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Clinical performance of a resin-modified glass-ionomer and a compomer in restoring non-carious cervical lesions. 5-year results.

PURPOSE: To evaluate the 5-yr clinical performance of a resin-modified glass-ionomer cement and a polyacid-modified resin composite in restoring non-carious cervical lesions. MATERIALS AND METHODS: Non-carious cervical lesions in 46 incisors, canines, and premolars were restored either with Fuji II LC (n=18) or with Dyract (n=28) in 16 healthy patients. The lesions were restored without cavity preparation strictly according to the manufacturer's instructions. The restorations were clinically evaluated single blind after 5 yrs using modified USPHS criteria. RESULTS: The percentage of Alfa ratings were as follows (Dyract/Fuji II LC): color match 81.3%/28.6%, surface texture 93.8%/21.4%, anatomic form 75.0%/28.6%, marginal integrity (enamel) 62.5%/42.9%, marginal integrity (dentin) 68.8%/28.6%, marginal discoloration (enamel) 56.3%/42.9%, marginal discoloration (dentin) 68.8%/21.5%. Five-yr data revealed a significant difference between the clinical ratings of Dyract and Fuji II LC for all criteria except marginal integrity and marginal discoloration in enamel. A total of five Dyract restorations and four Fuji II LC restorations failed within the study period. CLINICAL SIGNIFICANCE: A considerably high and almost similar overall failure rate was found for both restorative materials in restoring non-carious cervical lesions. However, retained Dyract restorations presented superior clinical performance compared to Fuji II LC restorations.

Acrylic Resins↗

Microleakage of adhesive restorative materials.

PURPOSE: To compare the marginal sealing ability of two conventional and one polyacid-modified resin-based composite, and two conventional and three resin-modified glass-ionomers in conventional cylindrical box cavities following a silver-staining microleakage evaluation method. MATERIALS AND METHODS: In 80 freshly extracted and caries-free human third molars, three standardized cylindrical butt-joint cavities were prepared: the first cavity in coronal enamel, the second at the cemento-enamel junction (CEJ) and the third completely in root cementum. A control group of 10 additional teeth was chosen. After the cavities were restored randomly using the eight restorative materials tested, the specimens were first stored in distilled water at 37 degrees C for 7 days and then thermocycled (500 cycles). Thereafter, the specimens were centrifuged for 10 min in plastic bottles containing 50 wt% silver nitrate aqueous solution. The degree of microleakage was recorded at four different depths along the restoration margins using an optical stereomicroscope equipped with a measuring gauge. RESULTS: None of the tested systems prevented microleakage completely, but the extent of leakage decreased towards the bottom of the restorations. The resin-modified glass-ionomers performed better than the conventional resin-based composites and conventional glass-ionomers. CLINICAL SIGNIFICANCE: Distinct leakage patterns were recorded among all materials investigated. Complete marginal sealing could still not be reached with the new adhesive restorative materials.

Analysis of Variance↗

A review of the biomechanics of abfraction.

Loss of tooth substance in the cervical region is usually attributed to abrasion or erosion. However, the role of occlusal loading is becoming increasingly prominent. It is suggested that high occlusal loads result in large stress concentrations in the cervical region of the teeth. These stresses may be high enough to cause disruption of the bonds between the hydroxyapatite crystals, eventually resulting in the loss of cervical enamel. This article reviews the available evidence to support the thesis that occlusal loading can contribute to the process of non-carious cervical tooth loss or abfraction. It also reviews the potential interactions between occlusal loading and erosion that may contribute to non-carious cervical tooth loss.

Biomechanical Phenomena↗

The erosive susceptibility of cervical versus occlusal enamel.

Clinical studies have strongly suggested a multifactorial aetiology for abfraction lesions or non-carious cervical tooth loss, with a contribution from erosive agents. Structural studies have shown that cervical enamel is more porous with a poorly developed crystal structure that may be more prone to erosion. The aim of this study was to examine the susceptibility to erosion of cervical and occlusal enamel from human premolar and molar teeth. Small blocks of cervical and cuspal enamel were immersed in either orange juice or Coca-Cola and the surface enamel loss was measured using profilometry. The enamel loss was essentially linear at a rate of 2.2-8.8 microns/hr. It was concluded that there was little difference in the susceptibility to erosion between cervical and cuspal enamel, even when the surface hypermineralised layer was removed.

Analysis of Variance↗

Avoiding "the space" by the treatment of compromised teeth.

The advent of implant therapy has given new a dimension to dentistry particularly where teeth have been irretrievably damaged or pathologically involved. There are many situations however, where endodontic or combined therapy may effectively retain compromised teeth and clinicians should carefully evaluate evidence-based treatment. The main areas discussed are: transverse and crown root fractures and invasive cervical resorption. Transverse root fractures have an excellent natural healing capacity and will also respond favourably to treatment if pulp necrosis occurs in the coronal segment. Studies have shown that crown root fractures can be effectively treated by combined endodontic-orthodontic-periodontic and prosthodontic therapy. Invasive cervical resorption has been classified into four classes depending on the degree of infiltration of resorptive tissue into the tooth structure. A study of treatment results following the topical application of 90% aqueous trichloracetic acid, curettage and restoration indicated that this regimen could be successfully applied to Classes 1, 2 and 3 resorption.

Aluminum Compounds↗

Invasive cervical resorption--a periodontist's perspective.

Invasive cervical resorption (ICR) is a relatively uncommon, insidious, resorptive lesion starting subgingivally at the cervical root surface of a tooth. ICR is of uncertain aetiology, although damage to the cervical periodontal attachment to the tooth appears to be a prerequisite. For the most part the lesion is asymptomatic so early detection can be difficult. Nevertheless, if less than a third of the root of the tooth is affected by an ICR lesion treatment of the resorptive tissue using the chemical escharotic agent trichloracetic acid, with or without surgical access, followed by curettage of the lesion and restoration of the defect with glass ionomer cement, is generally successful.

Caustics↗

Bonding to root canal: structural characteristics of the substrate.

PURPOSE: To evaluate in vitro the dentin morphology in root canals in terms of tubule orientation, density and increase in surface area after etching. MATERIALS AND METHODS: Thirty anterior teeth were divided in 3 groups at random: the samples of Group 1 were used to study tubular morphology in SEM. Groups 2 and 3 samples were etched with 32% phosphoric acid. The teeth in Group 2 were examined by SEM without further treatment. The samples in Group 3 were treated with a bonding system and fiber posts were luted into the canal. These teeth were then processed for evaluation of hybrid layer formation and resin tags in dentin tubules. The observations were made according to location in the root dentin, tubule density was estimated, and the increase in area available for bonding after etching was calculated. RESULTS: The observations revealed variability in tubule density and orientation within different areas of any one sample. Statistically significant differences in the density of tubules were found depending on location. The dentin surface area available for bonding increased by 202% after etching in the cervical third, 156% in the middle third, and 113% in the apical third of the root dentin. Group 3 samples showed that the thickness of the hybrid layer depended on the density of tubules. In the sectors with a low density of tubules, the hybrid layer was significantly thinner than in areas with a higher density of tubules. The increase in dentin surface area might be responsible for the enhanced bond strength after acid etching, but not all areas exhibited equal responses to etching.

Acid Etching, Dental↗

Myxomatous odontogenic tumor of the maxilla. An unusual case with squamous and mucoproducing epithelial component.

A tumor attached to the amelo-cemental junction of a third molar impacted in the maxillary tuberosity, consisted histologically of a myxomatous stroma, in which multicystic cavities lined by a columnar epithelium and mucoproducing cells, together with an aggressive squamous epithelial component were present. Although the diagnosis of polyp of the maxillary sinus cannot be excluded, this lesion most likely constitutes an unusual presentation for an odontogenic myxoma of the maxilla, in which an aggressive squamous epithelial component is present, along with a mucosecreting glandular component.

Adult↗

A bioresorbable barrier in the treatment of gingival recession: description of a new resorbable dome device.

The biologic principle of guided tissue regeneration has been expanded to mucogingival surgery, using resorbable barrier membranes for the treatment of gingival recessions. Space provision is one of the main problems in non-space making defects, considering the softness of resorbable membranes. In this study, we tested the possibility to create and maintain a secluded space using a slow, long-lasting resorbable suture so that a resorbable dome device could support the barrier and immediately become a space-making device. Ten purely mucogingival recessions in ten patients were treated. At 12 months, the results were evaluated. In five subjects the gingival margin was within 1 mm of the cementoenamel junction, in four patients it was within 2 mm, and in one case a residual gingival recession was present (where the membrane became exposed). The mean root coverage obtained was 70.4%, while the mean gain of clinical attachment was 3.3 mm.

Absorbable Implants↗

Connective tissue grafting employing the tunnel technique: a case report of complete root coverage in the anterior maxilla.

Techniques for surgical root coverage have been continuously revised over the past few decades. With increased knowledge on the etiopathogenesis of gingival recessions and on the repair/regeneration mechanisms of deep and superficial periodontal tissues, procedure simplification has been possible, and more predictable and stable results have been obtained. The maintenance of maximal blood supply has brought major changes in flap design. The coverage of contiguous recessions on the maxillary central incisors using a conservative technique for the incision of the recipient site is presented, along with the 11-month follow-up from surgery. A supraperiosteal tunnel was performed for the insertion and stabilization of a connective tissue autograft.

Adult↗

One-year clinical performance of a resin-modified glass ionomer and a resin composite restorative material in unprepared Class V restorations.

This study evaluated the clinical performance and appearance of a resin-modified glass ionomer and a resin composite over one year. Thirty-seven pairs of restorations of Fuji II LC and Z250/Single Bond were placed in caries-free cervical erosion/abfraction lesions without tooth preparation. Restorations were clinically evaluated at baseline and 6 and 12 months, using modified Ryge/USPHS criteria. No significant difference (p>0.05) was observed in performance of both materials, although retention of the Z250 restorations was below the minimum specified in the ADA Acceptance Program for Dentin and Enamel Adhesives. Little difference in the restorations' appearance was observed.

Adult↗

Tooth movement and vascularity of the dental pulp: a pilot study.

The effect of orthodontic tooth movement on the dental pulp was assessed histologically in twelve subjects. The participants in this study required the extraction of at least two maxillary first premolars for orthodontic treatment. They were asked to wear a maxillary removable appliance that acted to move a randomly determined premolar in a buccal direction. The appliance was designed to avoid contacting the contra-lateral tooth that was used as the matched control. The appliance was initially worn for a week to ensure patient comfort and cooperation. The appliance was then activated and the patient dismissed. After two weeks, the appliance was reactivated. Both the control and experimental teeth were extracted three weeks later, on the thirty-fifth day of activated appliance wear. The teeth were fixed, decalcified and sectioned. The sections were stained with haematoxylin and eosin for histological examination. This investigation demonstrated that orthodontic tooth movement did have an effect upon the dental pulp, causing vasodilation in the pulp of an orthodontically stressed tooth.

Activator Appliances↗

Soft tissue root coverage as treatment for cervical abrasion and caries.

Root exposure caused by gingival recession may result in cervical abrasion, root caries, root sensitivity, and compromised esthetics. Although cervical root lesions can be treated with Class V restorations, there may be advantages in treating them with soft tissue grafts for root coverage since they restore the dento-gingival unit to its prerecession condition. The rationale for root coverage with soft tissue grafts is reviewed and two cases are presented of successful root coverage procedures in which gingival recession associated with cervical abrasion and caries was present.

Adult↗

Relating visual and radiographic ranked scoring systems for occlusal caries detection to histological and microbiological evidence.

This study compared a visual ranked scoring system and a radiographic ranked scoring system for occlusal caries detection with the level of infection of dentin. Seventy-five third-molars, designated for extraction, were professionally cleaned. Caries was scored according to a visual ranked scoring system at a selected site in the groove-fossa system. Radiographs of the teeth were available and caries was recorded along a five-point ranked scoring system. Each tooth was extracted and hemi-sectioned through the investigation site under aseptic conditions. A burful of dentin was removed from the EDJ of one of the section faces and these samples were processed to establish the level of dentin infection. The depth of the lesion was assessed on the other section face using a five-point ranked histological scoring system. A strong relationship was observed between the histological lesion depth and visual score (r(s)=0.93) while a moderate relationship was seen between lesion depth and radiographic scores (r(s)=0.77). The dentin from teeth with cavities exposing dentin was heavily infected. The dentin from teeth with microcavities or grey discoloration of the dentin was less infected than the lesions with frank cavitation (score 4) (p<0.05, t-test), but more infected than the initial lesions (p<0.05, t-test). The latter lesions showed minimal infection. A similar tendency was seen with respect to increasing radiographic scores and the level of infection of the dentin.

Colony Count, Microbial↗

One-year clinical performance of a self-etching adhesive in class V resin composites cured by two methods.

This study evaluated the clinical performance of a self-etching adhesive for resin composites over one year. Thirty pairs of restorations of Pertac II, using the adhesive Prompt L-Pop, were placed in caries-free cervical erosion/abfraction lesions without tooth preparation. One of each pair was cured using "soft-start" polymerization, while the other was polymerized with high-intensity halogen light. Restorations were clinically evaluated at baseline, six and 12 months using modified Ryge/USPHS criteria. Although no significant difference (p>0.05) was observed between the curing methods, adhesive performance was poor, with a 35% loss of restorations overall.

Acid Etching, Dental↗

Bilateral talon cusp: case report.

Talon cusp is an uncommon condition often present in the maxillary incisors and mandibular premolars. Morphologically, this anomaly has a well-delineated cusp that extends at least half the distance from the cementoenamel junction or cingulum area to the incisal edge. The alteration can cause clinical problems such as caries or occlusal interference. Management of the talon cusp varies according to the circumstances of the individual case and should be as conservative as possible. Presented is a case of bilateral bifid talon cusp in maxillary central incisors that was successfully managed with conservative therapy.

Acid Etching, Dental↗