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An immediate-extraction anterior single-tooth replacement utilizing a fiber-reinforced dual-component bridge.

Replacement of a single anterior tooth is an extremely challenging procedure. Numerous objective and subjective factors must be evaluated by the interdisciplinary team in the determination of the appropriate restorative method. This article reviews the restorative options and describes an emerging treatment modality--the fiber-reinforced dual-component bridge--as the option selected in a case requiring an immediate extraction of the maxillary right central incisor. The pertinent technology, indications, contraindications, and current clinical technique of dual-component nonmetallic prostheses are examined.

Adult↗

Primary incisor restoration using resin-veneered stainless steel crowns.

The restoration of primary incisors with extensive caries lesions is a clinical challenge of severe dimensions. Not only are these teeth difficult to restore, but the patient's behavior can affect the treatment negatively. Requirements for an acceptable restoration include natural color; durability; adhesive cementation that is biocompatible with the pulp; easily and rapidly placed; requires only one treatment visit. Compared to other options, stainless steel crowns are the easiest to place. The most attractive restoration for these cases today is the adhesively bonded resin-composite crown, made by using acetate crown-form matrices, but this is being surpassed by the stainless steel crown forms (3M Unitek) that can be preveneered. This article describes a step-by-step method of placing preveneered stainless steel crowns for primary incisors.

Child, Preschool↗

Predictably restoring endodontically treated teeth.

Endodontically treated teeth can be restored with a wide range of techniques of varying complexity. This paper presents a straightforward technique for the restoration of endodontically treated teeth that meet certain standards. Criteria are provided for the utilization of crowns, composite resins, cast gold post cores, amalgam or composite build-ups, and passive, parallel, small diameter stainless steel posts to restore these teeth. Consideration is given to ferrule design and its importance in achieving success.

Dental Cements↗

In vitro fracture behavior of maxillary premolars with metal crowns and several post-and-core systems.

The in vitro fracture behavior of severely damaged premolars, restored with metal crowns with limited ferrule and several post-and-core systems, was investigated. Crowns of maxillary premolars were removed and canals were prepared with Gates Glidden drills and with Parapost drills. Groups of 11 samples were each treated with cast post-and-cores (Parapost XP, Wironium Plus) (group 1), prefabricated metal posts (Parapost XH) (group 2), prefabricated glass fiber posts (Parapost FiberWhite) (group 3), and custom-made glass fiber posts (EverStick Post) (group 4). Posts and composite cores and metal crowns in groups 2, 3, and 4 were adhesively cemented. Post-and-cores and crowns in group 1 were cemented with phosphate cement. Thermocycling was performed (6,000x, 5-55 degrees C). Two static load tests (30 degrees ) were applied. During the first load test (preloading) no failures occurred. Failure modes from the second load test were categorized into favorable and unfavorable failures. Mean failure loads among the four groups (group 1, 1,845 N; group 2, 1,718 N; group 3, 1,812 N; and group 4, 1,514 N) were not significantly different. Unfavorable failures were root fractures and favorable failures were postcrown displacements. No differences in frequencies of unfavorable/favorable failures were seen among the groups. The results suggest that different post-and-core systems have no influence on the fracture behavior of severely damaged premolars restored with metal crowns with limited ferrule.

Bicuspid↗

Indirect composite preparation width and depth and tooth fracture resistance.

PURPOSE: To evaluate the influence of preparation width and depth on the fracture resistance of teeth restored with one type of indirect composite restoration. MATERIALS AND METHODS: Variations of depth and width were superimposed on a preparation of dentin design and dimensions with other variables including tooth size and morphology being controlled. Indirect composite restorations were constructed and placed in accordance with manufacturer's instructions. The restored teeth were subjected to compressive loading with fracture being induced by application of a 4 mm steel rod to the specimens in a universal testing machine, at a cross-head speed of 1 mm/minute. RESULTS: Preparation depths of 3 to 4 mm were found to be preferable, but when the prevalence of severe tooth fracture was assessed, the shallower preparation depth was found to be indicated. Cavity depths of one-third and one-half bucco-lingual width were evaluated, the fracturing forces for the group with the narrower width being statistically lower.

Analysis of Variance↗

Fracture resistance of class II packable composite restorations with and without flowable liners.

This study evaluated fracture resistance in class II slot packable composite restorations with and without the use of a flowable composite liner. A conventional microhybrid composite was used as a control. Thirty-six sound, caries-free human mandibulary molar teeth were used. Separate mesio-occlusal and disto-occlusal class II slot cavity preparations were made in each tooth. The prepared teeth were randomly divided into three groups of 12 teeth. Two packable composites (Surefil, Filtek P60) and one microhybrid composite (Filtek Z250) with their respective manufacturer's bonding agents were used to restore the cavities. One side of each tooth was restored with composite alone, while the other side was restored with the composite lined with that manufacturer's flowable liner. The marginal ridges of the restorations were loaded at an angle of 13.5 degrees to the long-axis of the tooth in an Instron Testing Machine until failure. The data were analysed using a one-way anova. There was no significant difference in fracture resistance between composite restorations with and without flowable liners.

Bisphenol A-Glycidyl Methacrylate↗

[Oscillating procedures in the preparation technic (I)].

An optimal preparation technique should meet the following requirements: a cavity that does not extend beyond the carious lesion; maximum preservation of sound tooth substance, preparation and margin design adapted to the requirements of the restorative material and its adhesion properties, prevention of adjacent tooth damage, and low technique sensitivity. Oscillating instruments with one diamond-coated and one polished surface have been developed to overcome the limitations of conventional preparation designs dictated by rotary burs. Previously untreated carious lesions were prepared using a modified air-scaler handpiece (Sonicsys) with various working tips allowing interproximal cavity preparation with minimal extension and a low risk of damaging the neighboring tooth. Another oscillating system is based on the EVA-System. It uses files for the preparation of interproximal bevels and for the finishing of margins of interproximal box, crown and veneer preparations. These oscillating instruments overcome the major limitations of rotary burs for tooth preparation and facilitate conventional cavity preparation. In addition, they allow the use of cavity designs that could not be achieved with conventional instruments.

Crowns↗

A combined porcelain onlay/amalgam restoration for an endodontically treated posterior tooth.

This article describes a new method of fabricating an aesthetic restoration for an endodontically treated posterior tooth. The tooth is prepared with minimal reduction of sound tooth tissue. Amalgam is condensed into the orifices of the root canals, the pulp chamber, and the remainder of the cavity. The tooth and the amalgam core are then prepared to receive a porcelain onlay. Additional retention is provided by 1 mm deep holes cut in the amalgam floor of the preparation which is then microetched. The porcelain onlay with its margins remote from the gingiva is bonded with dual-cure composite cement. The learning objective of this article is to familiarize the reader with this new procedure.

Dental Amalgam↗

Provisional restoration for abutment of an existing removable partial denture.

The abutment of an existing removable partial denture may require a crown restoration. Fabrication of a provisional restoration to fit the existing clasp assembly requires special consideration. This article presents a simple technique for fabrication of such provisional restorations. An alginate impression is made of the arch with the removable partial denture in place. The abutment tooth is then prepared, providing adequate clearance between the clasp assembly and the tooth preparation. Cold curing acrylic resin of proper shade is mixed and poured in the impression of the abutment tooth. The impression is then seated in the mouth and removed before the acrylic resin is completely polymerized. The provisional restoration is then separated from the partial denture, finished and polished.

Adult↗