Biomedical subjects

N H Creugers

Publications and source records attributed to N H Creugers.

At least 19 recordsLinked to original sources

PubMed2001

Occlusal stability in shortened dental arches.

Shortened dental arches consisting of anterior and premolar teeth have been shown to meet oral functional demands. However, the occlusal stability may be at risk as a result of tooth migration. The aim of this nine-year study was to investigate occlusal stability in shortened dental arches as a function over time. Occlusal stability indicators were: 'interdental spacing', 'occlusal contacts of anterior teeth in Intercuspal Position', 'overbite', 'occlusal tooth wear', and 'alveolar bone support'. Subjects with shortened dental arches (n = 74) were compared with subjects with complete dental arches (controls, n = 72). Repeated-measurement regression analyses were applied to assess age-dependent variables in the controls and to relate the occlusal changes to the period of time since the treatment that led to the shortened dental arches. Compared with complete dental arches, shortened dental arches had similar overbite and occlusal tooth wear. They showed more interdental spacing in the premolar regions, more anterior teeth in occlusal contact, and lower alveolar bone scores. Since the differences remained constant over time, we conclude that shortened dental arches can provide long-term occlusal stability. Occlusal changes were self-limiting, indicating a new occlusal equilibrium.

Adult↗

PubMed2001

[Repair and revision 5. Failures and repair of resin-bonded bridges].

This article describes a number of aspects dealing with debonding, recementation and patients' satisfaction in the treatment with resin-bonded bridges. Experiences from two large clinical trials are reported. It was found that rebonded bridges were less successful than the originally bonded bridges. However, since the functional survival rate was significantly higher than the original survival rate, together with the relative low cost of recementation, it is advised to recement debonded bridges. After multiple debonding recementation can be questioned. Multiple debonding is considered to point to an inadequate indication of this type of fixed prostheses. Debonding of bridges did not alter the patients' satisfaction. This might be caused by the fact that the possibility of failure was explained to the patient when informed consent was obtained.

Cementation↗

PubMed2001

[Meta-analysis of anterior veneer restorations in clinical studies].

A systematic review was used to make an inventory of clinical studies on veneer restorations. Based on a protocol articles were selected that were subsequently assessed for their quality. With 'failure of the restoration' as a study outcome, survival data of the restorations were generated from the selected studies and a mean survival result was composed. Porcelain veneer restorations showed an acceptable 3-year survival, which was favourable to the 3-year survival of preformed acrylic veneers. The quality assessment expressed that reports on clinical studies should be more standardised in order to make it easier to compare the results of different studies.

Acrylic Resins↗

PubMed2000

Time-and-motion study on class II copy-milled ceramic inlays.

OBJECTIVES: To obtain an estimate of working times of Class II copy-milled ceramic inlays as an indication of their efficiency, and to analyse factors of influence. METHODS: In a controlled clinical trial, 173 MO/DO or MOD ceramic inlays of the Celay system were constructed in 101 patients. Treatment was carried out by seven dentists. The inlays were replacements of existing amalgam restorations in both molar and premolar teeth. Net-times needed for the treatment and for the laboratory stage were registered. Variables of influence on the working time were assessed by using ln-working times in ANOVA. Differences of working times were expressed as the relative difference between the upper and lower value of each variable (Delta). RESULTS: The mean clinical treatment time was 67(+/-22)min. The laboratory stage required 60(+/-17)min working time. 'Cavity modification technique' (composite basing/conventional, Delta=17%), 'clinical operator' (seven dentists, Delta=57%), and 'size of the restoration' (large/medium, Delta=16%) significantly influenced the clinical treatment time (p<0.001). Although the dentists were familiar with inlay construction, they showed a 25% decrease in working time towards the end of the study. CONCLUSIONS: Class II copy-milled ceramic inlays in this time-and-motion study required about 125min of working time. Working time increased by applying composite basing and making large restorations. The dentist influenced working times, while efficiency increased over time. Dentists needed more laboratory time to produce an inlay than the dental technician.

Adult↗

PubMed2000

A systematic review of single-tooth restorations supported by implants.

OBJECTIVES: To make an inventory of clinical studies on single-tooth restorations supported by implants using a systematic review procedure and to aggregate overall survival results. DATA SOURCES: Papers referring to single-tooth implants were located by a MEDLINE search 1990 to April 1998. Three hundred and twenty references were found, and they were subjected to a systematic review procedure. STUDY SELECTION: A three-step inclusion/exclusion procedure was applied to identify papers that represented: good scientific practice (GSP), reported results of all patients, implants and crowns for more than 2years, and had sufficient data to generate life-table analyses. The outcomes were 'implant failure' and 'crown completion'. Nine studies survived. These data showed an overall mean GSP of 0.37 with a predicted 4year implant survival of 97% (n=459), and an uncomplicated crown maintenance of 83% (n=240). CONCLUSION: Single-tooth implants show an acceptable short-term survival of 4years, but crown complications are common.

Clinical Trials as Topic↗

PubMed2000

Patients' satisfaction in two long-term clinical studies on resin-bonded bridges.

This study aimed to evaluate patients' satisfaction with resin-bonded bridges and the effect of failures on the degree of satisfaction. In two clinical trials, 358 patients completed guided questionnaires at regular recalls (n=1484). In this way, data regarding 'overall function', 'colour', 'shape', 'functional changes', 'complaints' and 'recommendation to other patients' were obtained. The scores of each criterion were evaluated for the variables 'trial', 'gender', 'time after placement' and 'failure', using 4-way ANOVA. Encountered failures were rated using a 'failure severity scale'. For all combinations of measurement periods, the changes in patient's opinions were calculated and the differences tested using the paired t-test. Overall satisfaction was correlated with 'colour', 'shape' and inversely correlated with 'complaints' (r>0.34; all P<0.005). No statistical differences were found between males and females. No significant changes were observed in patient satisfaction over time. Failures influenced the failure sensitive variables 'functional changes' and 'avoidance of load'. The z-scores were independent of the severity of the failures (r<0.13; all P>0. 10). The degree of patient satisfaction with resin-bonded bridges appeared to be high and did not seem to be influenced by the occurrence of failure.

Adolescent↗

PubMed2000

[Restoration materials in overdenture abutment teeth].

To assess the performance of amalgam, resin composite and resin-modified glass ionomer cement as filling material in overdenture abutment teeth, 155 restorations were made to seal the root canal orifices in 49 patients. The three restorative materials were randomly assigned to the abutment teeth using a number of balancing criteria. All patients were reviewed every six months and received the same preventive regimen. Survival was assessed at two levels: complete survival even without maintenance treatments (Scomp) and survival of the original restoration independent from eventual maintenance treatments (Sorig). The calculated overall survival of Sorig and Scomp were 63 +/- 6% and 57 +/- 6% respectively (mean +/- SE). At both levels no statistically significant differences were observed between the survival of the investigated materials. The results of this study did not point out a superior restorative material for the seal of root canal orifices of overdenture abutment teeth. The distribution of failures over the patients indicated a certain patient dependency.

Aged↗

PubMed2000

[Long-term survival of extensive amalgam restorations].

In cost-effectiveness analysis and contemporary treatment planning strategies, the postponement of placement of cast crowns plays an important role. Extensive Amalgam Restorations (EAR), that involve the rebuilding of cusps and the provision of auxiliary retention, are thought to make this postponement possible. This study reports the long-term survival (100 months) of EAR in a randomized, controlled clinical trial. A total of 300 EAR were placed by 3 operators in molar teeth in which one or more cusps were reconstructed. Five different auxiliary retention methods were used for retention of these restorations. As the purpose of EAR is considered to be twofold (to restore a broken-down molar to acceptably function as an independent restoration and to create a substructure for subsequent crown construction), survival was assessed at different levels. The survival rate of EAR as an independent restoration was 88 +/- 2%. The functional survival rate (as an independent restoration or as a substructure) was 92 +/- 2%. The influence of experimental variables (retention method and operator) and background variables (tooth type, extension of EAR and age of patient) on the survival was analysed using Log Rank and Breslow tests. The analyses revealed that there were no statistically significant influences on the survival rates except for the variable 'age of patient' (p < 0.05). EAR was more prone to failure in the group of older patients than the group of younger ones.

Adult↗

PubMed1999

In vitro dentine hardness following gamma-irradiation and freezing.

OBJECTIVES: To investigate the short term effects of gamma-irradiation and conventional freezing on the hardness of human dentine. METHODS: Twenty-one dentine disks were produced by transverse sectioning 21 sound extracted human permanent molar teeth. The 2.1 mm thick disks were wet polished using 4000 grit polishing paper. Three lines were drawn dividing each disk into six symmetrical areas. Seven disks were randomly assigned for freezing in water at -18 degrees C for 12 days; seven were exposed to a single dose of 25.2 kGy gamma radiation in water; seven were kept in water at 20 degrees C for 12 days (control). Before treatment, three Vicker's indentations at a load of 30 kg and a dwelling time of 20 s were made in one half of each disk, at equal distances from its edge and centre. Using light microscopy and image analysis software, the indentation diagonals were measured 4 h after preparation. Vicker's hardness values (VHN = kg/mm2) were calculated for each indentation. Following the treatment, VHNs were calculated again, for three symmetrical indentations in the second half of each disk. A statistical analysis was performed using the Wilcoxon rank sum test. RESULTS: The frozen group showed no changes following the treatment (VHN = 58 +/- 6 before vs. 57 +/- 6 after). The irradiation and control groups showed some hardening (VHN = 53 +/- 7 vs. 59 +/- 8; 57 +/- 3 vs. 63 +/- 6, respectively), however all values were within the normal variation. CONCLUSION: Both conventional freezing at -18 degrees C for 12 days in water, and a single gamma-irradiation dose of 25.2 kGy in water, appeared to have no short term effects on the hardness of human coronal dentine.

Dentin↗

PubMed1999

A 4-year clinical study on amalgam, resin composite and resin-modified glass ionomer cement restorations in overdenture abutments.

OBJECTIVE: To assess the performance of three different filling materials in overdenture abutment teeth. METHODS: In 49 patients amalgam, resin composite and resin-modified glass ionomer cement were used to seal the root canal orifices of 155 overdenture abutment teeth. After initial preparation of the cavities, the three restorative materials were randomly assigned to the abutment teeth using a number of balancing criteria. All patients were reviewed every six months and received the same preventive regimen. Survival was assessed at two levels: Sorig (survival of the restoration independent from eventual maintenance treatments) and Scomp (restorations survived even without maintenance treatments). RESULTS: The calculated overall survival percentage of the original restorations (Sorig) after four years was 63 +/- 6% (mean +/- SE). Calculation for the overall complete survival (Scomp) revealed a percentage survival of 57 +/- 6%. At both levels, the differences between the survivals of the investigated materials were not statistically significant (p-values > 0.05). Two abutments were lost, severe caries was the reason for one extraction and another abutment tooth was extracted for periodontal reasons. CONCLUSIONS: The results of this study did not point out a superior restorative material for the seal of root canal orifices of overdenture abutments. The distribution of failures over the patients indicates a certain patient dependency.

Composite Resins↗

PubMed1999

The shortened dental arch concept and its implications for oral health care.

The minimum number of teeth needed to satisfy functional demands has been the subject of several studies. However, since functional demands--and consequently the number of teeth needed--can vary from individual to individual, this minimum number cannot be defined exactly. In general, occlusion of a complete dental arch is preferable. However, this goal might be neither attainable, for general, dental or financial reasons, nor necessary. Many studies demonstrate that shortened dental arches comprising the anterior and premolar regions can meet the requirements of a functional dentition. Consequently, when priorities have to be set, restorative therapy should be aimed at preserving the most strategic parts of the dental arch: the anterior and premolar regions. This also implies that in cases of a shortened dental arch, the prompt replacement of absent posterior molars by free-end removable partial dentures leads to overtreatment and discomfort. The shortened dental arch concept is based on circumstantial evidence: it does not contradict current theories of occlusion and fits well with a problem-solving approach. The concept offers some important advantages and may be considered a strategy to reduce the need for complex restorative treatment in the posterior regions of the mouth.

Adult↗

PubMed1999

[Etiology of missing teeth].

This article gives a brief overview of the causes of tooth loss. Caries is still the most prominent reason for tooth loss. In patients over 40 years, periodontal reasons become more prevalent. However, also in this age category caries is the main reason. In young individuals, missing teeth are most frequently associated with agenesia or trauma. Iatrogenic damage is considered to be a casuistic cause of tooth loss. Nevertheless, some specific areas, such as in the combined treatment 'endodontic treatment--post and core--crown', can be distinguished in which tooth loss is more frequently seen.

Age Factors↗

PubMed1999

[Five year survival of posterior adhesive bridges. Influence of bonding systems and tooth preparation].

The present study reports the final analysis of a randomized controlled clinical trial in which different designs of posterior resin-bonded bridges were evaluated for a period of at least 5 years. The operational hypothesis was that the bonding system and the preparation design used in posterior resin-bonded bridges have an influence on the survival and clinical functioning of these restorations. Survival in this study was defined at two levels: (1) 'primary' survival (survival without any debonding), and (2) 'functional' survival (survival including loss of retention on one occasion and successful rebonding of the original resin-bonded bridge without further debonding). Preparation of grooves in abutment teeth for posterior resin-bonded bridges appeared to be beneficial to their chance of survival. Resin-bonded bridges placed in the maxilla have a better prognosis than those made in the mandible. The bonding systems used in this study (etching/Clearfil F2, sand blasting/Panavia EX and silica-coating/Microfill Pontic C) appear to have no influence on the chance of failure with regards to the 'primary' survival. In rebonded posterior resin-bonded bridges, the bonding system silica coating/Microfill Pontic C was more retentive than the other systems tested.

Acid Etching, Dental↗

PubMed1999

[Human tooth tissue as dental restorative material].

With the recent development of copy-milling systems for porcelain, it has now become possible to construct fitting restorations from natural human tooth substance. This preliminary study aimed to find out whether it is possible to produce a well fitting Class II inlay from an extracted tooth using a copy-milling machine, so that the inlay produced will have enamel over its whole outer surface and dentine on its inner surface. Two pairs of matching sound extracted permanent molars were used. The molars were matched for mesio-distal size of the tooth crown and the convexity of the approximal surfaces. One tooth of each pair was assigned to be the 'donor' tooth, the other tooth being the 'host'. MO inlay preparations were made in the 'host' teeth. These were restored with the milled 'natural inlays' produced from the 'donor' teeth using the CELAY system. The restored 'host' teeth were sliced and examined using light-microscopy. All specimens showed a good fit and the desired location of enamel and dentine. The milling accuracy was assessed in a second experiment. This experiment showed similar marginal gaps for 'natural inlays' as for ceramic inlays. This study has shown that by using the CELAY milling machine it is possible to 'recycle' extracted teeth for the production of accurate restorations.

Dental Cavity Preparation↗

PubMed1998

The novel use of extracted teeth as a dental restorative material--the 'Natural Inlay'.

OBJECTIVE: This preliminary study aimed to find out whether it is possible to produce a well fitting Class II inlay from an extracted tooth using a copy-milling technique. METHODS: Two pairs of matching sound extracted permanent molar teeth were used. The molars were matched for mesio-distal size of the tooth crown and the convexity of the approximal surfaces. One tooth of each pair was assigned to be the 'donor' tooth, the other tooth being the 'host'. MO inlay preparations were made in the host teeth. These were restored with the milled 'Natural Inlays' produced from the donor teeth using the CELAY system. The restored host teeth were sliced and examined using light-microscopy. RESULTS: The specimens showed the desired location of enamel and dentine, and a clinically acceptable fit. CONCLUSION: This study has shown that by using the CELAY milling machine it is possible to 'recycle' extracted teeth for the production of dental restorations.

Cementation↗

PubMed1998

Qualitative assessment of stress distribution during insertion of endodontic posts in photoelastic material.

OBJECTIVES: The purpose of this study was to investigate the stress patterns associated with prefabricated endodontic posts during the various stages of insertion according to a number of design characteristics. METHODS: In a photoelastic material with elastic properties comparable to dentin, analyses were performed of the overall stress patterns with polarized light revealing substantial differences in stresses generated by the various posts. The effects of variations in design for certain configurations of the posts were also assessed. RESULTS: One geometric feature was the retentive thread of the post. The stress patterns within the photoelastic material revealed a homogeneous distribution of stress along the entire length of the thread, and more threads induced additional stress. The stress recorded with a vent when the pitch of the thread was 0.8-1.0 mm was classified as minimal-to-mild stress. Another geometric feature considered was the head (coronal extension) of the post. Minimal stress was recorded in the material in contact with the head and the apical end of the post when the contact surface of head was more than 3 mm2. CONCLUSIONS: This study suggests that during insertion of threaded posts the least stress occurs when the head contact surface is sufficient (> or = 3 mm2). A thread with a pitch of 0.8-1.0 mm is most desirable in stress reduction. The number of windings should also be limited (less than six windings) as samples with a substantial number of windings (N = 13 or 30) produce severe stress.

Cementation↗

PubMed1998

Effect of composite basing on the resistance to bulk fracture of industrial porcelain inlays.

OBJECTIVES: Bases are used in restorative dentistry for several reasons (i.e. isolation, elimination of undercuts, etc). Glass ionomers are the standard materials used as bases for porcelain inlays, despite the disadvantages of their mechanical properties. An alternative basing material is composite: a generous layer of posterior composite is cured and shaped in the cavity before an impression is taken. The composite basing technique has several clinical advantages. The aim of this study was to investigate the effect of the thickness of a composite base on the bulk fracture resistance of industrial porcelain, and to describe the procedure. METHODS: Fifteen porcelain (P) and 15 composite (C) bars, 1-, 2-, and 3-mm thick were joined to form 15 C/P bars, all 4-mm thick. Three groups were created: C 1 mm/P 3 mm (group 1), C 2 mm/P 2 mm (group 2), and C 3 mm/P 1 mm (group 3). The pairs were joined using Twinlook cement, subjected to a three-point bending test and loaded to fracture. The beam theory was used to support and explain the results. RESULTS: The fracture load means were: group 1, 197.7 +/- 18.7 N; group 2, 234.3 +/- 63.3 N, group 3, 336.3 +/- 31.3 N. Group 3 was significantly stronger than group 1 (P = 0.01) and group 2 (P = 0.03). Groups 1 and 2 were not statistically different. CONCLUSION: Composite basing is a tissue conserving method which may significantly increase the resistance to bulk fracture of adhesive porcelain inlays.

Acid Etching, Dental↗

PubMed1998

Meta-analysis of anterior veneer restorations in clinical studies.

OBJECTIVES: To make an inventory of clinical studies on veneer restorations (VRs) using a meta-analysis review procedure and to aggregate an overall survival result for four types of VRs. METHODS: From the dental literature published from 1983 to November 1996, papers were selected using an in- and exclusion protocol in a two-step procedure. Additionally, the papers selected were subjected to a quality assessment. Although not all studies used an identical definition of 'failure of a restoration', this item was chosen to be the common study outcome. After a homogeneity test, cumulative survival curves were constructed by pooling the data from the studies. RESULTS: On a 0-1 scale, the weighted overall mean quality score of the studies was 0.57 (s.e. 0.09). There was adequate agreement between the independent assessors. The results of the quality assessment could not be used as weights for the survivals, but the quality outcome supports the description of the sample of studies. From the nine studies on porcelain VRs, the pooled cumulative proportion of survival after 3 years was 0.92 (s.e. 0.01) and from three studies on preformed acrylic VRs this figure was 0.74 (s.e. 0.03). From both direct and indirect resin composite VRs, data from only one study were available after 2.5 and 2 years, respectively. CONCLUSION: The evaluative and statistical basis of clinical VR studies may be improved to obtain an effective inference of the results. Furthermore, porcelain VRs show acceptable longevity after 3 years, which appears to be better than that of preformed acrylic VRs.

Acrylic Resins↗