Posterior direct restorations: innovative materials and procedures for aesthetic success.
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Teeth with severe tetracycline staining can present a restorative challenge to the clinician. While a variety of options facilitate predictable aesthetic treatment of patients with such dentition, they often require significant tooth reduction in order to provide the dentist and the laboratory technician with adequate space for the restorative material to conceal the discoloration. This presentation outlines an alternative to this treatment that uses resin cement to mask the discolorations prior to the cementation of the porcelain laminate veneers.
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The two-cord retraction technique is used for troughing around a crown to achieve biologic width. This technique can cause significant discomfort for the patient and offers several potential clinical disadvantages for the dentist, of which unpredictable tissue recession is the most significant. The clinical case presented in this article compares the use of the standard two-cord retraction technique with that of an 2,780 nm erbium-class dental laser to determine which method achieves an accurate, easily readable impression while respecting the biologic width. Using an erbium laser to achieve the trough prior to placing an indirect restoration results in little or no postoperative discomfort for the patient; in addition, the erbium laser reduces intraoperative complications related to tissue recession and patient discomfort while providing consistently accurate impressions.
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This paper, the third in the series, initially details the role of the restorative dentist in treating patients with hypodontia. (See Quintessence Int 2005;36:263-270 and 345-353 for the first two papers.) A range of treatment options, including implants, adhesive techniques, and removable prostheses, are covered. The investigators have detailed the clinical indications, and noted their relative advantages and disadvantages.
This article describes a technique using ParaPost Tenax Fiber White, ParaPost Cement, and ParaPost ParaCore build-up material to restore a tooth with a significant loss of tooth structure. After successful root canal therapy, the posts were bonded in the canals and the core was built using ParaPost ParaCore build-up material. At that point, the tooth was prepared to receive a conventional porcelain-fused-to-metal crown.
Computer-assisted design, computer-assisted machining (CAD/CAM) technology has received considerable clinical and research interest as a means to fabricate all-ceramic restorations. Laboratory CAD/CAM systems recreate occlusal anatomy and functional contacts using accurately articulated casts to minimize the amount of intraoral occlusal adjustment. CAD/CAM systems designed for the chairside do not use articulated casts, and yet fabricate full-contour restorations in a single appointment. Several design techniques are discussed to illustrate the 3 dimensional capability of the CAD program to plan and control occlusal contacts before milling the final restoration.
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OBJECTIVE: To investigate the effect of camera control devices of Cerec 2 on the fit of CAD/CAM all-ceramic copyings of posterior tooth. METHODS: 24 all-ceramic copyings were made by Cerec 2 with camera control devices and that without camera control devices. Copyings were embed and sectioned, then SEM and image analyzer was used to measure the space between the copyings and dies at the marginal opening, the axial wall, and the occlusal adaptation at the measurement locations. RESULTS: The marginal fit at buccal space of copyings with camera control devices group was smaller than that without camera control devices group (P < 0.05). The internal fit of of copyings had statistically significant difference at mesio-axial, disto-axial, bucco-axial, bucco-occlusal, linguo-occlusal and disto-occlusal space between camera control device group and without camera control devices group (P < 0.05). There was no statistical difference on the marginal fit and internal fit of copyings between Vita MK II and porous alumina oxide (P < 0.05). CONCLUSION: The Cerec 2 with camera control devices reduced effectively the inaccuracy of inner space of copyings which contributed from the technical errors of the operator, and provided well-proportioned space for adhesive. Both the fit of copyings made of Vita MK II and porous alumina oxide satisfied the clinical demand.
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The accuracy of working length determination in root canal treatment plays a crucial role in the treatment and prevention of periapical disease. Since the introduction of the first apex locator by Sunada in 1961, new and more accurate devices have been developed. Electronic apex locators reduce the number of radiographs required and may detect root canal perforations and fractures. Third and fourth generation apex locators can operate in the presence of intact or necrotic tissue, blood, inflammatory exudates, and various irrigants. The Raypex 4 and the Apex NRG novel apex locators are discussed in detail.
This study evaluated the effect of dental handpiece lubricant on the shear bond strength of three bonding agents to dentin. A lubrication-free handpiece (one that does not require the user to lubricate it) and a handpiece requiring routine lubrication were used in the study. In addition, two different handpiece lubrication methods (automated versus manual application) were also investigated. One hundred and eighty extracted human teeth were ground to expose flat dentin surfaces that were then finished with wet silicon carbide paper. The teeth were randomly divided into 18 groups (n=10). The dentin surface of each specimen was exposed for 30 seconds to water spray from either a lubrication-free handpiece or a lubricated handpiece. Prior to exposure, various lubrication regimens were used on the handpieces that required lubrication. The dentin surfaces were then treated with total-etch, two-step; a self-etch, two-step or a self-etch, one-step bonding agent. Resin composite cylinders were bonded to dentin, the specimens were then thermocycled and tested to failure in shear at seven days. Mean bond strength data were analyzed using Dunnett's multiple comparison test at an 0.05 level of significance. Results indicated that within each of the bonding agents, there were no significant differences in bond strength between the control group and the treatment groups regardless of the type of handpiece or use of routine lubrication.