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Glass ionomer restoratives.

This article gives an overview of the new hybrid (light-cured) glass ionomers, which are a combination of auto-cured glass ionomer and light-cured composite resin. The characteristics of these materials and the different brands available are discussed. A clinical technique for restoration of cervical lesions with these materials is presented.

Acrylic Resins↗

Clinical evaluation of five adhesive systems.

One hundred cervical "abrasion/erosion" lesions were restored in groups of twenty with All-Bond, Photobond, Denthesive, and Pertac dentin adhesives with resin composite, and Geristore resin-based material. The mean patient age was 63 years. All but seven restoration sites were examined for up to approximately 14 months, and the cumulative retention rates of restorations calculated. At the end of the observation period, the percentage of restorations retained was; All-Bond 69.6%, Photobond 78.2%, Denthesive 42.8%, Pertac 7.5%, Geristore 71.8%, which was in approximate quantitative agreement with laboratory bond strength studies. The relationship of laboratory bond strength tests to clinical performance, and the influence of patient age on the clinical results, are discussed.

Adult↗

Marginal sealing ability of three cervical restorative systems.

The purpose of this in vitro study was to evaluate the enamel and dentinal marginal sealing ability of three different cervical restorative systems. Class V preparations were made at the cementoenamel junction of 36 freshly extracted premolars. The teeth were randomly divided into three groups of 12 and restored with either a polyacid-modified resin composite ("compomer"), resin composite, or resin-modified glass-ionomer cement. The restored teeth were stored in saline at 37 degrees C for 1 week, thermally stressed for 500 cycles, and subjected to dye penetration testing. The results showed that there was no significant difference in dentinal margin sealing ability among the three materials evaluated. When the margins were in enamel, the resin composite restorations had significantly less leakage than did compomer or resin-modified glass-ionomer cement restorations. The marginal sealing ability of all three materials was significantly poorer in dentin than in enamel.

Analysis of Variance↗

Factors associated with clinical success of cervical abrasion/erosion restorations.

The purpose of this study was to evaluate the clinical performance of class 5 restorations according to USPHS criteria. Twenty-five patients and 116 abrasion/erosion lesions were restored with either a glass-ionomer cement restoration (Ketac-Fil), a composite resin restoration with a dentin bonding agent (Silux Plus, Scotchbond 2), or a composite resin restoration with a dentin bonding agent and a glass-ionomer liner (Silux Plus, Scotchbond 2, Vitrebond). At 3 years, 24 patients and 110 teeth were evaluated. All restorations were rated clinically acceptable for color match, cavosurface discoloration, surface texture, and caries development. Glass-ionomer cement restorations demonstrated a slightly rougher surface texture than the composite restorations (Friedman Two-way ANOVA, P=0.000). Significant differences were found with retention (Cochran Q test, P=0.012). Percentages retained were: glass ionomer, 97.3% (36/37); composite/dentin bonding agent, 75.7% (28/37); composite/dentin bonding agent/glass-ionomer liner, 100% (36/36). At 3 years class 5 restorations of glass-ionomer cement or composite with a dentin bonding and a glass-ionomer liner demonstrated significantly better retention than restorations of composite with a dentin bonding agent. Increased occlusal function, mobility, and mandibular arch were associated with a decrease in retention rate.

Aged↗

Retrospective audit of patients with advanced toothwear restored with removable partial dentures.

The dental records of 50 patients with advanced tooth wear restored with removable prostheses were examined. Retrospective data were collected with regard to source of referral, presenting complaint, aetiological factors, clinical features, dentures provided, details of failures and maintenance. The maximum follow up period was three years. The ratio of male to female patients was 4:1 and the age range 31-75 years. Failures were recorded in 38% of patients with provisional and 64% with definitive dentures. The most common failure was fracture or wear of the incisal or occlusal surfaces. The majority of failures were addressed by adjustment of the dentures and the audit confirmed the need for regular maintenance.

Adult↗

Management of the short clinical crown by indirect restorations.

This paper describes the acute and chronic causes of short clinical crowns and their management. Fracture or trauma are common causes of acute failures whilst toothwear is the most common cause for chronic causes. There are many methods of restoring teeth using conventional indirect techniques, which may alter the existing occlusal vertical dimension (such as orthodontic Dahl appliances), or conserving the vertical dimension by increasing the length of the teeth. These methods are described and illustrated to assist the practitioner choose the most appropriate restoration.

Crown Lengthening↗

Esthetics and vertical tooth position: orthodontic possibilities.

Throughout the 1990s, esthetic dentistry has become a prominent part of the treatment protocol of most dentists. Patients have become more conscious of the benefits of a beautiful smile and are willing to invest time and money to improve the appearance of their teeth. Many of these patients can be treated with routine restorative procedures (crowns, composites, laminates) to achieve the desired results. However, some patients have problems with tooth position that create significant discrepancies in gingival levels which can compromise the esthetic result of restorative dentistry. Prerestorative orthodontic therapy can often resolve these tooth position problems and enhance the esthetic restoration. This article describes the indication, methods, and results achieved when orthodontics preceded restorative dentistry in the treatment of various esthetic challenges.

Adult↗

Non-carious cervical lesions.

Non-carious cervical lesions are commonly encountered in clinical practice and present in a variety of forms. A knowledge of the aetiology of these lesions is important for preventing further lesions, halting progression of lesions already present, and determining appropriate treatment. The most commonly cited aetiological factors thought to lead to the development of cervical lesions are erosion, abrasion and tooth flexure. Evidence supports a multifactorial aetiology for non-carious cervical lesions. The purpose of this paper is to review the evidence for each of these aetiological factors as it relates to the development of non-carious cervical lesions. Specific features of cervical lesions linked to these factors, including their morphology, location, prevalence and distribution by age and sex will be discussed. Suggestions for future research into the cause and prevention of non-carious cervical lesions will be presented.

Dental Occlusion, Traumatic↗

Cervical tooth wear and sensitivity: erosion, softening and rehardening of dentine; effects of pH, time and ultrasonication.

BACKGROUND: Cervical dentine wear is commonly observed and may be associated with dentine hypersensitivity. Erosion is thought to play a part in both conditions but compared to enamel has been little studied in dentine. AIM: The aims of these studies in vitro were to: (i) determine the effects of citric acid on dentine at different pH values and over time; (ii) measure the depth of dentine demineralisation or softening using ultrasonication; (iii) determine whether softened dentine can be remineralised or rehardened using artificial saliva. METHODS: Groups of flat dentine specimens prepared from unerupted human third molar teeth were: (a) exposed to citric acid at pH 3.2 for periods up to 4 h with mineral water as control; (b) exposed to citric acid at pH 2.54, 3.2, 4.5, 5.5 and 6.0 for 2 h and then subjected to ultrasonication stepwise up to 480 s; (c) exposed to citric acid at pH 2.54, 3.2, and 4.5, placed into artificial saliva for 24 h and then subjected to ultrasonication as in (b). Loss of dentine was measured by profilometry, after, each phase of erosion, ultrasonication and immersion in artificial saliva. RESULTS: Depth of erosion significantly increased non-linearly with time and significantly decreased with increasing pH. Ultrasonication had minimal albeit significant effects on control specimens. Removal of softened dentine increased with ultrasonication time. Depth of softening significantly increased with increasing erosion time to 2 h, plateauing at 2 microm. Depth of softening increased to 2 microm from pH 2.54 to pH 3.2 and decreased at higher pH values thereafter. 24 h in artificial saliva provided no protection to the soften zone against ultrasonicaion. Citric acid at all pH values and exposure times removed the dentine smear layer to expose tubules. Ultrasonication did not remove the smear layer on control specimens but removed all deposits formed after exposure to artificial saliva. CONCLUSION: It is concluded that dentine is susceptible to erosion even at relatively high pH, the tubule system is readily exposed and dentine, unlike enamel, shows little propensity to remineralise.

Analysis of Variance↗

Case-control study of non-carious cervical lesions.

An exploratory case-control study of non-carious cervical lesions was undertaken to examine the effects of a variety of risk factors. Candidate exposure variables were related to erosion, abrasion, and tooth flexure, the three principal putative causal mechanisms for cervical lesions. Because previous studies have tended to focus on specific causal mechanisms, evidence for a multifactorial etiology is inconclusive. Data describing exposure factors were obtained through clinical examination, dietary and behavioral questionnaires, and analysis of study casts from 264 subjects (137 cases, 127 control). Salivary data were also obtained for a subset of these subjects. Patient and tooth-level logistic regression models were constructed for the full subject group, and the subset with salivary data. For the two patient-level models, only exposures related to brushing entered. For tooth-level models, multiple exposures representing all three causal mechanisms were included in both models. The results suggest that non-carious cervical lesions do have a multifactorial etiology, and that multiple causal mechanisms may operate in the initiation and progression of individual lesions.

Adult↗

Diet and general health: dietary counselling.

Dietary guidelines are designed to maintain an adequate intake of nutrients and to protect against diet-related disease, particularly cardiovascular disease and obesity. Current population dietary guidelines advocate a reduction in total fat intake, particularly saturated fat intake, to 25-35% of the energy intake and an increased intake of carbohydrate to more than 55% of the dietary energy intake, which should mainly be derived from starch. There is a positive relationship between total sugar intake and the incidence of dental caries where dental hygiene is poor and exposure to fluoride is low. However, this relationship is stronger for frequency of consumption of sugary foods. The frequent consumption of acidic food and beverages should be also avoided as this can result in erosion of the tooth enamel. Risk of caries can be minimised by good oral hygiene, appropriate exposure to fluoride and by restricting the intake sugar containing snacks between meals to no more than four occasions per day. A need for randomized controlled trials to assess the effectiveness of dietary modification on oral health in adults is identified.

Coronary Disease↗

Dental erosion in a population of Swiss adults.

The purpose of this study was to determine the prevalence of dental erosion in an adult population in Switzerland. 391 randomly selected persons from two age groups (26-30 and 46-50 yr) were examined for frequency and severity of erosion on all tooth surfaces. Information was gathered by interview about lifestyle, dietary and oral health habits. For facial surfaces 7.7% of the younger age group and 13.2% of the older age group showed at least one tooth affected with erosion with involvement of dentin (grade 2). 3.5 teeth per person in the younger and 2.8 teeth per person in the older age group were affected. Occlusally, at least one severe erosion was observed in 29.9% of the younger and 42.6% of the older sample with 3.2 and 3.9 erosion-affected teeth per person, respectively. 3.6% of the younger age group and 6.1% of the older age group showed slight lingual erosion on the maxillary anterior teeth. Severe lingual erosions were scarce. Data from interviews and multiple regression analyses revealed that acids from beverages are significantly associated with presence of erosion.

Adult↗

Epidemiological studies of tooth wear and dental erosion in 14-year-old children in North West England. Part 1: The relationship with water fluoridation and social deprivation.

OBJECTIVE: The effect of water fluoridation upon dental erosion/tooth wear in the UK has not been investigated. This study aimed to compare the prevalence of tooth wear in 14-year-old schoolchildren in non-fluoridated and fluoridated districts of North West (NW) England. The influence of deprivation and tooth brushing was also investigated. DESIGN: A random sample of 10% of the 14-year-old population in NW England was selected and stratified according to fluoridation status as determined from water authority postcode listings. METHODS: Tooth wear was scored on the labial, incisal and palatal/lingual surfaces of the 12 anterior teeth and the occlusal surfaces of the first molars. Enamel wear was scored 0, dentine was scored 1 or 2, dependent on whether less than or more than a third of the surface had exposed dentine. Secondary dentine or pulpal exposure scored 3. Townsend deprivation scores were gained from residential post codes. RESULTS: A total of 2,351 children were examined, of which 637 (27%) lived in the one fluoridated district of South Cheshire and 1,714 (73%) lived in 11 non-fluoridated districts. Fifty-three per cent of the children had exposed dentine with significantly more males affected than females (p<0.001). In the fluoridated district, significantly fewer children had exposed dentine on labial and palatal smooth surfaces (p<0.001) but no differences were found for incisal and occlusal surfaces. The interaction of fluoridation and tooth brushing twice per day resulted in a significant (30%) reduction in erosion. Smooth surface wear was more prevalent in children resident in affluent areas. CONCLUSION: Children in non-fluoridated districts are 1.5 times more likely to have smooth surface wear compared with children in fluoridated districts. Fluoridation and use of fluoridated toothpaste twice a day provide added protection from dental erosion. The risk of tooth wear is greater with increasing affluence.

Adolescent↗

Prevention of erosion and abrasion by a high fluoride concentration gel applied at high frequencies.

The aim of this study was to determine maximum attainable protection of enamel from erosion and erosion abrasion using a highly fluoridated gel with and without additional fluoride from toothpaste. Thirty-six bovine enamel specimens were subjected to six erosive attacks per day (1% citric acid with pH 2.3 for 30 s), while the rest of the day the specimens were in artificial saliva. There were four treatment groups (9 specimens in each group): fluoride-free toothpaste/saliva slurry twice daily (group T0), fluoride-containing toothpaste/saliva slurry twice daily using 1,250 ppm F toothpaste (group TF), fluoride-containing toothpaste/saliva slurry twice per day plus application of a highly fluoridated gel (12,500 ppm F) twice a day for 120 s (group 2F) and a group with gel application 8 times a day (group 8F). Additionally, half of each specimen in all groups was subjected to brushing abrasion during application of the toothpaste/saliva slurry. Brushing abrasion alone led to no observable enamel loss measured with profilometry. After 14 days of cycling of erosion without toothbrushing abrasion, high-fluoride gel application 2 or 8 times daily showed significantly less enamel loss (median 24/19 microm) than with toothpaste with or without fluoride (41/45 microm). After 14 days of cycling of erosion and toothbrushing abrasion, gel application 2 or 8 times daily (33/29 microm) showed significantly less enamel loss than toothpaste with or without fluoride (57/62 microm). We conclude that a highly fluoridated acidic gel is able to protect enamel from erosion and toothbrushing abrasion while fluoridated tooth paste provides little protection.

Amines↗