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[Indications for the use of amalgam and the importance of cavity preparation].

The range of indications for amalgam includes class I cavities, when the occlusal carious lesions do not permit "extended fissure sealing," and similar class II cavities. Amalgam is not usable for class III and IV cavities in visible areas of the anterior teeth for aesthetic reasons. The standard rules for the class V preparation are also unreservedly valid for the preferred use of composite filling materials. Cervical lesions are not treatable according to the principles of adhesive restoration, or only as an exception. The construction of amalgam crowns represents an attempt at temporary restoration. Inlays, onlays, or crowns are the best methods of treating larger defects.

Dental Amalgam↗

Orthodontic extrusion--a new simplified aesthetic technique.

Various techniques have been described to extrude the roots of fractured teeth to facilitate prosthetic restoration. Many of these have the disadvantage of poor aesthetics, they require skill in fabrication and fitting, and there is often inadequate control over the amount of extrusion. With the technique described, root canal therapy is completed initially and a cast gold post is cemented into the root canal. The post has a channel extending from the labial to the palatal aspect. A temporary acrylic crown is fitted to restore aesthetics, and the channel is extended though the palatal and labial surfaces. An orthodontic wire framework with a horizontal strut at the level of the original incisal edge of the fractured tooth is then bonded to the adjacent abutment teeth. The amount of extrusion required is estimated and a corresponding reduction is made in the length of the acrylic temporary crown. An elastic threaded through the channel and looped over the horizontal strut of the framework provides the extrusive force. A 6 week retention period is required following the extrusion. Periodontal surgery is then carried out if necessary, and a new provisional crown is placed. The final porcelain restoration is fitted after 6 months.

Adolescent↗

A temporary space maintainer using acrylic resin teeth and a composite resin.

A one-session technique for preparing a temporary space maintainer has been described. The technique consists of attaching an acrylic resin pontic to etched surfaces of natural adjacent teeth by means of a composite resin. The main advantages of this technique are elimination of premature tooth preparation, good esthetics, fair strength, low cost, and rapid completion of the restoration without the need of a dental laboratory.

Acid Etching, Dental↗

Mutans streptococci, lactobacilli in saliva and acidity from organisms in dental plaque: changes after restorative treatment.

The effect of restorative dental treatment was evaluated on mutans streptococci and lactobacilli in saliva, as well as acid production by plaque bacteria. We used semiquantitative culture kits at time points up to 6 months following treatment. Changes in eating habits and oral hygiene during the study period were ruled out using a questionnaire. Mutans streptococci, lactobacilli, and acidity all had decreased significantly at 1 week after treatment. Acidity often was the first variable to return to pretreatment levels, while abundant at 6 than 3 months. Lactobacilli showed the most durable response to treatment. Restorative treatment achieves import temporary decreases in caries-associated bacteria, especially lactobacilli, without influence from potentially relevant behavioral changes. In addition, follow up examinations at relatively long intervals at least 3 month would appear most effective for dental health management.

Child↗

Dens invaginatus in a primary canine: a case report.

This article describes an unusual case of dens invaginatus in a primary canine. A 5-year-old boy presented with an infected mandibular primary canine. A periapical radiograph showed a developmental disturbance in the crown diagnosed as dens invaginatus. A necrotic pulp has been removed from the tooth and the root canal obturated with a resorbable paste. Six weeks later the tooth was found to be asymptomatic. A composite restoration replaced the temporary filling material. Dens invaginatus may appear in the primary dentition, and early diagnosis is important for preventative treatment.

Child, Preschool↗

Pulpal evaluation of teeth restored with fixed prostheses.

The literature demonstrates that each of the elements of crown fabrication involves possible and probable insult to the pulpal tissues of the tooth. Preparation of the tooth can result in pulpal inflammation or even burn lesions. The impression technique can result in reduction of the odontoblastic layer caused by drying of the dentin. Temporary coverage of the preparation involves the use of self-curing resins and temporary cements, both of which can irritate the pulp. The final restoration is attached with cements that are often implicated in pulpal irritation. Dental caries and the procedures necessary to remove it and restore the tooth before preparation for a fixed prosthesis can injure the pulp. This study was done to evaluate the effects of complete coverage fixed prosthetic restorations on the dental pulp. A recall letter was mailed to 1221 patients who had received a fixed partial denture or single crown during the years 1984-1988. One hundred thirty patients were examined. Each tooth was evaluated for pulpal health, periodontal integrity, and clinical acceptability of the restoration. Of the 603 teeth examined, 166 had undergone root canal therapy before placement of the restoration, leaving 437 that were crowned while vital. Of these, 25 (5.7%) were in need of root canal therapy or had undergone root canal therapy after cementation of the fixed prosthesis.

Crowns↗

Dissolution of cement, root caries, fracture, and retrofit of post and cores.

Fixed partial denture abutments severely damaged by dental caries or fracture present a challenge to the dentist. The fixed partial denture may need to be removed for endodontic treatment with post and core fabrication. Frequently, the existing fixed partial denture can be recycled as a provisional restoration. Retrofitting the post and core greatly improves the stabilization of the interim as well as the remake of the definitive fixed partial denture. This article describes a chair side procedure for retrofitting posts and cores and, at the same appointment, converting the original fixed partial denture to an effective provisional restoration.

Dental Abutments↗

The Hong Kong Bridge Protocol. Immediate loading of mandibular Brånemark fixtures using a fixed provisional prosthesis: preliminary results.

BACKGROUND: The Brånemark System Classic is well documented for its successful and predictable results in dental implant rehabilitation. However, the classic two-stage protocol is associated with problems, such as long treatment time and high treatment cost. To overcome these problems, new developments, including early functional loading protocol and Brånemark System Novum, have been introduced by various groups of researchers. In Hong Kong, a protocol has been developed to immediately load the Brånemark System fixtures with a fixed provisional prosthesis. PURPOSE: The goal of this prospective study was to present the Hong Kong Bridge protocol and report the short-term evaluation of this protocol in a group of patients who had undergone dental implant treatment for their edentulous mandibles. MATERIALS AND METHODS: Twenty-seven consecutive patients being treated at the Hong Kong Osseointegration Implant Centre between June 1998 and December 2000 were included in this study. A total of 123 Brånemark System fixtures were installed and regularly followed up for 3 to 30 months. The prosthesis stability and the marginal bone level were regularly evaluated clinically and radiographically, respectively, after the implant surgery. RESULTS: Fifteen of the 27 patients had been followed up for 1 year or longer. Two patients with eight fixtures were withdrawn from the study. Two of the 115 remaining fixtures failed, resulting in an overall implant survival rate of 98.3%. The mean marginal bone change was reported on 49 fixtures that had passed the 1-year review. The mean marginal bone loss was 0.60 mm (p < .05) after 1 year of functional loading. CONCLUSIONS: To load the mandibular Brånemark System fixtures immediately according to the Hong Kong Bridge protocol was a predictable and simple method with good results during this preliminary study period.

Adult↗

Clinical evaluation of a new resin composite crown system to eliminate postoperative sensitivity.

This study evaluated the long-term clinical performance of a new resin composite restorative system with a 4-META dentin-bonding agent to seal complete crown preparations prior to temporization and after permanent luting with a companion resin cement. Complete-coverage crown preparations were completed on 33 vital teeth and 5 nonvital teeth (control). The new restorative material demonstrated satisfactory clinical performance for the 3-year test period. The dentin-bonding agent and its companion resin cement successfully eliminated postoperative hypersensitivity in 100% of the prepared vital teeth over the 3-year term, suggesting excellent seal of dentinal tubules exposed by the complete-crown preparations.

Acrylic Resins↗