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The Nd:YAG laser in caries removal.

This paper shows how a laser can be used in the various stages of caries removal prior to the placement of a glass-ionomer restoration. In the future the laser may prove to be a valuable tool in enabling the dentist to perform surgical procedures with maximum comfort to the patient.

Anesthesia, Dental↗

Clinical evaluation of an anterior hybrid composite resin over 8 years.

AIM: To evaluate the performance of an anterior hybrid composite resin restorative material (Opalux). DESIGN: Single-centre clinical trial. MATERIALS AND METHODS: Scores were obtained based on USPHS criteria for marginal adaptation, anatomic form, colour match, surface roughness and marginal discolouration. INTERVENTIONS: The restorative material was evaluated in suitable cavities in 24 patients (12 male, 12 female). Ethical permission and consent were obtained. MAIN OUTCOME MEASURES: Baseline data was collected on 44 restorations (25 Class III, 3 Class IV, 16 Class V) and reviewed independently by two of the three clinicians who contributed to the study who then reached a consensus score. Restorations were reviewed and scored in the same way at 3 months and 1, 2, 3 and 8 years. RESULTS: The total number of alpha ratings at baseline and review (3 months and 1, 2, 3 and 8 years) appointments for the following parameters were: marginal adaptation (33, 28, 29, 27, 12, 17), anatomic form (39, 30, 32, 26, 17, 15), surface roughness (34, 26, 24, 23, 11, 4), colour match (24, 25, 26, 24, 15, 12) and marginal discolouration (39, 31, 30, 25, 10, 9). The incidence of secondary caries was very low. Life table analysis suggests a 73% survival, with no scores below B, at 8 years. CONCLUSIONS: The majority of these restorations continued to perform satisfactorily. Although this particular material is no longer available, these results may be applicable to currently available similar materials.

Adolescent↗

A milled ceramic inlay/onlay system: a report from a series of cases.

The aims of this study were to assess the handling properties of restorations produced by a milled ceramic system (Celay) and to evaluate by direct clinical means some of the characteristics of Celay restorations following placement and after one year of clinical service.

Adolescent↗

Clinical evaluation of ferric oxalate in relieving dentine hypersensitivity.

Previous in vitro permeability and scanning electron microscopic (SEM) studies have demonstrated the effectiveness of the oxalate ion in dentine permeability reduction and effective tubule occlusion. The aim of this randomized double-blind, split mouth 4-week clinical study, therefore was to determine whether a 1-min application of ferric oxalate (Sensodyne Sealant) on exposed root dentine was effective in reducing dentine hypersensitivity (DH). Thirteen subjects [8F:5M, mean age 46.2 (s.d. 4.15) years] completed the study. The subjective response was evaluated by tactile, thermal and evaporative methods of assessment. Data were collected at baseline and post-application at +5 min and 4 weeks. Analysis was based on paired t-test (P=0.05) and Wilcoxon-Mann-Whitney tests. No statistically significant differences were noted between ferric oxalate and placebo preparations at +5 min and 4 weeks for any of the test stimuli. There was, however, a clear trend towards immediate reduction (+5 min) in DH reverting back to baseline values at 4 weeks with the exception of the Biomat Thermal Probe mean values, which maintained the reductions in DH compared with placebo. The results of the present study demonstrated that a 1-min application of ferric oxalate is both rapid and effective in reducing DH although its long-term effectiveness still needs to be determined.

Cold Temperature↗

Lasers in endodontics: a review.

Since the development of the ruby laser by Maiman in 1960 and the application of the laser for endodontics by Weichman in 1971, a variety of papers on potential applications for lasers in endodontics have been published. The purpose of this paper is to summarize laser applications in endodontics, including their use in pulp diagnosis, dentinal hypersensitivity, pulp capping and pulpotomy, sterilization of root canals, root canal shaping and obturation and apicectomy. The effects of laser on root canal walls and periodontal tissues are also reviewed. The essential question is whether a laser can provide equal or improved treatment over conventional care. Secondary issues include treatment duration and cost/benefit ratio. This article reviews the role of lasers in endodontics since the early 1970s, summarizes many research reports from the last decade, and surmises what the future may hold for lasers in endodontics. With the potential availability of many new laser wavelengths and modes, much interest is developing in this promising field.

Dental Pulp↗

The effect of light premature occlusal contact on tooth pain threshold in humans.

The purpose of this study was to assess the influence of an experimentally induced light premature occlusal contact on tooth sensation. This assessment involved monitoring the electric tooth pain threshold (TPT) at multiple times before and after altering the occlusal contact. This alteration was produced by placing high inlays, which were measured with a custom made measuring device in maximum intercuspation. Data were collected on 10 teeth in 5 subjects, all whom were male and between the ages of 24 and 30 years. The contact area of the high inlays varied from 75 microm to 193 microm. The TPT changes in these teeth ranged from -43 to +21% of their baseline level. Seven of these teeth showed a significant decrease (P < 0.05) in the TPT, one showed an increase and two did not show a significant change. Two of the teeth with a decreased TPT had cold water triggered occlusal pain, and 2 teeth had only occlusal pain. After several inlay adjustments to eliminate interference in maximum intercuspation, all tested teeth returned to their TPT baseline level and all symptoms disappeared. These results suggested that a light premature occlusal contact may change tooth sensation.

Adult↗

Dentine hypersensitivity: the effects of brushing desensitizing toothpastes, their solid and liquid phases, and detergents on dentine and acrylic: studies in vitro.

Dentine exhibiting symptoms of dentine hypersensitivity has tubules open at the dentine surface and patent to the pulp. The mechanisms whereby dentinal tubules are exposed is ill understood but probably involves a variety of abrasive and/or erosive agents. This study in vitro examined the quantitative and qualitative effects of toothpastes, their solid and liquid phases and detergents on dentine and acrylic. Abrasion of dentine and acrylic were measured by surfometry. Morphological changes to dentine were assessed by scanning electron microscopy. Abrasion of dentine and acrylic by toothpastes increased with increasing brushstrokes with marked differences in the extent of abrasion between different pastes. Brushing dentine with water or detergents produced progressive abrasion but which appeared to plateau around 2 microm loss. Water and detergents produced minimal effects on acrylic. At 5000 strokes dentine abrasion by solid phases was less than the parent toothpastes but the ranking order of abrasivity was the same as the parent toothpastes. Loss of dentine produced by liquid phases was minimal and in the order of 1-2 microm. Observationally, all toothpastes removed at least the dentine smear layer to expose many tubules; with one desensitizing product leaving a particulate deposit occluding most tubules. The solid phases of the toothpaste produced identical morphological changes to the parent paste. The liquid phases and detergents all exposed dentinal tubules by 5000 strokes. Water had little or no effect on the dentine smear layer. It is concluded that toothpastes, solid phase, liquid phase and detergents have the potential to abrade or erode dentine to a variable degree and result in tubule exposure. The effects of the liquid phases and detergents appear limited to the removal of the smear layer. Such detrimental effects seen in vitro could have relevance to the aetiology and management of dentine hypersensitivity. Toothpaste formulations which despite exposing tubules have ingredients capable of occluding tubules may be an area of development for such products.

Acrylic Resins↗

Perceptions of dentine hypersensitivity in a general practice population.

Recent studies have attempted to determine the prevalence of dentine hypersensitivity (DH) in both hospital and general practice. Results indicate that DH prevalence is higher in patients referred for specialist treatment than in general practice. The aim of this study was to determine perception and prevalence of DH in general practice. Completed questionnaires from 277 patients (115 males, 162 females, mean age 41.7 years [SD 14.36]) were collected. Self-reported DH prevalence (52%) was observed between the third and fourth decades, peaking in the third and in good agreement with that previously published (45.2%), and significantly more females complained of DH than males (SND=2.24, 95% CI 0.01734-0.2661). Cold was perceived as the most common cause of DH, in agreement with other studies. Only 12.6% of patients reported periodontal surgery compared to 15.5% previously. Of those who received hygiene therapy (67.9%) only 15.5% reported DH following treatment which mainly did not last >/=5 days. Most patients with DH did not perceive the condition as severe and did not seek treatment (75.1%). Only 23.3% used a desensitizing dentifrice. The results indicated that self-reporting of DH is lower than reported in a dental hospital population and was not perceived as a major dental problem by most patients in a general dental practice population.

Adult↗

Dentine hypersensitivity: the effects of brushing toothpaste on etched and unetched dentine in vitro.

Although many people have exposed dentine, only a percentage exhibit symptoms of dentine hypersensitivity. This has been ascribed to opening and closing of the dentinal tubules by for example, smear layer changes or tubular occlusion. The aims of this study were to examine the surface morphological changes of etched and unetched dentine in vitro, attributed to the effects of toothbrushing with and without toothpastes designed for the alleviation of dentine hypersensitivity. A total of 96 etched and 96 unetched human dentine specimens were brushed with various toothpastes and water for 1, 2, 5 or 10-min periods in a toothbrushing machine and subsequently examined under scanning electron microscopy for surface changes. Analyses of brushed etched specimens demonstrated that time and treatment were significant variables (P < 0.05) for tubule occlusion. Further, the interaction between time and treatment was significant (P < 0.05). The artificial silica based paste was significantly better for all time intervals at occluding the dentine tubules. All toothpastes investigated caused dynamic changes to the smear layer of the unetched dentine, opening tubules. However, the artificial silica based paste resulted in occluded rather than patent tubules. All of the pastes evaluated had the capacity to remove the smear layer but some could then occlude tubules through the contained abrasives.

Acid Etching, Dental↗

Mineralization of dentin induced by treatment with bioactive glass S53P4 in vitro.

Dentin hypersensitivity can be managed to occlude dentin tubules, but none of the agents used are components of natural dentin. Using a calcium phosphate precipitation (CPP) method, dentin tubules can be occluded with a calcium phosphate (CaP) layer similar to the major inorganic component of dentin. The CPP method utilizes acidic pH conditions, such as etching of dentin, over the course of several dental treatments. A gentler method can be used to produce a CaP layer on the surface of dentin. By treating with bioactive glass S53P4 (BAG), or regular commercial glass (CG), mineralization occurs in physiologically neutral solutions such as simulated body fluid (SBF) and remineralization solution (RMS). After a short period of immersion, silica is dissolved from both types of glass, but the amount of silica released is much greater from BAG than from CG. The dissolved silica is adsorbed on the surface of dentin during the pretreatment procedure and enhances the mineralization of dentin in SBF. After 14 days' mineralization the dentin is fully covered by the CaP layer, but after 14 days' immersion in RMS decalcification of the dentin occurs. Pretreatment with BAG decreases the degree of decalcification of dentin during the mineralization process. These findings suggest that bioactive glass S53P4 can be used as a therapeutic material for mineralization of dentin and its tubules in a physiological environment.

Adsorption↗

Clinical dental application of Er:YAG laser for Class V cavity preparation.

Following the development of the ruby laser by Maiman in 1960, the Nd:YAG laser, the CO2 laser, the semiconductor laser, the He-Ne laser, excimer lasers, the argon laser, and finally the Er:YAG laser capable of cutting hard tissue easily were developed and have come to be applied clinically. In the present study, the Er:YAG laser emitting at a wavelength of 2.94 microns developed by Luxar was used for the clinical preparation of class V cavities. Parameters of 8 Hz and approx. 250 mJ/pulse maximum output were used for irradiation. Sixty teeth of 40 patients were used in this clinical study. The Er:YAG laser used in this study was found to be a system suitable for clinical application. No adverse reaction was observed in any of the cases. Class V cavity preparation was performed without inducing any pain in 48/60 cases (80%). All of the 12 cases that complained of mild or severe intraoperative pain had previously complained of cervical dentin hypersensibility during the preoperative examination. Cavity preparation was completed with this laser system in 58/60 cases (91.7%). No treatment-related clinical problems were observed during the follow-up period of approx. 30 days after cavity preparation and resin filling. Cavity preparation took between approx. 10 sec and 3 min and was related more or less to cavity size and depth. Overall clinical evaluation showed no safety problem with very good rating in 49 cases (81.7%).

Adult↗

Treatment of dentin hypersensitivity by Nd:YAG laser.

Our previous study indicated that dentin surface irradiated with an Nd:YAG laser at an energy output of 30 mJ, 10 pulses/sec (pps), for 2 min resulted in a melted surface and a closure of exposed dentinal tubules orifices, but without dentin surface cracking. The purpose of this study is to evaluate the effectiveness of the Nd:YAG laser in the treatment of dentin hypersensitivity. Thirty subjects participated in this study and were followed for 3 months. Two sites of dentin hypersensitivity in a patient were treated; one received Nd:YAG laser treatment and the other served as control. Dentin hypersensitivity was assessed by mechanical and thermal stimulus. Pulpal vitality was measured using an electrical stimulus. The Nd:YAG laser treatment reduced dentin hypersensitivity to air by 65% and to mechanical stimulus by 72% over 3 months. All teeth remained vital after laser treatment, without adverse reactions or complications. In conclusion, the Nd:YAG laser can be used to reduce dentin hypersensitivity without detrimental pulpal effects.

Adult↗