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Conventional cementation technique for Targis restorations.

Ivoclar can now recommend a clinical and laboratory procedure for the conventional cementation of Targis single- and multiple-unit full-coverage restorations. The ability to bond restorations utilizing enamel/dentin bonding systems and dual-cure resin cements (Variolink II, Ivoclar Vivadent, Amherst, NY) has minimized microleakage and postoperative sensitivity, provided stronger restorations, and reinforced remaining tooth structure. Unfortunately, the benefits of the adhesive technique can often be compromised by existing or pre-existing clinical conditions. This challenge has limited the broad use of adhesive, metal-free restorations in many clinical situations. Targis restorations can now be successfully cemented utilizing zinc phosphate or conventional glass ionomer cements. This article describes the technique through a case presentation.

Cementation↗

Restoration of a single anterior crown.

All-ceramic restorations have gained patient acceptance and are increasingly being used in aesthetic appearance-related restorations. This case report of a single anterior crown matching natural dentition utilizes some of the new special-effect ceramic powders designed for use with the layering technique. These powders help to properly replicate incisal, mamelon, and gingival areas. The clinical procedure is described, using photographs of the case to illustrate the steps involved.

Adult↗

Dentin bond strength of Dyract Cem.

PURPOSE: To evaluate the influence of provisional cements and of a dentin bonding agent on the adhesion of a self-curing polyacid-modified resin composite (Dyract Cem) on pressurized human dentin. MATERIALS AND METHODS: Freshly prepared dentin specimens of human teeth were perfused with physiologic saline. Three different types of surface treatment were evaluated. (1) Dyract Cem was applied to freshly prepared dentin without (Group 1.1) or with (Group 1.2) the respective dentin bonding agent (Prime & Bond 2.0) and cured. (2) Freegenol (Groups 2.1 and 2.2) or Temp Bond (Groups 2.3 and 2.4) were applied first on the dentin surface for 24 hours. Only then was Dyract Cem (with or without Prime & Bond 2.0) added onto the dentin after cleaning the dentin surface with pumice. 3) Prime & Bond 2.0 was applied first on the dentin surface and cured. Then Freegenol (Group 3.1) or Temp Bond (Group 3.2) were added for 24 hours. After cleaning with pumice, Prime & Bond 2.0 was applied for a second time on the dentin (= dual application) and finally Dyract Cem was added. As control, a conventional glass ionomer cement (Ketac-Cem Maxicap; Groups 4.1-4.3) was used in a similar way. After 1,500 thermal cycles with constant imitation of intrapulpal pressure, shear bond strengths were measured. Resulting shear bond strength values were displayed by means of a box plot and they were analyzed statistically by Mann-Whitney, Kruskal-Wallis or one way ANOVA tests. RESULTS: Lowest and highest mean shear bond strength values were 0.27 +/- 0.42 MPa (Group 2.4; single use of Prime & Bond 2.0 with prior application of TempBond) and 5.84 +/- 3.36 MPa (Group 3.1; dual use of Prime & Bond 2.0 with intermediate application of Freegenol). A clearly significant difference between groups could only be found when a single or dual use of the dentin bonding agent Prime & Bond 2.0 were combined with either Freegenol (Groups 2.1, 2.2 and 3.1; Kruskal-Wallis: P < 0.01) or Temp Bond (Groups 2.3, 2.4 and 3.2; Kruskal-Wallis: P < 0.001) as additional dentin surface treatment.

Adhesiveness↗

Temporarily permanent.

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Dental Restoration, Permanent↗

Teenage luxation injury: report of case.

The endodontic, restorative, and orthodontic treatment sequence of the accidental injury of three maxillary incisors has been presented. The treatment objective was to achieve an esthetically acceptable result for a young adult, until a definitive fixed prosthetic restoration can be planned. The ankylosed maxillary right permanent central incisor (11) is being maintained for reasons of arch-length space and alveolar bone height.

Adolescent↗

Selection of restorative materials in permanent teeth in general dental practice.

In this study, we recorded the type of restoration and the materials used in 24,429 restorations in permanent teeth by 243 Norwegian clinicians in general practice. Demographic information included patient's gender and age, and clinician's gender, years since graduation, and practice setting (private or salaried). The overall recorded use of restorative materials in permanent teeth shows that 32% are amalgams, just over 40% composites, and about 25% glass ionomer type materials. Three percent are "other" materials. A marked shift away from amalgam restorations is noted both in the clinician's estimated use during the last 2 decades and by comparing the present use of materials with that in failed restorations. Tooth-colored materials are more commonly used in adolescents, especially glass ionomer materials, and in female patients. In patients < or = 18 years, amalgam is used in 25% of all restorations. The use of amalgam is similar in private practice and in public health service practice, but private practitioners use more composites and salaried dentists more glass ionomers. The clinician's gender does not have any effect on the selection of restorative materials. The change from amalgam to tooth-colored material is particularly noticeable for Class I and Class V restorations. Amalgam is the predominant material in 2- and 3-surface Class II restorations.

Adolescent↗

Direct placement restorative materials for use in posterior teeth: the current options.

The purpose of this paper is to provide guidelines to assist in the selection of dental materials for restoring posterior teeth in adolescents. Currently, amalgam is still the best plastic restorative material for some Class I cavities, and for Class II cavities and all multi-surface restorations. Tooth-coloured materials are preferred by some patients and dentists, however these alternatives are more technique sensitive than amalgam. Composite resin is the most common direct placement alternative to dental amalgam, providing patients with relatively low cost, tooth-coloured restorations. However, composite resins have limited indication, their placement is more time-consuming than for amalgam, cost-benefit considerations are a concern, difficulty in obtaining a marginal seal persists and there are few long-term studies published in the peer reviewed scientific literature. The literature currently supports the use of composite resin for the restoration of a limited range of Class I and Class II cavities. Composite resin restorations are not recommended for MOD or other multi-surface restorations. In selected clinical situations, fissure sealants, preventive resin restorations and glass ionomer cement are also appropriate materials to use to restore posterior teeth. Fissure sealants, when properly maintained, can play a significant role in the prevention and control of dental caries in pits and fissures in primary and permanent teeth. Preventive resin restorations should be placed to restore deep pits and fissures with incipient caries and/or developmental defects in primary and permanent teeth. Glass ionomer cement may be used for restoring Class V cavities where appearance is not the primary concern, for conservative Class III cavities, and as a provisional restorative material. It is not recommended for Class II or IV restorations.

Adolescent↗

WHY DO RESTORATIONS FAIL?

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Dental Restoration, Permanent↗

A comparative evaluation of four restorative materials to support undermined occlusal enamel of permanent teeth.

The purpose of this study was to test the support to undermined occlusal enamel provided by posterior restorative composite (FiltekTM P60, 3M Dental products USA), polyacid modified resin composite (F2000 compomer, 3M Dental products, USA.), radiopaque silver alloy-glass ionomer cement (Miracle Mix. GC Corp, Tokyo, Japan) and Glass Ionomer cement (Fuji IX GP). To test each material, 20 human permanent mandibular third molars were selected. The lingual cusps were removed and the dentin supporting the facial cusps was cut away, leaving a shell of enamel. Each group of prepared teeth was restored using the materials according to the manufacturer's instructions. All the specimens were thermocycled (250 cycles, 6 degrees C- 60 degrees C, dwell time 30 seconds) and then mounted on an acrylic base. Specimens were loaded evenly across the cusp tips at a crosshead speed of 5 mm /minute in Hounsfield universal testing machine until fracture occurred. Data obtained was analyzed using analysis of variance and Studentized- Newman- Keul's range test. No significant differences were detected in the support provided by P-60, F 2000, Miracle Mix or Fuji IX GP groups. The support provided to undermined occlusal enamel by these materials was intermediate between no support and that provided by sound dentin. Without further development in dental material technology and evidence of its efficacy, restorative materials should not be relied upon to support undermined occlusal enamel to a level comparable to that provided by sound dentin.

Analysis of Variance↗

Resin bonding to primary teeth using three adhesive systems.

In vitro bond strengths of three resin adhesive systems were tested using 111 primary teeth. Ninety-six flat dentin surface specimens were divided into six groups consisting of 16 primed or 16 unprimed samples for each adhesive system. The remaining 15 tooth samples were divided into three groups of five to determine each adhesive system's bond strength to primary etched enamel. Resin buttons were polymerized to all specimens with visible light, thermocycled for 2000 cycles between 5 and 55 degrees C, and shear bond strength was measured with a Instron Testing Machine (Instron Engineering Corp, Canton, MA). ANOVA and multiple comparison tests showed that Optibond Multiuse Bonding Agent had a statistically greater mean shear bond strength to primary dentin (20.5 +/- 3.5 MPa) than Prisma Universal Bond 3 Multi-purpose Bonding System (9.1 +/- 4.4 MPa), Scotchbond Multi-purpose Dental Adhesive System (7.3 +/- 3.7 MPa), and primary etched enamel (9.8 +/- 4.4 MPa) at P < 0.05. This study demonstrated that resin adhesive systems may achieve bond strengths to primary dentin comparable to those of primary enamel, and that these bonds may be as strong as bonds to permanent enamel and dentin. These adhesive systems may allow more confident esthetic restoration of primary anterior teeth.

Acid Etching, Dental↗

Molar incisor hypomineralisation: restorative management.

AIM: The methods for the restoration of permanent molars and incisors affected by Molar Incisor Hypomineralisation are reviewed. The special problems associated with restoring these teeth, such as sensitivity, occlusion and aesthetics are discussed. The various options for restoration are outlined and recommendations made as to the appropriate types of restoration.

Child↗

Dentigerous cysts of inflammatory origin. A clinicopathologic study.

The exact histogenesis of dentigerous cysts remains unknown, but most authors favor a developmental origin from the tooth follicle. The aim of this article is to report a series of 15 dentigerous cysts that we believe to be of inflammatory origin. These inflammatory dentigerous cysts occurred in the first and early part of the second decades of life. Males were affected more frequently, and there did not appear to be any racial predilection. All of the cases involved permanent teeth: premolars in nine cases, canines in four cases, and second molars in two cases. The mandible was affected twice as frequently as the maxilla. In 13 cases, nonvital grossly carious or heavily restored deciduous teeth were associated with the cysts. Some of these teeth had been extracted before the cysts were diagnosed. In the remaining two cases, both of which involved the second permanent molars, there were no nonvital deciduous teeth, however both had concomitant proliferative periostitis. All of the cysts were moderately or intensely inflamed and were lined predominantly or entirely by nonkeratinized stratified squamous epithelium that in some cases was markedly hyperplastic and exhibited anastomosing rete ridges mimicking radicular cysts. In the majority of cases, parts of the cysts were lined with a 2 to 3 cell layer thick cuboidal epithelium that we believe was derived from reduced enamel epithelium. Rests of odontogenic epithelium frequently were evident in the cyst walls. We suggest that these cysts arose as a result of periapical inflammation from any source but usually from a nonvital deciduous tooth and spreading to involve the follicles of the unerupted permanent successors. The inflammatory exudate causes separation of the reduced enamel epithelium from the enamel with resultant cyst formation. This study proposes the existence of two types of dentigerous cysts: one developmental and the other inflammatory in nature.

Bicuspid↗

[Measurements of the elastic and permanent deflection of MOD restorations during vertical loading].

In a loading device the mesio-distal deflection of mod restorations caused by different forces is measured reproducibly with inductive transducers. The accuracy of the measurements is about +/- 1 micron. Uncemented inlays of a soft gold casting alloy deflect 40 microns under load and 25 microns permanently; for an extra hard gold casting alloy the maximum values amount to 30 and 5 microns, respectively, and for a silver palladium alloy to 15 and 2 microns, respectively. Restorations of a non-gamma-2 amalgam reveal deflections within the range of accuracy near 2 microns.

Bite Force↗