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Orthodontic extrusion: its use in restorative dentistry.

The technique described in this study demonstrates that the use of orthodontic extrusion can provide an alternative to extraction and extensive periodontal surgery. Selection of patients is an important aspect when considering this type of treatment. The crown-root ratio, as well as the root anatomy, if inadequate, may render this type of treatment inappropriate. The concept of a biologic width is discussed, and its application to forced eruption is described.

Adolescent↗

Endodontic abutments and complete dentures.

In this in vitro study, 90% of maxillary single-rooted teeth, 89% of maxillary multirooted teeth, 82% of mandibular single-rooted teeth, and 92.5% of mandibular molars had root canals that terminated short of the radiographic root apex. dimensional variability was considerable. Mean measurements provide acceptable levels for underfilling canals and dictate generally applicable levels at which root canal fillings are best terminated. These measurements indicate that, when filling maxillary teeth and mandibular molars, the termination point of the filling should be approximately 0.89 mm short of the radiographic root apex. When filling mandibular single-rooted teeth, the terminal point of the filling material should be approximately 0.69 mm short of the radiographic root apex. Complete overdentures are a valuable alternative to extraction and conventional denture placement. The nonvital teeth that are used for stability, retention, preservation of alveolar bone, proprioception, and psychological support are of critical importance. Failure in endodontic selection and procedure immediately negates the concept of overdentures.

Adult↗

The hemisected mandibular molar: a strategic abutment.

The loss of a strategic distal abutment can result in the patient wearing a removable partial denture. The indications and techniques necessary to retain a hemisected mandibular molar as a fixed partial denture abutment are presented.

Crowns↗

Fracture resistance of amalgam coronal-radicular restorations.

The effect of pulp chamber depth and extension into the root canal space on fracture resistance was examined on endodontically treated teeth with coronal-radicular amalgam restorations. Six groups of 10 mandibular molars were mounted in acrylic resin, and crowns were ground apically until the wall height of the pulp chamber was 2, 4, or 6 mm. Three millimeters of gutta-percha was removed from the three canals of one-half the teeth and amalgam was condensed into the canal space to a height 7.5 mm above the cementoenamel junction (CEJ). The remaining teeth had amalgam condensed from the floor of the chamber to 7.5 mm above the CEJ. The amalgam restorations were loaded with an Instron instrument (Instron Corp., Canton, Mass.) until failure. Amalgam extension into the root canal space contributed minimally to the fracture resistance of the amalgam coronal-radicular restoration with four or more millimeters of chamber wall. If less than 4 mm of chamber wall height remained, however, the fracture load was substantially increased. Amalgam extension into the root canal space should be confined to teeth with limited remaining pulp chambers.

Crowns↗

The dentin-root complex: anatomic and biologic considerations in restoring endodontically treated teeth.

The restoration of endodontically treated teeth has been the focus of considerable controversy and empiricism. Time-tested methods have been highly successful in some respects, but failures are still apparent. The inherent causes of failure are rarely evaluated and the limitations of specific restorative systems are seldom identified. Regardless of the system, there should be a thorough understanding of the anatomy and biology of the dentin and root supporting the restoration on the part of the practitioner, because both endodontic and restorative procedures alter the hard tissues.

Biology↗

Biomechanical considerations in restoring endodontically treated teeth.

Various concepts for dental treatment have been established without appropriate documentation, such as restoration of endodontically treated teeth. Some researchers and dentists strongly recommend including a post with the restoration to strengthen the root. Other studies have indicated that posts may substantially weaken the roots and should be avoided. An additional approach suggested that the post did not improve the resistance to fracture during occlusion and did not support the restoration. Biomechanical problems are analyzed, and a recommended clinical approach is presented.

Biomechanical Phenomena↗