An unusual foreign body after dental filling

We report a case of a 71-year-old Caucasian woman who was referred to our emergency department for acute onset of dyspnoea and dry cough. She underwent dental filling for caries ~2 h before. During the treatment, the distal part of the odontoiatric drill unintentionally fell off into the patient's oral cavity and was accidentally inhaled. Posteroanterior chest X-ray evidenced the foreign body localized in the right bronchial tree. A chest computed tomography scan showed the drill (with the tip pointed upward) wedged at the beginning of the right basal pyramid. A subsequent fiberoptic bronchoscopy confirmed the tip of the drill in the right lower bronchus, and the foreign body was easily removed due to the favorable position of the tip. The patient was discharged in first postoperative day without consequences.

Does a consistently reliable solution exist for the successful placement of Class II composite resin restorations?

Many restorative dentists cobble together materials and techniques from different manufacturers to create systems that work for their clinical needs. The author proposes that it may be possible to improve outcomes and continue toward excellence by selecting the ideal restorative solution with materials designed, tested, and intended to be used together. DENTSPLY Caulk's Class II solution is examined in this article as a means for helping in placement of posterior restorations, namely Class II restorations. A case report is explored.

Calcium orthophosphates in dentistry

Dental caries, also known as tooth decay or a cavity, remains a major public health problem in the most communities even though the prevalence of disease has decreased since the introduction of fluorides for dental care. Therefore, biomaterials to fill dental defects appear to be necessary to fulfill customers' needs regarding the properties and the processing of the products. Bioceramics and glass-ceramics are widely used for these purposes, as dental inlays, onlays, veneers, crowns or bridges. Calcium orthophosphates belong to bioceramics but they have some specific advantages over other types of bioceramics due to a chemical similarity to the inorganic part of both human and mammalian bones and teeth. Therefore, calcium orthophosphates (both alone and as components of various formulations) are used in dentistry as both dental fillers and implantable scaffolds. This review provides brief information on calcium orthophosphates and describes in details current state-of-the-art on their applications in dentistry and dentistry-related fields. Among the recognized dental specialties, calcium orthophosphates are most frequently used in periodontics; however, the majority of the publications on calcium orthophosphates in dentistry are devoted to unspecified "dental" fields.

Shear resistance of fiber-reinforced composite and metal dentin pins

PURPOSE

To assess whether dentin pins increase shear resistance of extensive composite restorations and to compare performance of mini fiber-reinforced composite (FRC) anchors with metal dentin pins in the laboratory.

METHODS

30 extracted sound molars were randomly divided into three groups. Occlusal surfaces were ground flat with a standard surface area and resin composite restorations were made in Group A. In Groups B and C similar restorations were made, with additionally four metal pins placed in Group B and four FRC pins in Group C. Specimens were statically loaded until failure occurred. Failure modes were characterized as intact remaining tooth substrate (adhesive or cohesive failure of restoration) or fractured remaining tooth substrate.

RESULTS

Mean failure stresses were 6.5 MPa (SD 3.2 MPa) for Group A, 9.7 MPa (SD 2.6 MPa) for Group B and 9.2 MPa (SD 2.6 MPa) for Group C. Difference in mean failure stresses between Group A and Groups B and C was statistically significant (P = 0.01), while the difference between Groups B and C was not (P = 0.63). Failures of the restoration without fracture of tooth substrate were seen for 80% of specimens in Group A and 20% in Groups B and C (P = 0.04).

Use of video eyewear to manage distress in children during restorative dental treatment

PURPOSE

The purpose of this study was to evaluate the effectiveness of video eyewear in reducing disruptive behavior in a typical pediatric dental population during restorative treatment appointments.

METHODS

One hundred twenty-eight 4- to 16-year-olds were recruited from a continuous sample of patients seen in an urban dental clinic. Direct observations of distress, self-reported measures of pain, and patient satisfaction were obtained in a randomized clinical trial comparing 2 different types of glasses: (1) wraparound video eyewear; and (2) sunglasses (typical treatment in this dental clinic).

RESULTS

Analyses of covariance, using treatment condition (control vs experimental) as the primary independent variable and controlling for the effects of age, found that children wearing video eyewear glasses demonstrated significantly less disruptive behavior than those in the control group and that they liked their eyewear significantly better than those wearing the regular sunglasses.

CONCLUSIONS

Wraparound video eyewear can be an effective approach to managing distress in children undergoing restorative dental treatment.

"MI" caries management--an overview

Minimum intervention dentistry, with its non-operative prevention and control of disease, underpins the basis of a patient-centred, team-based approach to managing dental caries in patients, who must take an active responsibility in maintaining their personal oral health. In patients where cavities are present causing pain, poor aesthetics and/or functional problems, restorations will need to be placed. Minimally invasive caries excavation strategies can be deployed depending on the patient's caries risk, lesion-pulp proximity and vitality, the extent of remaining supra-gingival tooth structure and clinical factors (e.g., moisture control, access) present in each case treated. Excavation instruments, including burs/handpieces, hand excavators, chemo-mechanical agents and/or air-abrasives which limit caries removal selectively to the more superficial caries-infected dentine and partial removal of caries-affected dentine when required, help create smaller cavities with healthy enamel/dentine margins. Using adhesive restorative materials, the operator can, if handling with care, optimize the histological substrate coupled with the applied chemistry of the material so helping to form a durable peripheral seal and bond to aid retention of the restoration as well as arresting the carious process within the remaining tooth structure. Achieving a smooth tooth-restoration interface clinically to aid the co-operative, motivated patient in biofilm removal, is an essential pre-requisite to prevent further secondary caries.

Duplicating the form and function of posterior teeth with Class II resin-based composite

The most common material used to fill Class II restorations in posterior teeth is resin-based composite (RBC). Despite the popularity of RBC restorations, there are challenges to placing them properly. Improperly shaped restorations with sharp edges and corners will chip and fracture, resulting in premature failure. Properly placed RBC restorations will duplicate the embrasures, contact area, marginal ridge, and occlusal fossa of natural teeth. RBC restorations should mimic the smooth and rounded contours of the natural dentition to ensure longevity.

Rubber dam isolation in pediatric patients: a review

The rubber dam has been available to the dental profession for over 145 years and can serve as an invaluable tool to dental practitioners. Here we review the rubber dam and its application on children including advantages and disadvantages associated with its use and alternative isolation methods.

Comparison of retention rates of fissure sealants using two flowable restorative materials and a conventional resin sealant: two-year follow-up

OBJECTIVE

The purpose of this clinical study was to compare the retention rates of two flowable restorative systems (Admira Flow and Grandio Flow) with that of a conventional resin-based sealant (Fissurit F).

MATERIALS AND METHODS

The study was planned as a clinical trial with a split-mouth design. A total of 122 sealants (38 Admira Flow, 41 Grandio Flow, 43 Fissurit F) were randomly applied to completely erupted permanent molars in 35 patients aged 9-20 years and followed up for 24 months. Data were analyzed using Pearson's χ(2) and multiple comparison tests.

RESULTS

At the end of the follow-up period, Fissurit F had higher retention rates (81.0%) than both Admira Flow (60.5%) and Grandio Flow (57.1%), with p < 0.05. However, there was no significant difference in caries development among groups (p > 0.05).

CONCLUSION

The two flowable composite resin materials used as fissure sealant were less retentive than the conventional resin sealant.

Effect of implant abutment modification on the extrusion of excess cement at the crown-abutment margin for cement-retained implant restorations

PURPOSE

To compare the effect of implant abutment modification on the amount of cement extruded at the crown-abutment margin and to evaluate the vertical discrepancy after cementation.

MATERIALS AND METHODS

Access openings of titanium abutments were modified with an opening (open) and placement of two vent holes 3 mm from the occlusal edge and 180 degrees apart (internal vent). Access openings were filled with resin material (closed) and used as controls. Each abutment was secured to an implant analog. Eugenol-free zinc oxide cement (TempBond NE) was selected to cement the cast crowns (n = 9) onto test abutments. The amount of cement extruded out of the margin was calculated, and vertical seating discrepancies were determined with a linear transducer device before and after cementation. Differences among groups were analyzed statistically.

RESULTS

The mean amount of extruded cement ranged from 36% to 90% of the total cement placed within the crowns. The order, from least to greatest amount of excess cement extrusion at the margins, was internal vent, open, and closed; significant differences were observed between test groups. The net vertical discrepancies of tested specimens ranged from -7 μm to +6 μm (mean, 0 μm). No statistically significant differences in vertical discrepancy were found between the groups.

CONCLUSIONS

Venting the hollow abutment resulted in the least amount of cement extrusion when compared to closing off the screw access channel or leaving it open. Within the limitations of this study, it may be concluded that the use of two, 0.75-mm radius vent holes placed 3 mm apical to the occlusal area of the abutment and 180 degrees apart will limit the amount of cement extruded into the gingival sulcus of implant-retained crowns.

Efficacy of two methods for restorative materials' removal in primary teeth

AIM

This in vitro study aimed to compare the time required for removal, the presence of residues of restorative material, tooth structure loss and dental surface morphology after removal of composite resin and amalgam restorations from occlusal cavities in primary molars using conventional high-speed bur and CVDentus® ultrasonic diamond tips.

MATERIALS AND METHODS

A total of 37 primary molars were allocated into four groups: Group 1 (n=9)-amalgam restorations removed using high-speed bur; Group 2 (n=10)-amalgam restorations removed using ultrasonic tip; Group 3 (n=8)- composite resin restorations removed using high-speed bur; Group 4 (n=10)-composite resin restorations removed using ultrasonic tip. After being restored, teeth were sectioned and analyzed through stereoscopic microscope images before and after restoration removal. The structural loss was analyzed by software of image analysis, and an examiner assessed for the presence of residues. Scanning electron microscopy was used to evaluate the morphology. Time and structural loss values were compared using ANOVA, and the percentages of samples with residues using Fisher test.

RESULTS

There was no statistically significant difference in the tooth structure loss among different methods and restorative materials, as well as in the presence of residues of restorative material. However, diamond burs were faster than the ultrasonic method for both materials. Differences in dental morphology were observed between the methods of restoration removal, but not related to the restorative material.

CONCLUSION

Both conventional high-speed bur and ultrasonic diamond tip methods remove similar amounts of tooth structure, but the removal performed with diamond tips in ultrasonic devices is slower.

CLINICAL SIGNIFICANCE

This study shows that both ultrasonic and conventional high-speed bur methods for removing restorations generate similar loss of sound dental tissue, but the former is slower.

Effect of light curing methods on microleakage and microhardness of different resin sealants

PURPOSE

This study's purpose was to evaluate the effect of light curing methods on the microleakage and microhardness of sealants.

METHODS

The Elipar Free Light 2 light emitting diode (LED) with 10- and 20-second curing times, and the Elipar 2500 halogen light with a 20-second curing time were compared. Four different sealants were used: (1) Delton Clear; (2) Delton Opaque; (3) UltraSeal XT Clear; and (4) UltraSeal XT Opaque. Specimens were fabricated in a silicone mold (2-mm thick) and cured. Knoop hardness was measured at the bottom and top surfaces. For the microleakage evaluation, 120 human molars were divided into 12 groups and sealed with the sealants and curing methods, as stated previously. The teeth were thermocycled and immersed in 2% methylene blue for 24 hours. Each tooth was sectioned and examined for dye penetration.

RESULTS

There were no statistically significant differences in the microleakage of sealants polymerized by either the halogen or LED curing methods. The microhardness of sealants varied according to the type of material and curing method.

CONCLUSIONS

A 10-second polymerization time with light emitting diodes was not sufficient to cure the 2-mm-thick opaque or high filler loaded sealants. Decreasing the curing time, however, had no effect on the microleakage of the sealants.

Clinical evaluation of an oval-shaped prefabricated glass fiber post in endodontically treated premolars presenting an oval root canal cross-section: a retrospective cohort study

PURPOSE

This retrospective cohort study investigated the clinical effectiveness of preformed oval-shaped glass fiber posts in combination with a dual-curing composite resin core material in endodontically treated premolars presenting an oval root canal cross-section and restored with all-ceramic crowns over up to 45 months.

MATERIALS AND METHODS

The study population comprised 134 patients and 154 endodontically treated premolars, with varying degrees of hard tissue loss, restored by means of oval-shaped fiber-reinforced posts. Inclusion criteria were premolars presenting an oval-shaped root canal, symptom-free endodontic therapy, root canal treatment with a minimum apical seal of 4 mm, application of rubber dam, and the need for a post and core complex because of coronal tooth loss. Four groups were defined based on the number of preserved coronal walls after endodontic treatment and before core buildup. Survival rate of the post and core restorations was determined using Kaplan-Meier analysis, and statistical analysis was performed using the log-rank test (P < .05).

RESULTS

The posts and cores were examined clinically and radiographically. The mean observation period was 42.3 ± 2.7 months. The overall survival rate was 95.45%. Comparisons revealed that the difference between premolars with no coronal wall retention and premolars that had maintained one to four coronal walls was statistically significant (P = .0006). On the contrary, comparison between premolars with one and two residual walls was found to be not significant for the overall survival rate (P = .0698).

CONCLUSION

A satisfactory clinical performance was observed for preformed oval-shaped glass fiber posts. Survival was higher for teeth retaining three and four coronal walls.

Clinical performance of fluoride-releasing dental restoratives

OBJECTIVES

The purpose of the this study was to evaluate the performance of several different fluoride-releasing restoratives placed on deciduous and immature permanent teeth in respect of time; and additionally to compare the effect of conditioning prior to their placement.

MATERIAL AND METHODS

A total of 270 restorations--restored with one conventional glass-ionomer cement, one resin-modified glass-ionomer cement, one compomer and one fluoride-releasing glass-ionomer cement (135 placed on deciduous and 135 on permanent immature teeth)--were evaluated. The fillings were analysed after 1 month, 6, 12 and 18 months, by the criteria for evaluation of the dental clinical materials given by Ryge.

RESULTS

Restorations mostly gave excellent results, especially those placed on permanent immature teeth. Actually, Dyract AP and Unifil Flow were marked (A) after 18 months in 93.3% of the cases. Fuji IX restorations had the lowest retention rate, especially on deciduous teeth, due mostly to bad oral hygiene habits. Dissatisfaction with the tested criteria was, above all, because of the bad marginal adaptation and the colour dismatch of the restorations. Conditioning prior to the application of the restoratives was beneficial.

CONCLUSIONS

Fluoride-releasing materials are a revolution in the treatment of tooth decay, especially in children. This is mostly due to their ability to reduce seconddary and recurrent caries levels and the simplified application.

Evaluation of ocular hazards from 4 types of curing lights

OBJECTIVE

To assess the risk of ocular damage from 4 types of light curing units (LCUs) and to estimate the maximum permissible ocular exposure times from each LCU during an 8-hour workday.

METHODS

Extracted human maxillary teeth were mounted in a dentoform. Four types of LCUs (plasma arc, low-power and high-power light-emitting diode, and quartz-tungsten-halogen) were used to cure a simulated restoration in the maxillary central incisor from the facial and palatal aspects. To simulate ocular exposure, the spectral irradiance (W/[cm2 · nm]) from the LCUs was measured 5 times at each of 3 distances (30 cm, 50 cm and 100 cm) from the tooth, using a cosine-corrected probe attached, via a fibre optic cable, to a calibrated spectroradiometer. The weighted blue-light and effective ultraviolet (UV) irradiances that would be received by the eye from each LCU were calculated.

RESULTS

The maximum permissible daily exposure limits for UV light exceeded 8 hours at all distances and orientations. The maximum permissible cumulative daily exposure time to blue light was as low as 6 seconds when curing from the palatal aspect with the plasma arc LCU and as high as 1.5 hours when the low-power light-emitting diode LCU was used from the facial aspect.

CONCLUSIONS

The 4 LCUs tested did not pose a risk of UV-mediated ocular damage. The higher-powered lamps showed potential to cause blue-light-mediated ocular damage at shorter distances, with damage potentially occurring after cumulative viewing of only 6 seconds at the 30-cm distance during an 8-hour workday.

Effect of chlorhexidine disinfectant on bond strength of glass ionomer cement to dentin using atraumatic restorative treatment

This study investigated the effect of 2% chlorhexidine gluconate (CHX) disinfectant on bond strength (BS) of high-density glass ionomer cement (HDGIC) to dentin following atraumatic restorative treatment (ART) and conventional preparations. Specimens were divided into four groups: Group 1--ART (control); Group 2--ART with CHX disinfection; Group 3--Conventional (control); Group 4--Conventional with CHX disinfection. HDGIC was packed in cylindrical molds placed over flat dentin surfaces; BS was measured after seven days. ART-prepared dentin surfaces disinfected with CHX provided bonding to HDGIC that was comparable to untreated dentin and to conventionally prepared dentin.