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This Predictor Variables study is designed to determine which one of 11 factors evaluated may be correlated to Non-carious Loss of Cervical Tooth Tissues (NLCTT) using subjects with and without NLCTT. The ultimate objective is to successfully predict the path toward risky behaviors and reduce the incidence of NLCTT.
This pilot study evaluated the effect of removing acid-etch-exposed dentin collagen on the clinical performance of composite restorations of noncarious cervical lesions placed using 2 different adhesive systems. Fifty-six restorations were placed in 14 subjects, each subject receiving at least 4 restorations. No cavity preparation or mechanical retention form was used. The variables tested were: 1) dentin treatment prior to application of the adhesive (acid-etch only vs acid-etch and collagen removal) and 2) type of adhesive (acetone- vs ethanol-based). For the acid-etch only groups, enamel and dentin were etched with 37% phosphoric acid for 15 seconds, rinsed and blot dried. Prime & Bond 2.1 (Dentsply Caulk) or Single Bond (3M ESPE) was applied and light-cured according to the manufacturer's instructions. For the acid-etch and collagen removal groups, the enamel and dentin were etched and rinsed in the same manner and a 10% sodium hypochlorite (NaOCl) solution was applied for 60 seconds and rinsed before adhesive application. Filtek Z-250 (3M ESPE) was applied to all specimens and light-cured according to the manufacturer's instructions, and the restorations were finished and polished immediately. The restorations were evaluated for pre- and post-operative sensitivity, retention, marginal staining and secondary caries at baseline, 12 and 24 months after placement, using modified USPHS criteria. Data were analyzed using the Kruskal-Wallis and Wilcoxon statistical tests (p=0.05). At 24 months, the retention rates for Prime & Bond 2.1 with and without NaOCl pretreatment were 80% and 63%, respectively. The corresponding retention rates for Single Bond were 70% and 90%. Marginal staining was minimal. Statistical analyses revealed no significant differences at any time interval between groups for retention or marginal staining. No post-operative sensitivity or secondary caries was detected during the study.
AIM: To comparatively assess the 5-year clinical performance of a 1-bottle adhesive and resin composite system with a resin-modified glass ionomer restorative in non-carious cervical lesions. METHOD AND MATERIALS: One operator placed 70 restorations (35 resin modified glass ionomer restorations and 35 resin composite restorations) in 30 patients under rubber dam isolation without mechanical preparation. The restorations were directly assessed by 2 independent examiners, using modified USPHS criteria at baseline and 6, 12, 24 and 60 months. RESULTS: Twenty-two patients were available for recall after 5 years (73.3% recall rate) and 55 out of 70 restorations were evaluated. Excellent agreement was registered for all criteria between examiners (kappa > or = 0.85). Sixteen composite restorations were dislodged (51.5% retention) and 1 ionomer restoration was lost (96.4% retention). The McNemar test detected significant differences in resin composite restorations between baseline and 5-year recall for marginal integrity (p<0.001) and retention (p=0.004). For resin modified glass ionomer restorations, no significant differences were identified for all criteria (p>0.05). When comparing both materials, the Fisher exact test pointed out significant differences in retention (p=0.002) after 5 years of clinical service. CONCLUSIONS: After 5 years of evaluation, the clinical performance of resin modified glass ionomer restorations was superior to resin composite restorations.
Bleaching tetracycline-stained teeth is the most challenging form of tooth lightening. This article reports on 44 subjects who bleached their tetracycline-stained teeth for 6 months using trays with reservoirs overnight in a half-mouth designed study and 2 of 3 different concentrations of carbamide peroxide (10%, 15% or 20%). The subjects were followed for 5 years. The area evaluated was the middle third of the teeth. More than 55% of tooth lightening occurred within 1 month; after 5 years, more than 65% of the maximum tooth whitening remained for all 3 gel concentrations. Tooth whitening can be accomplished with any of the 3 concentrations used.
This study reports on the causative factors of dental erosion in selected high- (n = 19) and low-erosion (n = 19) subgroups of a larger random sample (n = 95) of young male Saudi military inductees. By means of a questionnaire, the role of various possible factors related to oral health in general, and to dental erosion in particular, was assessed for each participant. Clinical examination included recordings of severity of dental erosion and fluorosis, presence of buccal cervical defects and first permanent molar 'cuppings', DMFT and DMFS, visible plaque index, and gingival bleeding index. In addition, bitewing radiographs, study casts, and intraoral color transparencies were obtained for each individual. Logistic regression analysis showed a strong correlation between the presence of dental erosion and a high level of consumption of cola-type soft drinks. Other statistically significant associated factors, although of less predictive strength, were type of cleaning aid and gingival bleeding index. In subgroup comparisons, dental problems (primarily pain), number of buccal cervical defects, and number of missing teeth were significantly greater in the high- than in the low-erosion subgroup.
Scanning electron microscopy was used to study the effect of cyclophosphamide (Cy) on molar development in 18 Sprague-Dawley rats from 15 to 48 days of age after birth. Doses of 30 mg/kg body weight of Cy dissolved in 1 ml 0.9% NaCl were given to the rats at 10 and 13 days of age. Eighteen control rats had injections of 1 ml 0.9% NaCl at the same ages. The most obvious changes in the experimental teeth were found in the developing roots of the first and second molars and in both the crown and roots of the third molar. The roots of the first and second molars were short and showed apical closure in the experimental rats. In addition to the disturbances in crown and root formation, the third molars were also significantly reduced in total size as compared with the third molars in the control rats.
The aim of the present study was to describe some histopathologic features of tissues collected from root resorption areas of maxillary canines after transalveolar transplantation surgery. In 8 of 101 transplanted canines, complications including cervical root resorption occurred between 6 and 11 years after treatment. The resorptive processes were located at the supra-alveolar portions of the distal and/or mesial aspects of the teeth and were scheduled for treatment involving surgical exploration. The resorption cavities, which extended from the cementoenamel junction to a position immediately below the bone crest, were filled with a granulation tissue. In four of the diagnosed complication cases, this granulation tissue was carefully excised concomitant with the adjacent gingival tissue after flap elevation and placed in a buffered fixative. After proper soft-tissue healing, the cavities were filled with a glass-ionomer material. The collected biopsy specimens were, after fixation and, in one case, decalcification in ethylenediaminetetraacetic acid, dehydrated and embedded in Epon. Sections 3 microns thick were produced, stained in periodic acid-Schiff and toluidine blue, and used for histometric and morphometric analyses. The histologic analysis showed that the dissected tissue harbored well-encapsulated areas of inflammatory infiltrates. The lesions comprised a relatively low volume of collagen and a large number of inflammatory cells, predominantly lymphocytes.
The purpose of this study was to investigate the effects of the location and orientation of dentinal tubules in the tooth on tensile strengths of the dentin. Dumbbell-shaped specimens of 12 groups from various locations and dentinal tubule orientations were prepared. The tensile test was performed in distilled water at a temperature of 37 degrees C. The tensile strengths of the parallel to the orientation were significantly greater than those of the perpendicular to the orientation; the tensile strengths of the radicular dentin were significantly greater than those of the coronal dentin. Nevertheless, in the radicular dentin, the tensile strengths of the perpendicular to dentinal tubules differ with respect to tensile forces. These results suggest that tensile strength of the dentin varies according to the location and orientation of dentinal tubules in the tooth.
AIM: To assess the percentage of root coverage with autogenous free gingival grafts. MATERIALS & METHODS: Ten non-smoking patients with Miller's class I or class II recessions were included in the study. The clinical parameters such as recession depth, recession width, probing pocket depth, clinical attachment level and width of the keratinized gingiva were recorded at the baseline, at the end of 1 month, 3 months, and 6 months after the surgical procedure. Autogenous free gingival grafts harvested from the palatal mucosa were used to cover the denuded roots. RESULTS: Four out of ten sites showed 100% root coverage. A mean percentage of 80.3% of root coverage was achieved.
The present cross-sectional investigation examined the relationship between proximal caries/defective restorations, dental plaque and gingival indices and the distance of the cemento-enamel junction to the alveolar bone crest (CEJ-ABC). Three hundred and eight children aged 7 years were examined. Proximal caries and defective restorations were diagnosed in bite-wing radiographs. CEJ-ABC was measured on radiographs using a Boley gauge. Dental plaque and gingivitis were recorded clinically by their presence or absence. Multiple linear regression was used for the statistical analyses. The results showed significantly association between the proximal caries index and CEJ-ABC. Dental plaque, gingivitis and gender were not associated significantly with CEJ-ABC.
Tooth resorption is a common sequela following injuries to or irritation of the periodontal ligament and/or tooth pulp. The course of tooth resorption involves an elaborate interaction among inflammatory cells, resorbing cells, and hard tissue structures. The key cells involved in resorption are of the classic type, which include osteoblasts and odontoclasts. Types of tooth resorption include internal resorption and external resorption. There are two types of internal resorption: root canal (internal) replacement resorption and internal inflammatory resorption. External resorption can be classified into four categories by its clinical and histologic manifestations: external surface resorption, external inflammatory root resorption, replacement resorption, and ankylosis. External inflammatory root resorption can be further categorized into cervical resorption with or without a vital pulp (invasive cervical root resorption) and external apical root resorption. Other variations of resorption include combined internal and external resorption and transient apical breakdown.
Invasive cervical resorption is a relatively uncommon form of external root resorption. There may be no external signs, and the resorptive condition is often detected by routine radiographic examination. Where the lesion is visible, the clinical features vary from a small defect at the gingival margin to a pink coronal discoloration of the tooth crown resulting in ultimate cavitation of the overlying enamel. The condition is usually painless unless pulpal or periodontal infection supervenes. Radiographic features of lesions vary from well-delineated to irregularly bordered mottled radiolucencies, and these can be confused with dental caries. A characteristic radiopaque line generally separates the image of the lesion from that of the root canal, because the pulp remains protected by a thin layer of predentin until late in the process. Histopathologically, the lesions contain fibrovascular tissue with resorbing classic cells adjacent to the dentin surface. More advanced lesions display fibro-osseous characteristics with deposition of ectopic bonelike calcifications both within the resorbing tissue and directly on the dentin surface. Secondary invasion of microorganisms into the pulp or periodontal ligament space will elicit a normal inflammatory response.
OBJECTIVE: An investigation was undertaken to assess potential predisposing factors to invasive cervical resorption. METHOD AND MATERIALS: A group of 222 patients with a total of 257 teeth displaying varying degrees of invasive cervical resorption were analyzed. Potential predisposing factors, including trauma, intracoronal bleaching, surgery, orthodontics, periodontal root scaling or planing, bruxism, delayed eruption, developmental defects, and restorations were assessed from the patients' history and oral examination. RESULTS: Of the potential predisposing factors identified, orthodontics was the most common sole factor, constituting 21.2% of patients and 24.1% of teeth examined. Other factors were present in an additional 5.0% of orthodontically treated patients (4.3% of teeth), and these consisted principally of trauma and/or intracoronal bleaching. Trauma was the second most frequent sole factor (14.0% of patients and 15.1% of teeth). Trauma in combination with intracoronal bleaching, orthodontics, or delayed eruption constituted an additional 11.2% of patients (10.6% of teeth). Intracoronal bleaching was found to be the sole potential predisposing factor in 4.5% of patients and 3.9% of teeth, and an additional 10.4% of patients and 9.7% of teeth showed a combination of intracoronal bleaching with trauma and/or orthodontics. Surgery, particularly involving the cementoenamel junction area, was a sole potential predisposing factor in 6.3% of patients and 5.4% of teeth. Periodontal therapy, including deep root scaling and planing, showed a low incidence, as did other factors, such as bruxism and developmental defects. The presence of an intracoronal restoration was the only identifiable factor in 15.3% of patients and 14.4% of teeth, while 15.0% of patients and 16.4% of teeth showed no identifiable potential pedisposing factors. CONCLUSION: These results indicated a strong association between invasive cervical resorption and orthodontic treatment, trauma, and intracoronal bleaching, either alone or in combination.
PURPOSE: This study was undertaken to compare the clinical performance of a polyacid-modified resin-based composite and a resin-modified glass-ionomer restorative material over 1 year. MATERIALS AND METHODS: Thirty-four pairs of restorations of Compoglass (C) and Fuji II LC (F) were placed in 31 patients, with no patient receiving more than two pairs, and with materials assigned at random within the pairs. Caries-free cervical erosion/abfraction lesions of the facial surface were restored without tooth preparation according to manufacturers' instructions, except that tooth structure to be restored was etched with 37% phosphoric acid prior to placement of Compoglass. Restorations were clinically evaluated by two blinded examiners at baseline, 6 months, and 1 year, using modified Ryge/USPHS criteria. Restorations receiving a score of "Charlie" in either retention or secondary caries were classified as failed restorations. The incidence of failures was statistically analyzed as a pairwise comparison, using an exact binomial test. RESULTS: Thirty-one pairs of restorations were available for recall at 1 year. The percentage of Alfa scores for each material in each category were: Retention (C = 84%, F = 100%), Color match (C = 81%, F = 100%), Marginal discoloration (C = 78%, F = 97%), Secondary caries (C = 88%, F = 100%), Anatomic form (C = 92%, F = 100%), and Marginal adaptation (C = 26%, F = 46%). Except for the failed restorations, no other Charlie scores were assigned. A significant difference in the incidence of failed restorations was found between the materials (P = 0.01).
OBJECTIVE: The purpose of this study was to compare the esthetics of 3 resin-modified glass-ionomer materials and 1 polyacid-modified resin composite to the esthetics of a conventional glass-ionomer control material. METHOD AND MATERIALS: One hundred eighty-seven Class V cervical restorations were observed clinically over 18 months. The esthetic index system that was used evaluated color match, translucency or opacity, and surface roughness. RESULTS: The tested materials behaved very dissimilarly and inconsistently. In general, the esthetic results of the resin-modified glass-ionomer materials and the polyacid-modified resin composite were far from optimal. The esthetic appearance of restorations seriously deteriorated during clinical service, mainly because of discoloration of margins, changes in translucency and opacity, and rapidly appearing roughness or dullness on the surface. Both the resin-modified glass-ionomer materials and the polyacid-modified resin composite evaluated in this study performed better esthetically than did the conventional glass-ionomer material. CONCLUSION: Indications for these combination materials are limited to areas where esthetics is not a primary concern but where their ease of application may guarantee a more durable functional result.
PURPOSE: The aim of the study was to access the clinical performance of two esthetic materials (Vitremer and Z100 + Scotchbond Multipurpose) when used as Class II restorations in primary molars, and compare them to amalgam controls. METHODS: A total of 102 restorations were placed in primary molars of 29 schoolchildren; 40 were of Vitremer, 38 of Z100 + Scotchbond Multipurpose, and 24 of amalgam (Dispersalloy). The restorations were evaluated clinically at baseline and after 6, 12, 18, 24 months, or until tooth exfoliation or patient drop-out, following the modified Cvar and Ryge criteria. Radiographs were taken at yearly intervals, and the radiograph of the last examination available was assessed and scored. RESULTS: The majority of the restorations examined clinically up to 18 months was good (Alpha according to Cvar and Ryge), and no statistically significant differences between the groups was observed. However, at the 19-24 months evaluation, Z100 rated better than Vitremer for surface appearance and color match. The prevalence of radiolucent defects at the cervical margin for the Z100 (47%) was significantly higher than for amalgam (11%) restorations (P = 0.002) and for Vitremer (13%) restorations (P = 0.008). CONCLUSION: The three materials evaluated (Vitremer, Z100 and Dispersalloy) presented satisfactory clinical performance during the time evaluated (approximately 2 years). Approximately half of the composite resin restorations presented radiographic defects that might require replacement at a later date. In contrast, glass ionomer and amalgam restorations presented significantly less radiographic defects at the time of the final examination. This study suggests that composite resins are indicated for classII restorations in primary molars that are expected to exfoliate within two years.
Night-time use of extra-oral traction for anchorage may cause jiggling, rotational and extrusional forces. The purpose of the study was to test the hypothesis that headgear forces in an anchorage system may increase the risk of radiographically detectable root resorptions on molar teeth. Twenty-one patients were selected among patients planned for orthodontic treatment, in which there was a need of anchorage in a full-bond appliance during a period of at least 6 months. An experimental group of 11 patients was given reinforcement anchorage in the maxilla with an extra-oral traction (cervical-pull) during night. Ten patients in a control group was given anchorage by a Goshgarian palatal bar, or by Class II-elastics. Periapical radiographs were taken of the upper first molars according to a standardised technique at the start of treatment, and at 3 and 6 months. Recordings included also patient compliance, force evaluation and the measurement of tooth movement. Significant reduction of root length was shown for some roots already after 3 months. However, mean root resorption after 6 months did not exceed 0.6 millimeter in any upper first molar root of the present sample. The degree of root resorption was similar in the experimental and the control groups. The hypothesis of a significant effect on root resorption of upper first molars by night-time use of extra-oral traction for a 6 month period was rejected. It is concluded that patients given anchorage by night-time use of extra-oral traction will show similar degrees of root resorption of the upper molars as those in which anchorage is given by a Goshgarian bar or Class II elastics.
The condition of delayed or altered passive eruption exists in adults when the gingival unit remains positioned on the convex prominence of the enamel rather than at or in proximity to the cementoenamel junction. Treatment protocol is based on periodontal, esthetic, and prosthetic considerations. In addition, the gingival/osseous relationship becomes important for proper diagnosis and treatment. The purpose of this article is to increase awareness of the pathognomonic signs and symptoms of delayed passive eruption so that appropriate treatment can be rendered.