Lipid peroxidation in patients with ischemic heart disease, hyperlipidemia and/or hypertension while polyunsaturated omega-3 fatty acids of plant and animal origin were in their diet

Missing anterior teeth are being replaced by implant-supported restorations quite frequently in modern dentistry. Providing the patient with a temporary prosthesis prior to or following implant fixture placement must satisfy established esthetic and functional criteria. When orthodontic treatment is included as part of the overall treatment effort, additional considerations include the retention and stabilization of newly established tooth positions. This article describes the fabrication, use and advantages of a provisional anterior prosthesis that replaces missing teeth prior to or following implant placement.     

Provisionalization for ceramic laminate veneer restorations: a clinical update

At the inception of ceramic veneer restorations in the early 1980s, provisional veneer restorations were not customarily placed over teeth which had undergone tooth reduction. During the last several years, provisional veneer restorations have been utilized with increased frequency for a variety of valid reasons. The learning objective of this article is to examine the reasons for the increased utilization of provisional veneer restorations and to describe a selection of the clinical methods employed for direct and indirect fabrication. The indications and contraindications for provisionalization are presented. Four case reports are utilized to describe and illustrate the various clinical circumstances, the provisionalization procedures, the appropriate instruments, and the materials that facilitate the fabrication of aesthetic, functionally sound, and biocompatible provisional restorations.     

The clinical aspects of hydrocephalus in children

The removal of tooth structure during preparation results in varying degrees of pulpal hyperemia. The ability of the pulpal tissue to respond either by recovery or degeneration depends in part upon the adequacy and fit of the provisional restoration. The response of the gingival tissue also depends on a large degree on the success of the temporary coverage. Provisional restorations are commonly given less attention and importance thereby biologic, mechanical, and esthetic considerations are not adequately met. Since a provisional restoration must be made or improvised during the same appointment in which the abutment teeth are prepared, costly chairside time most often leads to an unacceptable restoration. Failures such as color instability, color incompatibility, inappropriate anatomic contours, fractures, occlusal disharmony, changes in tooth position, gingival inflammation, and unhealthy periodontal conditions are usually encountered. A technique of fabricating an exacting provisional restoration with compliance to optimum quality is presented.     

Usefulness of enhanced insulin secretion during an oral glucose tolerance test as a predictor of restenosis after direct percutaneous transluminal coronary angioplasty during acute myocardial infarction in patients without diabetes mellitus

Extensive prosthodontic treatment often requires fabrication of long-term provisional restorations. Numerous materials and techniques have been described for prolonged insertion of interim restorations. This article describes a procedure for fabrication of long-term reinforced heat-processed provisional restorations based on a diagnostic wax-up. Reinforced heat-processed provisional restorations reduced flexure, which minimizes progressive loss of cement and diminished the possibility of recurrent decay. Occlusal stability and vertical dimension were maintained because of greater wear resistance. Occlusion, tooth contours, and pontic design developed in the provisional restoration were duplicated in the definitive restoration. The use of a matrix from a diagnostic wax-up facilitated fabrication of the prosthesis, and made the procedure less time-consuming and more predictable.     

Implants in the partially edentulous patient: restorative considerations

Restorative considerations are critical to the long-term success of fixed implant-supported prostheses, especially in the posterior quadrants of the partially edentulous patient. The parafunctional habit of bruxism must be identified and addressed. The restoration should dictate implant placement. Control of forces directed upon the prosthesis and implants is critical to long-term success. Anatomic limitations to implant placement and surgical procedures to correct these deficiencies must be considered for their impact on the prosthetic restoration. Nonaxial forces or bending moments should be minimized by the use of an adequate number, position and alignment of implants; by control of the occlusion; and by design of the prosthesis. The patient must understand the risks, limitations, costs and time commitments of implant restorations prior to treatment.     

Single implant restorations: prosthetically induced soft tissue topography

An aesthetic transition from the smaller diameter of the implant to the prosthetic restoration that resembles the size of the natural tooth has presented an ongoing challenge to the implant restorative dentists. The appearance of the surrounding soft tissue is of major importance, and various techniques have been developed to guide and optimize its topography. The learning objective of this article is to present a cervical contouring concept, whereby the soft tissue topography is optimally determined already in the laboratory phase. Using a custom abutment and provisional crown as components of the transmucosal prosthetic unit (TPU), the topography is transferred to the vital intraoral tissues, which predictably adapt to the enhanced aesthetic configuration. Clinical cases are presented to demonstrate the sequence of the technique in treating the anterior region of the maxilla.     

The use of implant-supported titanium prostheses for treatment of periodontally compromised patients including functional and orthodontic therapy. Report of 2 cases

Due to its corrosion resistance and biocompatibility, titanium appears to be an alternative material for implant-supported restorations. However, due to technological difficulties, the clinical application of titanium in implant restorations has been limited. Only after recent progress in technology could the clinical use of ceramo-metal titanium restorations be recommended. The therapeutic repertoire for treating patients with missing teeth has been significantly expanded by modern implant methods. Osseointegrated prostheses have become an integral part of restorative therapy also for periodontally compromised dentitions. This article presents 2 case reports for the use of ceramo-metal implant-supported titanium cast prostheses for restorative treatment of periodontally compromised patients requiring comprehensive treatment involving periodontal, functional, orthodontic and prosthodontic therapy. Favourable clinical results have been obtained and a complication-free service of these reconstructions has been documented throughout a 12- to 24-month observation period. These observations suggest that implant-supported ceramo-metal titanium prostheses may be a valuable part of restorative therapy for periodontally compromised dentitions in that they facilitate restorations with optimal biocompatibility. However, controlled clinical studies are needed to establish the long-term serviceability of these titanium restorations.     

Anterior maxillary aesthetics utilizing all-ceramic restorations

The use of all-ceramic systems has increased significantly during recent years, due to the improved strength and the introduction of a new generation of dental adhesive agents and resin cements. Both factors permit reliable and predictable results in single jacket crown restorations in the maxillary anterior region. Due to their natural appearance, the all-ceramic materials, especially the glass ceramics, blend harmoniously with the oral environment and are particularly appreciated where aesthetics is a priority. The learning objective of this article is to demonstrate a routine utilization of all-ceramic systems in the maxillary anterior region, preceded by a proper case selection. Two clinical cases are used to illustrate the preparation procedure, the importance of well-integrated provisional restorations, and the accuracy in transferring provisional information onto the final jacket crowns.     

The extracted tooth pontic--provisional replacement during bone graft and implant healing

When tooth extraction is required, a provisional restoration may be utilized as an interim prosthesis during bone graft and implant healing. The selection of provisional replacement of the anterior teeth following extraction may have a direct influence on the success of the definitive tooth replacement. This article describes a technique for using the extracted tooth or a denture tooth as an interim prosthesis during bone graft and implant healing. This method of provisionalization offers several advantages, including no adjacent tooth preparation, natural appearance, and retention of the papillae.     

The custom implant impression coping: technical note

Unsupported soft tissue can collapse around a submerged implant or abutment head during the time interval between removal of the provisional prosthesis and placement of the impression material. A technique is described for accurately recording the implant or abutment position as well as the position of the soft tissue for a single tooth restoration using the provisional prosthesis as a custom implant impression coping.     

Establishing approximal contacts in Class 2 composite resin restorations

Ensuring adequate approximal contacts when performing class 2 composite resin restorations is a significant challenge for the dentist. Fabrication of custom composite cylinders for placement into prepared cavity preparations enables the dentist to wedge the matrix band firmly against adjacent teeth, as well as eliminating the curing contraction variable that occurs when composite restorations are placed. Thus, predictable approximal contacts are obtained when class 2 composite restorations are completed.     

Anterior crowns in re-establishing vertical dimension of occlusion: overcoming fear of heights

The rejuvenation of this dentition is initiated with the placement of six anterior crowns. Re-establishing the vertical dimension has allowed the restoration of pleasing proportions to the centrals. This has led to the re-assertion of the dominance of the centrals and thus corrected the reverse smile line. The restoration of these teeth demands harmonious accommodation of the requirements of esthetics, phonetics and function. These considerations are inseparable and are in fact, determinants of each other. Esthetics and phonetics help determine the degree of vertical opening and incisal edge placement. This location influences anterior guidance, lingual and labial contours, the pitch of the anterior teeth and proper lip support. The principles of proportion, so important in esthetics, allow us, to calculate incisor length. Thus, function, phonetics and esthetics are intimately intertwined and enhance one another in the restoration of vertical dimension of occlusion.     

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.     

Microleakage of cervical restorations etched with a weak organic acid

This in-vitro study evaluated the microleakage of Class V restorations prepared using 10 per cent maleic acid and a composite resin. Thirty human premolar teeth were evenly distributed and randomly assigned to three groups. Conventional retentive preparations, etched with 10 per cent maleic acid for either 15, 30, or 60 seconds, were cut in the enamel on the facial surface of each tooth to a 1.5 mm depth (dentin). All teeth were restored with Z-100, a small particle composite resin. The teeth were then stored in deionized water for seven days, thermocycled, stained with methylene blue dye, invested, and sectioned vertically through the centre of the restoration. Leakage was established along each wall of the sectioned restoration. Analysis of variance (ANOVA) tests indicate that the restored teeth in Group 1 (15-second etch) had significantly greater microleakage (p < 0.05) on the enamel wall than the restored teeth in Group 2 (30-second etch) or Group 3 (60-second etch). In addition, Group 1 restorations had significantly greater overall microleakage (p < 0.05) than Group 2 or Group 3 restorations. Although the results were not statistically significant, it would appear that etching with 10 per cent maleic acid for 30 seconds could be clinically significant. Since a 30-second etch time was found to produce the least amount of microleakage (not statistically significant), it can be assumed that this etch time would also be optimal for etching enamel and dentin. Similarly, since Group 1 revealed the most overall microleakage, it can be assumed that a 15-second etch would be inadequate for etching enamel and dentin. Restorations in Groups 2 and 3 displayed statistically significant lower overall microleakage results.     

Two-implant-supported single molar replacement: interdental space requirements and comparison to alternative options

Posterior single-tooth implant restorations are subjected to an increased risk of bending overload. A high incidence of implant fracture has been reported when using a single standard 3.75-mm-diameter implant to support a molar restoration. The purpose of this article is to demonstrate the clinical feasibility of placing two implants to support a molar restoration and to compare this treatment option to the use of a single standard implant or a wide-diameter implant. Two osseointegrated dental implants used to support a molar restoration in interdental spaces as small as 10 mm is shown to be effective and predictable in 60 restorations over the past 7 years. The use of two implants provides more surface area for osseointegration and spreads the occlusal loading forces out over a wider area, reducing the potential bending forces that would otherwise exist in a single-implant molar restoration.     

An effective technique for extended proximal contacts in composite resin restorations

Obtaining a firm anatomic contact has been a difficult criteria in placing Class II posterior composite restorations. Various techniques have been developed and a number of products marketed to accomplish this task, but none have combined the necessary qualifications of ease, simplicity, and effectiveness for consistent and predictable results. To address this challenge, two innovative devices--a precontoured (biplanar concave) sectional matrix band and a light--focusing tip-have been developed. Using a clinical case presentation, this article describes the application of these devices to obtain high quality proximal contacts, even in widely separated teeth. The learning objective of this article is to familiarize clinicians with this procedure. The technique is simple and universally applicable with a variety of posterior composite materials and placement methods.     

The effect of core translucency on the aesthetics of all-ceramic restorations

Recent advances in ceramic technology have revolutionized aesthetic dentistry. When treating a single anterior tooth in need of a full-coverage restoration, a multitude of options in restorative materials and techniques is available to the clinician. The learning objective of this article is to present and evaluate a selection of all-ceramic dental materials currently available for aesthetic full-coverage crown restorations. When selecting an all-ceramic system, there are several major factors to consider, including the inherent translucency of the ceramic material and of the adjacent dentition, the color of the prepared tooth, and the forces anticipated in that region. Preparation and restoration of discolored and nondiscolored tooth structure are reviewed. The techniques presented can be utilized to obtain predictable results in the anterior region for aesthetic all-ceramic full-coverage restorations.     

Replacements of restorations in the primary and young permanent dentition

The present study focused on the type of restorative material used and the reasons for replacements of restorations in the primary and the young permanent dentition. All patients with restorations and who were 8 and 19 years of age in 1995 and were regularly treated at 11 Public Dental Health clinics in J?nk?ping County, Sweden, participated in the study. Data were extracted from the records for all types of restorations in canines and molars for the preceeding of 5 years for the 8-year-olds (i.e. from 3 to 8 years of age; n = 546) and for approximal restorations in premolars and molars for the preceeding 13 years for the 19-year-olds (i.e. from 6 to 19 years of age; n = 606). In all, 6012 restorations were evaluated. The two most common restorative materials used in the primary dentition were compomer and glass ionomer cement and in the young permanent dentition composite and amalgam. In the primary dentition, 29% of the restorations had been replaced and 4% of the teeth with restorations had been extracted. Thus, 33% of the restorations in the primary dentition failed. The corresponding figure for the young permanent dentition was 13%. The most common reason for replacements in the permanent dentition was secondary caries. That restorations often fail because of caries and that the development of secondary caries is not prevented by replacement of an old restoration indicate that more attention should be paid to preventive dental care for patients with restorations in the primary as well as in the young permanent dentition.     

Establishing soft tissue integration with natural tooth-shaped abutments

The disparity in dimensions between implant fixtures and the exposed extraction sockets has resulted in the development of anatomically shaped abutments. Systems have been recently introduced that facilitate the fabrication of abutments to the configuration of natural teeth in the anterior maxilla. These systems permit development of an aesthetic emergence profile and contours for easy access in maintenance of oral hygiene of maxillary anterior single-tooth implant-supported restorations. The rationale for the development, indications, advantages, and clinical utilization of a recently introduced abutment system is discussed.     

Direct composite resin restorations of the anterior single tooth: clinical implications and practical applications

Modern technology has continued to improve composite resins to the point where they are commonly used in restorative dentistry. In spite of some drawbacks, such as polymerization shrinkage, incomplete conversion and cross-linking, and undesirable water sorption, the expected time of service of these restorations is extended continuously due to physical and chemical improvements. The improved handling and excellent optical properties of the latest generation of composite resins can provide the appearance of natural dentition. Sophisticated effects can be obtained through the use of direct intraoral applications of stratification techniques. This article discusses common indications for direct restoration of anterior teeth and their treatment in order to be biocompatible with the adjacent hard and soft tissues and to meet the requirements of form, function, and phonetics.