The use of liners under amalgam restorations: an in vitro study on marginal leakage

OBJECTIVE: Marginal leakage of amalgam restorations may lead to secondary caries and pulpal damage. The purpose of this study was to determine the effect various cavity liners might have on microleakage. METHOD AND MATERIALS: Mesio-occlusodistal amalgam restorations with margins on enamel and dentin were treated with different liner materials (an adhesive system, a topical fluoride gel, a cavity varnish, and a glass-ionomer cement) in vitro. Following restoration, the teeth were submitted to thermocycling in a stained solution and sectioned to allow assessment of microleakage. RESULTS: On enamel, the control group (no liner) and the glass-ionomer-lined group had equivalent leakage scores and were superior to every other group. On dentin, only the glass-ionomer specimens had superior performance. The cavity varnish and fluoride-lined specimens exhibited the highest leakage scores. CONCLUSION: The use of liners does not reduce microleakage on amalgam restorations when the cavity margins remain on enamel. On dentin margins, a glass-ionomer liner can reduce microleakage.     

Marginal seal composition in amalgam restored teeth of varying marginal leakage

This article focuses on anesthetic considerations of cardiovascular risk for electroconvulsive (ECT) therapy. Preoperative evaluation, intraoperative management, and postoperative care are reviewed. Although the anesthetic risk to ECT patients is quite low, elderly patients or those presenting with known cardiovascular disease may be at increased risk and need special intervention or management during ECT.     

Fracture resistance of complex amalgam restorations

We surveyed the clinical presentation, initial management and subsequent course of a prospectively registered cohort of 60 children with insulin-dependent diabetes mellitus (IDDM) diagnosed before age 15 years in the Sultanate of Oman between January 1990 and December 1993. Clinical details from the time of diagnosis were available on all the children. At diagnosis 9 (15 per cent) presented with severe ketoacidosis (DKA) with pH less than 7.1 or plasma bicarbonate less than 10 mmol/l, and 16 (27 per cent) had mild to moderate ketoacidosis with pH 7.1-7.35 or plasma bicarbonate 10-18 mmol/l. During DKA electrolyte disturbances included: hypokalemia (K < 3.5 mmol/l) 25 per cent), hyperkalemia (K > 5.5 mmol/l) (18 per cent) and hyponatremia (Na < 130 mmol/l) (40 per cent). Serum creatinine concentrations were high in 25 per cent of children with DKA. Within the first year of diagnosis, 17 of the 60 children (28 per cent) experienced symptomatic hypoglycaemia, which in six (10 per cent) led to one or more admissions. Re-admission for unstable glycaemic control, excluding acute hypoglycaemia occurred at least once in six children (10 per cent) within 1 year of diagnosis and in 10 (17 per cent) within 2 years. Statural growth velocity (GV) and GVSDS (6.9 +/- 0.85 cm/year and 0.75, respectively) were significantly higher in the group of children with good glycaemic control (HbA1C = 7.9 +/- 0.4 per cent) compared to those children (3.7 +/- 0.44 cm/ year and -1.6, respectively) with bad glycaemic control (HbA1C = 12.5 +/- 1.5 per cent). Insulin-like growth factor-I (IGF-I) concentrations were significantly higher (260 +/- 21 ng/ml) in the group with good glycemic control v. the group with bad control (149 +/- 15 ng/ml). In summary, greater public and medical awareness of the presenting features of diabetes in young children is needed to reduce the frequency of DKA at presentation, and improvement of patient and family education is necessary to reduce the incidence of DKA and hypoglycaemia in children with IDDM.     

Utilization of ceromer inlays/onlays for replacement of amalgam restorations

Fiber-reinforced Ceromer technology has been recommended for a variety of restorations, including inlays/onlays, crowns and bridges, and direct restorations. Ideal restorative dental materials must exhibit adequate physical properties and fit, as well as ease and predictability of fabrication and repair. The Ceromer restorative material combines the positive attributes of indirect composite restorations, feldspathic ceramics, and cast-gold restorations. This article reviews the material properties and aesthetic characteristics inherent to Ceromers, as well as the appropriate preparation and adhesive techniques for inlay/onlay restorations.     

Marginal leakage in class II-restorations after use of ceramic-inserts luted with different materials

A high concentration (30 microg/ml or more) of Con A caused the death of not only thymocytes but also splenic cells of BALB/c mice, whereas a moderate concentration (3 microg/ml) of Con A induced proliferation of these cells. A high concentration of Con A also induced the death of splenic cells of athymic BALB/c-nu/nu mice and the bone marrow cells of BALB/c mice which mainly consist of non-T cells. However, any concentration (1-30 microg/ml) of Con A failed to induce the proliferation of these cells. Specific binding of tetrameric Con A to mannose-containing receptors was required for the induction of cell death. DNA fragmentation was observed by both laser flow cytometry and electrophoresis in Con A-stimulated T cells and non-T cells. This indicated that the mechanism of induction of apoptosis with Con A is not necessarily TCR-dependent. Con A induced tyrosine phosphorylation of a number of proteins in various types of cells. Interestingly, phosphorylation of the 40 kDa protein developed only in the thymocytes and spleen cells that contain T cells, whereas phosphorylation of the 80 and 120 kDa proteins appeared in both T cells and non-T cells. These results suggested that the Con A-induced apoptosis of T cells and non-T cells involves different but possibly mutually related protein tyrosine phosphorylation-linked signals.     

Marginal integrity and postoperative sensitivity in Class 2 resin composite restorations in vivo

INTRODUCTION: Problems that may arise in resin composite Class 2 restorations include microleakage and postoperative sensitivity. However, limited in-vivo research is conducted to evaluate these processes. AIM: The aim of this study was to assess postoperative sensitivity, microleakage and the pooling of adhesives in relation to Class 2 box-type composite restorations placed in vivo using various adhesive systems and application techniques. MATERIALS AND METHODS: One hundred and forty-four Class 2 box restorations were placed in the mesial and distal surfaces of 72 premolar teeth in-vivo using one of three combinations of adhesive systems and three filling techniques. After 6 weeks of clinical service postoperative sensitivity was recorded. The teeth were then extracted, immersed in a dye solution and sectioned. Microleakage and pooling of the adhesive was recorded. Statistical analysis involved logistic regression and chi2 tests to identify differences between groups at p < 0.05. RESULTS: Of the 144 restorations, 65 showed minimal cervical leakage in enamel, 5 suffered leakage into dentin and 74 were free of microleakage. No statistically significant differences were found in cervical microleakage between the adhesive systems or between filling procedures. Occlusal microleakage in the enamel was present in 16 of the 160 restorations. Liner Bond 2 restorations leaked significantly more at the occlusal surface (p < 0.05). Pooling of the adhesive was significantly less when PhotoBond was used. No spontaneous postoperative sensitivity was reported. Twenty-eight restorations were sensitive to loading. Postoperative sensitivity was significantly less in patients with Liner Bond 2 restorations. CONCLUSIONS: The adhesive systems used in this study showed minimal leakage into dentin in vivo. Using Liner Bond 2, restorations exhibited more occlusal leakage but were significantly less sensitive to loading.     

Marginal accuracy of indirect provisional restorations fabricated on poly(vinyl siloxane) models

Indirect interim restorations have been traditionally fabricated on stone casts. Recently, flexible models fabricated from poly(vinyl siloxane) impression material have been suggested in place of stone casts. This study compared the marginal accuracy of indirect single-unit provisional restorations fabricated on stone casts with units made on poly(vinyl siloxane) impression material models. The mean marginal discrepancy of provisional restorations was compared for restorations fabricated from stone, low-viscosity poly(vinyl siloxane), and medium-viscosity poly(vinyl siloxane). Ten restorations were also fabricated directly on a master metal model (control). The mean marginal discrepancies were: control = 0.161 mm; stone model = 0.180 mm; low-viscosity poly(vinyl siloxane) = 0.245 mm; and medium-viscosity poly(vinyl siloxane) = 0.157 mm. The mean marginal discrepancy for the low-viscosity poly(vinyl siloxane) models was significantly higher than the other three groups. No significant difference was found between the control, stone cast, and medium-viscosity poly(vinyl siloxane) model groups.     

Perforation repair comparing mineral trioxide aggregate and amalgam using an anaerobic bacterial leakage model

The purpose of this study was to evaluate the ability of mineral trioxide aggregate (MTA) and amalgam to seal furcal perforations in extracted human molars using an anaerobic bacterial leakage model. Furcal perforations were made in 39 maxillary and mandibular human molars with a high-speed bur. These were randomly divided into two experimental groups of 18, with the remaining three teeth used as positive controls. Experimental group 1 was repaired with MTA and group 2 with amalgam. Three additional teeth without perforations served as negative controls. A dual chamber anaerobic bacterial leakage model was assembled. Brain heart infusion broth with yeast extract, hemin, menadione, and the chromogenic indicator bromcresol purple was used as the culture broth for Fusobacterium nucleatum. Eight of 18 amalgam samples leaked, whereas none of the 18 MTA samples leaked. MTA was significantly better than amalgam in preventing leakage of F. nucleatum past furcal perforation repairs.     

Influence of finishing and polishing procedures on the decision to replace old amalgam restorations: an in vitro study

The purpose of this study was to establish the influence that finishing and polishing of existing amalgam restorations might have on the decision to replace them. Forty extracted teeth, in which amalgam restorations had been placed in vivo, were individually examined by 60 practitioners and students prior to and following standard finishing and polishing procedures. Examiners, who had not been informed of the study's methodology or objective, opted either for maintaining or replacing the restoration in question. The main reasons for replacement were also registered. Finishing and polishing significantly reduced the number of decisions to replace restorations in all groups and for all practitioners. "Appearance" (anatomic shape) was the most frequently cited reason for replacing restorations before finishing and polishing, followed by marginal defects and secondary caries.     

Interfacial bond strengths of amalgam bonded to amalgam and resin composite bonded to amalgam

A preparative method for the preparation of large peptides is described. An advantageous theoretical weight of peptide/weight of starting resin ratio (tPw/Rw) of about 0.3 was successfully experimented. The esterification of the first amino acid was realized with a racemization of less than 1%. The study of the coupling conditions led to the use of a diluted acylating mixture that allowed a 56% consumption of the amino acid derivatives (percentage use of amino acids) introduced in the synthesis. The cost analysis of the synthesis showed that the recovery of the amino acid derivatives was not worthwhile.     

Caries diagnosis with dye-staining at amalgam restoration margins

PURPOSE: To determine the strength of agreement between detection of caries at the margin of amalgam restorations with a caries detector dye, and detection of caries histologically utilizing light/polarizing light microscopy. MATERIALS AND METHODS: 17 permanent molars with intact amalgam restorations, determined to be caries-free by visual inspection and explorer probing, cleansed with an air/water/abrasive slurry system, and with evidence of amalgam enamel marginal staining from application of a 1% solution of sulforhodamine B caries detector dye were utilized. Longitudinal, undecalcified sections, 80-100 micrometers thick, were prepared including stained and unstained regions of the amalgam/enamel margin of each tooth, providing 34 margins for study. The sections were examined in the light/polarizing light microscope for evidence of marginal caries. The Kappa Index was calculated to determine the strength of agreement between the caries dye method and the light/polarizing light microscopic method of caries diagnosis. RESULTS: Microscopically, caries was detected in 14 of 34 margins (41%). Agreement for presence of caries was 5 of 34, and for absence of caries 8 of 34 (total agreement 38%). 12 of 17 dye-stained margins were microscopically caries-free, and 9 of 17 unstained margins had caries microscopically. Kappa Index for these findings was 0.23, indicating poor strength of agreement.     

patients'' satisfaction with different types of veneer restorations

Serum-deprived mouse osteoblastic (MC3T3E1) cells were subjected to a vibrational force modeled by NASA to simulate a space shuttle launch (7.83 G rms). The mRNA levels for eight genes were investigated to determine the effect of vibrational force on mRNA expression. The mRNA levels of two growth-related protooncogenes, c-fos and c-myc, were up-regulated significantly within 30 min after vibration, whereas those of osteocalcin as well as transforming growth factor-beta1 were decreased significantly within 3 h after vibration. No changes were detected in the levels of beta-actin, histone H4, or cytoplasmic phospholipase A2 after vibration. No basal levels of cyclooxygenase-2 expression were detected. In addition, the extracellular concentrations of prostaglandin E2 (PGE2), a potent autocrine/paracrine growth factor in bone, were not significantly altered after vibration most likely due to the serum deprivation state of the osteoblasts. In comparison with the gravitational launch profile, vibrational-induced changes in gene expression were greater both in magnitude and number of genes activated. Taken together, these data suggest that the changes in mRNA expression are due to a direct mechanical effect of the vibrational force on the osteoblast cells and not to changes in the local PGE2 concentrations. The finding that launch forces induce gene expression is of utmost importance since many of the biological experiments do not dampen vibrational loads on experimental samples. This lack of dampening of vibrational forces may partially explain why 1-G onboard controls sometimes do not reflect 1-G ground controls. These data may also suggest that scientists use extra ground controls that are exposed to launch forces, have these forces dampened on launched samples, or use facilities such as Biorack that provide an onboard 1-G centrufuge in order to control for space shuttle launch forces.     

Microleakage of tooth-colored restorations with a beveled gingival margin

Restenosis remains a major limitation of coronary angioplasty in spite of major advances in techniques and technology. Recent studies have demonstrated that ionizing radiation may limit the degree of this problem. Gamma radiation has been shown to be effective in reducing in stent restenosis in humans, and beta radiation following encouraging results in animals has been shown to be feasible in humans. The objective of this study was to assess the feasibility of a 5 F non-centered catheter to deliver beta radiation emitting seeds to the lesion site post angioplasty and its effect on restenosis. Following successful angioplasty, patients were randomized to treatment with 12, 14 or 16 Gy at the angioplasty site. This was delivered with a 5 F non-centered catheter. Twelve beta radiation emitting seeds (90Sr/Y) were delivered to an area 3 cm in length to cover the angioplasty site. Angiographic follow-up was performed at 6 months. Baseline and follow-up angiograms were performed by blinded investigators at a core laboratory. This interim report comprises the first 35 patients to complete 6-month angiographic follow-up. There were no major radiation incidents. Four patients had evidence of angiographic restenosis. The MLD (mm) and percent stenosis were 0.77 +/- 0.27/72.5 +/- 8.6 pre angioplasty, 2.08 +/- 0.4/25.7 +/- 9.8 post angioplasty and radiation and 2.05 +/- 0.59/25.7 +/- 19.8 at follow-up respectively. CONCLUSION: Beta radiation can be feasibly and safely delivered post coronary angioplasty with a very encouraging reduction of restenosis.     

Use of provisional restorations to enhance soft-tissue contours for implant restorations

The objective of restoring missing teeth with implant-supported restorations should not merely be achieving osseointegration with an implant and a biomechanically sound restoration. The objective must be the esthetic and functional restoration of the missing teeth. To achieve this, proper treatment planning is critical. Precise implant placement and delicate soft-tissue manipulation during surgery will allow the restorative dentist to enhance the peri-implant soft-tissue contours with the use of provisional restorations. Empirically, it seems that the earlier the provisional restoration is delivered in the treatment process the more ideal the esthetics. Several methods of using provisional restorations to enhance soft-tissue contours are presented. The concept of immediately delivering provisional restorations on placement of an implant is discussed.