Enamel pretreatment with sodium hypochlorite to enhance bonding in hypocalcified amelogenesis imperfecta: case report and SEM analysis

Bonding composite resin to enamel of teeth affected by amelogenesis imperfecta (AI) is often problematic, especially in cases with poorly mineralized, friable enamel. Difficulty in bonding hypomineralized enamel can significantly limit the restorative and orthodontic treatment options for AI patients. In this report, we document a novel approach to bonding AI enamel by pretreating the tooth surface with 5% sodium hypochlorite (NaOCl), resulting in improved bonding of an orthodontic bracket to a previously impacted maxillary canine.     

Intraoral repair of cosmetic restorations

The longevity of porcelain and composite resin restorations can often be prolonged by using sound principles, up-to-date materials, and judicious attention to repair when fracture problems arise. Careful case selection and correct usage of surface treatment agents, followed by the use of a quality bonding system and restorative materials, can result in a repair that exhibits excellent retention and natural color blending. This article outlines procedures and materials to repair both resin composite and porcelain intraorally.     

Trans-surgical restoration of extensive Class IV defects in the anterior dentition

Direct bonding is the most commonly utilized treatment for conservative aesthetic restoration of the anterior dentition. Class IV defects require special attention due to their high incidence, particularly in young patients. One of the major challenges for the clinician in treating defects in this category is selecting the appropriate restorative composite resin material that emulates the physical and optical characteristics of dentin and enamel and conceal the fracture line at the tooth/composite interface. Class IV defects with margins violating the biologic width present another concern, since this violation often impedes the attainment of the correct anatomic contours. The learning objective of this article is to describe a technique for achieving a correct integration of the periodontium, the tooth structure, and the restorative composite resin material to achieve a high level of aesthetic excellence.     

Recent advances in the surgical treatment of faecal incontinence

STATEMENT OF PROBLEM: Even though assessments of borderline restorative items in terms of accuracy and interexaminer variation have been reported, no attempt has been made to simultaneously evaluate diagnostic and treatment planning decision using objective normative standards. PURPOSE: This study established the accuracy of caries presence assessment as compared with gold standards, interexaminer agreement in assessment of caries presence and restorative needs, and influences of perceived caries status and restoration quality on treatment planning in borderline restorative situations. MATERIALS AND METHODS: Fifteen senior dental students in Mexico City (66% women; mean age 23.2 years) evaluated predetermined areas in 109 restored and unrestored posterior teeth in an in vitro model. Teeth were subsequently assessed for restoration quality and the presence of enamel and dentinal caries by use of histologic and specific dye techniques. Student's t test, Cohen's kappa, and Pearson's correlation analyses were used to analyze the data. RESULTS: There were significant caries misdiagnoses and substantial overtreatment proposed. In a few instances, teeth were left untreated, but usually they were programmed for restoration. Interexaminer agreement varied markedly and was not high. However, performance while correctly detecting lesions was better than in treatment planning. CONCLUSION: There was a high correlation between a diagnosis of caries and restorative treatment in unrestored teeth; the correlation was lower for restored teeth, although they were allocated to restorative treatment more often. This difference hinged on perceived quality of the restoration, an important factor in the frequency of proposed re-restoration.     

Guidelines for the restoration of Class V lesions

Approximately 18 percent of all permanent teeth have Class V lesions. In addition, the prolonged retention of teeth in an increasingly older population is expected to increase the prevalence of Class V lesions. Much has been written about the merits of various techniques for restoring such lesions, but little information is available comparing and contrasting all the material and procedural options available to the general dentist. Etiologies, indications for treatment, and restorative materials are discussed to provide guidance in planning treatment. A diagnostic decision tree is proposed for this dynamic area of restorative dentistry.     

The use of organic compounds of phosphorus in clinical dentistry

Organic compounds of phosphorus have been developed for a range of applications in clinical dentistry. These include dentine bonding agents, restorative materials and therapeutic agents, such as active ingredients in anticaries mouthwashes. A characteristic feature of all of these applications is the good bonding of the phosphorus compound to the tooth. This review highlights the progress that has been made to date in preparing functional and durable organophosphorus bonding agents and cements, and includes coverage of recent synthetic work aimed at preparing improved organophosphorus molecules for this application. The review concludes that this remains a promising field of chemistry to explore in the search for improved, clinically useful dental materials.     

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.     

Strength of roots before and after endodontic treatment and restoration

The resistance to fracture of mandibular premolar roots before and after endodontic and restorative procedures was tested. Seven treatment groups were evaluated. A Universal testing machine was used to apply vertical and lateral (45-degree) forces. Overall, the untreated roots showed the highest resistance to fracture. Factors of importance to prevent fracture were found to be (a) the amount of remaining tooth structure; (b) strength of post and core; and (c) bonding between core material and dentin. These factors suggest that a composite core following the use of EDTA to remove the smear layer may be a successful treatment when sufficient tooth structure remains.     

Who suffers when ignorance prevails? Stories about thalassaemia

As the average age of the population increases, we are seeing a significant rise in root caries and in the need for restorative procedures associated more often with an older population. This paper describes the subgingival placement of a resin-ionomer for several restorative procedures, including root caries, resorption, endodontic perforation and root fracture. After endodontic therapy, full thickness flaps may be used to gain access to the lesion or root defect. The defects may be prepared with ultrasonic instruments and the preparations treated with a dentin conditioner. The preparations are then washed and lightly air-dried and treated with a dentin bonding agent. A resin-ionomer may then be syringed into the preparations and either light-activated or allowed to undergo a chemical set. No untoward effect has been observed during the time frame of this project. The cases presented indicate that a resin-ionomer may be used as a subgingival restorative and may be placed in lesions originally thought to be unrestorable. Thus, teeth may be saved that were previously designated for extraction.     

Dental iatrogenesis, Part 2

To substantiate biocompatibility of dental materials and techniques, and thereby reduce iatrogenesis, tests for pulp and dentinal responses have been developed. These have shown that high-speed tooth cutting techniques are superior to low-speed techniques even when both incorporate air-water coolant sprays; pressure when placing restorative materials intensifies pulp responses induced by the cutting procedure, and that chemically self-cured resin composites requiring the application of a matrix to enhance adaptation intensify pulp response as compared to visible light-cured equivalents applied incrementally, fully cured throughout, and not requiring the pressure of a matrix. Most cements are irritating to the pulp when used as luting agents and when used less than 0.5 mm from it. Conditioning agents using weak acids for short periods induce little irritation while bonding agents appear to be beneficial by providing protection from subsequently placed restorative material. Clinicians should make every effort to minimize the development of pulp responses and reduce iatrogenic efforts.     

The dentin substrate: structure and properties related to bonding

OBJECTIVES: Dentin is a vital, hydrated composite material with structural components and properties that vary with location. These variations are reviewed along with alterations by physiological and pathological changes that allow classification into various forms of dentin. Structural characteristics and mechanical properties are reviewed and the limitations of our understanding of structure-property relationships for normal and modified forms of dentin are discussed with respect to their impact on dentin bonding. Recent progress in methods available to study dentin and its demineralization are emphasized with their promise to increase our understanding of dentin properties and structure. DATA SOURCES: Recent microstructural studies, focusing on scanning electron microscopy, atomic force microscopy and X-ray tomographic microscopy are included. A review of fundamental studies with emphasis on microstructurally sensitive methods, and prior reviews of basic mechanical properties are included with discussion of their correlation to composition and structure. STUDY SELECTION AND CONCLUSIONS: Emphasis in this work was placed on the major structural components of the tissue, including the collagen based organic matrix and its mineral reinforcement, the distribution of these components and their microstructural organization as related to mechanical properties and response to demineralization. Little information is included on biochemical and developmental studies or on non-collagenous proteins and other organic components for which limited understanding is available with respect to their role in structure-property relations and influence on bonding. In spite of the fact that the complexity of dentin precluded a comprehensive review, it is clear that local structural variations influence properties and impact nearly all preventive and restorative dental treatments. Much more work is needed in order to understand differences between vital and non-vital dentin, and dentin from extracted teeth. Although our knowledge is rudimentary in certain areas, increasingly sophisticated methods of studying dentin should provide the necessary information to model structure-property relations, optimize dentin bonding, and improve many aspects of preventive and restorative dentistry.     

Biocompatibility of posterior restorative materials

Biocompatibility of dental materials is an important consideration for the patient, clinician, laboratory technician and manufacturer. This paper examines biocompatibility testing methods and the biocompatibility of posterior restorative materials, including amalgam, casting alloys, resin composites, dentin bonding agents, cements, porcelains and ceramics.     

Diagnosis and treatment planning for implant dentistry

Dental implants are well-established in dentistry and allow the restorative dentist to offer patients the best that dentistry has to offer. Through examination, radiographs, and study models, the restorative dentist and implant surgeon can develop a treatment plan. Comprehensive diagnosis and treatment planning involve much more than a clinical exam--they require an investigation involving past, present and future dental therapy.     

Non-crown and bridge stabilization of severely mobile, periodontally involved teeth. A 25-year perspective

It is the author's belief, after analyzing forces and stresses on the periodontium for more than 30 years, that stabilization of severely mobile teeth can retain teeth, if in health, almost indefinitely. Because these teeth are retained using restorative materials, recurrent caries is a problem that needs to be treated. Tooth loss resulting from caries can occur. In the author's 26 years of using extracoronal adhesive resins for splinting, the technology of adhesive bonding and restorative resins have been improved. Earlier shortcomings of the physical properties of these materials never dissuaded the author from recommending splinting. When the cases were presented to the patient and the referring dentist, the types of the current materials used to splint teeth were immaterial. Realizing that improvements in adhesives and resins would be developed, the near-hopeless teeth were retained. Because the elderly population is the fastest-growing segment of the population, caries control is more of a concern than it was 50 or more years ago. Because teeth are being retained longer in this cohort, and because caries has a greater potential to exist, supportive periodontal therapy and recalls and caries examination become more important.     

Ectodermal dysplasia in adulthood: the restorative difficulties and management

Ectodermal dysplasia can result in a number of oral problems. As the condition is usually diagnosed in childhood, multidisciplinary specialist dental care at an early age may minimize the long-term dental complications. This article describes the restorative management of an adult patient suffering from ectodermal dysplasia for whom such support was not available, resulting in the provision of complex and highly invasive restorative treatment in adult life to provide a functional and aesthetically acceptable dentition. The various treatment options that were considered are discussed together with the details of the treatment provided.     

Esthetics and vertical tooth position: orthodontic possibilities

Throughout the 1990s, esthetic dentistry has become a prominent part of the treatment protocol of most dentists. Patients have become more conscious of the benefits of a beautiful smile and are willing to invest time and money to improve the appearance of their teeth. Many of these patients can be treated with routine restorative procedures (crowns, composites, laminates) to achieve the desired results. However, some patients have problems with tooth position that create significant discrepancies in gingival levels which can compromise the esthetic result of restorative dentistry. Prerestorative orthodontic therapy can often resolve these tooth position problems and enhance the esthetic restoration. This article describes the indication, methods, and results achieved when orthodontics preceded restorative dentistry in the treatment of various esthetic challenges.     

Problems in restorative dentistry: who copes with them?

The views of general dental practitioners, practising in part of the Yorkshire Region, as to how they would cope with a variety of restorative problems were sought using a questionnaire. If advice or advice and treatment were to be requested from a consultant in restorative dentistry, the questionnaire was designed to discover whether the distance from a hospital created a barrier to the preferred course of action. Only one-third of the dentists were happy to treat a troublesome complete denture case, provide a replacement obturator or look after a natural dentition with considerable periodontal problems. Travel constraints were particularly apparent when it came to seeking help for the elderly edentulous patient. The results of the study indicate that in the Yorkshire Region, there is a high level of demand for consultant advice and treatment for a number of common restorative problems.     

Prevalence and predictors of work related respiratory symptoms in workers exposed to organic dusts

Treatment of initial caries, albeit an everyday occurrence for the dental practitioner, presents considerable demands of patient assessment and diagnosis. Whatever decisions are made--to restore caries or to attempt to arrest its progress--the adoption of a maintenance program is of paramount importance. Patient motivation, in respect to dietary control and satisfactory oral hygiene, is central to a successful outcome, and in the future, practice management programs may include RAC as a diagnostic aid. New methods of caries management are more dynamic than traditional methods and place restoration of the lesion toward the bottom of the list of possible treatments, with the biologic rather than the mechanistic approach being a priority. However, the teaching of RAC in dental schools and the third-party funding of diagnostic tests and diagnosis are also required to reflect the increasing complexity of management of initial caries. If restorative intervention is indicated following diagnosis and RAC, treatment of initial caries should involve a minimal-intervention adhesive technique.     

Presurgical prosthetic management of the periodontal patient--a modern adhesive approach

The comprehensive management of the periodontal prosthetic patient requires that treatment be provided in a logical sequence; initial therapy, presurgical prosthetic management, surgical management of hard and soft tissue lesions, post-surgical prosthetics, followed by maintenance therapy. This article focuses on some of the most perplexing challenges encountered during the presurgical prosthetic management phase of periodontal diagnosis and therapy, including the stabilization of mobile teeth, the immediate replacement of teeth that require removal due to advanced attachment loss, and the correction of visual defects created by soft tissue loss. A number of creative treatment modalities are described that utilize silane-treated etched-glass fiber ropes and tapes (GlasSpan, GlasSpan, Inc.) for the internal reinforcement of periodontal splints and for the attachment of composite and natural tooth pontics as transitional tooth replacements. Gingival-colored composite (Gingiblend, Jeneric Pentron) and its importance as a diagnostic aid during the early stages of periodontal therapy and as an esthetic permanent restorative material are also examined.     

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.