based on Chromium and Cobalt are widely used in the dentistry field [11].
The Co-Cr or Ni-Cr alloys have good corrosion comportment because of Chromium presence, which forms a stable chromium oxide layer on the alloy surface [12-18]. In addition, the allergenic potential of Cr-Co based dental alloys is very small compared with the allergenic potential of the dental alloys based on Ni-Cr [18] in patients with allergic ground.

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This entry was posted in Original paper, Volume 1, Issue 1, June 2018 on June 12, 2018
Jun 12

Oral health among children with cardiovascular disease and risk of infective endocarditis

Adriana Craciun 1, Diana Cerghizan 1, Cristina Bica 1
1 Faculty of Dental Medicine, University of Medicine and Pharmacy of Tirgu Mures, Romania

Congenital cardiac diseases are the most common and severe anomalies present at birth, with a significant impact on infant morbidity and mortality. In Romania, 1,500-1,600 babies with congenital cardiac diseases are born every year. Of these, 850-950 a year require surgical correction. Each of these babies’ hospital discharge sheet recommends preventing infective endocarditis. For this reason, treating these patients is a challenge not just for pediatricians, but also for pediatric dentists or dentists in general. Firstly, these children are predisposed to developing infective endocarditis as a consequence of bacteremia induced by dental procedures.
Secondly, children whose health is severely affected can have a low tolerance to the stress induced by dental treatment. Thirdly, hematological, respiratory and neurological complications, as well as any chronic medication administered, must be taken into account when preparing a dental treatment plan for children with congenital cardiac conditions [1, 2]. Certain authors believed that the role of dental procedures in inducing infective endocarditis had been overestimated [3, 4]. The prevention of bacterial endocarditis in the case of children at risk involves both parents and pediatric dentists knowing the risks these children are exposed to, as well as the responsibilities they have.

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This entry was posted in Original paper, Volume 1, Issue 1, June 2018 on June 12, 2018
Jun 12

Combination therapeutic strategies to improve the outcomes of reconstructive periodontal surgery

Richard J. Miron 1, Anton Sculean 1
1 School of Dentistry, University of Bern, Switzerland

Periodontal disease, which begins as superficial inflammation of the gingiva without attachment or bone loss (gingivitis) and later progresses to attachment loss with subsequent bone destruction (periodontitis), is one of the leading infectious diseases known to mankind. Results from a national survey conducted in the United States in 2010 analyzing the distribution of the disease found that over 47% of the adult population was affected [1]. Furthermore, 38.5% of the population had either moderate or severe forms of periodontitis, which are more difficult and cost-intensive to handle due to the advanced loss of the tooth’s supporting apparatus and subsequently resulting niches that make infection control challenging [1]. Thus, it becomes vital for healthcare providers to diagnose the disease as early as possible and provide appropriate treatment. It has been extensively documented that periodontal infections can be successfully treated by non-surgical and surgical periodontal therapy associated with meticulous oral hygiene.

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This entry was posted in Review, Volume 1, Issue 1, June 2018 on June 12, 2018