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PubMed2003

Peer review amongst restorative specialists on the quality of their communication with referring dental practitioners.

OBJECTIVE: A peer review study was carried out to assess the written communication between consultants and specialist registrars in restorative dentistry with the referring general dental practitioners. METHODS: Seven people took part in the study and each presented referral and reply letters for five patients whom they had seen for consultation. The referral letters were used for information only and were not used in the peer review process. Each participant inspected the referral and reply letters from the other six participants. The reply letters were anonymously peer reviewed by using a proforma containing agreed criteria in relation to appropriate factors to include in the reply letter. The reviewer also ranked the letter in relation to overall quality on a 1-10 point scale. RESULTS: It was found that the participants' letters generally conformed positively with the agreed criteria although there were some differences between individuals. There were particular problems identified in relation to tooth notation. Reply letters commonly used different forms of tooth notation to the referring practitioners. CONCLUSIONS: The ranking of the letters generally indicated that the participants' replies were judged to be favourable by their peers. There may be scope for continuing this study in relation to peer review by other groups of professionals, in particular practitioners in primary dental care.

Attitude of Health Personnel↗
PubMed2004

Putting dental mercury pollution into perspective.

This paper deals with the issue of amalgam waste from dental offices. The aim is to put into perspective the very small contribution of dental mercury to the overall volume of mercury discharged into the environment each year. While the amount discharged from dental offices is very small compared to other sources, the amount discharged into the environment from amalgam fillings in people's mouths is estimated as less than 2% of the amount from dental offices. At least 50% of mercury in the environment comes from natural sources. The major source of man-made mercury pollution is the industrial burning of fossil fuels. It is important to distinguish between inorganic mercury and organic mercury in terms of the impact on the health of the population.

Dental Amalgam↗
PubMed2005

Contemporary dental practice in the UK: indirect restorations and fixed prosthodontics.

OBJECTIVES: To investigate, by questionnaire, the use and selection of materials and techniques for indirect restorations and fixed prosthodontics by dental practitioners in the North West of England and Scotland. METHODS: A questionnaire was sent to 1,000 general dental practitioners selected at random from dentists in Scotland and the North West of England. Non-responders were sent another questionnaire after a period of 4 weeks had elapsed. RESULTS: A total of 701 usable questionnaires were returned, giving a response rate of 70%. When selecting a material for the core build-up of vital teeth, practitioners used the following materials (%): amalgam (60), dual and light-cured resin composite (54), glass-ionomer cements (47), compomer (29) and resin-modified glass-ionomer cements (24). Where the use of a post was indicated indirect posts of both precious (67) and non-precious (37) alloys were preferred to prefabricated posts by the majority of practitioners for the restoration of root filled teeth. Direct titanium (14) and stainless steel (14) posts were not used extensively. Impression materials used by the practitioners were as follows: addition-cured silicone (70), condensation-cured silicone (20), polyether (9) and polysulphide (2). Traditional glass-ionomer cements (59) were used for the luting of single and multiple porcelain fused to metal units, with zinc phosphate and polycarboxylate cements (33) being the preferred alternatives. CONCLUSIONS: The majority of the practitioners surveyed in this study used: amalgam for core build-ups; indirect posts; addition-cured silicone for impressions; and glass-ionomer cements for luting procedures.

Crowns↗
PubMed2005

Conscious sedation services provided in secondary care for restorative dentistry in the UK: a survey.

OBJECTIVES: To assess the views of consultants in restorative dentistry on sedation services in secondary care for restorative dentistry and their involvement in the provision of this. DESIGN: Postal questionnaire survey in the UK. SETTING: Consultants in restorative dentistry. RESULTS: There was an 80% response rate from 179 consultants. Among consultants in restorative dentistry there was a perceived need for sedation services in restorative dentistry within NHS hospitals other than for teaching purposes. Anxiety and level of trauma of dental treatment affected whether consultants felt it appropriate for patients to have such treatment under sedation. One third (48) of consultants treated patients under conscious sedation, a significant number of these held NHS posts and had graduated more recently. Of those (41) who provided treatment under conscious sedation in an NHS setting, most (38, 93%) provided treatment under intravenous sedation of whom only eight (21%) acted as operator/sedationist. Nearly all consultants (135, 94%) felt that specialist registrars in restorative dentistry should undergo some form of training in sedation. CONCLUSIONS: Although consultants in restorative dentistry recognise the need for training in and the provision of sedation in secondary care for restorative dentistry, only one third of respondents currently provide this service.

Anesthesia, Dental↗
PubMed2005

Can a single composite resin serve all purposes?

The consensus view less than a decade ago was that direct posterior composites should be restricted to small restorations, preferably in premolar teeth with little, if any, occlusal function. Major advances in adhesive systems, materials and restorative techniques have combined to allow us to question this view and our increased clinical evidence base makes it appropriate to reconsider this viewpoint.

Composite Resins↗
PubMed2004

A reappraisal of the incremental packing technique for light cured composite resins.

The cuspal flexure caused by a direct placement composite resin was measured using a technique that did not interfere with cuspal movement. Twenty upper premolar teeth with mesial-occlusal-distal (MOD) cavity preparations were restored using a posterior composite resin. Ten teeth were restored using a bulk packing technique and 10 were restored using three 'U' shaped bucco-lingual increments. Total cuspal movement was measured 1 h following the initiation of curing. Bulk placement of the composite resin produced slightly more cuspal movement (12.5 microm) compared with the incremental placement of composite (11.3 microm). This difference was not statistically significant. The technique of incremental packing to reduce cuspal flexure is therefore questioned.

Bicuspid↗
PubMed1998

Environmental aspects of dental filling materials.

In recent years, the possible environmental impact caused by certain routines in dental practice has attracted attention among regulators. As part of point source reduction strategies, the discharge of mercury/amalgam-contaminated wastes has been regulated in a number of countries, even though it has been documented that by adopting appropriate mercury hygiene measures, including installation of amalgam-separating devices, the environmental impact of amalgam use in dentistry is minimal. There are, so far, no data indicating the environmental impact of methacrylate-based dental filling materials. As to the occupational environment, recent reports have stated that when normal occupational recommendations for proper mercury hygiene routines are followed (e.g., water spray coolant and high vacuum suction during removal of amalgam restorations), no occupational health risk can be assumed. An increasing number of reports on occupational allergic reactions to components of polymer-based dental filling materials call for attention to the sensitizing potential of certain ingredients in these products.

Dental Amalgam↗
PubMed1998

The role of cuspal flexure in the development of abfraction lesions: a finite element study.

A tooth flexure mechanism has been proposed over the past 15 yr to explain non-carious cervical tooth loss. It is well established that cavity preparation weakens a tooth, resulting in more cuspal movement under occlusal load. The aim of this study was to investigate the effect that an occlusal restoration would have on the stress profile in the cervical region of a lower second premolar using two-dimensional finite element stress analysis. Under an eccentric 100 N occlusal load, a premolar with an occlusal amalgam restoration showed peak tensile and shear stresses in the buccal cervical region that were in excess of the known failure stress for enamel. Increases in the cavity depth of the occlusal amalgam restoration were found to increase cervical stress more than increases in cavity width. It was concluded that the weakening effect of cavity preparation may contribute to the development of non-carious cervical tooth loss.

Bicuspid↗
PubMed1998

In vitro evaluation of marginal and internal adaptation of class II resin composite restorations after thermal and occlusal stressing.

The aim of this in vitro trial was to evaluate the external and internal adaptation of class II composite restorations to tooth structure by means of replica scanning electron microscope (SEM) observation. Standard MOD preparations were cut in human extracted teeth with margins located above and below the cementoenamel junction. Cavities were restored with either a direct multilayered technique, inlays (using conventional or dual DBA application) or prepolymerized composite inserts, using similar restorative material (Syntac, Variolink and Tetric). Evaluations were performed after mechanical and thermocycling. For the marginal adaptation in enamel, the bevelled margins of the direct group resulted in higher percentages of "continuity" (92.5% mesially and 94.6% distally), while the "marginal tooth fracture" was the most commonly found defect in groups with a butt preparation (up to 29.4%, with inserts). For the marginal adaptation in dentin, "continuity" percentages varied from 59% (inlay) to 87.9% (insert). As regards the internal adaptation, results for the whole dentin interface varied from 43.1% (inlay) to 63.9% (inlay with dual bonding) of "continuity". No regional difference in internal adaptation was found between the different preparation areas, except between gingival dentin and gingival enamel (44.9% vs. 80.7% of continuity, all group pooled data). Debonding occurred only at the dentin-restoration interface and consistently took place at the top of the hybrid layer. In the present experimental conditions, the inlay or insert techniques, which make use of the Dual bonding concept, proved to have the best potential to maintain the integrity of dentin-restoration interface.

Composite Resins↗
PubMed1997

Clinical performance of porcelain laminate veneers. A retrospective evaluation over a period of 6.5 years.

Three-hundred and seventy-two porcelain laminate veneers were fitted to defective and discoloured teeth in 102 patients. Ninety per cent of the restorations were fitted to unprepared teeth. Restorations were reviewed up to 78 months after cementation. Survival probabilities were calculated using the Kaplan-Meier method. Results showed higher rates of failure and problem development in veneers fitted over existing restorations and in those fitted by inexperienced operators. A considerable number of veneers suffered minor problems that were successfully repaired.

Adolescent↗
PubMed1997

The application of thermoelastic analysis to study stresses in human teeth.

The aims of this investigation were to use a full-field thermoelastic technique to study the stress distribution on human teeth subjected to dynamic loads and derive a value for the thermoelastic constant for human enamel. Surface stresses were observed on extracted intact human molar teeth subjected to a load of 200 N cycled at 20 Hz. Measurements were repeated for the same teeth following mesio-occluso-distal cavity preparation and restoration with amalgam and adhesively bonded composite restorations. A value for the thermoelastic constant for human enamel (Km) of 2.25 X 10(-12)m2/N was calculated from physical coefficients in the literature. Unprepared specimens exhibited a comparable magnitude and distribution of stresses to those seen when teeth were restored with adhesively bonded composite restorations. Higher stresses were observed on prepared teeth and there was little change following restoration with amalgam. It can be concluded that a full-field thermoelastic stress analysis technique can be successfully applied to study teeth subjected to axial dynamic loads in vitro and that the resultant stresses are greater in prepared teeth than those restored with bonded composite materials.

Acid Etching, Dental↗
PubMed1999

Finishing and polishing of the ceromer material Targis. Lab-side and chair-side methods.

UNLABELLED: The aim of the study was to check four lab-side and four chair-side methods for finishing and polishing the ceromer material Targis. Eighty bar-shaped specimens (20 mm x 10 mm x 2 mm) of Vectris were produced; 72 were covered with a 2 mm (thickness) layer of the Ceromer Targis and eight samples with the composite Tetric. All specimens were ground plane parallel with 320 Silicium carbide grit sandpaper in order to start with the same level of roughness. Then the specimens were finished and polished using the following methods: (1) Artglass toolkit, (2) pumice-stone and brushes/linen brush and polishing paste P3, (3) Robinson brush/Ivoclar Universal paste and wool brush, (4) Silicone wheel and rag wheel, (5) Shofu Rainbow set, (6) Sof-Lex discs, (7) Vivadent Politip set and (8) Nupro-pastes and brushes. The surface roughness was determined with a profilometer. The arithmetical roughness value Ra was calculated. From each group one specimen was randomly chosen and sputtered with gold in order to observe the surface with a scanning electron microscope to evaluate its smoothness. The methods were ranked as followed: 2, 3 and 5 with the lowest roughness, then 8, 6, 7, 4, 1. The best ranked chair-side method (5) and the best ranked lab-side methods (2, 3) did not differ significantly between the Ra values. No difference was observed between the composite Tetric and the ceromer Targis when these materials were polished using the same method. CONCLUSION: the lab-side-methods 2 and 3 and the chair-side-method 5 can be recommended for finishing and polishing the new ceromer material Targis.

Carbon Compounds, Inorganic↗
PubMed1999

The stress reducing capacity of unfilled resin in a Class V cavity.

This study examined the stress reducing capacity of varying thicknesses of unfilled resin in a Class V cavity. A two dimensional plane strain mesh of a Class V cavity, 3 mm in diameter and 2 mm deep, was produced and the thickness of the unfilled resin layer was varied from 0 to 80 microm. A polymerization shrinkage of 1.5% was applied to the composite resin and the interfacial forces examined. The maximum shear stresses were found to occur along the pulpal floor of the restoration at the unfilled resin-dentine interface. The maximum shear stress values varied from 11.1 to 22.4 MPa and the shear stresses decreased by up to 38% as the thickness of the unfilled resin increased to 80 microm.

Composite Resins↗
PubMed1999

Fracture resistance of four different restorations for cuspal replacement.

The purpose of this study was to compare the fracture resistance of four posterior restorations involving an entire cusp replacement. Four groups were established, each containing eight caries-free mandibular molars, similar in size and anatomic form. A mesio-occlusal preparation including the lingual cusp was prepared on all teeth. Group A were restored with a pin-retained amalgam. Group B were restored with amalgam and a meta adhesive. Group C were restored with a composite resin with a beta-glass quartz insert. Group D were restored with composite resin and a HEMA adhesive. All specimens were mounted in acrylic and stored in artificial saliva for 30 days. Each specimen was loaded in compression at a 90 degrees angle in an Instron testing machine with a crosshead speed of 0.5 cm/min. Results demonstrated the mean (SD) failure loads in kilograms for each group to be: A, 1155 (388); B, 1232 (436); C, 1345 (375); D, 1595 (373). Analysis of variance indicated no significant difference among groups at P<0.05. Although the values for the composite resin restoration with the adhesive were higher than the other restorative techniques.

Adhesives↗
PubMed2000

An investigation of temperature and stress distribution on a restored maxillary second premolar tooth using a three-dimensional finite element method.

This paper presents the stress analysis of the maxillary second premolar tooth under thermal loading as a result of hot/cold liquid in the mouth using the three-dimensional (3D) finite element method (FEM). The tooth was considered to be in a restored state with composite resin and amalgam on glass-ionomer as the base material. In the first step of the study, the temperature changes as a result of hot/cold liquid in the mouth were calculated. The thermal stress distributions owing to the temperature changes were then obtained. All calculation programs were prepared by the authors using FORTRAN 77. The tooth was assumed to be isotropic, homogeneous, elastic and unsymmetric. The distribution of temperature and stress were plotted for some critical points.

Bicuspid↗
PubMed2001

Comparison of dentine hypersensitivity in selected occidental and oriental populations.

Epidemiological data on dentine hypersensitivity (DH) prevalence are limited. Few studies have compared prevalence between populations. The aim of this investigation, therefore, was to compare the perception and prevalence of DH in two distinct non-periodontal practice populations, one U.K. and one Korean. Completed questionnaires from 557 patients (230 males and 327 females, comprising 115 males and 162 females, mean age 41.7 years (s.d.=14.36), U.K. and 115 males and 165 females, mean age 29.7 years (s.d.=11.86), Korean) were collected. Analysis was by frequency distribution and cross-tabulation (Statistical Package for the Social Sciences (SPSS)). DH prevalence was similar and at levels comparable with those reported previously. Prevalence was higher in the third and fourth decades in both populations. Although there were no differences between U.K. or Korean males and U.K. or Korean females, there was a significant difference between gender reporting of DH, with more females complaining of DH than males (standard normal deviation (SND)=4.3, 95% confidence interval (CI)=0.1134-0.2736). DH appeared to be regarded by patients as not severe in most cases, so treatment was not generally sought. Of those who claimed to have sought treatment, a significant number had received restorative treatment. Of those patients, only 23.3% of U.K. and or=7 days in either population. The results indicated that there were no significant differences between U.K.- and Korean-based populations in their perception of DH, with the exception that more females complained of sensitivity than males in both groups. Overall, DH was not considered a major dental problem by most patients in either of the populations.

Adult↗
PubMed2002

Atraumatic dental treatment among Finnish elderly persons.

There is an increase in elderly dentate adults who will retain more of their natural teeth, and thus the demand for restorative dental services among them will be high. In Finland, systematic dental care for old people has not been organized. Health centres have mainly targeted the development of dental care for children, adolescents and young adults. With this background, atraumatic restorative treatment (ART) was seen as a complementary procedure in oral health services for the elderly. It was tested in 1997-1999 in Helsinki among 119 old people (mean age 72.5 years) living in their homes and receiving community-based support services. Patients were satisfied with having dental examination and oral health education at home. The ART fillings (n=33) were provided for 21 persons and depuration for 56. After 1 year, 25 fillings (58%) could be evaluated: 68% of the fillings were assessed as being good, 11% as having a slight marginal detect and 16% as having unacceptable marginal defect, and one filling was totally lost. In conclusion, ART is an appropriate approach in dental care for the elderly. However, more testing should be completed to find out how the screening could be organized to make the dental home visits more cost-effective and less time consuming.

Activities of Daily Living↗