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Much confusion exists in the dental community regarding the restoration of endodontically treated teeth; few review articles present succinct guidelines for the restoration of these teeth. This article reviews the literature and presents guidelines for restoration of endodontically treated teeth.
This investigation involved the creation of coronal-radicular fractures in vitro and compared the fracture resistance of intact human mandibular molars, with molars after varied tooth preparation. Forty freshly extracted, non-carious, nonrestored human mandibular molars were randomly divided into four treatment groups. The molars were subjected to constantly increasing occlusal load until coronal-radicular fracture occurred. Tooth preparations significantly diminished resistance to coronal-radicular fracture.
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I have not discussed the full veneer restoration of metals or ceramics. These are costly services-between four and six times amalgam's cost. No clinical evidence supports longevity much greater than amalgam. Full veneer restoration requires significant reduction of tooth structure and may also require a buildup for appropriate retention. A buildup requirement again debates the question of alternative to amalgam. Full cast restorations have not been discussed as legitimate alternatives, though partial veneers would be equivalent to onlay procedures. Full veneer procedures are better suited to significant reconstructions of tooth structure, and only then when there can be some expectation of home care by the patient. Dr. Miles Markley extolled the use of amalgam during his career. He was innovative in creating extremely conservative preparations, and the placement procedures for quality amalgam restorations. He stated: "Amalgam is the standard." All techniques for single tooth restoration, whether esthetic or not, could stand a comparison to this standard. There are materials and techniques that begin to compare well with amalgam. No one material or technique fits all the needs amalgam has fulfilled, but some can begin to compete.
Since the introduction of porcelain jacket crowns in the early 1900s, dental ceramics have been praised for their esthetic appearance. But there's more to consider: other benefits, longevity, limitations. This review addresses major developments in modern dental ceramics and metal-ceramics.
As the CAD-CAM technique has been expanded to include porcelain facings, of particular interest is adapting the veneer to the prepared surface. In a comparison of the gap dimension of CAD-CAM generated veneers to those produced in the laboratory, no statistically significant differences were detected.
The new generation of dentin bonding materials can withstand the contraction shrinkage of composite materials. A two-year clinical trial of one material showed an excellent retention rate.
This cross-sectional study compared the periodontal health and clinical acceptability of maxillary incisors restored with porcelain veneers vs. porcelain-fused-to-metal crowns. The authors evaluated 60 patients, a total of 120 restorations, in groups according to the age of the restorations (zero to 60 months). Margins of veneers were generally more supragingival with less gingival inflammation. All veneers were clinically acceptable, while 5 percent of PFMs failed because of secondary caries.
This in vitro study involving 84 caries-free molar specimens examined the resistance of complex amalgam restorations retained by two dentin bonding agents--Amalgambond and Amalgambond Plus--four regular TMS pins, six regular TMS pins and four pins in conjunction with Amalgambond. Analysis indicated that the Amalgambond restorations were significantly weaker than the other types. Amalgambond Plus restorations were significantly stronger than the Amalgambond restorations but not different from the remaining groups. The authors concluded that complex amalgam restorations should be retained with a combination of adhesive and mechanical retention.
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Esthetic restorative procedures are routine in most dental practices. The procedures considered to be standard and acceptable by practitioners are bleaching teeth outside the dental office; bonding; intracoronal direct resin restorations; tooth-colored inlays and onlays; porcelain veneers; all-ceramic crowns; and PFM crowns. Unfortunately, some third-party payment organizations do not pay adequately for numerous esthetic restorative procedures, and continued education of these groups about the reliability of esthetic restorative procedures is necessary.
This paper explores the implications of bleaching procedures on restorative dentistry. The effects of tooth whitening systems on the bond strength, marginal integrity, color and other properties of restorative materials are reviewed. Also, clinical considerations in combining bleaching and aesthetic restorative techniques are discussed.
Concerns about ergonomic risk factors have been growing among health care and other workers. The authors undertook a study to determine the presence of certain ergonomic risk factors in typical tasks performed by dentists and dental hygienists. They further investigated--by means of electromyography and goniometry--the force, frequency and duration of the task. The study suggests that when a task's duration, force and frequency are accounted for, scaling, polishing, flossing and probing activities do not represent exposure to high ergonomic risk.
BACKGROUND: Esthetic care is changing dentistry from a need-based to a want-based practice. Patients are asking for esthetic treatment, and clinicians are retooling their practices to satisfy this need. One important part of providing esthetic dentistry is ensuring that the patient is as well-informed as possible about treatment outcomes. DESCRIPTION OF TECHNIQUE: This article describes a tool dentists can use to show patients potential tooth sizes, shapes and arrangements before carrying out treatment. Simulated shape design, or SSD, is a reversible method of demonstrating potential esthetic outcomes that involves creating trial restoration shapes and placing them over a patient's teeth. SSD is a simple technique that any dentist can perform. In essence, the technician makes new tooth shapes in wax, the dentist places these in the patient's mouth and the patient evaluates them. The dentist then makes modifications in the SSD, which he or she reports to the technician. CLINICAL IMPLICATIONS: With the decisions of shape, arrangement and size made at chairside, the whole flow of esthetic treatment can be handled smoothly. Preparations can be cut more accurately to better support the restorative material; decisions can be made to open or not open the contacts; and shapes can be agreed on in the earliest stage of evaluation, then duplicated faithfully in the provisional and final restorations. There are no surprises for the patient, the dentist or the technician. Both the esthetic (smile design) and functional elements (anterior guidance) of the restoration can be checked with SSD. SSD could become the standard in determining whether or not to proceed with esthetic treatment.
BACKGROUND: The authors describe the treatment of three patients who had severe apical root resorption of maxillary lateral incisors caused by ectopically erupting canines. Ectopically erupting canines derive from a normal path of eruption and may cause resorption of the adjacent teeth. CASE DESCRIPTION: The authors present the three cases of severe root resorption caused by ectopically erupting canines. They then discuss various prosthetic options; the indications, advantages and disadvantages of various treatment modalities; the long-term retention and esthetic concerns of the patients; and the inherent limitations of restorative treatment. CLINICAL IMPLICATIONS: Increased tooth mobility and long-term retention are significant concerns in cases of patients who have severe root resorption. Attaining stability with lingual splinting can cause esthetic problems. An interdisciplinary approach is necessary to provide optimal care for the patient.
In my opinion, there is an obvious trend in the dental literature and in continuing education courses to promote overcutting teeth when preparing them for restorations. There are many reasons for overcutting. Some feel that there is a more optimum esthetic potential when the teeth are prepared more deeply, which is a debatable view. Others are using all-ceramic crowns or polymer crowns when other types of less radical crowns could be used. There also is a significant tendency to prepare teeth for crowns instead of for onlays or inlays, thereby removing more tooth structure than is necessary. High-speed dental air rotor or electric handpieces can cause inadvertent removal of more tooth structure than is necessary. Using large burs can overcut tooth structure, and teeth should be reversed.
BACKGROUND: Dental patients who have epilepsy with pharmacologically refractory seizures may be treated with an implanted pulse generator that electrically stimulates the left vagus nerve. The pulse generator functions like a cardiac pacemaker. Some electrical dental devices have been shown to cause electromagnetic interference with the function of cardiac pacemakers. The potential effect of similar dental equipment on vagus nerve stimulators is unknown. METHODS: Common electrical dental devices were operated at maximum power settings in close proximity to a representative vagus nerve stimulator. The author assessed any interference of the dental devices with the nerve stimulator function by observing oscilloscope tracings. RESULTS: Under the conditions of this evaluation, none of the dental devices tested altered the function of the vagus nerve stimulator. CONCLUSIONS: Some commonly used electrical dental devices may be used in close proximity to patients who have implanted vagus nerve stimulators without adverse effects on the nerve stimulator function. CLINICAL IMPLICATIONS: Dentists and dental hygienists may encounter patients with implanted vagus nerve stimulators, and they need to be cognizant of developments in the treatment of epilepsy. Under the conditions of this study, use of common dental electrical devices did not alter the function of a vagus nerve stimulator. The findings of this study, however, should not be generalized to all types of electrical dental or medical devices, as a recent report indicates that treatment with diathermy devices is contraindicated for patients with implanted nerve stimulators.
BACKGROUND: This article reports the authors' development of nanofillers and a resulting nanocomposite. They measured the nanocomposite's properties in vitro in comparison with those of several existing composites (hybrids, microhybrids and microfill). METHODS: The authors developed two types of nanofillers: nanomeric particles and nanoclusters. They used optimal combinations of these nanofillers in a proprietary resin matrix to prepare the nanocomposite system with a wide range of shades and opacities. The properties they studied were compressive, diametral tensile and flexural strengths; in vitro three-body wear; fracture resistance; polish retention; and surface morphology after toothbrush abrasion. They performed statistical analysis using analysis of variance/Tukey-Kramer paired analysis at a 95 percent confidence interval. RESULTS: The compressive and diametral strengths and the fracture resistance of the nanocomposite were equivalent to or higher than those of the other commercial composites tested. The three-body wear results of the nanocomposite system were statistically better than those of all other composites tested. The nanocomposite showed better polish retention than the hybrids and microhybrids tested at the extended brushing periods. After extended toothbrush abrasion, the dentin, body and enamel shades showed polish retention equivalent to that of the microfill tested, while translucent shades showed better polish retention than the microfill. CONCLUSIONS: The dental nanocomposite system studied showed high translucency, high polish and polish retention similar to those of microfills while maintaining physical properties and wear resistance equivalent to those of several hybrid composites. CLINICAL IMPLICATIONS: The strength and esthetic properties of the resin-based nanocomposite tested should allow the clinician to use it for both anterior and posterior restorations.