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[Decision to extract for periodontal reasons].
The decisions to extract that are discussed here mainly relate to severe periodontal bone losses and plain interradicular attacks. Extractions for periodontal reasons appear at several treatment stages: immediate extraction in terminal stages, e.g. for teeth without any strategic importance, or deferred extraction if one chooses to wait for treatment response. The elements of the decision are various: function and strategic importance of the tooth, extension of the lesion, level of the interradicular attack, any endoperiodontal lesions, fractures and luxations, radicular proximity, implication of wisdom teeth, evolution after treatment. All these factors are discussed.
Root surface treatment with glass ionomers and resin composites.
Recommendations for restorative treatments of root surfaces are made difficult by a lack of information on the etiology of root conditions and on the clinical performance of available materials used to treat these conditions. Resin composite and glass ionomer materials are popular restorative materials because they are esthetic and can bond to tooth structure. However, the role each can play in restoration of root surface lesions is not well documented. This article presents a rationale for using these materials for a number of restorative situations.
Glass ionomer cements and future research.
Once a root surface lesion has extended into tooth structure beyond the point at which it can be successfully remineralized it is necessary to carry out traditional restorative procedures. Often the extent of the lesion is difficult to define and development of a pulp exposure is an ever present risk. Access may be difficult and placement of a restorative material, such as amalgam, which requires positive condensation for correct placement, poses a problem. The principal requirement of a restoration in such a lesion is that it should completely seal the restoration/tooth interface and prevent the ingress of further bacteria or bacterial nutrients. As there will be no occlusal load, physical properties of the restorative material are not significant. As these lesions will often occur on anterior teeth it is desirable that the material be reasonably esthetic although there will be no need for a great depth of translucency. The modern trend to light curing of restorative materials facilitates placement but there are situations with these lesions where it is difficult or impossible to obtain proper access for the light and an auto cure material may be indicated. Because the patient who presents with root surface lesions is likely to pose a continuing problem, it is desirable that the restorative material have some degree of in-built protection against further demineralization. An ongoing fluoride release is very desirable. Glass ionomer cement fulfils all the above requirements and is therefore at present the material of choice. Either the original auto cure cement or the newer dual cure materials will provide a complete marginal seal with a continuing fluoride release throughout the life of the restoration and both varieties are sufficiently esthetic to be entirely acceptable.
Exposed Root Interactions Symposium: consensus and recommendations.
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Oral health needs of the elderly.
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An improved technique for Class V composite resin inlays.
Treatment of cervical carious lesions presents significant problems to the restorative dentist, including difficulties with access and with the restorative materials themselves. Conventional approaches are not suitable for inaccessible or multisurface cervical lesions. Polymerization shrinkage associated with composite resins is also a problem. Although indirect composite resin inlay techniques address these shortcomings, they generally require two patient visits. An improved technique solves these problems by utilizing a copper band impression technique, a quick-setting stone die, extraoral curing of the composite resin inlay, and dentinal adhesive bonding technology in a one-visit restorative approach to the cervical carious lesion.
Initial therapy for the periodontally diseased patient.
The crucial first steps in periodontal therapy often are neglected. In initial therapy must include oral hygiene instruction; scaling and root planing; caries control, endodontic therapy, occlusal adjustments, reduction or elimination of tooth mobility, provisionalization, extraction and/or specialty consultation as warranted; and re-evaluation.
Soft tissue augmentation on previously restored root surfaces.
Three cases are presented demonstrating that soft tissue augmentation procedures can be accomplished on previously restored root surfaces. Diagnostic techniques to help determine ideal tooth length are discussed, and clinical examples of how to surgically manage the previously restored root surfaces are presented.
Resin-ionomer and hybrid-ionomer cements: Part I. Comparison of three materials for the treatment of subgingival root lesions.
The purpose of this study was to compare the characteristics of three different restorative materials for the treatment of subgingival root lesions. Eighteen recently extracted teeth were used to test the depth of cure and the surface characteristics of these products. Although none of the materials tested exhibited all of the author's ideal characteristics for a subgingival restoration, one restorative material displayed the most favorable result.
Classification of cervical burnout and its distribution in the dentition.
A retrospective analysis of 25 full mouth intra oral radiographs, including bitewing films was carried out from the hospital records of King Saud University College of Dentistry in Riyadh, Saudi Arabia, A new classification of cervical burnout (CB) based on shape was attempted. Analysis of the data revealed greater frequency of CB in maxillary teeth (67.5%) than in the mandibular teeth (32.5%). The highest frequency among maxillary teeth was in incisors (75%), while the least was in the molars (30%). In mandible, the corresponding findings was in the canines (40%) and in the molars (15.3%). Seventy per cent of CB disappeared in bitewing view in maxillary and mandibular premolars while remaining teeth showed this phenomenon in less than 50% cases. It was concluded that the frequency of CB was greater in maxillary teeth than mandibular teeth. Maxillary incisors and mandibular canines are more likely to show CB. In molars and premolars, CB present in periapical radiographs may disappear in a bitewing view.
A study of fixed prosthodontics performed at a university clinic 18 years after insertion.
This study obtained information on the long-term efficiency of prosthetic rehabilitation with fixed partial dentures performed by undergraduate students. From a list of discharged patients treated from 1975 to 1976 by undergraduate students at a dental school, 101 were recalled for free clinical examinations after 6, 11, and 18 years. A total of 163 fixed partial dentures were inserted. The majority (85%) of the fixed partial dentures were acrylic resin veneer-gold restorations; 15% were metal ceramic restorations. During this study period, 14 individuals died, leaving 138 fixed partial dentures to be examined. Of these, 35 (25%) were removed after a mean of 11 years in function, which left 75% in place and functioning after 18 years. The main causes for removal included caries, periodontitis, root fracture, and endodontic complications. Fewer metal ceramic restorations than acrylic resin veneer-gold restorations were removed. The removal rate for abutments with cast posts and cores was higher than the removal rate of total abutments. There was no difference in removal frequency between fixed partial dentures with moderate cantilever extensions and those with end-supported extensions.
The need for mucogingival surgery re-evaluated.
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A quantitative comparison of selected bacteria in human carious dentine by microscopic counts.
The levels of selected cariogenic and obligately anaerobic bacteria have been compared in carious dentine taken from fissures, smooth surfaces, and root surfaces. The numbers of infected dentinal tubules were determined by immunohistological staining using species-specific antisera against selected bacteria. Selective localization was observed; mutans streptococci were the predominant bacteria in dentine from fissures and smooth surface coronal caries, but not from root surface caries. The proportion of mutans streptococci was higher in the shallow and middle layers of dentine from fissures and smooth surface coronal carious lesions than from the deep layers. In root surface caries, Actinomyces spp. were the predominant bacteria, and were present at higher levels in the deep layer of root lesions than in the shallow and middle layers. The proportion of Lactobacillus spp. was relatively low despite its high detection frequency in all layers of the three types of carious lesion. Immunohistological staining with species-specific antisera was able to reveal the distribution and the localization of various bacteria in carious dentine.
[Problems of direct pulp capping. II. Clinical studies on the effect of caries and of the number of roots on therapeutic results].
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Randomized clinical comparison of endodontically treated teeth restored with amalgam or with fiber posts and resin composite: five-year results.
Prospective clinical studies comparing the results of different types of restorations of endodontically treated teeth are lacking. This study compared the clinical success rate of endodontically treated premolars restored with fiber posts and direct composite to the restorations of premolars using amalgam. Premolars with Class II carious lesions were selected and randomly assigned to one of two experimental groups: (1) restoration with amalgam or (2) restoration with fiber posts and composite. One hundred and nine teeth were included in Group 1 and 110 in Group 2. Patients were recalled after 1, 3 and 5 years. No statistically significant difference was found between the proportion of failed teeth in the two experimental groups. Significant differences were observed between the proportion of root fractures (p=0.029) and caries (p=0.047), with more root fractures and less caries observed in the teeth restored with amalgam at the five-year recall. Within the limits of this study, it can be concluded that restorations with fiber posts and composite were found to be more effective than amalgam in preventing root fractures but less effective in preventing secondary caries.
The polarized light microscopic appearance of caries-like lesions adjacent to restored cavities in the crowns and roots of extracted human teeth.
Longitudinal clinical studies indicate consistently that secondary caries is the major cause of failure of restorations. Recently there has been an increase in the number of fluoride-containing materials coming to the market place and this has renewed the debate about the cariostatic effectiveness of such materials. The present study examined the histologic appearance of caries-like lesions adjacent to a non-fluoride-containing material (amalgam), a low fluoride-containing material (composite) and a moderate fluoride-containing material (glass-ionomer). The artificial caries system used to produce lesions has been previously reported and is a microbial system using Streptococcus mutans NCTC 10832. The lesions produced were similar to naturally occurring lesions in many respects, indicating the usefulness of this in vitro technique. Variations in the appearance of lesions were found adjacent to the different materials and the effect of the fluoride contained within two of the materials is discussed.
Role of dentinal carious lesions in the pathogenesis of oral candidiasis in HIV infection.
The authors describe a clinicopathologic study that evaluated whether dentinal carious lesions are colonized by candidal organisms--and if so, whether there is a relationship between dentinal carious lesion colonization and clinical oral candidiasis, or OC, in HIV infection. Using light microscopy, the authors examined 30 extracted teeth with dentinal carious lesions from people in each of two groups: 30 consecutively treated HIV-positive patients and 30 consecutively treated HIV-negative patients. OC was diagnosed only in HIV-positive patients (40 percent). The dentinal carious lesion pattern in both groups was similar in occlusal, root and proximal caries. Candidal colonization of carious dentinal tubules was more frequent in HIV-positive subjects than it was in HIV-negative subjects. This research shows that it may be important to restore dentinal caries in HIV-infected patients to remove a protected niche for candidal organisms.