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[Histopathological and therapeutical aspects of cervical lesions].

The term "cervical lesions" definies all the alterations consisting in a loss of hard dental tissues located along the cement-enamel junction, and may be more specifically defined as carious lesions (LCC) and non-carious lesions (NCCL). The non-carious cervical lesions are characterized by the loss of mineralised dental tissue in the absence of a carious process. This definition includes three different lesion categories: abrasion, erosion and the cervical lesions caused by stress (abfractions). In this paper the authors explain the histological, clinical, preventive findings of NCCL and try to give some guidelines to choose the appropriate material to restore different types of non carious cervical lesions.

Dental Caries↗

In vitro wear of composite with varied cure, filler level, and filler treatment.

For the clinical wear of composite filing materials to be reduced, compositional factors such as degree of cure, filler level, and silanation level should be optimized. An oral-wear-stimulating machine was used to explore the effects of these factors on abrasion and attrition wear as well as on opposing enamel wear. The composites were made from Sr glass (1-2 micron avg) and a 50/50 Bis-GMA/TEGDMA resin. Series I (A-D, E) were light-cured (Triad II) for 9, 12, 25, and 40 sec/side to produce degree of cure (DC) as measured by FTIR of 56, 60, 61, and 63%, respectively. E received an additional heat cure (120 degrees C for 10 min) to reach a DC of 66%. Series II (D, F-I) were filled to 62, 53, 48, 37, and 28 vol%, respectively. In series III (D, J-M), the portion of fillers treated with a silane coupler (MPS) was 100, 80, 60, 40, and 20%, respectively. Samples were cycled 50,000 times against an enamel antagonist in a poppy seed/PMMA slurry in the oral wear simulator to produce abrasion (load = 20 N) and attrition (load = 70 N) simultaneously. Wear depth (micron: n = 5) was measured by profilometry. Results for each series were analysed by ANOVA/Turkey's (p < or = 0.05). The wear depths did reflect cure values, though only the abrasion difference for E < A was significant. Greater wear was correlated with lower filler levels (r2 = 0.88; p < 0.05), significantly increasing below 48 vol% (G). Wear increased linearly as the percent of silane-treated fillers was reduced (r2 = 0.99; p < 0.05). Abrasion and attrition did not differ significantly for any composite. Wear of the opposing enamel was largely unchanged by these factors. Compositional factors including degree of cure, filler level, and silanation directly affected the wear resistance of dental composites evaluated in an oral wear simulator.

Analysis of Variance↗

Comparison of the mechanical effects of a toothbrush and standard abrasive on human and bovine dentine in vitro.

Dentine abrasion is an important possible side effect of individually used mechanical oral hygiene products. Since human teeth are sometimes not available in sufficient numbers for research purposes, bovine teeth are often used as a substitute for in vitro tests of dentine abrasion. The aim of the present comparative study was to determine the mechanical effects of a manual toothbrush and a standard abrasive on human and bovine dentine under standardized conditions. Roots of human and bovine teeth were radioactivated and subjected to standardized machine brushing using a manual toothbrush and a standard abrasive slurry. Dentine abrasion was assessed by measuring radioactive phosphorus contained in the slurry after brushing. Non-radioactive human and bovine roots were brushed in the same machine, and the generated surface roughness was assessed using profilometry. Artificially stained human and bovine roots were brushed as described, and the cleaning effect was expressed as the extent of stain-free surfaces after different brushing times. The results for abrasion and surface roughening found with bovine and human dentine suggest that if standardized methods are used, roots of bovine mandibular front teeth can be used in place of human roots for in vitro studies of the mechanical effects of toothbrushes and toothpastes on dentine. The use of bovine dentine for measuring the cleaning effects of these products is, however, not recommended.

Animals↗

[Mouth diseases in a prehistoric agricultural population of northeastern North America].

There is no longer any question that the consumption of refined sugar is a factor in the development of dental caries. In fact, researchers now believe that the production of refined sugar and, particularly, its great availability and use in post-industrial populations has led to a virtual revolution in both the food industry and buccopathology. Clinical and epidemiological studies on the relationship between caries and sugar consumption have been conducted for more than 40 years, and the harmful effects of sugar consumption on the development of dental caries are now well known. Some authors have also demonstrated a historical relationship between caries and sugar over the last three centuries. Another food revolution that had an equally great impact on oral health occurred with the introduction of agriculture. This innovation is discussed from both a technical and food perspective. Agriculture modified the diet of ancient populations by providing new foods that were rich in carbohydrates and by introducing new cooking methods (food was now often boiled instead of being roasted). These two factors alone contributed to an increased rate of dental caries, but at the same time reduced the abrasion of occlusal surfaces and dental crowns. This paper documents the relationship between dental caries, occlusal abrasion, fractures and periodontal disorders, as well as the agriculture practises of an Amerindian population that lived between 1000 and 1500 A.D. in parts of what are now New York State, Quebec and Ontario. The author's findings confirm those of many other researchers who have investigated agricultural populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Dental Caries↗

A laboratory method for assessment of dentrifrice abrasivity.

This is the report of the Laboratory Abrasion Committee of the American Dental Association (ADA) Dentifrice Program relative to specific methods to measure the in vitro abrasivity of dentifrices. This method was used in two collaborative studies with six participating laboratories. These studies were designed by the ADA Dentifrice Program Statistical Committee and their interpretations form a basis for recommendations on the use of the method. This laboratory method is recommended for use in dentifrice development and may provide some basis for expectations in normal dentifrice use.

American Dental Association↗

Comparison of exposed dentinal surfaces resulting from abrasion and erosion.

The aim of this study was to compare the shape of exposed dentinal surfaces caused by abrasion and erosion with a view to developing a diagnostic clinical test. The study material consisted of 80 natural teeth and 129 dental models obtained from Australian Aborigines known to display considerable dental abrasion due to their diet, and dental models of 37 Caucasians diagnosed with dental erosion through detailed history and dietary analysis. Polyvinyl siloxane impressions were obtained of all occlusal surfaces with dentinal scooping in both the 'abrasion' and 'erosion' groups. All impressions were sectioned buccolingually through the deepest point of the scooped dentine, and then the profiles were photocopied at x2 magnification. The breadth and depth of dentinal profiles were measured to an accuracy of 0.1 mm, enabling ratios of depth:breadth to be determined, and the position of the deepest part of each scooped surface was recorded. The mean depth:breadth ratio of scooped dentine was significantly greater in the Aboriginal natural teeth (0.19 +/- 0.06, mean +/- SE) than in the Aboriginal dental models (0.15 +/- 0.04). Both Aboriginal natural teeth and models with abrasion showed significantly smaller ratios (p < 0.05) than the Caucasian models showing erosion (0.33 +/- 0.07). Furthermore, in the abrasion samples, the deepest region of the scooped dentine tended to be lingually placed more often in maxillary teeth but buccally placed more often in mandibular teeth (p < 0.05). These results indicate that scooped dentine on abraded occlusal surfaces of teeth displays significant differences in shape compared with that caused mainly by erosion.

Adolescent↗

A study of the classification and treatment of noncarious cervical lesions by general practitioners.

PURPOSE: This study presented a survey to determine what general practitioners in Nova Scotia perceived to be the cause of noncarious cervical lesions, and to ascertain their most frequent method of treatment. METHODS: The survey was completed by 63% of the 343 dentists polled. RESULTS: Ninety-four percent classified the lesion as abrasion, and 66% rated toothbrushing as the most likely cause. Treatment methods were varied, with no clear preference. CONCLUSION: The most frequently used restorative materials were GI/composites (29%) and composites (27%). The results of the survey suggest that treatment provided for noncarious cervical lesions may not be based on the correct diagnosis.

Clinical Competence↗

A review of noncarious dental cervical lesions.

Noncarious dental cervical lesions are categorized as abrasions, attritions, erosions, or abfractions. From these destructive processes, hypersensitive dentin is a common sequela experienced by the dental patient. Cold air and tactile probing are among the stimuli that precipitate this reaction. A complete patient history and clinical evaluation are essential for an accurate diagnosis. Treatment measures for hypersensitive dentin include restoring the lesion with composite resin or glass-ionomer material, the application of dentin bonding agents and/or fluoride, and iontophoresis therapy.

Dentin Sensitivity↗

Subvertical grooves of interproximal facets in Neandertal posterior teeth.

Subvertical grooves, located on the interproximal facets of most Neandertal posterior teeth, are less frequently noted on the teeth of other hominids, including modern humans. These grooves, 0.1-0.5 mm in width, are strictly localized within the facet area. Scanning electron microscopic (SEM) examination of grooves present on Neandertal teeth from Caverna delle Fate (Liguria, Italy) and Genay (Côte d'Or, France) demonstrated that they were produced during the life of these individuals. Characteristics of the groove surface suggest an erosion-abrasion mechanism of formation. These grooves, which developed in parts of the dentition exposed to marked stress, originated in areas characterized by changes in the orientation of enamel prism bundles (i.e., Hunter-Schreger bands). Observations carried out on modern human molars showed a subvertical disposition of these bands near interproximal ridges facilitating subvertical microfractures. Possible correlations between enamel structure, masticatory stress, and interproximal groove formation in Neandertals are discussed.

Animals↗

Stress-induced cervical lesions.

The increasing occurrence of dental lesions at the cervical surfaces requires more knowledge of the causes of the process. Acidic and abrasive mechanisms have clearly been documented as causes but the stress theory by Lee and Eakle is still controversial. This report describes several incidences of possible stress-induced lesions according to the characteristics described by Lee and Eakle. The occurrences of subgingival lesions lend credence to the stress-induction theory by exclusion of other superimposing etiologic factors. With the current concepts, a perceptive approach to the treatment of cervical lesions can be executed.

Bite Force↗

Effects of occlusal load on cervical lesions.

Toothbrush abrasion has been considered to cause cervical lesions. However, some investigators have proposed that occlusal loading factors direct tensile stresses at the cervical area, resulting in wedge-shaped abfraction defects. The purpose of this study is to investigate the role of axial and non-axial load on the development of cervical lesions. Matched paired premolars, extracted for orthodontic purposes, were used in a custom-fabricated toothbrushing apparatus. A periodontal sulcus width of 0b1 mm with 1 mm gingival recession was simulated with denture base resin. In phase 1, eight matched premolar pairs were subjected to 80 h (1b4 million strokes) of brushing and 300 g of toothbrush force. Toothpaste slurry was applied continuously through the toothbrush. One specimen in each pair was subjected to 250 h and 45 kg of continuous axial load, while the other unloaded tooth served as a negative control. In phase 2, 10 matched premolar pairs were subjected to the same conditions; however, the experimental teeth were subjected to 250 h and 45 kg of intermittent non-axial load, directed at a 45 degrees angle to the buccal cusp. Rubber impressions were made of the cervical lesions, then trimmed, weighed, and compared to determine the amount of tooth material lost. When teeth were loaded axially, there was significantly less tooth material loss (P < 0b02); however, when teeth were loaded non-axially, there was no significant difference (P =0b80) when compared with controls. Optical and scanning electron microscopy did not reveal any significant differences in the morphology between pairs. Our data suggest that the application of occlusal load may not necessarily play a significant role in the progression of cervical tooth wear commonly referred to as abfraction.

Bicuspid↗

Three-year clinical evaluation of Tenure dentine bonding agent.

Twenty cervical abrasion lesions in five patients of mean age 58 years were restored with Tenure dentine bonding agent and Silux composite, without enamel etching. The cumulative loss rates of restorations were 5 per cent, 5 per cent, and 11 per cent after 1 year, 2 years and 3 years, respectively, and there was a slight increase of marginal staining. The results are in agreement with other authors.

Adult↗

[Morphologic and pathologic findings in teeth and jaws from the middle bronze age (Pitten, Lower Austria)].

The detailed examination of the masticating apparatus of 18 skulls from the Middle Bronze Age in Pitten (Lower Austria) revealed numerous pathological findings of the teeth. Most remarkable were frequency and extent of dental abrasions. In addition to it, indications on inflammatory processes in the marginal parodontium were obtained, combined with partly immense formations of concrements on the surfaces of the teeth. The incidence of dental caries was relatively low. Abnormal positions of the teeth and pathological processes concerning the development of dentition as well as the eruption of the wisdom teeth could be observed repeatedly. Conclusions on insufficiences of the oral hygiene in this time follow especially from the concrement findings and from the inflammatory reactions of the marginal parodontium.

Adult↗

Conservative management of erosion-abrasion: a system for the general practitioner.

This final article in a series of three covering general practice aspects of erosion-abrasion presents a three-phase system for clinical management of erosive-abrasive damage. The first phase comprises pre-restorative case evaluation, initial measures to control factors predisposing to continued erosion-abrasion and where necessary the provision of acrylic overlays to restore facial height. In the second phase the teeth are systematically restored using an acid-etch composite resin technique; guidance for comfortable occlusion is provided by the patient acceptance method. The third phase comprises follow-up, including monitoring of salivary and bacteriological parameters, maintenance of the restorations and modifications of preventive measures necessary to preserve the dentition restored by multiple composite therapy. Modern oral physiological concepts and recent developments in multiple composite therapy and erosion control are discussed.

Composite Resins↗

[The abrasion of amalgam and composites in the lateral dental region].

In 41 patients class 11 cavities each of the lower jaw were filled with the materials Adaptic, Concise cap, Epoxydent or amalgam. The models made from impressions were systemically measured by a coordinate measuring machine according to a procedure determined by us (measuring error of this method about 15 micron). After one year the following abrasions were found: amalgam 18 micron +/- 58 micron, Adaptic 92 micron +/- 97 micron, Concise Cap 146 micron +/- 75 micron, Epoxydent 38 micron +/- 50 micron. Evaluation of the clinical examination showed that the materials Concise and Epoxydent were significantly inferior as regards border closure than amalgam and Adaptic. We determined further that a large percentage of composite filling showed visible discoloration of the borders (Adaptic 42%, Concise 55%, Epoxydent 80%). Many of the fillings were discolored after a year. Adaptic was highly significantly different with 31.6% discolored fillings to both other materials (Concise 79%, Epoxydent 78.4%).

Bicuspid↗

[Dental and mandibular studies on mummies. Contribution of a stomatologist].

This is the sequence to an investigation on a mummy, 1965. Two further mummies could be examined: the first, a woman about 34 years old, from the 1st to 3rd century, shows similar advanced destruction of the teeth as the mummy investigated in 1965, caused by sand in the hand milled bread flour. This caused an early loss of molars by exaggerated abrasion, exposure of the pulps and periodontal bone loss. There was no evidence of occlusal caries. The second mummy was a 18-year-old young woman, 800-700 b. C. From the inscriptions on the sarcophagus name, family and living circumstances could be found. The same damages were found here, there was only a gradual difference owing to age difference. An interesting special finding was the absence of lip closure and the postmortal damage to the front teeth which may have been caused by the ritual of mouth opening.

Adolescent↗

Tongue piercing and associated oral and dental complications.

The insertion of metal objects into intraoral and perioral sites is growing in popularity. However, there are numerous oral and dental complications associated with tongue piercing. Fifteen patients with tongue piercings (pierced in the body of the tongue, anterior to the lingual frenum) attending the dental office of the authors, with and without complaints, were clinically and radiographically examined. The most common dental problem registered was chipping of teeth. Furthermore, two cracked teeth and four teeth with cusp fractures were also seen. One case of selective dental abrasion was registered. Trauma to the lingual anterior gingiva was the most common gingival problem. A salivary flow stimulating effect was only reported by 2 of the 15 individuals. None of the patients complained of interference with speech, mastication and swallowing. One case of galvanic currents produced by the appliance was registered. On the basis of the registered data, we concluded that patients need to be better informed of the potential complications associated with tongue and oral piercings, and that the dental profession can serve this role.

Adult↗