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Composite resins. A review of the materials and clinical indications.

The aim of this work is to present the different components of the composites currently used in dentistry and furnish dentists with a basis that can provide criteria for choosing one or another to suit their therapeutic requirements. Most composites used in dentistry are hybrid materials, so-called because they are composed of polymer groups reinforced by an inorganic phase of glass fillers with different compositions, particle sizes and fill percentages. Flowable or condensable composites have attempted to provide an answer to certain functional requirements, although they have not been too successful at improving properties. Turning to polymerisation initiators, both halogen lamps, whether conventional or high intensity, and LED curing lights which provide a gradual increase in light intensity are very useful for reducing shrinkage of the composite material. The clinical choice of a composite must consider whether priority should be given to mechanical or aesthetic requirements: if mechanical considerations are paramount the material with the greatest volume of filler will be chosen; if aesthetic considerations predominate, particle size will be the most important factor. Additional components such as opaques and tints make it possible to improve the aesthetic results. Equally, the spread of other therapeutic procedures, such as tooth bleaching, has made it necessary to design composite materials in shades that are suitable for the special colour situations found in teeth treated by these methods.

Composite Resins↗

Clinical trial evaluating two peroxide whitening strips used by teenagers.

Double-blind clinical research was conducted to compare the clinical response of a thin, concentrated peroxide whitening strip (relative to a marketed control) among a teenage population with preceding safety and efficacy data. Informed consent and child assent was obtained from 48 teens, 13-17 years of age. After baseline measurements were taken, subjects were divded randomly into two groups, one using a thin 10% hydrogen peroxide whitening strip, the other using a 6.5% hydrogen peroxide strip with a thicker gel layer. Strip use was 30 minutes twice per day for 22 days on the maxillary arch, followed by 22 days on the mandibular arch. Efficacy was measured objectively based on L*a*b* color change from digital images taken every 11 days, where L* indicates lightness and b* indicates blue-to-yellow shade. The mean age was 15.1 (+/-1.5) years. Relative to baseline, both strip groups experienced significant (p < 0.0001) color improvement for yellowness (deltab*) and lightness/brightness (deltaL*) beginning at the first visit (Day 11). Continued use resulted in significant color improvement through Day 22. Groups did not differ significantly (p > 0.33) with respect to combined deltab* or deltaL* at end-of-treatment. Tooth sensitivity and oral irritation represented the most common adverse events. No subject discontinued early due to a treatment-related adverse event. Teenagers who used either 10% hydrogen peroxide gel or 6.5% hydrogen peroxide gel whitening strips twice a day for 44 days saw significant tooth whitening without serious adverse events.

Adolescent↗

Whitening effect by stain inhibition from a chewing gum with sodium hexametaphosphate in a controlled twelve-week single-blind trial.

OBJECTIVE: A twelve-week clinical study was conducted to assess the effect of a chewing gum containing sodium hexametaphosphate (4%) on the inhibition of stain formation. METHODOLOGY: Fifty-four subjects were entered and completed all aspects of the study. Twenty-seven of the subjects were smokers, and the other half did not smoke. Subjects were randomly assigned to the test gum or no-gum group. Each participant received a full oral prophylaxis at the beginning of each period of observation. Those chewing the test gum agreed to chew four times a day, for five minutes each time, over twelve weeks. Those assigned to the no-gum group agreed not to chew any gum. After twelve weeks, participants were scored for stain deposits (Lobene Index), received a second oral prophylaxis, and joined the alternate group in this cross-over format. At the end of the twenty-fourth week, all subjects were again scored for stain deposits and the study was completed. In order to enhance stain formation during the entire 24-week study period, all participants received a supply of a chlorhexidine (0.12%) dentifrice without anionic agents to use three times a day. Stain levels were scored by the same examiner for all measurements and recorded on computer. The examiner was blinded to all treatment assignments. RESULTS: There were no reported problems associated with the chewing gum. The Lobene Index mean score for stain extent was 0.54 +/- 0.36) in the test-gum group and 0.81 +/- 0.47) for the no-gum group. The difference between the mean scores was highly significant with paired sample t-test (p < 0.001). Mean stain intensity was 0.57 +/- 0.38) in the test group and 0.95 (+/- 0.72) in the control group, with a statistically significant difference at p < 0.01. CONCLUSION: The results indicated that chewing gum containing sodium hexametaphosphate reduced induced stain formation by 33% compared to a no-gum treatment.

Adolescent↗

[Clinical and laboratory evidence for effectiveness of whitening toothpastes].

The article presents clinical and laboratory data concerning application of whitening toothpastes "Rembrandt". The effects of these pastes on the soft tissues status, the content of mineral substances in enamel biopsy liquid, enamel surface were evaluated. The results confirm the necessity of differential application of agents for tooth whitening and also of using whitening toothpastes for improvement of teeth color.

Data Interpretation, Statistical↗

Current developments in esthetic dentistry.

Current developments in esthetic dentistry center around new techniques and materials that improve the clinician's ability to provide esthetic services. These developments include the availability of improved composites for anterior and posterior use, a new generation of dentin bonding agents, bonded ceramic restorations, and more efficient and predictable ways to whiten teeth. There is a better understanding of factors contributing to the esthetic value of restoration as well as their longevity. New bonding techniques to dentin enable practitioners to perform difficult restorative procedures in a conservative manner, producing results that are highly esthetic and physiologically tolerable. The use of dental porcelains has expanded from the traditional applications in crowns and bridges to veneers, inlays, onlays and all-porcelain bridges that are directly bonded to teeth. Computer-designed and fabricated inlays and onlays are now an available treatment modality, with a reported 3-years follow-up looking very promising. The increasing public demand for esthetic dental procedures has made the discipline a significant part of dental practice and boosted interests and understanding of procedures, such as tooth bleaching and peridontal surgery, for improved esthetics.

Composite Resins↗

[Enamel microabrasion].

Enamel Micro-abrasion is a technique where an acid is used in combination with an abrasive to remove the superficial layer of enamel which has certain dental colorants within its structure. It is indicated as the treatment of choice for superficial enamel stains and is a technique which every dentist should offer to their patients. It is a simple, conservative, efficient and durable procedure.

Carbamide Peroxide↗

Acid-abrasive enamel reduction for tooth color correction.

The purpose of this article is to present an acid-abrasion ("enamel microabrasion") technique which can eliminate superficial enamel discoloration. The technique provides a conservative alternative for some patients who might otherwise have received porcelain or composite resin veneer restorations.

Adult↗

A simple technique for removal of mottling, opacities and pigmentation from enamel.

Mottling of teeth can have significant psychological impact on patients--particularly on adolescents, who may be subjected to much unkind teasing. A number of procedures have been suggested for removal of mottling and stains. The authors describe a simple and quick technique using a paste of hydrochloric acid and pumice, and on the basis of their clinical and laboratory experience suggest it as a treatment of first choice.

Adolescent↗