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Biomedical subjects

Terry E Donovan

Publications and source records attributed to Terry E Donovan.

13 recordsLinked to original sources
PubMed2006

Longevity of the tooth/restoration complex: a review.

The contemporary dentist has a wide variety of materials to utilize in the restoration of defective teeth. The decision as to which restorative approach should be utilized in any given clinical situation is a joint one between the patient and the treating dentist. The dentist's primary obligations are to understand the indications and contraindications of various materials, understand how to optimally manipulate those materials, and educate the patient so that they make intelligent decisions and give proper informed consent. The ultimate decision as to which approach to use rests with the patient, and the patient must clearly understand the benefits and risks associated with different restorative options. Clearly, one of the important considerations with any treatment is the prognosis and restoration longevity. When attempting to predict the long-term prognosis of any restoration, it is important to consider both the restorative material being considered as well as the specific tooth that is being restored. Many times the amount of remaining tooth structure has a more significant bearing on long-term prognosis than what material is used for restoration. Thus, the tooth/ restoration complex must be considered as a whole when predicting potential longevity. Many clinical trials have been conducted to attempt to answer those questions, and relatively few unbiased, unambiguous answers are available. The only completely honest answer to those questions is "It depends". This is because the prognosis of all restorative therapy depends on the complex interaction of a number of variables, some of which are controlled by the dentist, and some of which are totally out of the dentist's control. This article will attempt to delineate some of the factors related to the long-term prognosis of the tooth/restoration complex, and specifically identify factors that decrease the prognosis of the tooth/restoration complex.

Bruxism↗
PubMed2006

The selection of contemporary restorative materials: anecdote vs. evidence-based?

The contemporary practitioner is faced with a bewildering number of options from which to choose when selecting restorative materials. There are not only many different types of materials available, but also numerous options for any given group of materials. For example, many manufacturers offer their customers three or even four different dentin bonding agents. The sheer number of available products is in itself overwhelming. When coupled with aggressive marketing strategies, misinformation supplied by paid clinicians at many seminars and lectures, and infomercials disguised as scientific articles in many of the trade journals, it is little wonder that the average ethical practitioner is frustrated when attempting to make rational choices. Clinicians use information gleaned from a variety of sources to make these difficult decisions. This article will attempt to evaluate the validity of these sources and will provide a philosophical matrix to assist the practitioner in making rational decisions relative to materials selection.

Clinical Competence↗
PubMed2006

Selection of luting agents, part 1.

The clinical success of indirect restorations is dependent on multiple factors that include preparation design, mechanical forces, restorative material selection, oral hygiene, and selection of a proper luting agent. The selection of the luting agent is dependent on the specific clinical situation, the type of restoration utilized and the physical, biologic, and handling properties of the luting agent. Although it is important to choose the best luting agent for each clinical situation, far greater variations in physical properties result from improper manipulation of a given luting agent than exist between different types of cements. One study listed loss of retention as the third-leading cause of prosthetic replacement, with failure occurring after only 5.8 years in service. The primary purpose of the luting procedure is to achieve a durable bond and to have good marginal adaptation of the luting material to the restoration and tooth. Conventional cements have always relied upon retention and resistance forms in tooth preparations; Adhesive-type luting agents offer the clinician an added advantage by bonding to the tooth structure. Three main types of conventional "cements" are commonly used, zinc phosphate and the polyelectrolyte cements polycarboxylate, and glass ionomer cements. Because of its long history of successful clinical use, zinc phosphate is considered the gold standard against which all other luting agents are compared because of its long clinical history of successful use. Currently, two additional types of luting agents have gained considerable popularity. These include the resin-modified glass ionomer cements and resin cements. The resin cement category includes light-cured, dual-cured and chemically cured agents. The purpose of this article is to discuss the ideal attributes of a luting agent and make clinical recommendations for their use.

Adhesiveness↗
PubMed2004

Current concepts in gingival displacement.

Gingival displacement is an important procedure with fabricating indirect restorations. Gingival displacement is relatively simple and effective when dealing with healthy gingival tissues and when margins are properly placed a short distance into the sulcus. Several techniques have proven to be relatively predictable, safe,and efficacious. No scientific evidence has established the superiority of one technique over the others, so the choice of technique depends on the presenting clinical situation and operator preference.

Astringents↗
PubMed2004

Cervical margin design with contemporary esthetic restorations.

The contemporary dentist has a wide variety of options to use in the restoration of extensively damaged or previously restored teeth. Metal-ceramic and all-ceramic crowns are frequently used to restore esthetics and function. One of the essentials for success with either option is proper tooth preparation, which includes proper selection and preparation of the cervical margin of the preparation.

Ceramics↗
PubMed2004

A review of contemporary impression materials and techniques.

The contemporary restorative dentist has a host of impression materials available for making impressions in fixed prosthodontics,implant dentistry, and operative dentistry. With proper material selection and manipulation, accurate impressions can be obtained for fabrication of tooth- and implant-supported restorations. This article outlines the ideal properties of impression materials and explains the importance of critical manipulative variables. Available impression materials are analyzed relative to these variables, and several "specialized" impression techniques are described. Special attention is paid to polyvinyl siloxane impression materials because they have become the most widely used impression material in restorative dentistry.

Chemical Phenomena↗
PubMed2004

Promising indeed: the role of "experts" and practitioners in the introduction and use of new materials and techniques in restorative dentistry.

Contemporary general practitioners are facing enormous challenges. Whether they want to or not, they are forced to manage a complex small business and are often ill equipped educationally and emo- tionally to do so. They also have to manage a substantial number of staff members, often with complex emotional interactions. Young dentists today are frequently forced to service considerable debt as a result of educational costs and high practice overheads. Manufacturers and dental laboratories are aggressively marketing new products and procedures at an unprecedented rate, often with sophisticated marketing techniques. These practitioners also have lives outside of work as wives or husbands, fathers or mothers, scout leaders, and coaches. Although contemporary clinicians are faced with many challenges, they also must accept some responsibilities regarding new products and practices. They must possess critical thinking skills and a basic knowledge of materials science. Whether contemporary dental schools provide their students with an education that stimulates this is a topic for another editorial. Educationally prepared or not, practitioners should filter information through common sense and past experience. New products should be introduced to the practice carefully and used in a conservative manner. These overstressed individuals deserve the best possible information from those of us who are considered experts. We cannot continue to be politically correct when describing new products and materials. We need to call it the way it is. Those who are considered experts have achieved that status through a combination of hard work, talent, luck, and perhaps some sleight of hand. There are legitimate rewards to be reaped as an expert, but with those come responsibilities. Referring to products with no clinical testing or evidence-based foundation as "promising indeed" does not meet those responsibilities.

Dental Materials↗
PubMed2003

Esthetic considerations with removable partial dentures.

The reduction in partial edentulism that has occurred due to successful preventive procedures and the predictable use of osseointegrated implants has reduced the need for removable partial dentures. However, for a variety of reasons, many patients can continue to benefit from partial denture therapy; and these patients deserve the best esthetic result possible. The primary esthetic objection to removable partial denture therapy is the unsightly display of the clasp assemblies. This article describes three strategies that can be used by the discriminating clinician to eliminate the display of the clasp assembly and provide an esthetic and functional removable prosthesis.

Dental Clasps↗
PubMed2003

The role of all-ceramic crowns in contemporary restorative dentistry.

A large number of all-ceramic alternatives to metal-ceramic restorations are being marketed aggressively to the dental profession. Most of these all-ceramic alternatives have little or no scientific evidence to support their use. This article present guidelines for clinicians to analyze new ceramic systems and specific indications and contraindications for use. It is suggested that before practitioners consider using an all-ceramic system, they make sure that published clinical trials document a survival rate of at least 95 percent over five years. In addition, each system should be evaluated to determine whether it delivers the esthetic results anticipated.

Crowns↗