Fracture strengths of three core restorative materials supported with or without a prefabricated split-shank post

BACKGROUND: Conventional anterior cervical discectomy with fusion is thought to require postoperative neck immobilization for the promotion of bony fusion. Rigid internal fixation with anterior cervical plates may decrease graft-related complications and provide immediate stability. This stability may obviate postoperative external immobilization. METHODS: This report reviews one surgeon's experience with the use of rigid internal fixation for two-level anterior cervical discectomy and fusion for radiculopathy to promote early mobilization without external bracing. It compares outcomes and costs with a similar population of patients treated with anterior cervical discectomy and fusion who did not undergo rigid internal fixation. We compared patients who underwent two-level allograft anterior cervical discectomy and fusion with or without rigid internal fixation between 1989 and 1994 performed by a single surgeon (FJP) to evaluate the cost advantages and outcome of each procedure. All patients had clinical evidence of cervical radiculopathy unresponsive to medical therapy with magnetic resonance imaging confirmation of the appropriate nerve root impingement. Thirty-nine patients underwent two-level Cloward allograft fusion using Synthes anterior cervical locking plates, 25 underwent identical fusion without plating. Follow-up was 6 months to 4 years (mean, 31 months). RESULTS: Twenty-three of 25 patients in the nonplated group and 36 of 39 patients in the plated group achieved excellent or good outcomes using the Odom criteria. There were six complications (two major and four minor) in each group. Patients who underwent plating returned to light activities (mean, 17 vs. 29 days), driving (28 vs. 57 days), and unrestricted work (66 vs. 136 days) sooner than non-plated patients (p < 0.05, paired t test). No patient with plates was given external immobilization. CONCLUSIONS: Two-level anterior cervical discectomy and fusion with anterior plating for radiculopathy is safe, effective, and seems to provide shorter convalescence compared with conventional anterior cervical discectomy and fusion. Patients returned to unrestricted work sooner, thus reducing short-term disability. Rigid internal fixation may provide cost advantages to patients and insurance disability providers. The authors conclude that the increased cost of treatment for rigid internal fixation is more than offset by the benefits of earlier mobilization.     

Bond strengths of resin-to-metal bonding systems

STATEMENT OF PROBLEM: Resinous materials for the veneers of fixed prostheses commonly require mechanical retention on metal substructures because there is no chemical adhesion. However, mechanical retention does not restrict creation of a marginal gap at the resin-metal interface, which can cause discoloration or detachment of resinous material. The development of a chemical resin-to-metal bonding could resolve this problem and also reduce the need for mechanical retention (pearls, wires) on metal frameworks. PURPOSE: This study evaluated six current methods with the use of various storage conditions to predict clinical efficacy. MATERIAL AND METHODS: Six resin-to-metal bonding systems were tested: Silicoater, Silicoater MD, Rocatec, OVS, Sebond, and Spectra-Link. All specimens were examined in bending tests after 24 hours of dry storage (category A), after 24 hours of water storage and thermocycling (category B), and after 2 months of water storage and thermocycling (category C). Tensional tests were completed for all bonding systems after dry storage, and microscopic examination (optical and SEM) was performed for all specimens. RESULTS AND CONCLUSIONS: This study indicated that certain systems can provide stable bonding of resin to metal substructures despite prolonged wet storage and intensive thermocycling. These systems can also be used clinically without retentive configurations on metal frameworks, resulting in better esthetics. Some bonding systems revealed progressive weakening of bond strengths, so research is needed to verify their clinical efficacy.     

Bond strengths and SEM evaluation of Clearfil Liner Bond 2

PURPOSE: To evaluate a dental adhesive system that uses a single conditioning/primer agent. MATERIALS AND METHODS: Twenty-five flat enamel and dentin bonding sites were prepared to 600 grit on human molar teeth. The Clearfil Liner Bond 2 adhesive system was used to bond Clearfil AP-X composite to both enamel and dentin. After 24 hours of water storage, shear bond strengths were determined using an Instron testing machine. Fifty V-shaped cavity preparations were prepared in human molar teeth with an enamel and cementum margin. Composite restorations were placed using the new adhesive system. The teeth were stored for 24 hours, thermocycled, stained with AgNO3 , sectioned and examined for microleakage. SEM examinations were also completed to evaluate the effects of the treatment steps on enamel and dentin surfaces. RESULTS: Mean shear bond strengths for the experimental adhesive to enamel and dentin were 28.2 +/- 4.9 and 19.4 +/- 3.1 MPa. A t-test revealed that the enamel bond strength was significantly greater (P<0.05) than the dentin strength. No marginal leakage was observed from the enamel margins of the restorations. Three restorations showed minimal leakage from the cementum margins. SEM examinations showed resin penetration into both the conditioned enamel and dentin surfaces. The adhesive system produced high bond strengths to both enamel and dentin, exhibited very minimal microleakage and was easy to use.     

Gallium restorative materials

A case of renal cell carcinoma that was discovered in a patient with typical acute pyelonephritis is reported. A 62-year-old woman admitted with fever and right flank pain, was diagnosed as having acute pyelonephritis. Intravenous urography showed a compressed renal pelvis and mild dilated calyces, suggesting the existence of a tumor. Computed tomography revealed a parapelvic tumor 6 cm in diameter and a small low-density area separated from the tumor in the renal parenchyma. Selective renal arteriography revealed a typical renal cell carcinoma lesion. The patient underwent right radical nephrectomy, and her postoperative course was uneventful. She has remained free of disease for 7 months.     

Bond strengths of the adhesive resin-amalgam interface

Generalized (diffuse) plane xanthoma (GPX) is a normolipaemic xanthomatosis that is very frequently associated with a haematological disorder, and especially with monoclonal gammapathies, which it may precede by several months or years. Here, we report a case of GPX associated with idiopathic Bence-Jones proteinuria, a very rare type of monoclonal gammopathy of undetermined significance. To our knowledge, this association has not been previously described.     

Model investigations of caries inhibition by fluoride-releasing dental materials

Fluoride-releasing dental materials are generally believed to reduce or prevent secondary caries. The evidence for this is largely anecdotal and centers on clinical experience with silicate cements and, more recently, with glass-ionomer cements. Unfortunately, corroborating evidence from controlled clinical trials is inadequate to establish precisely how effective these materials are or under what conditions they might be effective. Even less is known about the clinical effectiveness of newer materials that, often, release less fluoride. In vitro model systems have been used to study the effects of dental materials on de/remineralization of surrounding tooth structure. Fluoride-releasing materials have been shown in these models to reduce demineralization of both enamel and dentin compared with a material that does not release fluoride. This is useful from a mechanistic standpoint, but without clinical "standards" to guide model results, it is not possible to define an acceptable level of fluoride release or the length of time such release is required. A limited number of in situ model studies has been conducted, and some fluoride dose-response information has been obtained. These models are closer to the real situation and perhaps provide the best means to define required levels of fluoride release from materials in the absence of adequate clinical information.     

The status of indirect restorative dental materials

The ideal restorative material should enable restoration of teeth that have either suffered trauma or have been prepared during the removal of caries to their original function and appearance. At the same time a seal should develop between the material and the tooth to prevent bacteria-laden fluids from permeating the dentine and reaching the pulp. Few, if any, of the available materials fulfil these requirements. This, the second of a short series, considers the status of indirect restorative materials as the millennium approaches. In this review indirect restorative materials are regarded as those which call not only upon the dexterity and judgement of the dental practitioner, but also upon the skills of the dental technician and techniques of construction that are suitable for use only in a laboratory. Included in this group are the dental casting and bonding alloys, dental ceramics and those resin composites that are shaped, cured and finished in the laboratory.     

Comparison of aesthetic properties of tooth-colored restorative materials

A capillary electrophoresis system that integrated an enzymatic reaction and capillary polymer sieving electrophoresis was used to check the enzymatic stability of oligonucleotides. Phosphodiesterase I was employed to assess the susceptibility to 3'-exonucleolytic breakdown of some unmodified and modified oligonucleotides. Before degradation, the purity of the synthetic oligodeoxynucleotides was checked by capillary electrophoresis with a replaceable hydroxyethyl cellulose polymer solution. Enzymatic breakdown was achieved inside the capillary by merging substrate and enzyme zones based on their difference in electrophoretic mobility. After reaction, oligonucleotide fragments were swept to the detector, where they were individually detected and the remaining substrate was quantified. The results from the in-capillary degradation were compared to an off-line incubation and separation.     

Concepts in biocompatibility testing of dental restorative materials

Due to the diversity of adverse biological effects which might be caused by dental restorative materials, biocompatibility assessment cannot rely on a single test but has to be based on a planned and structured approach (concept). First, the possible harm evoked by the material, the known data, and suitable biological and other test methods available must be taken into consideration. Modern regulatory concepts require for this purpose the services of experts to propose the appropriate set of required tests for a given material. The use of standards is generally emphasized because of better comparability of the data. Other tests may be chosen if more appropriate. Modern scientific concepts of biocompatibility testing are based on the need for rapid and cost-effective test methods, avoiding animal tests whenever possible. While formerly in vitro experiments did not take into account the special clinical situation in which the material would be used, modern concepts try to simulate important parameters of the in vivo situation as closely as possible. This may be achieved, for example, by including suitable barriers between the material and the target cells, by constructing appropriate target cells, and by choosing clinically relevant markers for measuring the biological effects caused by the material. There are indications so far that through this approach the number of animal tests can be reduced. The use of these methods may also lead to a better understanding of the mechanisms behind the biological reactions (mechanistic approach) in describing the biocompatibility of dental restorative materials.     

New direct restorative materials. FDI Commission Project

Immunophenotypic analysis of hematologic specimens is a useful laboratory adjunct to surgical pathology and cytology to confirm or further characterize diagnoses of leukemia or lymphoma. Laser scanning cytometry is a new laboratory technology that has been adapted to perform immunophenotypic analysis of hematologic specimens, with numerous advantages as compared with flow cytometry. In order to make full use of the laser scanning cytometer's capabilities, a new method of specimen preparation and means of performing the immunofluorescent reactions was developed. The technique described in this report, specific only to laser scanning cytometry, enables panels of up to 36 different antibodies to be used on specimens as small as 50,000 total cells. The laboratory methodology is simple, requires 85% less antibody than flow cytometric methods, and allows individual cell cytologic morphology to be correlated with objective physical and fluorescent measurements on a cell-by-cell basis. Other advantages are described in the text. Over the course of nine months in our community hospital, we have used this technique clinically to analyze 172 cases of suspected leukemia or lymphoma. The method has proven remarkably useful, particularly for extremely small specimens such as fine needle aspiration biopsies.     

Effect of two fluorescent dyes on color of restorative materials

A polymerase chain reaction was carried out to detect pathogenic leptospires isolated from animals and humans in Argentina. A double set of primers (G1/G2, B64-I/B64-II), described before, were used to amplify by PCR a DNA fragment from serogroups belonging to Leptospira interrogans but did not allow to detect saprophytic strains isolated from soil and water (L. biflexa). This fact represents an advantage since it makes possible the differentiation of pathogenic from non-pathogenic leptospires in cultures. The sensitivity of this assay has been determined, allowing to detect just only 10 leptospires in the reaction tube. Those sets of primers generated either a 285 bp or 360 bp fragment, depending on the pathogenic strain.     

Thermal stability of direct dental esthetic restorative materials at elevated temperatures

With increasing use of direct esthetic restorative materials, the identity of a body may rely upon knowledge of temperature effects on this class of dental restorations. This research examined the effect of atmospheric gas on thermal decomposition and color change of a wide variety of direct esthetic restorative materials. Cured discs (4 x 1 and 8 x 1 mm) were made using manufacturer's directions: traditional glass ionomer (Fuji II), light-curable resonomer (Fuji II LC), compomer (Geristore), and three types of resin composites--highly filled, urethane-based (Occlusin), and two Bis-GMA/TEGDMA resins: hybrid (Herculite XRV) and microfill (Silux Plus). Three replications of each material were heated at 5 degrees C/min in a thermogravimetric analysis unit using either room air or nitrogen purge to simulate different thermal environments. First derivative values of percent weight loss with respect to temperature were obtained to determine temperatures associated with increased decomposition rates. Room-air heating showed greater numbers of decomposition events than did nitrogen-heated discs. The only material decomposing less than 200 degrees C in either atmosphere was traditional glass ionomer. The majority of decomposition occurred between 200 degrees and 500 degrees C for all materials. Only products containing glass ionomer components decomposed between 600 degrees and 800 degrees C. Room-air heating resulted in ash white discs at 800 degrees C and higher. Specimens heated in nitrogen were gray to black at 600 degrees C and higher. Heating atmosphere greatly affected color, and some products demonstrated distinguishing color changes: glass ionomers, in particular, showed characteristic color features. An atlas was constructed from color change of specimens recovered after 200 degrees, 400 degrees, 600 degrees, 800 degrees, and 1000 degrees C compared with non-heated controls.     

Fluoride release from tooth-colored restorative materials: a 12-month report

BACKGROUND: This study measured the amount of fluoride released from three light-activated glass polyalkenoate (ionomer) cements, a conventional glass polyalkenoate, a compomer and a fluoridated composite over a period of 12 months. METHODS: Five discs (7 x 2 mm) of each material were sequentially immersed in 4 mL portions of deionized water at 37 degrees C and before each measurement, the test specimen was rinsed with 1 mL of deionised water. An Orion Model 901 microprocessor digital Ionalyzer was used for the measurements and the data obtained were converted into microgram/cm2. The amount of fluoride released was measured 86 times during the 12-month test period. RESULTS: It was found that the pattern of fluoride release from the light-activated glass polyalkenoates was similar to that of the conventional glass polyalkenoate. The light-activated glass polyalkenoates, however, released significantly more fluoride than the conventional material. The composite and the compomer released significantly less fluoride than any glass polyalkenoate tested and the difference between the composite and the compomer was not significant. CONCLUSION: It was concluded that the light-activated glass polyalkenoates tested released more fluoride than a conventional glass polyalkenoate, a compomer or a composite, and that with regard to fluoride release the compomer behaved more or less like the composite.     

Reinforcement of weakened cusps by adhesive restorative materials: an in-vitro study

Pairs of extracted premolar teeth were prepared with MOD cavities reducing the lingual cusp at its base to one of five widths: 1.25-2.25 mm. One of each pair was then restored with one of five adhesive restorative techniques and the weakened cusp of both teeth fractured by a force applied to the cusp at an angle of 30 degrees to the long axis of the tooth. At all cusp widths a layered restorative technique in which the cavities were filled to the enamel-dentine junction with glass-ionomer cement and the enamel replaced by composite, reinforced the weakened cusp more than the other restorative materials tested. This combination of materials to reinforce weakened cusps is worth considering as a cost effective alternative to removing the cusp entirely and making a crown or protecting the cusp with a cuspal coverage gold inlay.     

Wear of visible light-cured restorative materials and removable partial denture direct retainers

Parenteral nutrition is a part of the nutritional support regimen of patients with AIDS-associated wasting syndrome and gastrointestinal dysfunction. The cholesterol (CHOL) level in human immunodeficiency virus (HIV) membrane is very high, and recent lipid formulations with high phospholipid (PL) content have demonstrated the ability to trap CHOL from endogenous sources, modifying the composition of cell membranes. We administered lipid-based home parenteral nutrition for 3 mo to malnourished AIDS patients. The patients were randomly divided into two groups: 23 received the regular 20% fat emulsion formulation, and 27 received a 2% formulation enriched 10-fold with PLs but containing the same amount of triglycerides. All patients gained weight and improved their activity level. Those receiving the high-PL composition showed increased serum CHOL concentrations (from 147 to 241 mg/dL; P < 0.01), but no increase was seen in the number of CD4 cells or improvement in immune function. HIV infectivity was not modified. Patients receiving regular PLs had significantly decreased (P < 0.02) IgA concentrations (from 776 to 300 mg/dL) and improved mitogen response to phytohemagglutinin and to concanavalin A. This formula, too, had no effect on HIV infectivity. We conclude that standard parenteral nutritional influences the nutritional and immune status of malnourished AIDS patients. A PL-enriched parenteral formulation can trap CHOL, but it does not affect the immune profile or HIV infectivity in patients with advanced disease.     

Sealing ability of several restorative materials used for repair of lateral root perforations

Amalgam, IRM, Vitremer, Bisfil, and Ana Norm Liner were evaluated for repair of experimentally induced lateral perforations. Eighty-five sound, mandibular, and maxillary molars, extracted for periodontal reasons, were selected for this study. The sample teeth were randomly divided in five groups with 15 specimens each. Ten teeth were used as control groups. After the perforations were filled with the above-mentioned materials, the teeth were immersed in a 2% methylene blue solution for 48 h, sectioned, and dye penetration was measured. The results indicated that Bisfil 2 B provided a significantly better seal than the other materials.     

Dental practitioners' experiences on the usefulness of restorative materials in Finland 1992-1996

OBJECTIVE: To analyse general dentists' choice of restorative materials in Finland, where the use of amalgam has significantly decreased and the use of composites increased during the past 10 years. DESIGN AND SETTING: Postal survey in 1997 to a random sample of general dental practitioners mainly working with adult patients. MAIN OUTCOME MEASURES: Percentage distribution of dentists' opinions. RESULTS: The response rate was 82%. Tooth-coloured restorations were considered to be more time consuming, technically complicated and to have shorter life spans. Most dentists were not willing to return to the wide-scale use of amalgam restorations. CONCLUSIONS: The rapid changes in the restorative material selection have not resulted in serious problems in restorative therapy.     

Selection of restorative materials, reasons for replacement, and longevity of restorations in Florida

The purpose of the present study was to obtain information relating to the types of restorative materials used, the main reason for replacement of restorations, and the age of failed restorations. Dentists in general dental practice in Florida were invited to record details from their own work pertaining to restorations. The diagnostic criteria were described and coded. The clinicians were not calibrated in the use of the criteria but they could call in for further explanation if needed. The 27 clinicians involved placed 2,035 restorations of which 53% were replacements of failed restorations. The increased use of resin based restorative material was clearly evident including posterior composites. The clinical diagnosis secondary caries was the most common reason for replacement of amalgam (56%) and composite (59%) restorations. Only discoloration showed a statistically significant difference in the reason for replacement of the two types of materials. The median age of the replaced amalgam restoration was 15 years and that of composite restoration was 8 years.     

Artificial caries formation around fluoride-releasing restorations in roots

Secondary caries is one of the most important factors leading to replacement of dental restorations. This investigation assessed the capacity of fluoride-releasing restorative materials to resist caries in vitro when used in roots. Class 5 cavities were prepared in the buccal and lingual surfaces of 30 extracted premolars. The six materials used were: glass-ionomer cement (Fuji), glass-ionomer cement with silver particles added (Ketac-silver), fluoride-containing composite resin (Tetric), composite resin (Silux plus), fluoride-containing amalgam (Fluor-Alloy) and high-copper amalgam (Dispersalloy). After 5 weeks in an acid gel for caries-like lesion formation, the teeth were sectioned longitudinally and examined with polarized light. The results showed that repair with glass-ionomer materials of a carious lesion may be of great importance in the prevention of secondary caries around the restorations in roots.     

Biological influence of some crown and bridge restorative materials finished and polished by different techniques

Fixed restorations should satisfy certain biologic requirements and they must not be injurious to the surrounding living tissues as pulp, periodontal ligament, alveolar bone and gingiva. It is best to terminate preparations above the gingival margin but for retention and esthetics considerations the margins of the fixed restorations could be placed subgingivally. In recent years, the biologic effects of dental restorative materials on the gingiva and periodontal tissues have been better appreciated. A rough surface restoration attracts and retains bacterial plaque and irritates the surrounding soft tissues which is injurious to the living supporting structure of the abutments.