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Effect of provisional restorations on the final bond strengths of porcelain laminate veneers.

The purpose of this in vitro study was to evaluate the effect of the different provisional restorations cementation techniques on the final bond strengths of porcelain laminate veneers (PLVs). Thirty-six extracted human central incisors were sectioned 2 mm below the cemento-enamel junction, and crown parts were embedded into self-cure acrylic resin. Standardized PLV preparations were carried out on labial surfaces of the teeth. Then the teeth were randomly divided into three groups of 12 each. In group 1, provisional restorations were cemented with eugenol-free cement. In group 2, prepared teeth surfaces were first coated with a desensitizing agent then provisional restorations were cemented with resin cement. In group 3, provisional restorations were not fabricated to serve as control. After specimens were stored in distilled water for 2 weeks, provisional restorations were removed and final IPS Empress 2 ceramic veneers were bonded with a dual-curing resin. Two microtensile samples from each tooth measuring 1.2 x 1.2 x 5 mm were prepared. These sections were subjected to microtensile testing and failure values were recorded. The data were analysed by one-way anova and Tukey HSD tests. The PLVs, placed on the tooth surface that had received a dentine desensitizer and provisional restorations luted with resin cement (group 2), showed the lowest bond strength in all test groups. But no statistically significant differences were found between the bond strength of PLVs in control group (no provisional restorations) and group 1 (provisional restorations cemented with eugenol-free cement before final cementations). Scanning electron microscopic (SEM) examination of this study also showed that the bonding to enamel surface was better in control group and group 1 than group 2.

Dental Bonding↗

Influence of endodontic materials on the bonding of composite resin to dentin.

We assessed the bond strength of a composite resin to dentin that had been in contact with different materials. Flat dentin surfaces in freshly extracted human teeth were covered for 15 min or 48 h with a 1-mm layer of a variety of materials. The products were mechanically removed and a composite resin cylindrical specimen bonded to the dentin surface using the Prisma universal bond system. After 7 days immersion at 37 degrees C in water, the tensile bond strength was tested. The results were compared with those on dentin surfaces not in contact with any endodontic material. Statistical analysis showed that some materials (Grossmans Cement, IRM, Maisto's slowly resorbable paste) reduced the strength of the bond or even precluded bonding. It is necessary to develop techniques that will eliminate this when restoring endodontically treated teeth.

Adhesiveness↗

The use of hypnosis in hemophilia dental care.

The influence of emotional stress on the onset and control of bleeding episodes is a well-known fact. Oral surgical procedures are a common cause of severe states of anxiety in hemophiliacs. Anxiety has been shown to trigger and/or complicate an existing hemorrhagic episode in hemophiliacs. This is true in adults as well as children. Hypnosis, when applicable, has been found to be an excellent adjunct for the control of anxiety. It has been observed that in a relaxed and tranquil hemophiliac, his hemorrhagic tendency during and after surgery is considerably decreased. Induction to a hypnotic state depends on each individual's susceptibility, and therefore different approaches are used depending on the patient's knowledge of hypnosis. In addition to the control of fear, salivary secretions, pain, and capillary bleeding can well be brought under control during surgery and postoperatively by means of posthypnotic suggestions. Good oral hygiene habits such as daily brushing and flossing, so important as preventive measures for the prevention of caries and periodontal disease, can be reinforced through hypnotic suggestions. Preventive dentistry in hemophiliacs is of paramount importance.

Dental Restoration, Permanent↗

Prevalence and distribution of dental restorative materials in US Air Force veterans.

OBJECTIVES: Millions of restorative procedures are performed annually in the United States, yet very little is known about their distribution in the general population. With increasing concern about potential adverse health effects of some restorative materials, a better understanding of the extent of exposure to these materials in the population is important. The purpose of this study is to report the prevalence, patterns, and distribution of dental restorative materials in a population of male veterans. METHODS: This collaborative study with the US Air Force examined 1,166 male veterans to assess exposure to dental amalgam and other restorative materials. An inventory of dental materials in the study population was obtained through oral examinations. Dental materials were classified into five categories: (1) amalgam; (2) resin; (3) porcelain, cement, or temporary, including ionomer (PCT); (4) cast gold alloys/direct filling gold; and (5) other metals (OM). The mean age of the study participants was 52.9 years. Over 94 percent of the study participants were dentate. RESULTS: The study participants averaged 45.8 restored/replaced surfaces. Restored/replaced surfaces increased with age while the number of teeth decreased with age. The most frequently used restorative material was amalgam, averaging 19.89 surfaces per subject, followed by PCT (9.38), resins (8.99), OM (5.52), and gold (4.91). The distributions of restorative materials varied by age, arch type, and location in the mouth. CONCLUSION: The study population experienced substantial exposure to dental materials.

Adult↗

A clinical and microbiological study of deep carious lesions during stepwise excavation using long treatment intervals.

Concern about the survival of microorganisms in deep carious lesions may often lead to unnecessary exposure of the pulp during final excavation. There are reasons, therefore, to initiate systematic studies on the alternative procedure known as stepwise excavation. Clinical evaluation of stepwise excavation was performed on 31 deep carious lesions considered to result in pulp perforation by traditional excavation. This study examines the clinical and microbiological alterations during the final excavation performed during long intervals (6-12 months) after the initial treatment that included peripheral dentine excavation and removal of the central cariogenic biomass and the superficial necrotic dentine. The dentine colour and consistency were assessed by means of standardized scales before application of a Ca(OH)2 compound and a temporary sealing for 6-12 months. Reassessments were performed before the after final excavation. Microbiological dentine samples were obtained in 19 randomly selected lesions by a sterile bur, transferred to and diluted in reduced transport fluid, and plated on tryptic soy agar. After anaerobic incubation at 37 degrees C for 7 days, total colony-forming units per millilitre were counted from (1) peripheral excavated and hard dentine (control), (2) central demineralized dentine before and final excavation, and (3) central dentine after the final excavation. Six samples of central demineralized dentine were without any cultivable flora increasing to 9 samples after the final excavation. The clinical dentine changes occurring during stepwise excavation were characterized by enhanced hardness of the dentine which was associated with a marked reduction in bacterial growth after the final excavation. Despite the presence of bacteria in the excavated dentine none of the carious lesions resulted in pulp perforation, suggesting that the initial removal of the cariogenic biomass appears to be essential for control of caries progression. Stepwise excavation is not only an appropriate treatment of deep carious lesions but is also considered a suitable model for microbiological studies to determine the bacteria persisting in clinically excavated lesions.

Anaerobiosis↗

Extraction, immediate-load implants, impressions and final restorations in two patient visits.

BACKGROUND: Since the advent of immediately loaded implants, patients have experienced shorter treatment times, reduced amount of surgical therapy, preserved gingival esthetics and the comfort and security of fixed prostheses. Practitioners have experienced less expense in the form of chair time and greater patient satisfaction. CASE DESCRIPTION: The authors present two cases in which, at the first clinical visit, they extracted maxillary incisors, placed hydroxyapatite-coated implants, took impressions for final restorations and stabilized the implants immediately with a fixed interim prosthesis. At the second clinical visit, the authors placed the final restorations. All of the implants were integrated clinically, and gingival esthetics appeared to have benefited from preservation of papillary form, which was made possible with fixed interim anterior restorations. The patients expressed satisfaction with the results particularly because the treatment was accomplished in two clinical visits. CLINICAL IMPLICATIONS: The cases presented demonstrate a technique that may be of value to therapists who place immediate-load implants. The long-term effectiveness of immediate-load implants requires further evidence to ensure their long-term usefulness and safety.

Adult↗

[The Bambuí Project: a population-based study of factors associated with regular utilization of dental services in adults].

A cross-sectional study was conducted in Bambuí, Minas Gerais, to identify factors associated with regular use of dental services. Participants were interviewed with a structured questionnaire and previously validated questions. 999/1,221 (81.8%) randomly selected individuals aged > 18 years participated in the Bambuí dental survey. Of these, 654 out of 656 individuals who had at least one natural tooth and had visited a dentist during their lifetime participated in the study. Results adjusted by multiple logistic regression showed that regular use of dental services was significantly related to having > 8 and 4-7 years of schooling (OR = 9.90; 95% CI = 2.90-33.77 and OR = 3.87; 95% CI = 1.11-13.51, respectively), having a preference for restorative treatment rather than extraction (OR = 4.91; 95% CI = 2.23-10.79), having no present need of dental treatment (OR = 4.87; 95% CI = 3.17-7.49), and belief that visiting the dentist prevents tooth decay and gum disease (OR = 1.73; 95% CI = 1.13-2.65). The results show that regular use of dental services was related to factors distributed in the Andersen and Newman model (1973) explaining use of dentistry services.

Adolescent↗

The use of dental services in a population in Northern Norway.

The utilization of dental services was studied by means of records from dentist's files, a method which permits gathering of detailed information with high reliability and validity. 53% of the adult population of 358 persons living in a coastal community in Northern Norway had visited a dentist during a period of two years. In the group of 13% who were considered to be regular treatment attenders, number of teeth, sex and socio-economical status were the most influential predictors of utilization. Among the 182 persons with 10 or more remaining teeth, 59% had made preventive and restorative dental visits, and in this group there was a dominating proportion of women, young people and people with high income and/or social class. In contrast, only six persons out of 61 with one to nine remaining teeth had made such visits. People in social class 3 were overrepresented among the 26% of the population who visited a dentist because of extractions or complete denture services. The treatment profile according to age showed that younger people used most of their treatment time on consultations, preventive measures and conservative treatments, while fixed and removable prosthetics constituted a major part of the treatment time among elderly people.

Adult↗

[In vitro comparison of marginal adaptation of different filling materials. II. Effect of the site and method of preparation on the marginal adaptation].

In a two-month in vitro experiment we examined the marginal adaptation of ten dental materials. Fifty Class II restorations were prepared extending to the cemento-enamel junction. The cavities of the composite restorations were bevelled at the vestibulo-occlusal and -approximal enamel margins, on the other side enamel and gingival margins were prepared conventionally. The specimens were thermocycled and examined with SEM. The microleakage was measured at the vestibulo-occlusal and -approximal tooth-filling junction, where adhesive technique was used, and at the gingival, oroocclusal and -approximal margins, which were not bevelled before. The obviously most important conclusion of the study is, that in the case of deep Class II cavities the amalgam has a better adaptation at the gingival margin than the examined composite resins.

Dental Amalgam↗