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Biomedical subjects

Gerard Kugel

Publications and source records attributed to Gerard Kugel.

18 recordsLinked to original sources

Separate whitening effects on enamel and dentin after fourteen days.

The purpose of this study was to investigate the mechanism of action of a bleaching agent, as it relates to enamel and dentin. Twenty-six extracted human molar teeth were sectioned at the cemento-enamel junction and were randomly assigned to two groups. L*a*b* readings were taken with a spectrophotometer: on buccal surfaces of the crown, at enamel and dentin. The teeth were exposed to carbamide peroxide or placebo gel and L*a*b* scores were again recorded to determine color changes. Treatments were compared using ancova test with baseline color as the covariate. Relative to placebo, buccal surfaces exhibited the greatest Deltab* and DeltaL* color change. On buccal surfaces, the adjusted mean (SE) treatment differences were -7.8 (1.00) for Deltab* and 5.7 (0.97) for DeltaL, with groups differing significantly (p < 0.0001). On enamel surfaces, treatment differences were -3.6 (0.61) for Deltab* and 4.6 (0.80) for DeltaL* (p < 0.0001). Dentin exhibited the least color improvement. Adjusted mean (SE) treatment differences were -1.9 (0.87) for Deltab* and 2.4 (1.10) for DeltaL*, with groups differing significantly (p < 0.02) on dentin color change. The majority of color change seen on the buccal surface of tooth crowns exposed to carbamide peroxide 15% was because of the color change in enamel. As compared to enamel, dentin was less affected after 14 days.

Analysis of Variance↗

Clinical evaluation of chemical and light-activated tooth whitening systems.

Tooth whitening has become one of the most popular dental treatments available. This article compares the efficacy of 2 in-office whitening systems using a split-arch, randomized, parallel, blinded clinical evaluation study. Both in-office tooth whitening systems were effective and there was no significant statistical difference over the 2-week period of observation. The use of light did not demonstrate any benefit over the chemically activated tooth whitening system after a 2-week recall.

Double-Blind Method↗

The art and science of tooth whitening.

Although tooth whitening is one of the most popular dental procedures, it is also one of the least understood. We are still unclear as to its mechanism of action. There is little data as to the effects of both concentration and dose on outcome. The techniques for measuring color change have been brought into question. The cause(s) of sensitivity and the effects of long-term exposure to hydrogen peroxide are not clear. The issue of rebound in color has not been well examined, and issues related to maintenance of the whitening effect are also poorly understood. The immediate placement of composite resin on bleached teeth has been controversial. According to a study evaluating the shear bond strength of composite restorations placed on bleached and nonbleached teeth, there was no statistically significant difference when the composites were placed at 24 hours, 48 hours, four days, or six days. A different study, which evaluated the effects of take-home bleaching systems on enamel surfaces, suggests that a period of four days must elapse before bonding to a tooth bleached with a peroxide material, while no delay is necessary for a non-peroxide-based bleaching system. Most recently, there has been a push to find ways to accelerate and improve the delivery of the whitening process. These include the application of a number of different light sources believed to accelerate the breakdown of peroxide and thus speed up the whitening process. However, the research in this area has been controversial, with publications having quite different conclusions as to the efficacy of light-activated bleaching. Finally, the issues of adverse events and possible side effects were reviewed. The toxicological side effects of tooth bleaching systems seem to be minimal. However, tooth sensitivity can be quite significant. Although its causes are poorly understood, tooth sensitivity is most often seen as the result of tooth dehydration. So while patient demand for tooth whitening is at an all-time high, and dentists have more options for treatment, it's important that dentists evaluate which of these options is most ideal for their patients, factoring in the patients' cost and time issues, as well as sensitivity to the procedure.

Color↗

Layering and curing techniques for class III restorations: a two-year case report.

The direct resin buildup of a Class III restoration based on contemporary layering and curing techniques allows clinicians to provide conservative treatment and a virtually imperceptible blend with adjacent tooth structures. This presentation describes a new approach to the Class III buildup. The importance of restoring enamel and dentin as two different substrates is also stressed. In this context, the selection of a microhybrid composite resin system able to reproduce the optical and mechanical properties of the natural dentition can help to achieve these goals.

Acrylic Resins↗

Clinical trial evaluating the peroxide concentration response of whitening strips over 28 days.

PURPOSE: The research evaluated the peroxide concentration whitening response following self-directed use of whitening strips over a 28-day period. METHODS: A randomized, double-blind, parallel group clinical study was conducted. 37 healthy adult volunteers were randomly assigned to one of three groups based on tooth color at screening: 1.8% hydrogen peroxide strips (HPS), 3.3% HPS or 5.3% HPS. Subjects applied the assigned maxillary strips twice per day for 30 minutes over 28 days. Tooth color was evaluated at day 7, 14 and 28 from digital images of the maxillary six anterior teeth using a standard method. Treatments were compared using analysis of covariance (adjusting for baseline) at a 0.05 level of significance. RESULTS: Hydrogen peroxide at concentrations ranging from 1.8-5.3% resulted in significant (P< 0.05) color improvement versus baseline as early as Day 7. There was a concentration-response for reduction in yellowness (deltab*) and lightness improvement (deltaL*) at all timepoints, favoring the higher concentrations. While the concentration-whitening relationship approached a linear response at Day 7, continued treatment resulted in incremental color improvement. All three peroxide concentrations were well tolerated, and no subjects discontinued early due to a treatment-related adverse event.

Adult↗

Maintenance of whitening with a power toothbrush after bleaching treatment.

A randomized, parallel, examiner-blind clinical study was conducted to examine the ability of 2 toothbrushes to maintain teeth whitening after at-home bleaching. Forty subjects used a 15% carbamide peroxide tray bleaching system at home for 2 weeks per the manufacturer's instructions and then were randomly assigned to use either the Sonicare Advance power toothbrush or a manual toothbrush as part of their home oral hygiene routine for 6 months. The color of the labial surfaces of the subjects' maxillary anterior dentition was assessed before bleaching and immediately, 2 months, 3 months, and 6 months after bleaching. Color was assessed by comparison with Vita Classical shade tabs and by digital image analysis in the CIE L*a*b* color space. Both groups demonstrated a rebound effect at the 2-month visit and beyond, with mean Vita shade scores significantly higher than immediately after bleaching. At the 6-month evaluation, a significant difference in the amount of rebound in each group was observed. Specifically, the rebound of the Sonicare brush group was on average 1.12 Vita shades less than that of the manual brush group. The 6-month difference was confirmed through digital image analysis, with the Sonicare brush group 4.8 L* units lighter, corresponding to 2 Vita shades, and 2.1 b* units less yellow than the manual brush group. This clinical trial demonstrates that the Sonicare Advance toothbrush better maintains whitening after bleaching treatment than a manual toothbrush.

Adult↗

Lead-induced cell signaling cascades in GT1-7 cells.

The effects of lead on the signal transduction pathways that may be involved in the release of gonadotropin-releasing hormone (GnRH) from neurons in the hypothalamus have not been well defined. Using the GT1-7 cell line, an in vitro model for GnRH-secreting neurons, we examined signal transduction pathways directly affected by lead. We found that lead-induced phosphorylation of extracellular signal-regulated kinase 1 and 2 (ERK1 and ERK2), as well as p90RSK and cAMP response element-binding protein (CREB), but did not induce IkappaB degradation. MEK1/2 inhibitor (PD98059) suppressed lead-induced ERK and p90RSK activation. Neither PKC inhibitors (Go6983, Go6976) nor CaMKII inhibitor (KN-62) had a pronounced effect on lead-induced ERK1 and ERK2 phosphorylation. However, MEK1/2 inhibitor, CaMKII inhibitor, and PKC inhibitor significantly suppressed lead-induced CREB phosphorylation. These results indicate that lead-activated PKC, CaMKII and MEK/ERK/p90RSK pathways simultaneously, all of which contributed to CREB phosphorylation. Our results also indicate that lead-induced p90RSK and CREB activation does not alter expression of early response genes like c-fos. We conclude that lead activates PKC, CaMKII or MEK-ERK-p90RSK pathways in GT1-7 cells, leading to CREB phosphorylation and modulation of gene expression.

Animals↗

Over-the-counter tooth-whitening systems.

Sales of over-the-counter (OTC) tooth-whitening products have increased sharply in recent years because of heightened consumer demand for esthetic care, success of in-office and professional home bleaching systems, and heavy promotion by product manufacturers. All the whitening products contain hydrogen peroxide or carbamide peroxide and differ in their mode of delivery. Because tooth whiteners are not regulated by the Food and Drug Administration, many retail products have not undergone rigorous, objective, clinical testing and hence may be of questionable efficacy and safety. OTC tray-based systems in particular must be used with caution because ill-fitting trays can lead to soft-tissue injury, malocclusion problems, and poor compliance. Non--tray-based systems, including a paint-on system and whitening strips, have recently become available. These products are inexpensive, convenient, and easy to use, and they represent the fastest growing segment of the retail market. Whitening dentifrices comprise approximately 50% of OTC tooth whitening products work mainly by abrasion to remove superficial stains. With heightened consumer interest in whiter teeth, clinicians must become familiar with OTC products to provide optimal solutions and treatment to patients.

Dentifrices↗

Restoring anterior maxillary dentition using alumina- and zirconia-based CAD/CAM restorations.

Despite proven strength, durability, and improved esthetics, ceramometal restorations have not consistently enabled the most esthetic, lifelike reproduction of natural dentition. Also, inherent weaknesses in many metal-free materials have precluded their use in the high stress-bearing posterior region. Therefore, as a result of the need for esthetic and durable all-ceramic restorations, manufacturers have introduced ceramics with an increased alumina or zirconia content that are recommended for placement anywhere in the mouth for single units and as far back as the first premolar.

Aluminum Oxide↗

Daily use of whitening strips on tetracycline-stained teeth: comparative results after 2 months.

This article reviews the efficacy of a new 6.5% hydrogen peroxide tooth-whitening gel strip for bleaching teeth that have been intrinsically stained from tetracycline. Given the severity of staining in the cases presented during a recently conducted clinical trial, the resulting efficacy is dramatic. Additionally, the continuous use of these strips for 30 minutes per day, twice daily for 2 months with no meaningful adverse effects is noteworthy.

Adult↗

Success with inlays/onlays: the seven essentials.

Direct restorative materials have revolutionized the industry over the last several years. They offer the convenience to the patient of a one-visit procedure and they decrease overhead in the dental practice. However, it is essential to remember that direct procedures are not always the treatment of choice. For this reason, we should not discount the need for--or the value of--indirect techniques and laboratory-based procedures, such as inlays and onlays. Fit, form, and function can be more predictable when a procedure involves the ultraprecise workings of the dental laboratory--if the impression-making and other focus areas are given their due significance. This article provides key information about and clinical tips for the seven main facets of inlay/onlay fabrications that will lead to clinical success: diagnosis, tooth preparation, tissue management, impression making, temporization, laboratory communications, and final fit/occlusion.

Cementation↗

Clinical evaluation of a 35% hydrogen peroxide in-office whitening system.

This study evaluated the effectiveness of light-curing (heat conversion) vs no light-curing (no heat conversion) of a 35% hydrogen peroxide in-office tooth whitening system. Twenty patients with sound medical history (without tooth sensitivity) participated in this randomized, parallel clinical evaluation. Only six maxillary anterior teeth with discoloration and a tooth shade of A3 or darker were selected. Patients received a complete prophylaxis and were evaluated for initial (baseline) shade by three independent evaluators, precalibrated at 85% rater reliability in determining shades before the experiment began. Participants received a 20-minute chairside whitening treatment with a 35% hydrogen peroxide agent using a reflective resin barrier for gingival isolation. During the whitening treatment, the 35% hydrogen peroxide agent was light-activated with a halogen curing light on teeth Nos. 6 through 8 (Group I), but was not light-activated on teeth Nos. 9 through 11 (Group II). All patients returned 24 hours after the whitening application for shade evaluation. Although there were isolated instances (7 out of 20 patients) of greater degrees of lightening in the light-curing group, there was no statistically significant difference using the Mann-Whitney U test (P > .05). This study indicates that light-curing is optional with this 35% tooth whitening system.

Cuspid↗

Direct composite resins: an update.

Esthetic restorative materials require a bonding procedure to achieve durability and reliability. To accomplish this, the bonding system and restorative material must be biocompatible and bond well to both dentin and enamel. The direct restorative must have sufficient strength to resist masticatory forces as well as mechanical properties close to those of natural tooth structure. These materials should be resistant to degradation in the oral cavity and easy to use. This article reviews the published literature on direct composite restorative materials.

Ceramics↗

Impact of the sonicare toothbrush on plaque and gingivitis.

The sonicare toothbrush has been shown to be 40% more effective in removing plaque than a manual toothbrush, 82% better in removing plaque from interproximal areas, and to reverse gingivitis. In vitro studies have examined the ability of the sonicare toothbrush to remove plaque bacteria beyond the reach of the bristles. The sonicare toothbrush has also been shown to produce significantly less dentin wear in vitro than another leading power toothbrush. This article reviews both in vivo and in vitro studies that illustrate the efficacy of the sonicare toothbrush in improving oral health.

Adult↗

Effects of the sonicare toothbrush for specific indications.

The sonicare toothbrush has been shown to reduce plaque and gingivitis better than a manual toothbrush among orthodontic patients. The sonicare toothbrush has also been shown to reduce pocket depths in patients with periodontitis. Use of the sonicare toothbrush reduced hypersensitivity after 8 weeks of use and removed 82% of the extrinsic stain from coffee, tea, and tobacco after 4 weeks of use. It has also been shown to be as effective as or better than a manual toothbrush for reducing plaque and gingivitis around dental implants and to increase salivary flow in xerostomia patients.

Dental Implants↗

Comparison of temperature changes in the pulp chamber induced by various light curing units, in vitro.

This study compared the temperature increase in a pulp chamber as a result of using various light-curing units during resin composite polymerization, and it determined the effect of remaining dentin thickness on temperature rise. A Class II occlusodistal cavity with a remaining dentin thickness of 2 mm was prepared in an extracted human mandibular molar. A 2-mm layer of fine hybrid resin composite was placed on the floor of the proximal box. A K-type thermocouple was inserted into pulp chambers filled with heat sink compound, and pulp chamber temperature rise (starting temperature: 37.0 +/- 0.1 degrees C) during polymerization of the composite was measured. The light-curing units tested included two halogen lights, Spectrum 800 and Elipar Trilight (Standard and Exponential mode); a light-emitting diode (LED, Elipar Freelight) and a plasma arc (Virtuoso, Xenon Power Arc). Irradiation time was 40 seconds for the halogen and LED lights and 3 seconds for the plasma arc light. Five measurements were carried out for every light-curing unit. The same experimental design was conducted after the cavity preparation was modified, leaving a 1-mm thick dentin layer. The Kruskal-Wallis and multiple comparison tests were used to evaluate the differences among the tested curing units. Mann Whitney-U tests were used to compare the mean temperature rise in each curing unit for different remaining dentin thicknesses. The increase in pulp chamber temperature ranged between 1.40-3.8 degrees C. The highest temperature rise was observed when using Elipar Trilight Standard mode, and the lowest temperature rise was observed with light emitting diode for both remaining dentin thicknesses. The only significant differences in temperature rise were observed between Elipar Trilight Standard mode and LED. No significant difference (p > 0.01) existed for the different modes of Elipar Trilight. A statistically significant higher temperature rise was observed within each curing unit at a depth of 1 mm compared to 2 mm. Although the tested light-curing units caused a temperature rise in the pulp chamber, none exceed the critical value of 5.5 degrees C.

Acrylic Resins↗