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Restoration of the vertical dimension of occlusion in the severely worn dentition.

The guidelines presented in this article for diagnosis and treatment of extreme tooth wear are not meant to be all inclusive. Every patient has unique treatment needs, and all of these needs may not be addressed specifically in this article. We believe, however, that careful adherence to the guidelines presented should facilitate a successful treatment of most if not all patients with moderate or severe tooth wear. The general guidelines for treatment of these patients include the following: 1. A comprehensive examination, including a thorough medical and dental history, orofacial and dental clinical examination, dental radiographs, TMD screening history and examination, impressions and jaw relation records for mounting casts in a semi-adjustable articulator, 2. A diagnostic wax-up and diagnostic occlusal adjustment on additional or duplicated mounted casts, 3. Careful planning and consultation regarding the need for preparatory treatment. Careful integration and sequencing of the different areas of treatment needed to enhance the finished result, 4. Discussion with the patient of the different treatment alternatives and sequences possible for his or her individual case, with presentation of advantages and disadvantages and prognosis for each, 5. Finally, careful execution of the agreed upon treatment plan by the dentist. Although not specifically mentioned, treatment success requires a highly motivated patient and skilled dental laboratory technicians. These "treatment partners" should be included in the planning stages of treatment as early as possible to enhance the possibility of having a successful treatment result.

Dental Occlusion, Traumatic↗

Two-year clinical performance of Class V resin-modified glass-lonomer and resin composite restorations.

While a one-year report had been previously published, this study was undertaken to evaluate the clinical performance and appearance of a resin-modified glass ionomer and a resin composite over two years. Thirty-seven pairs of restorations of FujI II LC and Z 250/Single Bond were placed in caries-free cervical erosion/abfraction lesions without tooth preparation. Restorations were clinically evaluated at baseline, 6, 12, 18 and 24 months using modified Ryge/USPHS criteria. No statistically significant difference (p = 0.13) was observed in the overall performance of the materials. Retention was 96% for the resin-modified glass ionomer and 81% for the resin composite, with no additional restorations of either material lost after one year. As previously reported, retention of the Z 250 restorations at six months was below the minimum specified in the ADA Acceptance Program for Dentin and Enamel Adhesives. The resin composite restorations generally had a better appearance, with a 100% alpha rating in color match, versus 85% for the resin-modified glass ionomer.

Adult↗

Effect of resin viscosity and enamel beveling on the clinical performance of Class V composite restorations: three-year results.

This study evaluated the effect of the elastic modulus and margin configuration on the clinical performance of resin-based composite restorations in Class V non-carious defects. One hundred and five cervical non-carious defects on buccal surfaces of canines and premolars were included in this study. Defects were randomly divided into three Groups and restored according to the following techniques: Group 1--no enamel bevel was placed and the defect was restored with a microfilled resin-based composite (Durafill VS); Group 2--the enamel margin was beveled and the defect restored as in Group 1; Group 3-the enamel margin was beveled and the defect was restored with a flowable resin-based composite (Natural Flow). Each group comprised 35 lesions. A total-etch, one-bottle adhesive (One-Step) was used in all groups. Retention rate, pre- and post-operative sensitivity, marginal discoloration and secondary caries were determined over a three-year period and the data were analyzed statistically. At six months post-insertion, the restorations placed with beveled enamel margins resulted in 100% retention regardless of the composite used compared to a 66% retention of the non-beveled margins. At two and three years, no significant difference in retention rate was found among the three groups. Post-operative sensitivity, marginal discoloration and secondary caries were not affected by enamel beveling and restorative material. Beveled enamel margins resulted in significantly better clinical retention in the first six months only. Enamel beveling and composite viscosity appeared to not significantly affect the clinical performance of Class V non-retentive composite restorations after three years.

Adult↗

Five-year double-blind randomized clinical evaluation of a resin-modified glass ionomer and a polyacid-modified resin in noncarious cervical lesions.

PURPOSE: The aim of this double-blind randomized study was to compare the clinical performance of a resin-modified glass ionomer (Vitremer, 3M) and a polyacid-modified resin (Dyract, Dentsply DeTrey) in noncarious Class V restorations after 5 years. MATERIALS AND METHODS: Twelve patients, having at least one pair of equal-sized noncarious cervical lesions under occlusion and a mean age of 40 years (range 19 to 63 years; median 41), were enrolled in this study. A total of 32 restorations (16 with each material) were placed according to the manufacturers' instructions by two calibrated operators. Two other independent examiners evaluated the restorations at baseline and after 5 years according to the USPHS criteria. The assessment criteria were: retention, anatomical form, marginal adaptation and marginal discoloration, color match, surface texture, and secondary caries. Statistical analysis was conducted using Fisher's exact test (alpha = 0.05). RESULTS: No secondary caries was detected with either material. The retention rate for Vitremer (93%) and for Dyract (78.5%) did not differ significantly (p > 0.05). Regarding anatomical form, only two restorations of each material were recorded as bravo. In terms of marginal adaptation, 38.5% of Dyract restorations were rated alpha and 61.5% bravo, while 84.6% of Vitremer restorations were rated alpha and only 15.4% bravo (p < 0.05). For marginal discoloration, 18.2% of Dyract restorations and 84.6% of Vitremer restorations were rated alpha, with the remaining rated bravo. 86% of Vitremer restorations were rated as bravo and 23% alpha for both surface texture and color match. All Dyract restorations were classified as alpha regarding surface texture, and only two Dyract restorations (18.2%) were classified as bravo in the color match item. CONCLUSION: The marginal adaptation of the RMGIC (Vitremer) was significantly better, the marginal discoloration lower, and the retention rate higher (though not significantly) than that of the PMRC (Dyract) after 5 years in situ. Dyract performed better in terms of surface texture and color match in noncarious Class V restorations after 5 years.

Adult↗

[A patient with Prader-Willi syndrome. Characteristics, oral consequences and treatment options].

A dentist referred a 32-year-old man with the Prader-Willi syndrome to a center for special dental care because of the poor cooperation of the patient, progressive toothwear and advanced palatal trauma. The dental problems were, among others, caused by the disto-relation (Class II-2), a poor oral hygiene, the frequency of sugar intake, oesophageal reflux and a strongly reduced salivary pH of 5.5. Treatment of the dentition was established by minimal invasive and adhesive dentistry.

Adult↗

Tooth surface loss and associated factors among factory workers in Finland and Tanzania.

The relative importance of various factors in the occurrence of tooth surface loss was explored in a, cross-sectional study using blind dental examinations. Two samples were drawn; one from Finland, comprising 186 workers from four factories and another from Tanzania of 180 workers from two factories. Among the 326 dentate individuals who participated, 164 were exposed to acid fumes and 162 were not. In Finland, people with tooth surface loss were older and smoked cigarettes less frequently. In Tanzania, those with tooth surface loss were also older and the proportion of subjects with the condition was significantly higher among people not using a commercial toothbrush and those exposed to acids. Among the Tanzanians, exposure to acids increased the probability of tooth surface loss to a high level of significance, and increasing age increased its probability, both among the Finns and the Tanzanians. Both anterior and posterior teeth were affected. It can be concluded that if the exposure to acids from the air breathed is high, the probability of tooth surface loss will increase. It seems that explanatory factors for tooth surface loss from one society cannot be extrapolated to another.

Adult↗