Adult human enamel. II. An electron microscopic study of the effect of grinding.
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The incisors of 85 patients were examined for tooth wear with the aim to evaluate possible association between the degree of wear and anterior guidance. Apart from clinical functional analysis electronic axiography using the system CADIAX was carried out. Anterior guidance in protrusive movement was marked on individually mounted plaster casts and scanned using a pantograph. The cephalometric analysis program CADIAS was used for the metric determination of the anterior guidance angle to the axis-orbital plane, and in order to relate the anterior guidance to the horizontal condylar inclination. The interincisal angle was included in the evaluation as a further functional angle and according to overjet and overbite there were classified typical incisor relations. Where both anterior guidance and incisor inclination and relation were in the normal range, there was an increase in incisal tooth wear in the group investigated. With reduced functional space, frequently found together with anterior deep bite, incisor wear was less extensive. While the occurrence of parafunction was shown not to be related to anterior guidance and incisor inclination and relation parafunctions were the decisive factor in the occurrence of severe incisor wear. Where anterior guidance and incisor inclination and relation are normal, the area of enamel under load is smaller and the space for bruxism larger. Parafunctional forces thus appear to result in a higher degree of wear than is found with the reduced functional space of a steep incisor position. Anterior guidance could not be evaluated as a parafunctonal inducing factor, but only as determining the wear pattern in the individual.
AIMS OF THE STUDY: The high prevalence of ear, nose and throat symptoms in patients with temporomandibular disorders seems to depend on anatomical, functional, neuromuscular, or psychosomatic connections between both phenomena. The present study evaluates the prevalence of temporomandibular dysfunctions in tinnitus patients compared to controls. PATIENTS AND METHODS: A total of 40 patients and 35 controls were clinically examined. The case history as well as the quality of tinnitus and its influence on the patient's life were evaluated, and psychosocial data collected by a questionnaire dealing with stress factors. RESULTS: Tinnitus patients showed muscle tenderness in masticatory muscles as well as in other muscle groups significantly more frequently than controls. The prevalence of arthrogenous dysfunctions was not significantly different between the groups. Occlusal parameters such as instability of intercuspidation, presence of dysgnathia, and signs of parafunctions were significantly more frequent in patients than in controls. The psychosocial assessment showed some trend towards the tinnitus patients feeling more stress in society, daily life, their partnerships and at work. CONCLUSIONS: Tinnitus correlates significantly with myogenous disorders but not with arthrogenous disorders of the temporomandibular joint (TMJ). This result supports the concept of neuromuscular and functional relationships between tinnitus and the stomatognathic system.
In ungulates, tooth wear is often suggested as a proximate cause of senescence. Tooth wear is expected to be sex-dependent since energetic requirements and food selection varies largely between sexes in sexually dimorphic ungulates. Furthermore, tooth wear may lower mastication efficiency, and we predict a negative correlation between tooth wear and body weight or condition. We tested these predictions on data on tooth wear (estimated as height of first molar) of 1,311 male and 1,348 female red deer ( Cervus elaphus) aged 3-25 years and harvested along the west coast of Norway. The rate of tooth wear decreased with age. Males wear teeth at a higher rate (from 0.61 mm/year in 4-year olds to 0.45 mm/year in 11-year olds) than females (from 0.52 mm/year in 4-year olds to 0.39 mm/year in 11-year olds). Molar height correlated positively with body weight in both sexes, but not after adjusting for body size. Molar height was strongly dependent on body size in 3-year-old individuals (when tooth wear is minimal). Earlier reports in the literature of a positive correlation between tooth height and body weight may therefore be due to initial size differences rather than differences in condition due to tooth wear.
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Enamel surfaces were debonded by methods recommended in the literature and found to be problematic. A new method, not previously recommended, involving the use of a green rubber wheel followed by pumice or composite finishing paste was similarly examined and found to come closest to restoring the original, natural enamel surface. A step-by-step clinical procedure was described for highly filled, lightly filled, and unfilled adhesives.
A method of marking human enamel so that reduction in enamel thickness by etching, bonding, and wear could be measured to within a range of -2.5 to +3.5 microns for the impression accuracy and to within a range of -1.5 to +3.8 microns for the measurement error, was devised and used to measure the effects of the above factors on enamel. For five unetched surfaces studied in vivo, the 85-day loss of enamel averaged 1.6 microns. For twenty teeth etched and studied in vivo, the etch removed 9.9 microns of enamel and the subsequent loss over 85 days exceeded normal wear by 3.0 microns. The etch produces microporosities up to 50 microns in depth; therefore, the remaining 40 to 45 microns must be filled rather than worn smooth. For twelve teeth subjected to etching, bonding, bracket removal, and "clean up," enamel removed averaged 55.6 microns or approximately the entire thickness of the etch. The surface immediately following the "clean up" and 2 months after "clean up" were clinically and microscopically comparable to an untouched enamel surface.
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An in vitro study using steel reference markers in the enamel of 120 permanent premolars was conducted to determine the amount of enamel lost during prophylaxis and during multiple bonding/debonding procedures. A prophylaxis procedure was carried out on eighty teeth. The procedure was standardized with respect to time, pressure, and revolutions of the prophy handpiece. Both bristle brush and rubber cup were used with four different prophylaxis pastes. The enamel loss with the bristle brush (14.38 micrometers) was significantly (p less than 0.01) greater than the loss with the rubber cup (6.9 micrometers). No significant differences were associated with the use of different pastes. Multiple bonding/debonding procedures were conducted with filled and unfilled resin adhesives. Following the initial bond, twenty of the teeth received prophylaxis and acid etching prior to subsequent bonds while the remaining twenty did not. Total enamel loss was 71.5 micrometers in the group bonded with a filled resin with prophylaxis and acid etching between bonds. This was significantly (p less than 0.01) greater than the amount lost (22.3 micrometers) by the group bonded with the same resin without prophylaxis and acid etching between bonds. Total enamel loss was 45.4 micrometers in the group bonded with an unfilled resin with prophylaxis and acid etching between bonds. This was significantly (p less than 0.01) greater than the amount lost (17.8 micrometers) by the group bonded with the same resin without prophylaxis and acid etching between bonds.
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