July/August 2015

Table of Contents


  • Editorial Pastry cream pedagogy: what making macarons taught me about dental practice

    Eric K. Curtis, DDS, MA, MAGD
    2015 Jul/Aug; 63(4):6.
    Full Article (PDF)
  • Minimally Invasive Dentistry Trauma happens: a minimally invasive approach to restoring fractured anterior teeth

    Mark Malterud, DDS, MAGD
    2015 Jul/Aug; 63(4):8-12.
    Full Article (PDF)
  • Ethics A case of cyberbullying

    Toni M. Roucka, DDS, MA, FACD
    Pamela Zarkowski, JD, MPH, FACD
    2015 Jul/Aug; 63(4):13-15.
    Full Article (PDF)
  • Esthetics Smile Design 1.0: Learning from our past to meet the current challenge for predictable success

    Wynn Okuda, DMD, FAACD, FICD, FICOI
    2015 Jul/Aug; 63(4):16-18. 
    Full Article (PDF)
  • Answers Self-Instruction exercises No. 352, 353, and 354

    2015 Jul/Aug; 63(4):80.
    Full Article (PDF)

Clinical Articles

  • Operative (Restorative) Dentistry Conservative management of grossly carious mandibular first molar with a hemisection approach: a case report

    Swati Sharma, BDS, MDS
    Rajendra Kumar Tewari, BDS, MDS
    Surendra Kumar Mishra, BDS, MDS
    Pankaj Prakash Kharade, BDS, MDS
    2015 Jul/Aug; 63(4):19-21.  

    The term hemisection refers to the removal or separation of a root—with its accompanying crown portion—from a 2-rooted tooth, such as a mandibular molar. A hemisection is considered a conservative treatment option for mandibular molars that would otherwise require extraction. A hemisection of an affected tooth helps to preserve the tooth structure and alveolar bone and is more economical than other treatment options. Therefore, hemisection may be a suitable alternative to extraction and implant therapy and should be discussed with patients during their consideration of treatment options. This case report describes a hemisection procedure in which the grossly carious distal half of an endodontically treated mandibular left first molar was removed.
    Full Article (PDF)

    Operative (Restorative) Dentistry Influence of irrigation protocols on the bond strength of fiber posts cemented with a self-adhesive luting agent 24 hours after endodontic treatment

    Jessica Ferraz Carvalho Lima, DDS
    Adriano Fonseca Lima, DDS, MS, PhD
    Maria Malerba Colombi Humel, DDS, MS, PhD
    Luis Alexandre Maffei Sartini Paulillo, DDS, MS, PhD
    Giselle Maria Marchi, DDS, MS, PhD
    Caio Cezar Randi Ferraz, DDS, MS, PhD
    2015 Jul/Aug; 63(4):22-26.  

    The aim of this in vitro study was to evaluate the influence of different irrigation protocols on the bond strength, at different root depths, of fiber posts cemented with a self-adhesive cement 24 hours after endodontic treatment. Fifty-six bovine incisor roots were endodontically prepared and separated into 7 groups (n = 8) according to irrigation protocols: group 1, sterile saline (control); group 2, chlorhexidine (CHX) gel 2% and saline; group 3, sodium hypochlorite (NaOCl) 5.25% and saline; group 4, CHX and saline (final irrigation with ethylenediaminetetraacetic acid [EDTA] 17%); group 5, NaOCl and saline (final irrigation with EDTA); group 6, CHX and saline (final irrigation with NaOCl and EDTA); and group 7, NaOCl (final irrigation with CHX and EDTA).

    No statistically significant difference was found among the groups. Within the limitations of this study, it can be concluded that the different irrigation protocols did not influence the bond strength of self-adhesive resin cement, which presented similar behaviors at the 3 root depths studied.
    Full Article (PDF)
    Self-Instruction Exercise No. 370
  • Operative (Restorative) Dentistry Bond strengths of a self-etching adhesive to dentin surfaces treated with saliva, blood, and different hemostatic agents

    Nimet Unlu, DDS, PhD
    Fatma Cebe, DDS, PhD
    Mehmet Ata Cebe, DDS, PhD
    Ali Riza Cetin, DDS, PhD
    Nevin Cobanoglu, DDS, PhD
    2015 Jul/Aug; 63(4):28-32.  

    The aim of this study was to evaluate the microtensile bond strengths of a self-etching adhesive to dentin surfaces after treatment with 4 different hemostatic agents in the presence of saliva and blood. After testing, no significant differences were found between the mean bond strength of Clearfil SE (CSE) Bond resin adhesive to normal dentin and those of CSE to dentin treated with the hemostatic agents ViscoStat Clear, Astringedent, or Astringedent X (P > 0.05). However, the mean bond strength of CSE Bond to dentin treated with Ankaferd Blood Stopper (ABS) was significantly greater than those of the other groups (P < 0.05). Thus, while 3 of the tested hemostatic agents did not have significant effects on the bond strength of composite resin to dentin, ABS increased the bond strength of CSE Bond to dentin.
    Full Article (PDF)
  • Nutrition Soft drinks and in vitro dental erosion

    Brent L. Gravelle, PhD, MD
    Ted W. Hagen II, DMin, PhD
    Susan L. Mayhew, PharmD, BCNSP, FASHP
    Brooks Crumpton, DDS
    Tyler Sanders, PharmD
    Victoria Horne, PharmD
    2015 Jul/Aug; 63(4):33-38.

    The purpose of this investigation was to determine to what extent the in vitro exposure of healthy teeth to various commonly consumed carbonated soft drinks may precipitate dental erosion. Forty-two healthy, extracted, previously unerupted human molars were weighed prior to, during, and after suspension in various sugared and diet or zero-calorie carbonated beverages for 20 days; the specimens were stored at room temperature while being stirred at 275 rpm. The percentage decrease in tooth weight from before to after exposure represented the weight loss due to enamel erosion; values in the experimental groups varied from 3.22% to 44.52% after 20 days’ exposure. Data were subjected to analysis of variance and post hoc Scheffe testing at a level of α = 0.05. Nonsugared drinks (diet and zero-calorie) as a whole were more erosive than sugared beverages. A significant positive correlation was found between the amount of titratable acid and percentage of tooth erosion, while a significant negative correlation was revealed between the beverage pH and percentage of tooth erosion. No significant correlations were found between calcium or phosphate ion concentrations and the amount of erosion. It appears that enamel erosion is dependent on not only the beverage flow rate, pH, and amount of titratable acid, but also whether the soft drink is of the diet or zero-calorie variety, which reflects the type of artificial sweetener present.
    Full Article (PDF)
  • Cephalometrics Correlation of maxillary anterior tooth width and outer intercanthal distance

    Ehsan Eslami, DDS
    Pantea Zadparvar, DDS, MS
    Homeira Ansari Lari, DDS, MS
    Amir Hosein Mirhadian, DDS
    Romina Sadr-Eshkevari, BEng
    2015 Jul/Aug; 63(4):39-42.

    The selection of the correct maxillary anterior teeth to establish proper mesiodistal width in a prosthesis is one of the most crucial phases of prosthodontic treatment. The ratio of facial measurements to natural tooth width could be considered a helpful scale. The aim of this study was to explore the relationship between outer intercanthal distance (OICD) and the combined anterior width (CAW) of maxillary teeth. The CAW between the canine distal contacts and the OICD of 100 men and 100 women were measured. Pearson correlation coefficients demonstrated a positive correlation between OICD and CAW. There was no statistically significant difference between the sexes in mean difference between OICD and CAW. Within the limitations of this study, the results suggest that the OICD can be used as a fairly reliable method to determine the CAW for edentulous patients.
    Full Article (PDF)
  • Oral Medicine, Oral Diagnosis, Oral Pathology Relationship between the positions of impacted third molars and the presence of dentigerous cysts

    Francinne Miranda da Rosa, PhD
    Marcia Gaiger Oliveira, PhD
    Viviane Palmeira da Silva, DDS
    Pantelis Varvaki Rados, PhD
    Manoel Sant’Ana Filho, PhD
    2015 Jul/Aug; 63(4):43-46.  

    The objective of this study was to assess the association between the histopathological diagnoses of dentigerous cysts and pericoronal follicles and the positions of impacted third molars. The sample comprised 151 cases, diagnosed as dentigerous cysts and pericoronal follicles. Most patients were female (70.9%), white (90.1%), and age 20 years or older (63.6%). Ninety-eight cases (64.9%) were diagnosed as pericoronal follicles and 53 (35.1%) as dentigerous cysts. Teeth that developed dentigerous cysts were predominantly located in the mandible (84.9%), in a mesioangular position (49.1%), and in the 20- to 29-year age group (66.0%). The mandible seems to be the most frequent location of impacted teeth, probably because mandibular tooth eruption is more difficult, as well as dentigerous cysts, probably because the long duration of impaction increases the exposure to inflammatory stimuli and, thus, the potential for formation of dentigerous cysts. The findings also suggest that the incidence of dentigerous cysts tends to increase with age, especially for mandibular teeth in mesioangular positions.
    Full Article (PDF)

    Implant Placement Surgery Maxillary sinus and success of dental implants: an update

    Wesam T. Al-Salman, DDS, MSc
    Khalid Almas, BDS, MSc, FDRSCS (Edin), FRACDS, DDPH, RCS, FICD
    2015 Jul/Aug; 63(4):47-54. 

    The maxillary sinus augmentation procedure has been gaining more acceptance among dental professionals. The aim of this review article is to provide an update about various aspects of anatomy, physiology, and common pathological conditions of the maxillary sinus and their clinical relevance to the sinus augmentation procedure and subsequent implant placement.
    Full Article (PDF)
    Self-Instruction Exercise No. 371
  • Digital/Video Imaging Detection of Class II caries on the iPad with Retina Display

    Mohannad A. Hashem, DDS
    William S. Moore, DDS, MS, FAGD
    Marcel Noujeim, DDS, MS
    S. Thomas Deahl II, DMD, PhD
    Hassem Geha, DPL, MS
    Clyde Alex McMahan, PhD
    2015 Jul/Aug; 63(4):56-60.  

    With the increasing use of digital radiography, the display parameters of the devices used to view radiographs have become important factors in caries detection. Interest in the use of tablet devices for this application has increased due to their availability, portability, and ease of use. However, to be effective in clinical situations, these portable devices must have displays that perform well under multiple lighting conditions and at different angles. The purpose of this study was to assess the utility of the iPad with Retina Display for the detection of Class II caries under common overhead lighting conditions. The device was used in both standing and angled positions by 5 reviewers, and their diagnoses of caries were compared to the diagnoses the same reviewers made using a thin-film transistor flat-panel display (TFT-FPD) in dim lighting conditions. Histological analysis was used as the gold standard to confirm the presence or absence of caries. In a standing position, the tablet device performed as well as the TFT-FPD. When used in the angled position, the tablet performed slightly worse than the TFT-FPD. The findings suggest that if the user can compensate for overhead glare, the tablet device may perform as well as a calibrated, upright display in a dimly lit room.
    Full Article (PDF)
  • Patient Education/Motivation Ramadan fasting and dental treatment considerations: a review

    Shaeesta Khaleelahmed Bhavikatti, MDS
    M.L.V. Prabhuji, MDS
    Shruthi J.R., MDS
    2015 Jul/Aug; 63(4):61-66.

    During the sacred month of Ramadan, Muslims abstain from the consumption of food from dawn until dusk. Extended fasting hours produce changes in the body’s metabolism during this period. A majority of the population who fast also restrict themselves from undergoing dental treatments due to a fear of breaking the fast. Even among health professionals, a certain amount of uncertainty prevails about the implications of treating a patient who is fasting. To help clinicians carry out safe and effective treatment without hampering a patient’s religious beliefs, the present article focuses on the effect of Ramadan fasting on the body’s metabolism and the ramifications for treatment aspects, including medications and dental procedures.
    Full Article (PDF)
  • Dental Jurisprudence/Ethics Comparison of state dental radiography safety regulations

    Thomas F. McDaniel, DMD, FAGD
    Vijay Parashar, BDS, MDSc, DDS
    2015 Jul/Aug; 63(4):67-72.  

    The aim of this study was to compare and provide an overview of state policies on occupational exposure, dosimetry, collimation, patient protection, and the use of portable handheld X-ray machines in dentistry. State government webpages containing radiation protection rules and regulations were scanned. The contents were compared against current federal regulations established by the Nuclear Regulatory Commission (NRC) and the US Food and Drug Administration (FDA). They were further evaluated in light of current recommendations from the National Council on Radiation Protection & Measurements (NCRP) and the American Dental Association (ADA). Most states’ regulations mirror the exposure limits set forth by the NRC and FDA. Nonregulatory recommendations regarding use of dental radiography are periodically put forth by the NCRP and the ADA. State and federal agencies often follow recommendations from these scientific organizations when creating regulations. Clinicians must be aware of their state’s radiation protection rules, as variations among states exist. In addition, recommendations published by organizations such as the NCRP and the ADA, while not legally binding, contribute significantly to the reduction of radiation risks for operators and patients alike.

    Full Article (PDF)

    Cariology Remineralizing agents: effects on acid-softened enamel

    H.B.P. Porcelli, DDS, MS, PhD
    F.A. Maeda, DDS, MS, PhD
    B.R. Silva, DDS, MS
    W.G. Miranda Jr., DDS, MS, PhD
    P.E.C. Cardoso, DDS, MS, PhD
    2015 Jul/Aug; 63(4):73-76.

    This study sought to evaluate whether remineralizing toothpastes can protect acid-softened enamel against further erosive episodes. Fifty enamel slabs of bovine teeth with preformed erosion-like lesions were randomly assigned to 1 control and 4 experimental groups (n = 10): group 1, nanohydroxyapatite (nanoHAp) dentifrice; group 2, arginine and calcium carbonate (CaCO3) dentifrice; group 3, potassium nitrate (KNO3) and high–fluoride (F) availability dentifrice; group 4, ordinary fluoridated dentifrice (OFD); and group 5, control (deionized water). Initial hardness measurements were taken after the different treatments were applied.

    Statistically significant mineral gains of 8.0% and 10.0% were exhibited in groups 1 and 4, respectively. Groups 2 and 3 showed mineral gains of 4.5% and 2.1%, respectively; these were not statistically significant. Group 5 showed mineral loss (−11.8%).

    A 1-way analysis of variance showed no statistically significant differences in the mean microhardness values among groups. However, there are indications that the nanoHAp and OFD toothpastes may decrease erosive lesions after treatment, while the arginine + CaCO3 and KNO3 + F pastes may prevent the progression of erosive lesions.
    Full Article (PDF)
    Self-Instruction Exercise No. 372
  • Diagnosis & Treatment Planning Clinicopathologic correlation: palatal mass interfering with seating of a maxillary denture

    Amana Farrkh, DDS
    James J. Closmann, DDS
    Pallavi Parashar, BDS, DDS
    Thomas J. Borris, DDS
    2015 Jul/Aug; 63(4):77-78.  

    This paper is a clinicopathologic correlation regarding a 61-year-old patient with an ill-fitting maxillary denture. Examination revealed a firm, nontender palatal mass. Descriptions of the clinical findings, work-up, differential diagnosis, histological observations, and diagnosis of the lesion are presented.
    Full Article (PDF)
  • Dental Jurisprudence/Ethics Review of the peer review process

    Joseph P. Graskemper, DDS, JD, ABMM, FAGD, FAES, FICOI, FASO, FACLM, FACD
    2015 Jul/Aug; 63(4):e1-e4.

    Discussions of dental law, ethics, and risk management often center around what a dentist should do to reduce the risk that an upset, litigious patient will seek out an attorney to address the problem. There is a very useful option for the dentist and patient to pursue that eliminates the adversarial stance associated with a lawsuit. The peer review resolution process has been shown to be a positive, professional way to end certain dentist-patient confrontations, and the results normally are upheld in most jurisdictions.
    Full Article (PDF)
  • Patient Education/Motivation Influence of educational materials on the hygiene and utilization habits of denture wearers

    Fernanda Ferruzzi, DDS, MSc
    Julio Cesar Leonard Sabczak Martins, DDS
    Aline Akemi Mori, DDS, MSc
    Gabriela Cristina Santin, DDS, MSc
    Eduardo Kurihara, DDS, PhD
    Sergio Sabio, DDS, PhD
    2015 Jul/Aug; 63(4):e6-e10.  

    The objective of this study was to investigate the influence of educational materials on the denture hygiene and utilization habits of 70 adult volunteers who had been using complete dentures for at least 5 years. On the day they received new dentures, 32 patients were provided with an illustrated leaflet and verbal instructions on oral hygiene and utilization habits, while the remaining 38 participants were advised to continue cleaning and wearing their new dentures as they had their previous dentures. After a 6- to 10-week period, 66 of 70 subjects were interviewed about socioeconomic factors, denture hygiene, and utilization habits. The percentage of patients with a proper denture care routine was low in both groups, suggesting that patients had a tendency not to change old habits. However, statistical analysis showed a positive correlation between receiving instruction and performing denture care in a way that is closer to the recommended method: brushing without toothpaste, using a specific brush; soaking in a sodium hypochlorite solution; and removing the prosthesis at night. Within the limitations of this study, it was concluded that this approach to patient education could be applied to improve the hygiene and utilization habits of denture wearers as well as encourage the correct use of complete dentures.
    Full Article (PDF)
  • Cracked Tooth & Restorations Adhesive reattachment rehabilitating a nonvital central incisor with a complicated crown-root fracture: 1-year follow-up

    Marcilio Jorge Fernandes Monteiro, DDS
    Flavia Cohen-Carneiro, PhD
    Giselle Desideri Tino, MSc
    Andre Augusto Franco Marques, PhD
    Danielson Guedes Pontes, PhD
    2015 Jul/Aug; 63(4):e12-e17.  

    Dental trauma requires immediate treatment. However, some conventional treatments (such as an implant and/or partial fixed denture) will not always be immediately possible, due to the patient’s age (mainly in pediatric cases) or lack of immediate financial resources. In such situations, the technique of adhesive reattachment plays an important role as a treatment option in the interim. This case report describes the use of adhesive fragment reattachment in the rehabilitation of a maxillary central incisor with a complicated crown-root fracture.

    A 1-year follow-up affirmed that the adhesive reattachment efficiently resolved the crown-root fracture, allowing for the retention of the tooth structure. This more conservative multidisciplinary approach restored function, esthetics, and self-esteem to the patient, while preserving all bone and gingival architecture for future implant treatment.
    Full Article (PDF)
  • Caries Detection and Prevention Effects of the preparation technique and type of material on the penetrability of sealants

    John S. Cho, DDS
    David Covey, DDS, MS
    Faika Abdelmegid, BDS, MS
    Fouad Salama, BDS, MS
    2015 Jul/Aug; 63(4):e18-e22.  

    The purpose of this in vitro study was to compare the penetration of 2 resin-based and 2 glass ionomer sealants into fissures after either conventional or mechanical preparation. All the materials placed in the conventionally prepared and mechanically prepared fissures penetrated the fissures beyond the standard (0.5-mm) reference line used in this study. For 1 glass ionomer sealant, the number of specimens showing complete penetration of sealant was significantly greater (P < 0.05) in mechanically prepared fissures than in conventionally prepared ones. No significant differences were found between mechanically and conventionally prepared fissures for the other sealants.
    Full Article (PDF)
  • Partial Dentures Simple prosthesis for a cancer patient with a segmental mandibulectomy and free fibula flap reconstruction: a clinical report

    Kanchan Dholam, BDS, MDS
    Pankaj Kharade, BDS, MDS, FDPS
    Pravin Bhirangi, D Mech
    2015 Jul/Aug; 63(4):e23-e25.

    Tumors of the mandible often necessitate the resection of a major portion of the body of the mandible as well as tissue from the tongue. Resection of the body of the mandible often leads to discontinuity of the mandible, affecting function to a large extent. While the rehabilitation of such defects with free fibula flaps may provide a certain level of stability to the mandible and aid in the prosthetic rehabilitation of these patients, the bulk of these flaps may create difficulties during prosthetic rehabilitation. The economic constraints of patients and/or their fear of implant surgery may also rule out prosthetic rehabilitation with implant-retained prostheses. This case report describes a simple and cost-effective method of prosthetic rehabilitation for a cancer patient who had undergone a segmental mandibulectomy followed by reconstruction with a free fibula flap.
    Full Article (PDF)