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PubMed2006

A prospective randomised clinical trial of one bis-GMA-based and two ormocer-based composite restorative systems in class II cavities: three-year results.

OBJECTIVES: Ormocer composites, consisting of a silicon-based polymer, have been developed recently as a tooth-coloured restorative material. The purpose of this prospective randomised clinical trial was to evaluate the performance of two small-particle hybrid ormocer-based restorative systems (AD, Admira/Admira Bond, VOCO; DE, Definite/Etch & Prime 3.0, Dentsply) and one small-particle hybrid bis-GMA-based composite restorative system (TC, Tetric-Ceram/Syntac, Ivoclar-Vivadent) in occlusal stress-bearing restorations. METHODS: One hundred and twenty-eight occlusal-proximal restorations (44 AD, 43 DE and 41 TC) were placed according to the manufacturer's instructions in thirty-two adult patients. Their clinical performance was scored according to the USPHS criteria and evaluation of bite-wing radiographs. RESULTS: After 3 years, four AD, five DE and four TC restorations had failed due to fracture or marginal gap formation. Surface roughness improved significantly when compared to the baseline in AD and TC (Friedman test, p<0.05) during the first year but returned to baseline values after 3 years. DE had a significant tendency towards discolouration (p<0.05). Bite-wing radiographs showed two AD and one TC restorations with internal porosities. ANOVA showed that larger restorations (> or = 3 surfaces) showed significantly more degradation than smaller ones. CONCLUSIONS: In a group of class II restorations, there was no significant difference in failures after 3 years between ormocer-based and bis-GMA-based restorative systems.

Acrylates↗
PubMed2006

Detection of cavitated carious lesions in approximal tooth surfaces by ultrasonic caries detector.

OBJECTIVE: A new diagnostic method for detecting cavitated carious lesions in approximal surfaces with the aid of an ultrasonic caries detector (UCD) was tested for clinical use. The objective of this study was to evaluate the efficacy and clinical performance of the UCD system and to compare it with bite-wing radiography by using direct visual inspection during restoration preparation as a validation method. STUDY DESIGN: One hundred ninety-seven directly inspected approximal sites, 95 as cavitated carious lesions and 102 as intact sites, of adults 22 to 45 years of age were examined by UCD and radiography. RESULTS: Ultrasonic caries detector sensitivity was 0.82 compared with 0.75 for bite-wing radiographs when the threshold was determined as radiolucency in inner enamel and dentin, and 0.49 when the threshold of radiolucency was in dentin. The specificity of UCD was 0.75 versus 0.9 for radiographs. CONCLUSIONS: The UCD exhibited a higher sensitivity than the radiographs but a lower specificity. This study presents a new diagnostic tool that can reduce patient exposure to ionizing radiation and improve caries detection.

Adult↗
PubMed2000

Direct composite inlays versus conventional composite restorations: 5-year follow-up.

OBJECTIVES: To determine at 5 year follow-up the failure rate, wear rates and other aspects of clinical performance of direct composite inlays compared with conventional composite restorations placed incrementally. METHODS: 100 matched pairs of restorations were originally entered into the trial. Each pair consisted of a direct composite inlay and a conventional composite restoration made from the same material. At 5 years it was possible to recall 65 pairs, of which 54 were complete. Clinical assessments were made using USPHS criteria (indirect measurements of occlusal wear were made using Ivoclar standard dies) and annual bite wing radiographs. RESULTS: There was a trend to more failure of inlays than conventional composites (17.4 c.f. 7.5%) but this was not significant. The clinical performance of both types of restoration was similar and compared favourably with the results of studies of other materials. Secondary decay was diagnosed in only one restoration. Between 3 and 5 years there was some deterioration in cavo-marginal discoloration, marginal adaptation (occlusally) and surface roughness (occlusally). There was no apparent deterioration in colour match, proximal contact, shim stock contacts and Gingival Index. Wear rates of both types of restoration showed no significant difference and were essentially linear with a mean of 33-34 microm per year. CONCLUSIONS: Both inlays and conventional composite restorations complied with ADA specification minimum requirements for posterior composite restorations. In this study the direct inlay technique gave no clinical advantage over conventional, incremental placement.

Adult↗
PubMed1998

Interdental bone changes after orthodontic treatment: a 5-year longitudinal study.

Two groups of 20 adolescents, one treated and one untreated, were followed longitudinally for 5 years. The interdental alveolar bone level was estimated as the distance between the cementoenamel junction and the alveolar bone crest on bite-wing radiographs of the upper and lower premolars and molars on three occasions, the first at the start of treatment, the second after 2.8 years, and the third at the end of the 5-year study period. Between the first and second examination, the subjects in the treatment group were orthodontically treated in the upper arch with magnets and superelastic coils succeeded by straight-wire appliances in both arches. At the start of this study, no significant difference in alveolar bone level between treated and untreated groups was found. It was demonstrated that there was a small but significant decrease in interdental alveolar bone support ranging between 0.1 and 0.5 mm during the 5-year observation period both in the treated and untreated group. Neither group had any sites with clinically significant bone loss, i.e., a distance > 2 mm between the cementoenamel junction and the alveolar bone crest. The treated group exhibited a statistically significantly larger increase of cementoenamel junction and the alveolar bone crest distance at the mesial surfaces of the first and second maxillary molars than did the untreated group. This was thought to be a direct consequence of the orthodontic treatment, either as a result of band placement, tipping, or extrusive effects, or due to tooth morphology leading to plaque accumulation.

Adolescent↗
PubMed2000

A case report of subpontic osseous hyperplasia in the maxillary arch.

Subpontic osseous hyperplasia has been portrayed in both the historical and the current literature as occurring exclusively in the mandibular posterior region. This article presents the clinical, radiologic, and microscopic documentation of subpontic osseous hyperplasia occurring in the maxillary first molar region.

Aged↗
PubMed1995

Reproducibility of beam alignment using different bite-wing radiographic techniques.

Longitudinal radiographic assessment of crestal alveolar bone plays an important role in the diagnosis and long-term evaluation of periodontal disease in patients. Because practitioners use several radiographic techniques to obtain bite-wing radiographs, horizontal and vertical alignment errors could adversely affect the diagnostic impression gained from this type of radiographic examination. The objective of this study was to determine the alignment reproducibility of three different clinical techniques used to acquire bite-wing radiographs. Patients who require bite-wing radiographs as part of a dental school screening process were radiographed with modified standard bite-wing tabs and two different intraoral positioning devices. Horizontal and vertical angular deviations were measured and alignment errors were calculated for each radiograph. The mean total angular alignment error for the standard bite-wing tab technique was 6.2 degrees, whereas the mean alignment error for both positioning devices was less than 1.8 degrees. The results of this study suggest that an intraoral positioning device for acquiring bite-wing radiographs should be used.

Alveolar Bone Loss↗
PubMed1996

Effects of focal spot size on caries diagnosis with D and E speed images.

Annual measurement of the x-ray unit focal spot size has been recommended by the American Academy of Oral and Maxillofacial radiology as part of the dental radiographic quality control program. This study compares the effects of focal spot size on caries diagnosis. Three x-ray units with small, medium, and large focal spot sizes were used to produce bite-wing images on extracted teeth mounted in acrylic bases. Randomized films were scored for lesion presence and depth by two general dentists. Weighted kappa statistics were used to evaluate the agreement of reviewer caries diagnosis by film speed and focal spot size. Comparisons of caries cells with small versus medium and small versus large focal spot size produced weighted kappa statistics = 0.72 and 0.70, respectively. Differences in caries calls were greater because of film speed rather than focal spot size. The results of this study suggest that the clinical significance of varied focal spot size is negligible. The value of annual measurement of focal spot size is questionable, and its recommendation should be revisited.

Analysis of Variance↗
PubMed1998

Findings of clinical and radiographic caries among several adult age groups.

OBJECTIVE: The purpose of this study was to determine whether there are aged-based variations in the association between clinically detected and radiographically detected caries and whether the prevalence of clinically undetected radiographic caries varies across adult age groups. STUDY DESIGN: The data for the analysis were from a clinical study that evaluated the efficacy of guidelines for prescribing dental radiographs. A total of 460 subjects had clinical examinations and interpretation made on full-mouth radiographs. Analysis was conducted to determine the tooth-specific and subject-specific prevalences of clinically undetected caries and to establish whether the association between clinical signs and radiographic signs varied by subject age. RESULTS: In total, approximately 5.8% of clinically sound teeth showed radiographic evidence of dentinal caries, and the prevalence increased with patient age. The prevalence of clinical signs of medium and large caries was 7.8% in 12,358 teeth in which caries was both clinically and radiographically present. However, for more than 80% of the teeth with clinically undetected caries, the lesions were evident on the interproximal radiographs. The associations between clinical and radiographic signs of dentinal caries were homogeneous across age groups. CONCLUSION: The findings demonstrate that adolescents and adults continue to have medium and large caries, although the location of the caries differs by age group, with higher proportions of gingival caries in older patients.

Adolescent↗
PubMed1999

Geometric and densitometric standardization of intraoral radiography through use of a modified XCP system.

OBJECTIVE: The purposes of this study were to examine the density correction afforded by curve-fitting algorithms and to investigate whether the device we developed significantly improves the reliability of longitudinal alveolar process bone radiographic density measurements. STUDY DESIGN: Stepwedges were radiographed over a range of impulse settings, and curve-fitting algorithms were fitted to sets of step images on each digitized film. Differences between the actual thicknesses of an alternate set of steps and their corresponding thickness estimates were calculated. Next, clinicians made periapical radiographs from interproximal bony sites on a dry skull using our imaging device. Differences in bone densities between corresponding regions of interest taken 1 week apart were calculated. RESULTS: Analysis of variance and Duncan's Multiple Range test demonstrated that piecewise linear, third-degree polynomial, and fourth-degree polynomial curves provided significantly better estimates of stepwedge thickness than did sigmoid or first degree polynomial-curves (P < .05) and that the differences between repeat bone density measurements made with density correction were significantly less than those made without density correction (P < .05). CONCLUSIONS: Piecewise linear, third-degree polynomial, and fourth-degree polynomial curve-fitting algorithms provided the best densitometric correction. The use of our imaging device increased the reliability of longitudinal bone density measurements.

Absorptiometry, Photon↗
PubMed2001

Long-term evaluation of osseointegrated implants inserted at the time or after vertical ridge augmentation. A retrospective study on 123 implants with 1-5 year follow-up.

The purpose of the present study was to evaluate retrospectively, after 1 to 5 years of prosthetic loading, 123 implants consecutively inserted at the time of vertical ridge augmentation in 4 clinics. At the time of the implant surgery, 3 different techniques were used: the implants were allowed to protrude 2 to 7 mm from the bone level and a titanium reinforced expanded-polytetrafluoroethylene (e-PTFE) membrane was positioned to protect either the blood clot (Group A, 6 patients), or an allograft (Group B, 11 patients), or an autograft (Group C, 32 patients). The annual implant evaluation was carried out according to a standard protocol utilized for long term studies with endosseous implants inserted in non-regenerated bone. Only 1 implant failed immediately after the second stage surgery and after 1 month it was substituted with a new implant. All the remaining implants appeared clinically stable, no signs of radiolucency were present at the bone-implant interface, therefore, they could be defined successfully osseointegrated. The radiographic analysis showed stable bone crest levels with a mean bone loss of 1.35 mm for the Group A, of 1.87 mm for the Group B and of 1.71 for the Group C during the period of observation. Only 2 implants demonstrated an increased crestal bone loss of 3.5 mm and 4 mm respectively at the first year examination. On the base of these results, we can confirm previous long term studies on regenerated bone and we can conclude that vertically augmented bone with GBR techniques responds to implant placement like native, non-regenerated bone.

Adult↗
PubMed2003

IL-1 gene polymorphism and smoking as risk factors for peri-implant bone loss in a well-maintained population.

The aim of the present study was (i) to investigate the relation between specific interleukin-1 (IL-1) gene polymorphisms and peri-implant bone loss at osseointegrated ITI(R) dental implants and (ii) to explore the association between these allelic variants of the IL-1 gene complex and peri-implant mucosal inflammation, in both smoking and non-smoking individuals. A sample of 90 consecutive Caucasian patients (aged 33-88 years), treated with at least one ITI-implant participated in this retrospective investigation. Standardized periapical radiographs were taken after prosthetic rehabilitation (133.6 days, SD 136.9 days) and at the time of the re-examination, on average 5.6 years (SD 2.5 years) thereafter. The radiographs were analyzed by a calibrated examiner for changes in peri-implant bone levels. The examiner was blind with respect to clinical parameters and IL-1 status. The distance between the implant shoulder and the first visible bone-implant contact (DIB) at the respective time points were measured using a computerized method. The absolute bone level difference during the years of service (ABL) and the annual bone loss (DeltaBL/year) were calculated for all the implants. Percentages of full mouth bleeding on probing (BOP), as well as of BOP calculated separately for teeth and implants, were determined for all visits and averaged for the entire observation period. Out of the total patient sample, there were 14 heavy smokers (= 20 cigarettes/day), 14 moderate smokers (5-19 cigarettes/day), 23 previous smokers (smoking cessation > 5 years) and 39 non-smokers. Twenty-eight (31.11%) patients were IL-1 genotype positive. Upon stratification for smoking status, significant differences were found for the variables ABL (P < 0.04, U-test) and DeltaBL/year (P < 0.04, U-test) between non-smokers and heavy smokers for the IL-1 genotype positive group but not for the IL-1 genotype negative group. Moreover, significant differences in ABL (P < 0.04, U-test) and DeltaBL/year (P < 0.04, U-test) were identified between former smokers and heavy smokers for the IL-1 genotype positive group. The differences in inflammatory parameters (BOP) did not reach statistical significance. This study suggests that in heavy cigarette smokers, carriage of a functionally significant IL-1 gene complex polymorphism is associated with an increased risk for peri-implant bone loss following prosthetic reconstruction and during the supportive periodontal care phase of the treatment.

Adult↗
PubMed2003

Imaging of periimplant bone levels of implants with buccal bone defects.

The aim of the present study was to use four different methods to evaluate three radiographic techniques for their accuracy in assessing the marginal periimplant bone levels at implants with buccal bone defects in an experimental setting. Twenty-four implants were placed in the mandibles of six adult beagle dogs with substantial buccal bone defects, which were augmented by bone particles with and without resorbable membranes. After healing for 5 months, (1) periapical radiographs, (2, 3) reformatted images in (2) sagittal and (3) coronal planes from axial computer tomography (CT) scans and (4) direct magnification images (DIMA) were made and compared with histometric analysis of bone levels. Two values were used for comparison: (i) the lingual bone level and (ii) the true bone level calculated as a mean value from the lingual and the buccal bone levels of all histologic sections of each implant. Metric evaluation of periapical radiographs, sagittal reformation of CT scans and DIMA showed that the results were close to the histometrically assessed lingual bone level, while the true bone level was significantly lower and not reflected by any of the imaging modalities. Coronal reformation showed that there was significant overestimation of the lingual and underestimation of the buccal bone level when compared with histometric values. It is concluded that assessment of bone level and bone regeneration in implants with buccal bone defects remains problematic, and data from periapical radiograms tend considerably to overestimate the bone anchorage of these implants.

Absorbable Implants↗
PubMed2000

A prospective longitudinal study on periodontal bone height changes in a Swedish population.

BACKGROUND, AIMS: This investigation was performed to assess longitudinal changes in periodontal bone height in an adult population over a period of 17 years. METHODS: In 1973, a random sample of 1000 individuals aged 3-70 years in the city of Jönköping, Sweden, was examined clinically and radiographically to assess dental status and treatment needs. Out of the 574 dentate individuals 15-60 years, 433 accepted the invitation and were re-examined in 1989-91, 4 were edentulous and the study therefore finally included 429 dentate individuals. The examination included full mouth plaque and gingivitis scores and bone height measurements on full mouth intra-oral radiographs. All age groups except the youngest had very good oral hygiene with 50% or more having plaque and gingivitis scores below 20%. RESULTS: From the age of 20, there was a general pattern of bone height reduction over time corresponding to an annual loss of around 0.1 mm. From the age of 30 years, about 80% of the population had one or more sites with bone loss of 10% or more. Very few individuals, about 5%, exhibited an individual mean bone loss of 2 mm or more. 17% had > or =6 such sites indicating destructive periodontal disease. These individuals and sites could not be identified in advance based only on previous disease experience.

Adolescent↗
PubMed2000

Advanced dental maturity in children with juvenile rheumatoid arthritis.

The subjects of the investigation comprised 95 girls and 73 boys with juvenile rheumatoid arthritis (JRA), and 102 girls and 66 boys representing healthy controls, all with a chronological age from 6.3 to 14.4 yr. The dental development was assessed from panoramic radiographs using a seven-tooth model. The radiographs were evaluated on three separate occasions with a minimum interval of one month in a randomized order, and blind with respect to absence or presence of JRA. In both JRA patients and healthy controls, dental maturity was ahead of chronological age. In addition, dental maturity was significantly advanced in JRA patients with 0.26 yr in girls and 0.28 yr in boys. It is tentatively suggested that the advanced dental development in JRA patients compared with healthy children was partly an effect of treatment with cortisone, while the influence of the disorder per se remains to be elucidated.

Adolescent↗
PubMed2002

Treatment of replacement resorption with Emdogain--a prospective clinical study.

The present clinical study investigated the outcome of intentional replantation using Emdogain for periodontal healing following trauma-related ankylosis. Sixteen ankylosed teeth affected by replacement resorption were treated as follows: After tooth extraction, the root canal was obturated with a retrograde titanium post. Emdogain was applied to the root surface and into the extraction socket with subsequent replantation of the tooth. Evaluation parameters included horizontal and vertical Periotest scores, percussion sound and periapical radiographs. All findings were compared to those of the adjacent teeth. The mean follow-up period was 15 months (range 4-24 months). Eleven teeth showed no signs of recurrence of ankylosis: they were in full function and exhibited no pathological clinical findings. Four severely traumatized teeth demonstrated a recurrence of ankylosis after a mean period of 6 months, one tooth was lost in a second accident after 7 months. The estimated probability of 1 year without recurrence of ankylosis was P=0.66 (95% confidence interval [0.40; 0.94]). The mean survival time was 10.2 months (SD 1.1). The results indicate that treatment of replacement resorption following light to moderate trauma with replantation and Emdogain appears to prevent or delay recurrence of ankylosis in many cases.

Adolescent↗