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PubMed1994

A conservative, aesthetic, restorative treatment of a worn dentition.

Advances in adhesive technology and in materials science have combined to provide the dentist with techniques which increased the ability to achieve the ultimate restorative objective: The restoration of diseased or missing tooth structure, including its appearance, without the additional removal of healthy tooth structure. The learning objective of this article is to illustrate, using a case report, how far restorative dentistry, redefined as aesthetic, adhesive, restorative dentistry, has taken us in this endeavor.

Dental Restoration, Permanent↗

PubMed1994

Effect of occlusal load cycling on the marginal integrity of adhesive Class V restorations.

The objective of this study was to evaluate the gingival wall marginal integrity of adhesive Class V restorations subjected to occlusal load cycling. Extracted lower first and second molar teeth were used. For each tooth, a Class V cavity was prepared in the buccal or lingual surface with the gingival margin in the cementum. The cavities were restored with eight different adhesive systems: (1) Ketac-Fil; (2) Fuji II LC; (3) Ketac-Bond/Pertac; (4) Photac-Bond/Pertac; (5) Scotchbond 2/P50; (6) Scotchbond Multi-Purpose/P50; (7) Clearfil Liner Bond/Clearfil Photo Posterior; and (8) OptiBond/Herculite XR. For each material-combination, three test procedures were carried out: no loading (control), loading at 125 N and at 250 N. Six specimens were prepared for each procedure. The samples were loaded for 5000 cycles in a dye solution and kept in the dye for 24 hours after loading. Control samples were stored in the dye for the same period. All teeth were sectioned and dye penetration at the gingival wall was scored from 0 to 4. Under control condition, only groups 2, 6, 7 and 8 showed perfect marginal integrity. After loading at 125 N, groups 1, 3 and 5 showed significant increase in leakage (P < 0.05). Increasing the load to 250 N resulted in significant deterioration in the marginal adaptation of all test groups, except 6 and 7. This study indicates that the marginal integrity of occlusally stressed adhesive Class V restorations can only be preserved by a few products.

Bisphenol A-Glycidyl Methacrylate↗

PubMed1993

[Evaluation of amalgam separators].

There is an increased awareness about environmental protection and reduction of toxic waste. This applies also to the dental profession. One of the main concerns in dentistry is the reduction of amalgam slurry, which contains mercury, being drained by dental plants. The largest pieces of amalgam are stopped by the coarse filter. For eliminating the amalgam silt out of the sewage, amalgam separators have been developed. This paper presents an evaluation of seven separators, mounted in a preclinic set-up. The average particle size of the amalgam waste was determined. The flow-velocity of the separators differed very much between the different separators. One apparatus produced an inferior separation capacity compared to the others. Apparently not one was capable to purify the effluent to 0.05 mg/l during peak supplies of amalgam slurry. Other measures such as the reduction of the need for restoring, the use of alternative materials and modified preparation techniques, will further reduce the drain of amalgam silt by dental installations.

Dental Alloys↗

PubMed1993

[What efforts are being made by dentists in the Flemish region for the limiting of amalgam rejection? A study conducted on a representative sample of 373 Flemish dentists on the subject of amalgam waste: extent of the problem, waste management and foreseeable solutions].

The great Amalgam debate is also taking place in Flanders (Belgium). Mercury amalgam has been used for dental fillings since the last century. Over that time, questions have occasionally been raised with regard to its safety (mercury vapour given off by the amalgam fillings and the possible dangers that these could cause to the patient and the dentist) and with regard to the ecological impact of amalgam waste. Some materials used to treat dental patients endanger the environment. The most important polluting materials are the heavy metals, in particular mercury. This study investigated the answers to the following research questions: What is the total volume of amalgam that is used in Flemish dentistry and what part ended up in the household waste? How do Flemish dentists manage (store and dispose of) their dental amalgam waste? Are Flemish dentists using any alternatives (amalgam separators or alternative materials for dental fillings) for amalgam? A randomly selected group of 500 dentists working in the Flemish part of Belgium was invited to answer a mail questionnaire. A total of 373 dentists responded (response rate 74.6%), providing a representative sample. Of the 5000 kg amalgam being used in one year in Flemish dentistry, about 1.200 kg is discharged either into the sewage or into the household waste. Furthermore, a supplementary 1.900 kg amalgam (extracted teeth with amalgam fillings or bored out amalgam fillings) is also being discharged either into the sewage or into the household waste. Although dental amalgam is the restorative material most used in Flanders, composite materials are becoming more widely used. Only 5% of the respondents were using an amalgam separator.

Attitude of Health Personnel↗

PubMed1993

The general dental status of patients referred to the orthodontic department of the Glasgow Dental Hospital.

A survey of 280 orthodontic referrals to the Glasgow Dental Hospital, consecutively screened for orthodontic needs, revealed that 1 in 5 had untreated caries and more than half had a level of oral hygiene incompatible with wearing an orthodontic appliance. The suitability and motivation of such patients, therefore, must be questioned before prescribing orthodontic treatment.

Adolescent↗

PubMedDate not supplied

Properties related to strength and resistance to abrasion of VariGlass VLC, Fuji II L.C., Ketac-Silver, and Z-100 composite resin.

The purpose of this study was to evaluate the properties related to the strength and resistance to abrasion of new Type II lightcured glass ionomers, VariGlass VLC, and Fuji L.C., and to compare the results with Ketac-Silver and Z-100 composite resin. Each material was tested for strength with an Instron Universal Testing Machine and for resistance to abrasion with a motor-driven machine. The strengths of Z-100 were the highest. Among glass ionomers, Ketac-Silver had higher compressive strength, but lower diametral tensile and transverse strengths than the others; and Fuji II L.C. had higher strengths than VariGlass VLC. VariGlass VLC showed the greatest resistance to abrasion, followed respectively by Z-100, Fuji II L.C. and Ketac-Silver. ANOVA indicated significant differences in strengths and abrasion resistance, except, the volume losses of Fuji II L.C. and Ketac-Silver in the toothbrushing test were not significantly different (p < 0.01). The results support VariGlass VLC and Fuji II L.C. as alternative filling materials in Class III and V situations, but they are not recommended for stress-bearing restorations.

Acrylic Resins↗

PubMed1993

Freehand composite veneering-the direct option.

Freehand bonding of direct composite resin veneers is one of the new techniques developed during the past decade. This article discusses the clinical procedure of this technique, with indications and contraindications, and a new composite resin material used in this technique.

Composite Resins↗

PubMed1993

Porcelain veneers: concept, preparation, temporization, laboratory, and placement.

The success of porcelain veneers depends on knowledge of chairside and laboratory techniques. Improvements in porcelain materials and techniques have dramatically increased the ease and success of these procedures. The learning objective of this article is a review of the new porcelain veneer techniques. The same case is followed from conception to completion, describing and illustrating the techniques.

Dental Casting Technique↗

PubMed1993

Effect of thermal and mechanical load cycling on the marginal integrity of Class II resin composite restorations.

Class II cavities were prepared in extracted human teeth and adhesively restored with one of three different composite systems. Also, for each system samples were made with a light-cured glass ionomer base. Marginal integrity was measured by dye penetration and SEM observation before and after stressing the samples with thermal and mechanical load cycling. Before loading, the bond system in combination with acid etching the dentin provided superior results. Loading did not significantly affect marginal integrity in light-cured glass ionomer lined samples. This was in contrast to unlined resin dentin bonding system/resin composite restorations where loading did deteriorate marginal integrity significantly.

Acid Etching, Dental↗

PubMedDate not supplied

Effect of grooves on resistance form of Class 2 amalgams with wide occlusal preparations.

This study evaluated in vitro the necessity of retention grooves in approximal boxes in class 2 preparations with faciolingually wide occlusal extensions (occlusal isthmus width 1.8 mm). Thirty-six class 2 mesio-occlusal cavities were prepared in sound human maxillary premolar teeth and divided into three groups of 12. In one group, the preparations had no retention grooves. In another group, retention grooves 0.3-0.5 mm deep were prepared at the axioproximal line angles and extended from the gingival floor occlusally to just gingival to the occlusal dentinoenamel junction. In the third group, a 1 mm-long groove was prepared extending from the axiopulpal line angle occlusally to just gingival to the occlusal dentinoenamel junction. The marginal ridges of the amalgam were loaded at an angle of 13.5 degrees from vertical in an Instron Testing Machine until the restorations failed. Results indicated no significant difference in load to cause failure in any of the three groups. Restorations without approximal retention grooves possessed as much resistance to failure as those with grooves.

Analysis of Variance↗

PubMedDate not supplied

Esthetic veneering of amalgam restorations with composite resin--combining the best of both worlds?

Patients are becoming more and more aware of the esthetic alternatives to dental amalgam and are asking dentists to offer solutions that are more esthetically pleasing. However, the difficulties in inserting clinically durable composite resin restorations in the posterior area are numerous. With the high-copper amalgam systems, the dental profession has had an excellent restorative material. In the past there have been attempts to combine amalgam with the esthetic qualities of composite resin. The introduction of an adhesive and opaque light-curing glass-ionomer liner has created new opportunities to bond composite resin to existing amalgam restorations on esthetically disturbing surfaces. This paper describes a simple and quick way in which unesthetic buccal and occlusal extensions of amalgam restorations can be veneered with composite resin. Preliminary six-month results of about 100 restorations are presented. This method may prevent the premature replacement of good functioning amalgam restorations with porcelain-fused-to-metal crowns or composite resin restorations for only esthetic reasons.

Color↗

PubMed1993

Pins, dowels, and other retentive devices in posterior teeth.

Devices used to increase retention of restorations to severely damaged posterior teeth are described, with an emphasis on pins and dowels. Advantages and disadvantages of different techniques and measures to help prevent and correct problems are presented.

Bicuspid↗

PubMed1993

Esthetic applications of restorative materials and techniques in the anterior dentition.

The esthetic expectations of our patients can be met by doing a thorough initial examination with emphasis on periodontal health, caries incidence, occlusion, possible orthodontic corrections, esthetic needs, and economic concerns. Through proper communication with the patient, a written treatment plan can be developed that uses the various techniques of bleaching, cosmetic recontouring, direct resin bonding, porcelain veneering, or crowning to meet the patient's restorative needs. The most conservative noninvasive techniques should be evaluated first. Often, bleaching and partial direct bonding are all that is needed. If the dentition is badly worn or discolored, then more extensive treatment is indicated. Patients frequently have concerns about longevity of restorations or require very high levels of esthetic correction, which can only be accomplished with more invasive techniques. When patients understand what can be accomplished and are involved in the treatment decision, then successful results are assured. Esthetic restorative dentistry is probably the most rewarding aspect of practice today, but it is also the most challenging. New materials appear and techniques change so rapidly that it is sometimes difficult to keep up. Practitioners should acquire a thorough knowledge of available methods and materials, learn the limitations of these materials and techniques, and master skills through continuing education (courses, journals, and newsletters) as well as chairside repetition as new procedures become available.

Crowns↗

PubMed1993

Dental amalgam. The state of the art and science.

When you balance the benefits and liabilities of a modern dental amalgam, it is one of the materials that comes closet to being an ideal restorative. Its numerous clinical advantages have, in the past, made it a standard in dental care. The profession's and public's awareness of the issues surrounding the mercury content, coupled with the biased reporting of the controversy by less than responsible journalists, have served to impung the material. The dental profession has used the material successfully in its present form for almost 100 years. There are still valid questions about the material that require further scientific investigation. Investigators continue to make improvements in the alloy's strength and handling properties while limiting the mercury-release potential of the material. As we move into the twenty-first century, we are again told we will soon have a suitable replacement for dental amalgam. That is an often repeated promise for this multifunctional product. Time and sound research into the longevity and liabilities of all restorative materials as applied in the office of the general practitioner will tell us if amalgam is or is not going to disappear from the dental armamentarium in the near future.

Dental Amalgam↗

PubMed1993

Restorative considerations for special needs patients.

Individuals are living longer with more chronic and disabling conditions than previous generations of adults. In addition, they are retaining more of their natural dentition than ever before. As a result, it will be common for a dentist in practice in the next 20 to 30 years to care for many patients with special needs. These individuals offer unique challenges to the dental practitioner. Dentists must be knowledgeable in the oral aspects of various medical conditions and the systemic manifestation of oral diseases. In addition to the oral medicine aspects of practice, dentists must be skilled clinically to care for the unique restorative needs with which these patients present. As individuals age or become chronically ill, people deserve the opportunity to select from all that modern dentistry has to offer. Patients must be involved intimately in the decision-making process. No dental professional should assume because a patient is old or chronically ill that he or she lacks the financial resources or the desire to maintain his or her oral health.

Aged↗

PubMedDate not supplied

Porcelain laminate veneers for discolored teeth using complementary colors.

Porcelain laminate veneers are affected by the color of prepared abutment teeth, so that if these teeth are discolored they may cause problems in a restoration. This paper describes how complementary color theory is applied to resolve this situation and provide a more esthetic restoration. Tooth discoloration is classified into four base colors: orange, brown, blue-purple, and reddish gray, and a shade selection technique and a veneer fabrication technique are presented.

Color↗

PubMed1993

Advances and current research in ceramic restorative materials.

Ceramics are currently the most widely used material for veneering crowns and bridges. Newer applications, such as bonded inlays, onlays, and veneers, are steadily gaining in popularity. A new generation of metal-free, all-ceramic systems for crowns became available during the 1980s. More recently, other all-ceramic systems with improved mechanical properties affording a variety of uses have been introduced. Also, a computer-assisted design-computer-assisted manufacture method of fabricating ceramic inlays has become a routine treatment entity with favorable 5-year clinical data. Research is leading to a better understanding of conventional ceramic systems as well as providing information on laboratory manipulation and clinical methodology for optimal results.

Crowns↗

PubMed1993

Porcelain laminate veneers: a clinical success?

The rapid increase in the use of porcelain veneers is a result of the demand for a minimally invasive, colour and contour stable restoration. However, such restorations are not equally successful in all patients. This article describes the careful treatment planning and patient selection necessary to avoid problems and to ensure that the best result is achieved with porcelain veneers.

Dental Cavity Preparation↗