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Chairside repair of ceramo-metallic restorations.

The ceramo-metallic crown has enjoyed increasing universal popularity as the full-coverage restoration of choice where long-term esthetics is desirable. The porcelain veneer is colour stable and relatively wear resistant. It has excellent compressive strength but poor tensile and shear strength, which unfortunately can result in fracture. Consequently, there is a need for chairside repair, since remake is often contraindicated. Commercially available repair systems are inconsistent and unpredictable and provide, at best, only temporary results despite recent improvements in materials and technique. Two new adhesive composite resins appear promising, although long-term clinical studies are not available. This article deals first with prevention and a review of the literature. Secondly, clinically proven methods of providing mechanical retention for resin and composite resin repairs of fractured porcelain are presented. The combination of mechanical retention and recently developed adhesive composite resins should provide the dentist with a reliable chairside repair system that could last for many years.

Composite Resins↗

Pulpal response to tricalcium phosphate as a capping agent.

The purpose of this study was to evaluate tricalcium phosphate (TCP) as a pulp-capping agent. Two adult male beagle dogs were used for this investigation. Class I cavities were prepared in the posterior teeth and Class V cavities in the anterior teeth. With the use of a rubber dam and high speed with water coolant, minimal pulp exposures were created in both the experimental and control teeth, by means of a 1/2 round bur. Zinc oxide-eugenol was the temporary filling material used to restore all cavities. In each dog, five teeth served as control and were capped with the use of calcium hydroxide. In one dog, 10 teeth from two quadrants were capped with the tested material (TCP). In the other dog, 11 teeth were capped with TCP. Four teeth from the fourth quadrant in each dog were capped with a mixture of calcium hydroxide and TCP in a ratio of 1:1 by weight (50/50 group.) The two dogs were killed after 70 days. The histologic evaluation of the response to the capping agents and at the exposure site was recorded. A total of 39 teeth were evaluated in this study. It was found that TCP as a capping agent precipitated the highest mean inflammatory response and also demonstrated the highest percentage of reparative dentin formation.

Animals↗

Fluoride-releasing acrylics.

There are numerous examples in dentistry where demineralization, or even frank caries, develops near or in association with restorative or prosthetic materials. Leaking cavity margins and demineralization under bite splints are two examples. A slow-release source of fluoride could help to prevent these problems and provide added protection throughout the mouth. For this purpose a family of fluoride-releasing resins has been developed for use in various adhesive applications, and also for preparing temporary crowns and removable acrylic devices. These materials contain fluoride ions held to covalently bound positive charge sites within the polymer network. Release is by a diffusion/exchange mechanism in which anions from oral fluids diffuse to the charge sites and exchange with fluoride. Fluoride then diffuses to the surface and is released into solution. This method of release allows for the retention of adequate physical properties and is capable of a linear release rate for terms ranging from days to years.

Acrylic Resins↗

Retentive strength of metal copings on prefabricated abutments with five different cements.

BACKGROUND: Despite their wide use in implant dentistry, there is insufficient information concerning the retentive strength of cement-retained superstructures. PURPOSE: This study compared the retentive strength of metal copings on prefabricated abutments with five different luting cements. MATERIALS AND METHODS: Eight prefabricated abutments were placed on titanium screw implants torqued to 35 Ncm. Metal copings were cast with Au-Pt-Pd alloy (DeguDent Universal, Degussa, Hanau, Germany) using burnt-out plastic copings. Cements used were zinc oxide-eugenol-free temporary (ZO), zinc phosphate (ZP), glass ionomer (GI), resin-reinforced glass ionomer (RG), and composite resin (CR) cements. Retentive strength was measured with a universal testing machine. The means of each group were compared by one-way analysis of variance and Tukey-Kramer multiple-comparison intervals at a significance level of p < .05. RESULTS: The mean +/- SD retentive strength of the cements in Newtons was ZO 56 +/- 12 (Tukey group C), ZP 158 +/- 79 (Tukey group B), GI 132 +/- 29 (Tukey group B), RG 477 +/- 52 (Tukey group A), and CR 478 +/- 50 (Tukey group A). CONCLUSION: The retentive strength of metal copings on implant abutments is somewhat different from those of conventional cemented restorations on natural teeth. These differences may be influenced by differences in surface roughness and the height of the abutment.

Composite Resins↗

RBone volume reconstruction in atrophic edentulous ridges: placement method of graft-implant unity in single step together with endogenous growth factors.

AIM: The methods of inserting osseointegrated implants in atrophic edentulous ridges need first bone tissue graft and subsequently the insertion of fixtures. These methods need a long period of time before a prosthesis can be made: for this reason the researchers experimented different techniques to reduce times of prosthetic loading. Our experimented method makes it possible to shorten the prosthetic period notably. METHODS: During surgery an implant is inserted in the symphysis area and then it is removed by trephine bur having a diameter greater than 1 mm compared to the receiving site and by using irrigation with 4 degrees C physiological solution. After 75 days, the implant is loaded by temporary prosthesis and subsequently a final restoration is applied after 4-6 months, depending on bone quality. RESULTS: Our surgical method, in spite of being conditioned by the anatomical conformation of the edentulous ridge and anatomical limits, proved to be predictable and with the same success percentages as other surgical techniques used for morphological reconstruction of atrophic edentulous ridges, shortening prosthetic loading times notably. CONCLUSIONS: Despite the small number of patients treated and the short control period do not give enough elements to consider this new method applicable in all types of atrophies, our results confirm the validity of this technique if well used. In the future further studies and experimentations on greater number of patients and for at least 5 year follow-up are needed.

Adult↗

Full arch rehabilitation of the intact worn dentition: a case report.

When evaluating the worn intact dentition, there are instances when supervised monitoring and piecemeal restoration is the only treatment required. In other cases, especially those which do not fit the stereotype of the aging dentition, full corrective dentistry should be the treatment option. The challenge of reestablishing the vertical dimension of occlusion has frequently evoked the response of "let well enough alone." The objective of this case report is to present the author's solution to some of the challenges which typically create obstacles for general practitioners during full arch rehabilitation. It is by no means complete in theory or clinical protocol and, as with any data from single case reports, should be read as such.

Dental Impression Technique↗

Management of interdental papillae loss with forced eruption, immediate implantation, and root-form pontic.

BACKGROUND: A 25-year-old Asian woman complained of an unesthetic black triangle between her upper right front teeth. Defective interdental papillae may result from external root resorption, which makes esthetic restoration more difficult. A combined use of forced eruption, immediate implant placement, and a root-form pontic made a successful esthetic and functional restoration. METHODS: The treatment sequences of this patient included short-term forced eruption, subsequent immediate implant placement after tooth extraction, and a provisional root-form pontic restoration. A final prosthesis was completed 6 months later, followed by clinical maintenance. RESULTS: Papillae were augmented by forced eruption. After immediate implantation and root-form pontic placement had been performed, the peri-implant soft and hard tissues were manipulated and maintained in a stable state. CONCLUSIONS: We successfully reconstructed the interdental papillae and replaced the deficient tooth with an immediate implantation. During 2 years of follow-up, the implant and peri-implant structures remained stable and healthy.

Adult↗

Immediate loading of single-tooth implants: immediate versus non-immediate implantation. A clinical report.

The hypothesis of the present study was that immediate loading of implant-supported restorations replacing single missing teeth could be a successful procedure. The present study compared the clinical success of immediately loaded single-tooth implants placed in fresh extraction sites to that of immediately loaded single-tooth implants placed in healed sites. From the years 1997 to 1998, 26 patients, ranging in age from 18 to 70 years, presented for the placement of 28 immediately loaded implants intended to support single-tooth ceramometal restorations. Nineteen implants were placed into fresh extraction sites, and 9 implants were placed into healed sites. Temporary prefabricated acrylic resin crowns were prepared and adjusted. At the time of traditional second-stage surgery (3 to 6 months after implantation), the implants were restored with single-tooth ceramometal prostheses. The survival rates were 82.4% and 100% for immediate and non-immediate implants, respectively. Follow-up ranged from 6 to 24 months from the day of implant placement, with a mean of 13 months for the immediate implants and 16.4 months for the non-immediate implants. Radiographic marginal bone loss after 3 to 6 months did not extend beyond the abutment-implant junction. Within the limits of the present investigation, immediate loading of single-tooth implants placed in healed sites is a possible treatment alternative. Immediate loading of single-tooth implants placed in fresh extraction sites carried a risk of failure approximating 20% in this patient population.

Adolescent↗

Amalgam matrix for class II and class V preparations connected at the proximal box.

BACKGROUND: The authors present a technique for placing and reinforcing an amalgam matrix around combined Class II and Class V preparations that connect at the proximal box. OVERVIEW: First, the dentist fills the Class V aspect of the preparation, using a temporary resin-based composite wall at the line angle to support amalgam condensation. The dentist then removes the wall and places a matrix band around the tooth, internally reinforcing the band with smaller pieces of matrix band and resin-saturated cotton balls that are light-polymerized and externally reinforcing the band with fast-polymerizing vinyl polysiloxane. Finally, the dentist condenses the line angle amalgam through the proximal box and condenses the proximal box and occlusal aspects. CONCLUSION: For connected Class II and Class V preparations, this matrix technique permits controlled amalgam condensation, even at the line angle aspect, where it is difficult to condense amalgam without voids or microleakage. CLINICAL IMPLICATIONS: This technique allows dentists to provide a stable, inexpensive direct restoration for teeth with connected Class II and Class V preparations, providing an alternative for patients who do not wish to have crowns placed.

Composite Resins↗

Tooth stabilization and splinting before and after periodontal therapy with fixed partial dentures.

The design and use of fixed partial dentures as a definitive restoration to stabilize and splint teeth have been reviewed. The provisionalization of the splinted patient has been described as it is incorporated into the treatment plan of patients with a weakened periodontium. The current controversy of incorporating implants in the patient requiring splinting was discussed, and recommendations are made. Dentists are encouraged to explain all potential ramifications of splinting with fixed partial dentures, including cost, frequency of office visits, and potential alterations or remakes of the prosthesis should physiologic demands surpass the capabilities of the remaining teeth.

Dental Implantation, Endosseous↗

[Fixed partial denture on osseointegrated screw implants].

There are many differences between full dentures on Brånemark implants and fixed partial dentures built on the same type of implants: due to some more critical anatomical conditions, the choice of number, position and length of the implants is more delicate; the need of an harmonious crown-gingival tissue relationship; higher occlusal forces than in edentalous cases; difficulty in satisfying aesthetic requirements and ease of hygiene. The surgical treatment plan, a pre-requesite to any surgery, permits to determine the length of implants, their number, their position, their long axis direction and the design of the surgical guide, which will indicate to the surgeon the location and the axis for drilling. If this axis is nearly parallel to the sagittal plane for mandibular implants, it will be angulated to that same plane for maxillary implants. In the latter cases, it is often necessary to use angulated transepithelial abutments in order to prevent the abutment screw from having an occlusal access. In order to perform the prosthetis, an impression should be taken with the transepithelial abutments. The final reconstruction can be preceded by a temporary prosthesis, then (or) transitory to await gingival stabilization and not overload the implant immediately after it has been connected with the abutment. The fixed partial denture can be secured with screws or cemented when it is of small size and it must satisfy the functional and aesthetic requirements of the patient. The choice of the material used on the occlusal surface is very important and varies depending on the case. Aesthetics should not be prevent an in easy hygiene. These objectives are not reached at the time the prosthesis is made but during the course of the surgical and prosthetic treatment. Single restorations are subjected to the rules pertaining to any fixed partial denture on implants, but have particular characteristics, such as the almost systematic elimination of the abutment and the absolute necessity of the correct placement of the implant. The single units are more easily subject to unscrewing for mechanical reasons. Although the use of implants is a valuable aid in cases of partial fixed restoration, it requires particular attention with regard to precision.

Dental Implantation, Endosseous↗

The monitoring of deep caries lesions after incomplete dentine caries removal: results after 14-18 months.

This paper aims to assess radiographic changes after incomplete carious dentine removal and tooth sealing. Thirty-two teeth with deep caries lesions were studied. The treatment consisted of incomplete excavation, application of a Ca(OH)2 layer, sealing temporarily for a 6- to 7-month period and then restoration. Standardised bitewing radiographs were taken immediately after the temporary sealing and at 6- to 7- and 14- to 18-month intervals. The digitised images were analysed blind by image subtraction. The quantitative analyses subtractions were performed in the radiolucent zone (RZ) beneath the restoration and in two adjacent control areas (CA). Two cases were lost during the 6- to 7-month period (one pulp necrosis and one pulp exposure during removal of the provisional sealing). No difference (p > 0.05) was observed in the radiographic density of the CA and the RZ in the two experimental periods. The mean and standard deviation (grey tonalities scale) were 129.42+/-5.83 and 127.65+/-4.67 (control areas) and 132.96+/-7.41 and 132.90+/-5.99 (RZ) for the first and second experimental periods, respectively. The radiographic density of the CA differed from the RZ (Tukey test, p < 0.001). Interference in environmental conditions by partial dentine caries removal and tooth sealing arrests lesion progression, suggesting that complete dentine caries removal is not essential to control caries progression.

Adolescent↗

Effect of resins sealing of dentin on the bond strength of ceramic restorations.

OBJECTIVES: The purpose of this in vitro study was to evaluate shear bond strengths when ceramic cylinders were bonded to dentin following the use of different dentin adhesive systems as desensitizers. METHODS: Freshly extracted human molars were selected. Their buccal dentin was exposed and a standardized circular area was isolated. Dentin desensitizers included an experimental self-curing 'one-bottle' adhesive system, two light-curing 'one-bottle' bonding systems and a conventional three component adhesive system, which was selected as a control system. Ten teeth were prepared for each test group (40 teeth total). A layer of an eugenol-free temporary cement was applied on the treated surface and the specimens were stored in distilled water for 1 week. After the removal of cement, the dentin surfaces were cleaned, re-etched and a layer of the experimental self-curing 'one-bottle' adhesive was applied. Standardized cylindrical ceramic samples were luted using a resin cement. One week later, shear bond strengths were determined using a universal testing machine. The bond strength values obtained were tested for a statistical significance with Kruskall-Wallis one-way analysis of variance. The type of failure occurring on each specimen was observed and recorded by means of an optical and a scanning electron microscope. RESULTS: Mean shear bond strengths of the four groups ranged from 25.84 to 27.83 MPa and they were not significantly different. Most failures were cohesive in dentin. SIGNIFICANCE: The use of an adhesive system as a dentin desensitizing agent before cementation does not alter the retentive strength of adhesively luted ceramic restorations.

Analysis of Variance↗

A comparison of a composite restorative material and wire ligation as methods of stabilizing excessively mobile mandibular anterior teeth.

Eighteen patients with mobile mandibular anterior teeth were randomly assigned to one of two treatment groups in order to determine the relative effectiveness of two modalities of temporary stabilization. The two groups were well matched for initial horizontal tooth mobility, age and sex. Patients in Group I had their stabilized in the conventional fashion with extracoronal wire ligation. The Group II subjects' mandibular anterior teeth were acid-etched and then had composite restorative material applied to the lingual, facial and interproximal surfaces. Horizontal tooth mobility utilizing the periodontometer was recorded prior to, immediately after, and then at 1, 3, 6 and 12 months poststabilization. Löe's Gingival Index and the Silness and Löe Plaque Index were recorded for the same time periods. All subjects were instructed in oral hygiene techniques appropriate for splinted teeth. The mobility scores for both Group I and II dropped to significantly lower levels immediately after the splints were placed and then remained relatively unchanged for the next 12 months. There were no statistically significant changes in the gingival or plaque indices throughout the study. Three splints required repairs or adjustments in Group I subjects. Six fractures occurred in Group II subjects.

Acid Etching, Dental↗

Effects of cement on crown retention.

This study indicates that the frequent clinical technique of permanently cementing a crown without removing all traces of a temporary ZOE cement from the tooth has no adverse effect on retention. Circumferential grooving of the tooth preparation did not significantly increase retention. In contrast, cutting a shallow groove in the crown significantly improved retention. Therefore, it would appear that the grooving of the gold casting might be advantageous in conditions where the crown restoration has minimal retention. Significant improvement in retention with grooving of the restorations was accompanied by a change in the location of the cement film. The cement was retained in the crown coronal to the groove rather than on the tooth. This finding was interesting, since previous retention studies showed that adhesive failure occurred at the metal-cement interface. From this data it appears that a primary factor of crown retention is the adhesion or mechanical interlocking of the cement to the crown. This would explain why small variations in cement film thickness, such as those due to the use of die relief, have little effect on retention. In view of these findings, the current concepts on cement retention and cement adhesiveness should be reevaluated.

Crowns↗

A modern day application of the Rochette bridge.

A restoration that is frequently prescribed to provisionally restore the single unit edentulous space is the removable acrylic partial prosthesis. The Rochette bridge design provides an effective alternative when confronted with this clinical situation. The adaptable nature of this technique means that it can be utilised in a variety of clinical situations with success. The greatest benefits are seen in clinical situations where simple and aesthetic alteration of the pontic dimensions during treatment is necessary. It can also be used in long-term provisional situations where, if a removable acrylic partial prosthesis was used, multiple adjustments or remakes would be necessary. This paper presents three case reports where this technique has been utilised with distinctive advantages over a provisional removable partial acrylic prosthesis.

Adolescent↗

A laboratory study of coronal microleakage using four temporary restorative materials.

AIM: The aim of this study was to compare the sealing abilities of Fermin and Canseal with the more popular temporary coronal filling materials, Cavit and Caviton. METHODOLOGY: Standardized access cavities were prepared in 160 intact human permanent molar teeth. They were divided into five groups consisting of 32 samples. The teeth were restored using one of the temporary filling materials, namely: Fermin, Canseal at two powder to liquid ratios, Caviton and Cavit. Thermal cycling and/or load cycling were applied on the samples. Assessment of microleakage utilized methylene blue dye penetration. Grading of the microleakage pattern was from 1 to 3, with 3 providing the best seal. Results were analyzed using two-way anova and by Fisher's PLSD post hoc test (P < 0.05). RESULT: Microleakage along Fermin, Caviton and Cavit samples did not go beyond Leakage Grade 2. Dye penetration into these materials was noted. This was not observed in the two groups of Canseal tested. However, the two groups of Canseal exhibited total leakage notably after being subjected to thermal cycling. There was a statistically significant difference in the microleakage scores obtained between the materials and conditions tested (P < 0.0001). CONCLUSION: Fermin was found to exhibit the best seal amongst the four materials tested followed by Caviton, and Cavit. Thermal cycling influenced the seal of certain types of temporary filling materials more than load cycling.

Analysis of Variance↗

The use and predictable placement of Mineral Trioxide Aggregate in one-visit apexification cases.

Endodontic treatment of the pulpless tooth with an immature root apex poses a special challenge for the clinician. The main difficulty encountered is the lack of an apical stop against which to compact an interim dressing of calcium hydroxide (Ca(OH)2), or the final obturation material. In these situations the unpredictability of the result, the difficulty in creating a leak-proof temporary restoration for the duration of treatment, and the difficulty in protecting the thin root from fracture may lead to complications when using traditional (Ca(OH)2-based) apexification techniques. Furthermore, given the increased mobility of today's society, lengthy treatment protocols are fraught with problems, and may not be followed through to completion. This may lead to ultimate failure of the case. Mineral Trioxide Aggregate (MTA) has recently been introduced for use in endodontics. Current literature supports its efficacy in a multitude of procedures including apexification. The focus of this paper is to propose a one-visit apexification protocol with MTA as an alternative to the traditional treatment practices with Ca(OH)2. One-visit apexification may shorten the treatment time between the patient's first appointment and the final restoration. The importance of this approach lies in the expedient cleaning and shaping of the root canal system, followed by its apical seal with a material that favours regeneration. Furthermore, the potential for fractures of immature teeth with thin roots is reduced, as a bonded core can be placed immediately within the root canal.

Aluminum Compounds↗