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Microleakage of sealants after conventional, bur, and air-abrasion preparation of pits and fissures.

PURPOSE: The aim of this study was to compare the microleakage of unfilled and filled sealants after conventional, bur, and air-abrasion tooth preparation. METHODS: Seventy-two extracted molars were randomly divided into three groups. In group 1, 24 teeth were prepared by pumicing and acid etching with 37% phosphoric acid. In group 2, 24 teeth were prepared with a 1/4-round bur in a low-speed handpiece and then acid etched. In group 3, 24 teeth were prepared by high-speed (160 PSI) microabrasion using 50 mu alpha alumina particles in a KCP 2000 machine. In each group, 12 teeth were sealed with a filled sealant and 12 teeth with an unfilled sealant. All the teeth were stored in artificial saliva for 7 days and thermocycled for 2000 cycles. Teeth were then sealed apically and coated with nail varnish 1 mm from the margins and stained in 1% methylene blue for 24 h. Each tooth was sectioned in three locations and ranked (0-3) for microleakage. RESULTS: There were 216 sections and 66% showed no leakage. CONCLUSIONS: Chi-square statistical analysis of the data led to the following conclusions: 1) superior results were obtained when the tooth surfaces were prepared by a bur, 2) conventionally and KCP 2000-prepared tooth surfaces yielded similar results, and 3) the unfilled sealant was superior to the filled sealant.

Acid Etching, Dental↗

Surface roughness of tooth shoulder preparations created by rotary instrumentation, hand planing, and ultrasonic oscillation.

A dentinal shoulder with a smooth surface is necessary to ensure accurate adaptation of a porcelain crown. The surface roughness of dentinal shoulders prepared with different instruments was investigated in this in vitro study. Sixty shoulders, 1 mm wide, were prepared with coarse grit diamonds in extracted formalin-stored teeth. Of these 60 shoulders 20 were further refined with fine grit, and 20 more shoulders were refined with super-fine grit diamonds. The surface roughness (Ra) of the dentinal shoulders was recorded after each procedure. Thirty surfaces were further finished and refined with a hand chisel, and the other 30 surfaces were finished with a flat-ended diamond tip held in an ultrasonic generating device; the Ra was then recorded. These shoulder preparations were examined under a scanning electron microscope. The Ra of the dentinal shoulders prepared by the ends of the different grit diamonds was not significantly different (p > 0.05). Hand planing did not improve the Ra, and ultrasonic planing significantly increased the Ra (p < 0.05). Scanning electron micrographs revealed no apparent qualitative differences between surface roughness of the shoulders prepared by the diamonds or by the hand-planed surface. However, deeper scratches were evident at ultrasonically planed surfaces.

Crowns↗

In vitro tensile bond strengths of amalgam to treated dentin.

Since amalgam traditionally relies on undercuts in the tooth preparation for retention, extensive tooth structure must be removed for amalgam core build-ups. In contrast, the ideal build-up material would achieve its retention by directly bonding to tooth structure. This study compared tensile bond strengths of amalgam to dentin using All-Bond Liner-FX with three different dentin pretreatment conditions and Amalgambond according to the manufacturer's directions. One hundred and twenty dentin samples were tested. Groups 1-3 used All-Bond Liner-FX as a bonding agent. Group 1 received a 15-second application of 10 percent phosphoric acid on the dentin; Group 2 received the recommended dentin conditioner; and Group 3 received no dentin pretreatment. Group 4 used Amalgambond as the bonding agent after a 10-second application of 10 percent citric acid/3 percent ferric chloride. Analysis of the data was conducted using both ANOVA and the Weibull statistic. Results of the analysis of variance indicate that there were no statistical differences among mean tensile bond strengths for the three dentin pretreatment conditions using All-Bond. All (30) of the Amalgambond specimens debonded prior to testing. The All-Bond fracture data was well described by the Weibull function as evidenced by the high coefficient of determination (R2 = 0.98-0.99). Fracture analysis indicated that all of the Amalgambond failures were adhesive at the Amalgambond-amalgam interface. All-Bond fractures were mixed cohesive/adhesive failures indicating similar bonding to amalgam and dentin.

Acid Etching, Dental↗

A clinical scanning electron microscope study of tooth surface preparation and bonding.

This clinical study utilized cut dentine surfaces on which the Creation Bond System and Scotchbond were applied after various surface treatments. It was observed under the scanning electron microscope that preparation with a tungsten carbide bur left a smear layer on the dentine. When this surface was pumiced, the smear layer remained and the tubules were plugged with smear debris. Polyacrylic acid and citric acid removed the smear layer from the dentine surface. When the Creation Bond System was applied to the surface treated with polyacrylic acid, hollow depressions were produced. Application of the Creation Bond System to the surface treated with citric acid resulted in some resin tag formation into the dentinal tubules as well as hollow depressions on the resin surface. The presence of these irregularities in the resin indicated fluid from the dentinal tubules prevented contact of the bonding resin with the dentine surface. This degree of contamination was not observed when Scotchbond was applied to a pumiced dentine surface.

Acid Etching, Dental↗

Structural optimization of dental restorations using the principle of adaptive growth.

OBJECTIVES: In a restored tooth, the stresses that occur at the tooth-restoration interface during loading could become large enough to fracture the tooth and/or restoration and it has been estimated that 92% of fractured teeth have been previously restored. The tooth preparation process for a dental restoration is a classical optimization problem: tooth reduction must be minimized to preserve tooth tissue whilst stress levels must be kept low to avoid fracture of the restored unit. The objective of the present study was to derive alternative optimized designs for a second upper premolar cavity preparation by means of structural shape optimization based on the finite element method and biological adaptive growth. METHODS: Three models of cavity preparations were investigated: an inlay design for preparation of a premolar tooth, an undercut cavity design and an onlay preparation. Three restorative materials and several tooth/restoration contact conditions were utilized to replicate the in vitro situation as closely as possible. The optimization process was run for each cavity geometry. RESULTS: Mathematical shape optimization based on biological adaptive growth process was successfully applied to tooth preparations for dental restorations. Significant reduction in stress levels at the tooth-restoration interface where bonding is imperfect was achieved using optimized cavity or restoration shapes. In the best case, the maximum stress value was reduced by more than 50%. SIGNIFICANCE: Shape optimization techniques can provide an efficient and effective means of reducing the stresses in restored teeth and hence has the potential of prolonging their service lives. The technique can easily be adopted for optimizing other dental restorations.

Bicuspid↗

["Endo-prosthetic" preparation of curved roots].

During the tooth preparation for root posts, all must be attempted to avoid weakening of the root. This "must" is rather easy for straight roots, but the same is not true of curved roots. The authors have used the method described by BRAMANTE et al. to study the effects of various techniques of instrumental sequences of endodontic preparation, and of two instrumental sequences of root post preparation. From this studies, it results that: --the respect of the canal path during the endodontic phase conditions the respect of the internal wall of the curvature, during drilling. --among the four endodontic techniques studied: MM 3000, Step-Back, Anti Curvature Filling and Canal Finder System, the last two seem to allow more respect of the canal path. --the instrumental sequence using Largo drills to prepare a canal, presents two types of drawbacks: * Excessive abrasion of the convex (internal) wall of the canal system. It seems that the blunt point rests against the concave portion of the canal and pushes the drill toward the internal wall, therefore weakening it. * Inadequate match between the size of the drill and that of the prepared canal. --the Parapost drills, on the contrary, respect the endodontic path, and may even be used beyond the curvature (2 mm). Besides, the diameter of the prepared canal is similar to that of the instrument used. These two factors permit to obtain a better retention of the post as well as a lesser weakening of the root.

Dental Pulp Cavity↗

The art of crown preparation: a review of principles.

The following paper consists of a literature review related specifically to the biomechanical principles that determine the design and preparation of teeth: Retention and Resistance form. Magnitude of forces, geometry of tooth preparation, taper, stress concentration, the influence of luting agents and the clinical implication of these factors upon retention and resistance are presented and discussed from the point of view of several authors from the early 1900s until the present.

Biomechanical Phenomena↗

Two-year clinical evaluation of nonvital tooth whitening and resin composite restorations.

BACKGROUND: Adhesive systems, resin composites, and light curing systems underwent continuous improvement in the past decade. The number of patients asking for ultraconservative treatments is increasing; clinicians are starting to reevaluate the dogma of traditional restorative dentistry and look for alternative methods to build up severely destroyed teeth. PURPOSE: The purpose of this study was to evaluate the efficacy of nonvital tooth whitening and the clinical performance of direct composite restorations used to reconstruct extensive restorations on endodontically bleached teeth. MATERIALS AND METHODS: Twenty-one patients 18 years or older were included in this clinical trial, and 26 endodontically treated and bleached maxillary and mandibular teeth were restored using a microhybrid resin composite. Patients with severe internal (tetracycline stains) and external discoloration (fluorosis), smokers, and pregnant and nursing women were excluded from the study. Only patients with A3 or darker shades were included. Teeth having endodontic access opening only to be restored were excluded; conversely, teeth having a combination of endodontic access and Class III/IV cavities were included in the study. A Vita shade guide (Vita Zahnfabrik, Bad Säckingen, Germany) arranged by value order was used to record the shade for each patient. Temporary or existing restorations were removed, along with a 1 mm gutta-percha below the cementoenamel junction (CEJ), and a resin-modified glass ionomer barrier was placed at the CEJ. Bleaching treatment was performed using a combination of in-office (OpalescenceXtra, Ultradent Products, South Jordan, UT, USA) and at-home (Opalescence 10% PF, Ultradent Products) applications. Two weeks after completion of the bleaching, the teeth were restored using a combination of PQ1 adhesive system and Vit-l-escence microhybrid resin composite (Ultradent Products). Wedge-shaped increments were placed and cured using the VIP Light (Bisco, Inc Schaumburg, IL, USA) through a combination of pulse and progressive curing techniques. RESULTS: All but one restoration were evaluated by two independent evaluators every 6 months during a 2-year period using modified US Public Health Service criteria. No restoration failed and "alpha" scores were recorded for all parameters but color stability, which was scored "bravo." Analysis of variance showed a significant shade change between baseline (mean=14.4+/-1.9) versus 2 weeks (mean=1.6+/-0.7) and 2 years (mean=2.8+/-1.7) (p<.0001). Although a significant shade change was observed between 2 weeks and the 2-year follow-up (p=.008), no significant difference was reported between the baseline and 2 weeks (12.9+/-2) versus baseline and 2 years (11.9+/-2.3). CONCLUSIONS: Significant tooth lightening was reported after the completion of whitening therapy on devitalized teeth; shade rebound was reported in less than 50% of the treated teeth and was limited to a maximum of four shades. A microhybrid resin composite demonstrated excellent clinical performance in the restoration of all endodontically treated and bleached teeth after a 2-year evaluation period. CLINICAL SIGNIFICANCE: Nonvital tooth whitening is responsible for a significant change in color of endodontically stained teeth. Successful nonvital tooth-whitening therapy allows for conservative tooth preparation, preserving and reinforcing sound tooth structure. The proper use of modern adhesive systems along with resin composite restorations precludes the use of more extensive restorative treatment, delaying expensive crown and bridge procedures.

Carbamide Peroxide↗

The accuracy of dual-arch impressions: a pilot study.

STATEMENT OF PROBLEM: Dual-arch impression trays often are used for addition silicone final impressions of fixed prosthodontic preparations, but concerns about distortion of the impression are common because such trays lack rigidity. PURPOSE: This in vitro pilot study was designed to determine the accuracy of addition silicone impressions made with custom trays or made with either passive or stressed dual-arch trays. MATERIAL AND METHODS: Complete crown preparations of a mandibular molar, premolar, and incisor were made on a dentoform. These tooth preparations received flat, parallel indexes on the facial and lingual axial walls for accurate and reproducible positioning of a digital caliper. Gypsum dies were produced with an addition silicone impression material in either custom trays or dual-arch trays seated passively or with induced flexure (3 dies per tray group). The facio-lingual dimensions of the dies were measured with a digital caliper accurate to +/-5 microm and compared to the dimensions of the original preparations. Flexure in the latter group was induced by contact of the tray with a simulated torus, made of resin, in the lingual vestibule of the dentoform. Data were analyzed with 2-way analysis of variance and Tukey's multiple comparison test (alpha=.05). RESULTS: Dies fabricated with either the custom or passive dual-arch tray reproduced the facio-lingual dimensions of the preparations within a -27 to +13 microm range. Dies fabricated with the flexed dual-arch tray exhibited greater discrepancy, in the range of -47 to -67 microm relative to the preparations. Tray type was a significant factor (P=.002): the flexed tray group was significantly different than the other 2 groups, which did not differ from each other. CONCLUSION: Within the limitations of this pilot study, dual-arch impressions were comparable in accuracy to impressions made with custom trays. Accuracy was reduced, however, when the trays were flexed during closure of the arches.

Acrylic Resins↗