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Permanent mucosal discoloration correlated to magnesium-enriched hydroxyapatite: A case report
d e n t a l m a t e r i a l s 3 0 S ( 2 0 1 4 ) e1–e180
each manufacturer’s instructions. Light irradiation of the whitening agents was performed using a halogen lamp irradiator (XL3000 3M Co.). Whitening was performed 3 times per day for 3 days. Regarding the color of the tooth crown before and after whitening treatment, L*, a*, and b* were measured using a colorimeter (Shade Eye NCC, SHOFU Co.). Color differences between before and after whitening were calculated, and three-way ANOVA was performed. Results: Regarding the effects of the whitening agents, the color difference E*ab was 5.62 with HIL, and 4.63 with TON, with a significant difference being noted between them. Color differences increased with the number of whitening sessions. Regarding the presence of fluoride in polishing paste, the color difference was 5.94 with paste containing fluoride, and 4.76 with non-fluoride paste, with a significant difference occurring between them. Conclusion: Whitening effects were higher with the use of fluoride-containing polishing paste prior to whitening. Therefore, it is recommended to positively apply polishing paste containing fluoride, instead of using non-fluoride paste, prior to whitening. Furthermore, because the color difference between HIL and TON was more than 4, it was confirmed that sufficient whitening effects can be achieved on clinical application. Keywords: Office-whitening; containing pastes
Color
difference;
Fluoride-
http://dx.doi.org/10.1016/j.dental.2014.08.197
melanocytic hyperplasia in the epithelium. Mild inflammatory infiltrate was observed, without deposits of haemosiderin. These findings suggest that biomaterial represents the source of discoloration. Since the MHA preparation is white, it can be speculated that, one time into the organic environment, it has gone to a chromatic modification visible through the overlying soft tissues. However this hypothesis did not find a confirmation in the intraoperative observations, where the few particles of biomaterial seen coming out from the surgical areas were all white coloured. Alternatively an explanation of the discoloration can be found in the Tyndall effect, which refers to the fact that different wavelengths of light do not scatter depending on size of substances they encounter: longer redder wavelengths can penetrate more deeply into the soft tissues than shorter blue wavelength before reflecting out. So the light reflecting from tissue over the biomaterial contains less red light than blue, giving the biomaterial a bluish cast. For instance, a similar principle governs why veins appear blue in the skin, despite the red colour of transported blood. Conclusion: In spite of the excellent characteristics of MHA as bone substitute, the potential appearance of permanent mucosal discoloration represents a relevant drawback for oral cavity, especially for those areas with clear aesthetic demand. More investigations are needed in order to confirm the present observations and better comprehend the eventual origin of the mucosal discoloration. Keywords: Bone substitute; Periodontology; Pigmentation
197 Permanent mucosal discoloration correlated to magnesium-enriched hydroxyapatite: A case report M. Montevecchi ∗ , G. Marucci, A. Dorigo ∗ , L. Checchi Dibinem, University of Bologna – Alma Mater Studiorum, Italy Purpose: To describe a clinical case where magnesiumenriched hydroxyapatite (MHA) (SintLife® ) used for socket preservation has induced a permanent mucosal discoloration. Methods and materials: After a minimally traumatic extraction of a first maxillary right molar, MHA particulate was inserted into the socket for bone contour preservation. The surgical procedure as the healing process was uneventful. Two months later, the soft tissue areas corresponding to the vestibular sockets of the extracted roots displayed asymptomatic bluish discoloration. The rehabilitation of the area was suspended and the discoloration monitored. Six years later, the pigmentation was still present and the radiographic evaluation of the area showed residual biomaterial particles. The histomorphological evaluation of the soft and hard tissues was consequently performed in order to better comprehend the origin of the mucosal alteration. Results: Histological examination confirmed the presence of residual MHA particles, mainly in direct contact with bone tissue, but partly embedded into the subepithelial fibrotic chorion (see the enclosed picture). There was no melanosis or
e97
http://dx.doi.org/10.1016/j.dental.2014.08.198
each manufacturer’s instructions. Light irradiation of the whitening agents was performed using a halogen lamp irradiator (XL3000 3M Co.). Whitening was performed 3 times per day for 3 days. Regarding the color of the tooth crown before and after whitening treatment, L*, a*, and b* were measured using a colorimeter (Shade Eye NCC, SHOFU Co.). Color differences between before and after whitening were calculated, and three-way ANOVA was performed. Results: Regarding the effects of the whitening agents, the color difference E*ab was 5.62 with HIL, and 4.63 with TON, with a significant difference being noted between them. Color differences increased with the number of whitening sessions. Regarding the presence of fluoride in polishing paste, the color difference was 5.94 with paste containing fluoride, and 4.76 with non-fluoride paste, with a significant difference occurring between them. Conclusion: Whitening effects were higher with the use of fluoride-containing polishing paste prior to whitening. Therefore, it is recommended to positively apply polishing paste containing fluoride, instead of using non-fluoride paste, prior to whitening. Furthermore, because the color difference between HIL and TON was more than 4, it was confirmed that sufficient whitening effects can be achieved on clinical application. Keywords: Office-whitening; containing pastes
Color
difference;
Fluoride-
http://dx.doi.org/10.1016/j.dental.2014.08.197
melanocytic hyperplasia in the epithelium. Mild inflammatory infiltrate was observed, without deposits of haemosiderin. These findings suggest that biomaterial represents the source of discoloration. Since the MHA preparation is white, it can be speculated that, one time into the organic environment, it has gone to a chromatic modification visible through the overlying soft tissues. However this hypothesis did not find a confirmation in the intraoperative observations, where the few particles of biomaterial seen coming out from the surgical areas were all white coloured. Alternatively an explanation of the discoloration can be found in the Tyndall effect, which refers to the fact that different wavelengths of light do not scatter depending on size of substances they encounter: longer redder wavelengths can penetrate more deeply into the soft tissues than shorter blue wavelength before reflecting out. So the light reflecting from tissue over the biomaterial contains less red light than blue, giving the biomaterial a bluish cast. For instance, a similar principle governs why veins appear blue in the skin, despite the red colour of transported blood. Conclusion: In spite of the excellent characteristics of MHA as bone substitute, the potential appearance of permanent mucosal discoloration represents a relevant drawback for oral cavity, especially for those areas with clear aesthetic demand. More investigations are needed in order to confirm the present observations and better comprehend the eventual origin of the mucosal discoloration. Keywords: Bone substitute; Periodontology; Pigmentation
197 Permanent mucosal discoloration correlated to magnesium-enriched hydroxyapatite: A case report M. Montevecchi ∗ , G. Marucci, A. Dorigo ∗ , L. Checchi Dibinem, University of Bologna – Alma Mater Studiorum, Italy Purpose: To describe a clinical case where magnesiumenriched hydroxyapatite (MHA) (SintLife® ) used for socket preservation has induced a permanent mucosal discoloration. Methods and materials: After a minimally traumatic extraction of a first maxillary right molar, MHA particulate was inserted into the socket for bone contour preservation. The surgical procedure as the healing process was uneventful. Two months later, the soft tissue areas corresponding to the vestibular sockets of the extracted roots displayed asymptomatic bluish discoloration. The rehabilitation of the area was suspended and the discoloration monitored. Six years later, the pigmentation was still present and the radiographic evaluation of the area showed residual biomaterial particles. The histomorphological evaluation of the soft and hard tissues was consequently performed in order to better comprehend the origin of the mucosal alteration. Results: Histological examination confirmed the presence of residual MHA particles, mainly in direct contact with bone tissue, but partly embedded into the subepithelial fibrotic chorion (see the enclosed picture). There was no melanosis or
e97
http://dx.doi.org/10.1016/j.dental.2014.08.198