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The quality of routine class II cavity preparations for amalgam.

In spite of many improvements in operative dentistry, the incidence of replacements of amalgam restorations remains high. It is possible that specific cavity features are important for the longevity of the restorations. Six hundred and ten epoxy plastic models, made from impressions of permanent teeth in which class II cavities had been prepared by eight Scandinavian dentists, were examined. The examination showed prevalent imperfect external and internal cavity features. These may reflect the operators' opinion of adequate operative dentistry, neglect to control design features, or lack of training in examining a cavity critically.

Dental Amalgam↗

Controversies in posterior composite resin restorations.

The use of posterior composites is riddled with so many controversies that the puzzled practitioner must step warily among them. This modality is a minefield, where one careless movement can bring disaster. All composite restorations are subject to three big destructive forces--moisture, polymerization shrinkage, and clinical wear--forces that can eventually produce both microleakage and deterioration of the silane coupling agent linking filler particles to resin matrix. Despite the extreme technique sensitivity of posterior composite resins, knowledge of resin technology, sound operative dentistry principles and foresight in case selection can be effective in producing durable cosmetic restorations. Posterior composite resin restorations bonded to enamel and dentin reputedly strengthen teeth in both conventional and adhesive types of preparations provided polymerization shrinkage can be controlled. It is imperative that a knowledge of occlusal contacts be used to influence cavity outline, confining the trauma or occlusal forces away from the tooth-resin interface and helping to minimize occlusal wear. With the increased use of posterior resins, the trend in cavity preparations should break away from the traditional Black preparation toward the adhesive type preparation. If the Black Class II preparation is used, it is suggested that bevels be confined to the facial and lingual margins of the proximal box. Prewedging helps to maintain a conservative Class II preparation. Shade selection must be made prior to rubber dam isolation for greater accuracy and to help prevent postinsertion discoloration. The enamel should be pumiced to present a clean substrate for acid etching. The smear layer should be removed. The type of pulp protection applied before acid etching is dependent on the material used. After etching, the enamel should be washed with a 1 per cent potassium chloride solution. It is a more universally chemically stable solution than additive-laden local water supplies. The potassium chloride solution lowers the electrostatic forces on the enamel that would interfere with the flow of enamel bonding agents. Furthermore, tests have shown that the use of potassium chloride washes increase the strength of the enamel body by 40 per cent. Because of the depth of most posterior cavities, an incremental filling technique must be used to ensure a thorough polymerization of the resin and to forestall a massive polymerization shrinkage. When finished and contoured, the margins of the restoration should be re-etched, washed, and dried and then covered with an application of unfilled resin to discourage microleakage. Traditional operative dentistry technique must become flexible enough to meet the new demands of resin technology.(ABSTRACT TRUNCATED AT 400 WORDS)

Bicuspid↗

Effect of feedback on student attitudes.

We sought to determine the change in student attitude toward a testing program when the students used a self-assessment test and were given computer-generated feedback. Ninety-four junior dental students at one school were placed in two groups and surveyed about their attitudes toward the testing program of the Department of Operative Dentistry and themselves as operative dentists. A semantic differential instrument and Likert-scale questions were used. One week later, the students in the experimental group participated in a self-assessment and three weeks later received individual, computer-generated feedback. Both groups were surveyed again at this time. Students in the experimental group exhibited a significant improvement in attitude toward the department's testing program but not toward themselves as operative dentists. The control group showed no significant change in attitude toward either concept.

Attitude↗

The future of esthetic dentistry.

The materials and techniques of esthetic dentistry are provoking reconsideration of the basic principles of operative dentistry. Cavity preparations can be minimized, demands on retention are altered, and prevention can be practiced. Problems remain, particularly in bonding and sealing to dentin. The newer materials have yet to prove themselves in terms of durability, especially in regard to fracture and wear.

Dentistry, Operative↗

The transfer effect of leadup activities.

Previous literature shows that operative laboratory performance can be significantly improved through leadup training where students complete simulated preparations in plastic blocks. Since the task requirements of most fixed prosthodontic preparations seem similar to those of operative dentistry, it may be hypothesized that leadup training utilizing operative-like preparations would facilitate performance in the projects of both courses. The objective of this study was to test that hypothesis. The performance of students who had completed the leadup training nine months earlier was compared with that of randomly selected control groups, with replacement, in a subsequent operative and fixed prosthodontics course. Calibrated raters were unaware of group affiliation of products. Analyses of variance showed that students in the experimental group statistically significantly outperformed those in the control group on the two operative preparations which were most like products completed during the leadup training. There was no such difference for any of the three fixed prosthodontics products. It is concluded that transfer of training is highly specific and that leadup training must simulate the criterion in both its cognitive and motor components, if it is to have a facilitating effect.

Analysis of Variance↗

Evaluation of an illuminated mirror.

The viewing of oral structures with an adequate level of illumination is necessary to make accurate diagnoses of normalities and abnormalities in the oral cavity. The purpose of this study is to determine if a device with an illuminated mirror is heat sterilizable, easy to use, and compares in illumination potential to a traditional overhead dental operating light. We sterilized the Denlite in both chemical vapor and autoclave units (including a group that was cleaned ultrasonically prior to autoclave), testing the illuminance level every 10 cycles, for 100 cycles. We installed devices in the Graduate Operative Dentistry Clinic and requested those operators assigned to the units to rate the devices. Their acceptance rate was high in visibility, ease of use, acceptable temperature of handle, and lack of problems with the device. The device had an illuminance level of 14,200 lux, which is just below the maximum level of illuminance required by the American Dental Association's Specification on Dental Operating Lights.

Dental Instruments↗

Efficacy of a computerized local anesthesia device in pediatric dentistry.

PURPOSE: The purpose of this study was to evaluate the efficacy of a computerized anesthesia delivery system in reducing pain during injections when compared with a traditional delivery system (i.e., syringe). METHODS: Subjects consisted of 57 patients between the ages of 5 and 13 needing operative dentistry using local anesthesia. Patients were randomly assigned to either the computerized or traditional anesthesia delivery system. Inferior alveolar block injections, palatal, and buccal infiltrations were the only injections administered throughout this study. Pain behavior was videotaped and coded throughout the study. Pain perceptions were rated using a 10 point visual analogue rating scale. Subjects were also asked to rate their overall satisfaction and approval of the dentist and the treatment received. RESULTS: Results of multivariate analysis of variance indicated that there were no significant differences between the computerized and the traditional method of administering local anesthesia when comparing pain ratings and pain behavior. Average pain ratings for the computerized method were 4.5 while the average ratings for the traditional method were 3.6. In addition, all subjects reported overall satisfaction with their dental treatment and that they would be willing to return in the future. CONCLUSIONS: A computerized anesthesia injection method was found to be comparable to the traditional method of anesthesia injection.

Adolescent↗

Esthetic dentistry in North American dental schools.

OBJECTIVES: Esthetic dentistry is among the most dynamic areas of contemporary clinical dentistry. Teaching programs in dental schools have a strong effect on the practice of dentistry, not only for recent graduates, but also for established clinicians, especially with respect to new techniques and concepts. The purpose of the study reported here was to assess the frequency and extent of the teaching of esthetic dentistry in North American dental schools and to report how it differs among the various schools. MATERIALS AND METHODS: A 19-question survey was mailed to 64 North American dental schools. The questions inquired about the priority given to the teaching of esthetic dentistry in the school; how the subject was taught (through regular curricular courses; through a multidisciplinary approach or through elective classes); the duration of the esthetic dentistry course; the nature of the course content (theoretical or practical); the esthetic procedures taught to undergraduate students; the level of interaction among different disciplines in the teaching of esthetic dentistry; and the techniques and commercial materials used. The responses were summarized as percentages based on the number of schools that responded to each question. RESULTS: Fifty-two (81%) of the 64 dental schools completed and returned the questionnaire. Twenty-five of these schools (48%; designated group A) reported having a course exclusively for the teaching of esthetic dentistry. Twenty-seven schools (52%; designated group B) reported that esthetic dentistry was addressed in multiple courses, i.e., no specific course was available. Four schools in group B (15%) were in the process of developing a separate course for esthetic dentistry. In group A schools, esthetic dentistry was taught mainly in the operative dentistry department or division. The most frequent course duration was 4 to 6 months, but there were marked variations. Thirteen (52%) of these 25 schools had didactic and practical teaching at both the preclinical and the clinical levels. The schools in group B reported that only clinical instruction in esthetic dentistry was provided. Several concerns were addressed in the courses offered in group A schools: extrinsic and intrinsic discoloration, bleaching, diastemas, malformation and malpositioning (the latter including rotation, intrusion and labio-linguoversion), and replacement of amalgam and gold restorations. Only 7 (28%) of the group A schools reported having the support of an inhouse laboratory. The esthetic procedures taught were similar for schools in group A and group B. The use of direct posterior composite restorations, all-ceramic crowns and nonvital bleaching was more common among group B schools. Ceramic inlays, onlays and indirect posterior composite restorations were not taught by 4 (16%) of the schools in group A and 7 (26%) of the schools in group B. CONCLUSIONS: The teaching of esthetic dentistry in North American dental schools is highly variable and in many schools is shared among different disciplines. Dental schools should work together to establish the parameters for teaching this subject and should formulate the necessary standards for education and research in this new field.

Canada↗

Integrating dental anatomy and biomaterials: an innovative use of composite resin.

As part of the new integrated curriculum at the New York University College of Dentistry, a pilot program uses composite resins to teach dental anatomy. The Department of Biomaterials and Biomimetics, in conjunction with the Department of Cariology and Operative Dentistry, has created a teaching module to replicate the morphology of a central incisor through the manipulation and placement of a composite resin.

Biocompatible Materials↗

[Management of dental records: an example of the Department of Restorative Dentistry of the School of Odonto-Stomatology in Abidjan].

The patient's file is often mismanaged because of the crowd and the frequency of emergencies caused by pain. The practitioner is worrying about handling it in first place. The objective of this work is to recall the importance of a good management of the dental records and to suggest a charting system. The interest of the dental chart, fundamental part of the patient dental file, is described before developing the implications related to an adequate management. The charting system of the service of Operative Dentistry and Endodontics of Abidjan Dental school is described. It translates the target of a good dental records management, which presents appreciable assets for practitioner, patient and administration.

Cote d'Ivoire↗

Clinical studies concerning re-restoration of teeth.

Re-restoring teeth is an important component of operative dentistry, and the perceived presence of secondary caries is a major reason for undertaking it. In the absence of a diagnosis of secondary caries, a morphological discrepancy at the margin of a restoration commonly provides the necessary justification for replacement. However, several studies have demonstrated enormous variation among dentists, both in their diagnosis of secondary caries and in the clinical decisions they make regarding whether or not to restore or re-restore. Many of these decisions must have been wrong. Decisions to re-restore teeth have been shown to be particularly idiosyncratic, and some patients apparently become involved in a repeat restoration cycle whereby the more restorations they have, the more re-restorations they receive. The desire by some dentists to replace large numbers of restorations, for reasons other than the presence of disease, shows a fallibility of operative treatment. At the same time it suggests that these dentists have considerable faith in this aspect of dental care. There would appear to be a prima facie case for investigating more deeply the factors involved in the clinical assessment of restorations. It should then be possible to improve the standard of diagnosis and treatment decision-making, especially with respect to the need to re-restore teeth.

Decision Making↗

Dental treatment and dental health. Part 1. A review of studies in support of a philosophy of Minimum Intervention Dentistry.

An international movement emerged in 1986-1987 which heralded a major change in the role of conservative dentistry. This shift was away from the traditional operative dentistry, with its relatively frequent replacement of restorations, to a concept of 'Minimum Intervention Dentistry', which advocates the use of adhesive dental materials, remineralization techniques and monitoring of initial carious lesions. The move away from some of Black's concepts started as investigations examined the dental health of patients in the National Health Service of Great Britain. These investigations, and the report of the Committee of Enquiry into Unnecessary Dental Treatment, have resulted in an extensive re-education programme being initiated by the British Department of Health and Social Security in conjunction with the British Dental Association. This paper, and a subsequent one, were written to enable widespread dissemination of these ideologies to Australian practitioners. While they may appear provocative to some, these papers were merely meant to stimulate discussion on the implications of this research for dentistry in this country. In this paper the results from the British investigations are presented, as is a discussion of some of the outcomes of this and other related research.

Australia↗

[Vibration].

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Dentistry↗