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Cervical enamel: a danger zone.

The British Standards Institutions's document (1974) recommending toothpaste specifications states that 'There is no evidence that any toothpaste ever produces a level of abrasion causing harm to dental enamel'. This paper questions the assumption that the enamel crown, especially at the cervical margin, is able to cope with modern dietary insult and a 'good' oral hygiene regimen, regardless of the enamel abrasivity of the dentifrice used. Once the enamel crown is breached the underlying dentine is sensitive and vulnerable to physical damage. In this work the potential rates of erosive and abrasive loss are related to the thickness of the protective enamel and to the relevance of fluoride treatments for adults. It is suggested that improvements in dental care and an increased tooth life expectancy now make the loss of tooth tissues at the cervical margin more important than is apparent at first sight.

Dental Enamel↗

The Class V lesion--aetiology and restoration.

The aetiology of non-carious cervical lesions is discussed. These have been variously described as 'abrasion', 'erosion', 'abrasion/erosion', and 'idiopathic cervical'. However, many lesions do not fit the classical appearance or location of an erosive and/or abrasive origin, and there is increasing interest in the possible role of occlusal stress in their aetiology. Non-carious cervical lesions often require restoration, and there are essentially three options using tooth-coloured materials: a restorative glass ionomer cement, a liner/base glass ionomer cement overlayed with a resin composite, or a resin composite bonded by an enamel/dentine-adhesive. The materials and techniques used in these options are discussed, indicating their advantages and disadvantages. Results of available clinical trials of these systems are given, and the link with the stress theory of cervical tooth loss is described. The preferred restorative approaches in order are: resin-modified restorative glass ionomer; resin-modified liner/base glass ionomer with a microfine resin composite overlay; enamel/dentine bonding agent with a microfine resin composite.

Adhesives↗

[Longitudinal study on the abrasion of plastic teeth in total prostheses].

After a period of two years, the abrasion rate for standard plastic lateral teeth is one-tenth of a millimeter. The abrasion rate is then one-tenth of a millimeter per year for each succeeding year. A vertical loss of approximately four-tenths of a millimeter, for example, occurs during a five-year period. The abrasion rate is not related to the position of the prosthesis. The molar region shows a lesser degree of abrasion than anterior sections of the dental arch.

Aged↗

The effect of a jet abrasive instrument (Prophy Jet) on root surfaces.

A Prophy Jet instrument was tested in order to analyze the abrasive effect and surface alterations on human root cementum and dentine. Photomicrographs from scanning electron microscopy (SEM) and a profilometer technique for depth analyses were used for evaluation. The results of the experiments demonstrated that the Prophy Jet technique had an abrasive effect reaching about 25 microns in depth after 30 seconds treatment. The root surface, cementum as well as dentine also became rougher after treatment judging from the SEM micrographs. Clinical advantages and disadvantages by using the Prophy Jet instrument will be discussed. Further studies seems to be justified concerning the jet abrasive technique.

Dental Cementum↗

Two-year clinical effectiveness of a resin-modified glass-ionomer adhesive.

PURPOSE: To evaluate the clinical effectiveness of a resin-modified glass-ionomer adhesive FujiBond LC (GC) in non-carious Class V cervical lesions. METHODS: 28 patients and 52 abrasion-erosion lesions were restored using FujiBond LC and a microfilled resin composite in a cavity design with the adjacent enamel margins beveled. Clinical parameters as retention, marginal integrity, clinical microleakage, caries recurrence, esthetics, gingival response, tooth vitality and post-operative sensitivity were evaluated at 6 months, 1 and 2 years. RESULTS: A 100% retention rate was recorded after 2 years of clinical service. However, only 15% of the restorations showed a perfect marginal adaptation. All marginal defects were small, either located at the incisal or at the cervical margin. The percentage of small marginal defects was obviously higher at the incisal enamel margin than at the cervical dentin margin. At the 2-year recall, half of the restorations exhibited a superficial, localized discoloration at the restoration margin, however none of the restorations showed deep, generalized discoloration. Remaining criteria of clinical effectiveness were rated as excellent.

Adult↗

Relative wear of flowable and highly filled composite.

STATEMENT OF PROBLEM: By decreasing the proportion of filler, flowable composites are easy to adapt to small cavity preparations. However, the wear resistance of flowable composites is a clinical concern, as improved wear has been related to increased filler percentage. PURPOSE: The purpose of this study was to compare wear for flowable composites and comparable heavily filled materials. MATERIAL AND METHODS: Wear by attrition and abrasion (microm) of microfilled flowable (Heliomolar Flow) and heavily filled microfill (Heliomolar HB) was measured and compared to a microhybrid flowable (Tetric Flow) and a heavily filled microhybrid (Tetric HB). There were 5 specimens, 2 mm thick and 15 mm in diameter, in each group. The Oregon Health Sciences University oral wear simulator was used to produce abrasive wear and attrition for all specimens. Abrasion and attrition of the substrates were measured using a profilometer. Data were subjected to a 3-way analysis of variance for the 3 main factors: composite type, filler load, and wear type (alpha=.05) RESULTS: Composite wear rates were significantly influenced (P <.01) by both the type of wear and the filler amount. Abrasive wear occurred less than wear by attrition, and the heavily filled composites experienced less wear than the flowable composites. CONCLUSIONS: Results of this in vitro study suggest that highly filled microhybrid composites may have greater wear resistance for contact-supporting posterior restorations. However, in small noncontact restorations where longevity may be dictated by abrasion, flowable microfilled resins may be adequate.

Acrylic Resins↗

Brushing abrasion of eroded bovine enamel pretreated with topical fluorides.

Topical fluorides have been proposed for the prevention of erosive dental wear. This study evaluated the in vitro effect of a single professional application of 4% titanium tetrafluoride (TiF4), 1% amine fluoride (AmF) and 0.1% difluorosilane varnish (FV) in preventing wear due to combined erosion and brushing abrasion. One hundred and eight bovine enamel samples were used. Control groups were not pretreated with any product (C), pretreated with a fluoride-free varnish (FV-bl) or pretreated with fluoride varnish and subsequently submitted to varnish removal (FV-r). Wear was modeled by submitting the fluoride-treated and control groups to 3 cycles of the following regimens: erosion/remineralization (er/remin), abrasion/remineralization (abr/remin) or erosion/abrasion/remineralization (er/abr/remin). Erosion was simulated by immersion of the samples for 10 min in citric acid 50 mM (pH 3). Abrasion was carried out for 1 min (200 strokes, load 150 g) in a wear device. Remineralization (2 h artificial saliva) took place between the cycles. Two-way ANOVA showed that there was a significant interaction (p<or=0.001) between the fluoride treatments and the wear regimens. Under er/remin a significant wear protective effect was found for the FV, FV-r and FV-bl groups. Abr/remin resulted in some enamel loss for the TiF4 and AmF groups, but the amounts lost were not statistically significant (p=0.185 and p=1.000, respectively). Under er/abr/remin all products showed a significant protective effect, except for TiF4. It was concluded that FV and AmF protected bovine enamel against erosion followed by brushing abrasion in vitro.

Analysis of Variance↗

Toothbrush abrasion of erosively altered enamel after intraoral exposure to saliva: an in situ study.

The aim of this in situ study was to test the effect of toothbrush abrasion on enamel previously exposed to a standardized artificial erosive agent. To generate moderate erosive lesions, slabs of the buccal surface of human premolars were immersed in a solution of citric acid for 3 min. Then they were attached to intraoral appliances and each one was exposed for 0 min (= toothbrushing immediately after intraoral exposure), 30 or 60 min to the oral milieu of 1 of 7 female subjects with a mean age of 22 years. Immediately thereafter the volunteers brushed the slabs for 30 s with toothpaste using their preferred brushing technique. For each test person the secretion rate of resting and paraffin-stimulated saliva, buffering capacity and pH were measured. The following mean losses of substance at the surface were registered: 0.258+/-0.141 microm (toothbrushing immediately after intraoral exposure), 0. 224+/-0.087 microm (toothbrushing after intraoral exposure of 30 min) and 0.195+/-0.075 microm (toothbrushing after intraoral exposure of 60 min). Toothbrush abrasion in situ was significantly lower after 60-min exposure to the oral environment than after 0-min (p<0.001). Also, the 30- and 60-min values were significantly different from each other (p<0.001). Multiple linear regression analyses revealed that in this model toothbrush abrasion was associated with the intraoral exposure to saliva (p = 0.026), the severity of the erosive attack (p<0.001) and the secretion rate of resting saliva (p = 0.029). If no other preventive measures are taken we suggest that individuals at risk for erosive tooth wear wait at least 1 h before brushing their teeth after consuming erosive foodstuffs or beverages.

Adult↗