Biomedical subjects

D N J Ricketts

Publications and source records attributed to D N J Ricketts.

8 recordsLinked to original sources

PubMed2006

Complete or ultraconservative removal of decayed tissue in unfilled teeth.

BACKGROUND: The treatment of deep dental decay has traditionally involved removal of all the soft demineralised dentine before a filling is placed. However this has been challenged in three groups of studies which involve sealing soft caries into the tooth. The three main groups either remove no caries and seal the decay into the tooth, remove minimal (ultraconservative) caries at the entrance to a cavity and seal the remaining caries in, or remove caries in stages over two visits some months apart to allow the pulp time to lay down reparative dentine (the stepwise excavation technique). OBJECTIVES: To test the null hypothesis of no difference in the incidence of damage or disease of the nerve of the tooth (pulp), progression of decay and longevity of restorations irrespective of whether the removal of decay had been minimal (ultraconservative) or complete. SEARCH STRATEGY: The Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PubMed and EMBASE databases were searched. The reference lists in relevant papers were checked. SELECTION CRITERIA: Randomised controlled trials and controlled clinical trials comparing minimal (ultraconservative) caries removal with complete caries removal in unrestored permanent and deciduous teeth. DATA COLLECTION AND ANALYSIS: Outcome measures recorded were exposure of the nerve of the tooth (pulp) during caries removal, patient experience of symptoms of pulpal inflammation or necrosis, progression of caries under the filling, time until the filling was lost or replaced. Due to the heterogeneity of the included studies the overall estimate of effect was calculated using a random-effects model. MAIN RESULTS: Four studies met the inclusion criteria; two stepwise excavation studies and two ultraconservative caries removal studies. Partial caries removal in symptomless, primary or permanent teeth reduces the risk of pulp exposure. We found no detriment to the patient in terms of pulpal symptoms in this procedure and no reported premature loss or deterioration of the restoration. AUTHORS' CONCLUSIONS: The results of this systematic review reject the null hypothesis of no difference in the incidence of damage or disease of the nerve of the tooth (pulp) irrespective of whether the removal of decay had been minimal (ultraconservative) or complete and accepts the null hypothesis of no difference in the progression of decay and longevity of restorations. However, the number of included studies is small and differ considerably. Partial caries removal is therefore preferable to complete caries removal in the deep lesion, in order to reduce the risk of carious exposure. However, there is insufficient evidence to know whether it is necessary to re-enter and excavate further but studies that have not re-entered do not report adverse consequences.

Cariostatic Agents↗

PubMed2005

Weakened anterior roots--intraradicular rehabilitation.

This paper highlights the fact that many anterior teeth requiring restoration are severely weakened having wide, flared canal spaces, and thin dentinal walls that are prone to fracture. Traditionally these teeth have been restored using metal posts and are often unsuccessful because of lack of retention or root fracture. This paper describes how mineral trioxide aggregate (MTA) can be used to form an immediate apical seal rather than waiting months for apexification. Weakened roots can be reinforced using dentine bonding agents and composite resin and if insufficient coronal tooth structure is present a quartz-fibre post can be placed to retain a composite core.

Aluminum Compounds↗

PubMed2005

Post and core systems, refinements to tooth preparation and cementation.

With a plethora of post systems available, it is often difficult to decide which one to use. This is made more difficult by the fact that new posts are introduced before existing ones are fully evaluated in laboratory and clinical studies. This paper therefore describes the different post types and the main advantages and disadvantages of each. In addition, the choice of post system will influence whether further tooth preparation is required and will dictate which luting cement and core material are most appropriate. Whilst the choice of post will, for many dentists, be driven by personal preference and a history of clinical success, there are certain pit falls to avoid and these are outlined.

Cementation↗

PubMed2005

Tooth preparation for post-retained restorations.

Failure of root canal treatment and/or post crowns can be avoided in many cases if appropriate tooth preparation is carried out. This paper discusses the rationale for the timing of post placement following root canal treatment and appropriate methods for removal of gutta-percha prior to post space preparation. The basic principles of post space preparation are described, which should reduce the risk of weakening the root unnecessarily, causing damage to the periodontium and post perforation.

Biocompatible Materials↗

PubMed2005

Restoration of the root-filled tooth: pre-operative assessment.

This is the first in a series of four papers related to the management of root canal treated teeth. When teeth compromised by extensive restorations become non-vital, suggestions have been given as to how root canal treatment can be carried out with the greatest chance of success. Once root canal treated, either by a previous dentist or by the current dentist, a review of the assessment process that should be carried out prior to placing costly indirect definitive restorations is given. It will be clear that post-retained restorations are mainly reserved for anterior or single-rooted teeth, posterior teeth rarely requiring a post for core retention. The second paper in this series describes the basic tooth preparation that should be carried out prior to placing a post. Depending on the type of post system used, further modifications to tooth preparation may be required and the cementation techniques may also have to be modified. The third paper therefore discusses the various post types, when and how they should be used for optimum results. The final paper addresses reinforcement and restoration of compromised root canals, such as those with immature, open apices, or those that have been over-prepared for previous post-retained restorations.

Dental Restoration, Permanent↗

PubMed2003

Peer review amongst restorative specialists on the quality of their communication with referring dental practitioners.

OBJECTIVE: A peer review study was carried out to assess the written communication between consultants and specialist registrars in restorative dentistry with the referring general dental practitioners. METHODS: Seven people took part in the study and each presented referral and reply letters for five patients whom they had seen for consultation. The referral letters were used for information only and were not used in the peer review process. Each participant inspected the referral and reply letters from the other six participants. The reply letters were anonymously peer reviewed by using a proforma containing agreed criteria in relation to appropriate factors to include in the reply letter. The reviewer also ranked the letter in relation to overall quality on a 1-10 point scale. RESULTS: It was found that the participants' letters generally conformed positively with the agreed criteria although there were some differences between individuals. There were particular problems identified in relation to tooth notation. Reply letters commonly used different forms of tooth notation to the referring practitioners. CONCLUSIONS: The ranking of the letters generally indicated that the participants' replies were judged to be favourable by their peers. There may be scope for continuing this study in relation to peer review by other groups of professionals, in particular practitioners in primary dental care.

Attitude of Health Personnel↗

PubMed2003

Fibre-based post systems: a review.

OBJECTIVES: This article presents a review of published literature examining fibre-based endodontic post systems. DATA SOURCES: A MEDLINE search was carried out for any articles in dental journals pertaining to fibre-based post systems. Wherever possible articles cited were obtained from the journals and where this was not possible abstracts were obtained. Where no abstract was available the article was not considered for evaluation. DATA EXTRACTION: Articles were reviewed by a single observer and subject to meeting inclusion criteria were included in the review. Fifty-nine articles were considered suitable for inclusion. DATA SYNTHESIS: Articles were divided into categories and a subjective description of the articles was made. CONCLUSIONS: Review indicated that (1) most published literature on fibre-based posts took the form of laboratory analyses; (2) evidence for carbon-fibre posts far exceeds that for quartz-fibre posts; (3) laboratory evidence was contradictory and could not be used to inform practice reliably; (4) few clinical studies have been carried out though these have suggested fibre based posts may be clinically appropriate for restoration of the endodontically treated tooth; and (5) controlled prospective clinical trials evaluating fibre-based posts should be undertaken to inform use for clinical practice.

Carbon↗

PubMedDate not supplied

Visual and tactile assessment of arrested initial enamel carious lesions: an in vivo pilot study.

Accurate and reliable assessment of caries activity is important for determining appropriate treatment needs. The aim of this pilot study was to determine whether dentists could differentiate between the appearances (visual and tactile) of lesions inactivated by regular professional oral hygiene and those control lesions which were not cleaned (active). After a 3- to 4-week study period involving 10 children, with 4 similar carious lesions each, it was found that dentists were not able to reliably and reproducibly determine the subtle visual and tactile differences between active and inactive enamel lesions from a one-off clinical examination.

Child↗