How long will it last? The expected longevity of prosthodontic and restorative treatment

With the Internet facilitating access to vast amounts of free information, dental practitioners face providing treatment for an increasingly informed public. However, the available content is not filtered, and it can be difficult for patients to discriminate between research-informed evidence and "glamorised" material of dubious origin. Patients reasonably expect a return for their investment and want to know how long their treatment will last. Clinicians have an obligation to inform their patients so that they can make reasoned decisions about treatment options. Longevity data are also informative for health agencies setting service schedules for publicly funded treatment, and for determining settlements by insurers such as ACC. Historically, much of the prosthodontic treatment performed in practice has relied heavily on dogma, low-level anecdotal evidence, and clinical case reports. This paper considers the literature on fixed and removable prosthodontic restorations and provides a critical review which can be used practically as the basis for informing patients, and to assist decision-makers in making fair and appropriate judgements.

Evaluating the efficiency of caries removal using an Er:YAG laser driven by fluorescence feedback control

INTRODUCTION

Caries lesions in dental hard tissues autofluoresce when exposed to light of certain wavelengths, whereas sound tissues do not, and this can be used as an in vitro histological marker for dental caries. Detection of autofluorescence is the basis of KaVo DIAGNOdent™ technology, and provides objective feedback control of laser-stimulated ablation of dental caries for the KaVo Key Laser 3™. This Er:YAG laser operates at 2940nm wavelength, and is effective at removal of infected dental hard tissues. Micro-computed tomography (micro-CT) allows the non-invasive investigation of three-dimensional structures and analysis of mineral density profiles of dentine following laser ablation.

OBJECTIVE

To evaluate removal of infected, demineralised dentine by Er:YAG irradiation with a laser feedback mechanism, using micro-CT.

DESIGN

27 carious teeth (1 control) and 1 sound tooth, treated with the KaVo Key Laser 3™ using a KaVo™ non-contact 2060 handpiece at specific feedback settings, were examined using a Skyscan 1172 Micro-CT, to observe the efficiency of demineralised dentine removal. Grey scale images obtained were colour rendered to assist detection of demineralised tissue if present.

RESULTS

Complete removal of demineralised tissue occurred with laser-stimulated ablation under feedback control at values of 7 and 8 when measured by micro-CT. At greater values, removal of demineralised dentine was incomplete.

CONCLUSION

Examination of dental tissues by micro-CT allowed determination of the efficiency of Er:YAG laser-stimulated ablation. Feedback control of the KaVo Key Laser 3™ appeared to operate like a cut-off switch when infected dentine was eliminated, at a threshold of between 6 and 7.

In vitro demineralisation of the cervical region of human teeth

OBJECTIVE

The aim of this study was to investigate a possible role for demineralisation of the cervical region of human teeth in the development of non-carious cervical lesions (NCCLs).

MATERIALS AND METHODS

Freshly extracted human premolars were demineralised and prepared for nanoindentation and scanning electron microscope (SEM) observation. After 1 day or 2 days demineralisation in a solution of pH 4.5, specimens were embedded, cut and polished to 1 μm diamond paste. Nanoindentation was done at the cementum-enamel junction (CEJ) region with an interval of 30 μm, to develop mechanical properties maps. After the indentation, SEM with back-scatter detector was employed to observe the degree of demineralisation at the CEJ.

RESULTS

After 1 day and 2 days demineralisation, the mechanical properties of enamel and dentine at the CEJ decreased by ∼50% and ∼90%, respectively. SEM images illustrate that artificial demineralisation generated typical demineralised zones in enamel near the CEJ. Moreover, 2 days demineralisation penetrated the sound enamel at the CEJ, and the dentine beneath was undermined.

CONCLUSION AND SIGNIFICANCE

One day and 2 days demineralisation reduced the mechanical properties of teeth at the CEJ significantly. Demineralised enamel and dentine with low mechanical properties are prone to wear and abrasion. The findings of the investigation indicate that acid typical of that produced by dental plaque may compromise the mechanical properties of enamel and dentine at the CEJ to the extent that they would be susceptible to tooth brush abrasion, producing NCCLs.

A suitable base material for composite resin restorations: zinc oxide eugenol

OBJECTIVE

This in vitro study evaluated the effects of a zinc oxide eugenol (ZOE) base on the mechanical properties of a composite resin restoration.

METHODS

Class I cavities were prepared on plastic teeth and filled with ZOE plus composite resin, following standard clinical procedures. The samples were sectioned sagittally and the ZOE-resin interface was exposed. After polishing, nanoindentation was performed on the region near the interface, and elastic modulus and hardness were plotted in the form of a color contour map. SEM was employed to observe the interface between composite resin and ZOE base.

RESULTS

In the region close to the ZOE base, the elastic modulus and hardness of composite resin reduced to the values of 9.71+/-0.54 and 0.51+/-0.05 GPa, respectively. Eugenol from ZOE had detrimental effects on the composite resin only to a distance of less than 100 microm from the ZOE base.

CONCLUSION

Although eugenol suppresses polymerization slightly, by considering the biological advantages of ZOE, together with the results of the current investigation, ZOE may still be considered a suitable base material for composite resin. Bonding is essential for composite resin restorations over ZOE bases to avoid shrinkage detachment.

A system of calibrating microtomography for use in caries research

Desktop microcomputed tomography (micro-CT) offers a non-invasive 3-dimensional analysis of structures and their physical properties. To date, the use of micro-CT has mostly involved qualitative observations, with the extent of quantitative analysis relying on automated internal calibration by the micro-CT control software. However, the value of such calibration is limited by machine drift. For an accurate quantitative use of micro-CT, it is recognized that external means of calibration are needed. A novel system of calibration standards, also known as 'phantoms', is presented. A range of low mineral concentration phantoms involving triethylene glycol dimethacrylate/glycerolate dimethacrylate resin mixed with commercial pure hydroxyapatite (HAP), from 0.07 to 1.05 g/cm(3), was fabricated. Sintered HAP was impregnated with the same resin, producing phantoms with medium-level mineral concentrations up to 1.90 g/cm(3). These phantoms were easy to create, proved accurate and stable with repeated use, and were found to mimic the composite nature of dental enamel and dentine structures under investigation.

A novel instrument to determine pulp proximity

The aim was to determine whether extracted teeth could be used to test the Prepometer instrument, which indicates pulp proximity with green/amber/red light emitting diodes. Third molars were reduced to a plane in dentine and Prepometer readings made. Dentine was removed in 0.5 mm increments and readings made until only lights 9 or 10 (red) showed. The teeth were sectioned and the dentine thickness measured. Analysis permitted construction of a highly significant predictor-model (p < 0.01), the red/amber light boundary coinciding with a dentine thickness of 2.4 mm. The Prepometer was consistent in predicting pulp proximity but was more sensitive than specified.

Immediately Restored, Single-Tapered Implants in the Anterior Maxilla: Prosthodontic and Aesthetic Outcomes After 1 Year

BACKGROUND

Conventional implant protocols advocate a two-stage technique with a load-free, submerged healing period. Recent studies suggest that immediate restoration of single implants may be a viable treatment option.

PURPOSE

The purpose of this study was to evaluate prosthodontic and aesthetic peri-implant mucosal outcomes of immediately restored, Southern single-tapered implants in the anterior maxilla after 1 year.

MATERIALS AND METHODS

Participants (mean age: 43.25 years; range: 23-71 years) satisfying specified inclusion criteria were randomly allocated to conventional two-stage restoration (control group; n=14) and immediate restoration groups (test group; n =14) in a randomized controlled clinical trial. Tapered, roughened-surface Southern implants were placed using a standardized technique, and implant level bone impressions were made. Provisional screw-retained crowns, out of occlusion, were placed at second-stage surgery after 26 weeks for the conventional restoration group, and within 4 hours of implant placement for the immediate restoration group. Both groups had definitive screw-retained metal-ceramic crowns placed in occlusion 8 weeks later. Peri-implant mucosal response and papilla index were recorded 4 weeks after definitive crown placement to allow for mucosal maturation and at 1 year. Prosthodontic and aesthetic outcomes were assessed using established criteria.

RESULTS

There were no significant differences within, or between, the control and test groups for age, gender, bone quality or quantity, implant stability measurements at surgery, or implant length. There were no significant differences in the implant success rate as determined by radiographic bone loss and stability tests after 1 year. There were no significant differences in prosthodontic maintenance, peri-implant mucosal response, and papilla index between the two groups over 1 year.

CONCLUSIONS

Tapered, roughened-surface implants immediately restored with single provisional crowns at surgery and definitive crowns 8 weeks later were as prosthodontically and aesthetically successful as conventionally restored two-stage implants during the first year of service. Restoring single implants immediately with screw-retained crowns is an efficient procedure, but the short-term outcome is by no means superior to a conventional two-stage approach.

The use of endodontically treated teeth as abutments for crowns, fixed partial dentures, or removable partial dentures: a literature review

Endodontically treated teeth are commonly required to serve as abutments for crowns, fixed partial dentures, or removable partial dentures. Many clinicians are of the opinion that endodontically treated teeth do not serve as well as vital teeth. This article reviews the pertinent literature and seeks to reach a consensus for the use of endodontically treated teeth with each type of prosthesis. With appropriate preparation designs, endodontically treated teeth can serve well as abutments for crowns. As restorations become more complex and involve edentulous spans, some reservations apply. In some fixed partial denture designs, the use of endodontically treated teeth may be contraindicated.

A randomized controlled clinical trial of conventional and immediately loaded tapered implants with screw-retained crowns

PURPOSE

Surgical, prosthodontic, and esthetic outcomes of conventional and immediately loaded, single, tapered, roughened-surface Southern implants in the anterior maxilla that were restored with screw-retained crowns were compared over 1 year.

MATERIALS AND METHODS

Standardized surgical and prosthodontic procedures were followed and accepted criteria were used for assessment.

RESULTS

There were no significant differences within or between the control and test groups for age, gender, bone quality or quantity, implant stability measurements at surgery, or implant length.

CONCLUSION

After 1 year, the implants that had been immediately loaded with single provisional crowns at surgery and definitive crowns 8 weeks later were as successful as conventionally loaded 2-stage implants.

Distal implants to modify the Kennedy classification of a removable partial denture: a clinical report

Dental implants or precision attachments can be used to resolve the bilateral distal extension removable partial denture (RPD) dilemma. This report describes the fabrication of a mandibular implant-supported chromium-cobalt RPD with a combination of bilateral single molar implants and metal ceramic crowns using the principles of the channel-shoulder-pin system. The maxillary arch was restored with splinted metal crowns and a conventional RPD retained by extracoronal precision attachments.

The bitewing radiograph as an assessment tool in fixed prosthodontics

Molar crown preparations, as described in the literature, have standard forms dictated by the demands of retention, resistance and the physical properties of materials. Standard designs may not be appropriate for all patients because of ethnic variations in tooth shape, pulp size and dentine thickness. Accurate data on these features could assist clinicians to minimize the risk of accidental pulpal injury. The aim of this study was to compare the first molar crown and pulp dimensions between Asian (Chinese, Korean, Malay) and other ethnic groups, using measurements from the bitewing radiographs of 121 subjects. Comparisons revealed the following significantly different features of Asian first molars: larger total pulp areas in uppers (P < 0.0005); shorter crowns (P < 0.0005); narrower upper teeth at the cervix (P < 0.0005); wider pulps at the cervix of lowers (P < 0.02); more bulbous crowns (P < 0.0005 for uppers; P < 0.01 for lowers), and finally significantly thinner dentine interproximally at the cervix (P=0.001 for uppers; P=0.011 for lowers). Preparations with wide shoulders could pose hazards to the pulps in Asian subjects. This study emphasizes the value of bitewing films in assessing crown and pulp size and shape before making crown preparations. The experienced practitioner may intuitively include tooth and pulp morphology in treatment planning, but this appears not to be taught or documented in textbooks.

Factors influencing the removal of posts

AIM

To determine whether metal type, cement type and the use of ultrasonic vibration influence the amount of tensile force required to remove parallel-sided, prefabricated, metal posts from tooth roots.

METHODOLOGY

Ninety extracted canine teeth were sectioned horizontally 1-mm coronal to the labial cemento-enamel junction and embedded in acrylic blocks. Standardized post spaces were prepared with a ParaPost no. 5 (1.25 mm) drill to 10 mm and ParaPost XP no. 5 stainless steel and titanium posts were cemented using zinc phosphate, glass ionomer or composite resin cement. Sixty posts were subjected to 16 min of ultrasonic vibration whilst 30 stainless steel posts received no vibration. The force required for post removal was determined using a universal testing machine. Results were analysed using univariate anova.

RESULTS

The univariate anova revealed no statistically significant differences between the groups at the P = 0.05 level.

CONCLUSIONS

In this in vitro experiment, metal type, cement type and ultrasonic vibration did not influence the force required to remove posts.

Comparison of two methods for the removal of root canal posts

OBJECTIVE

To compare the application of ultrasound with the use of an engine-driven trephine bur to remove parallel-sided root canal posts.

METHOD AND MATERIALS

Single-rooted human canine teeth were decoronated and prepared to receive preformed titanium posts. The posts were cemented with Panavia F resin cement. Ten teeth acted as controls, 10 had a 4-mm-deep gutter cut around the post using a Masserann trephining bur, and 10 were subjected to 10 minutes of ultrasound. The forces required to dislodge the posts were determined using a universal testing machine, and the data were analyzed using analysis of variance.

RESULTS

The only significant difference was between the trephined and ultrasonically energized groups, with the ultrasonic group requiring greater forces for dislodgement.

CONCLUSION

Resin composite cement could be removed from around the posts with the trephine bur but with considerable difficulty, and neither method of dislodging the posts was effective.

Effect of thermocycling on the retention of glass-fiber root canal posts

OBJECTIVE

This study investigated the effects of thermocycling on the retention of glass-fiber and resin posts.

METHOD AND MATERIALS

Forty premolar and canine tooth roots were embedded in acrylic blocks shaped to fit into a retention device. The roots were randomly assigned to two groups of 20 to receive either Lightposts or Luscent Anchors which were cemented into 9-mm-deep post spaces, with Panavia F resin cement. Each group was randomly divided into two equal subgroups: one for thermocycling, and the other to serve as a control. The thermocycled specimens were cycled 3,000 times between water baths at 5 degrees C and 55 degrees C, with a dwell time of 60 seconds in each. Control specimens were stored at 37 degrees C. The tensile force required to dislodge each post from its root was recorded and the data analyzed using Student's t tests.

RESULTS

There were no significant differences in the forces required to cause post-retention failure between the control and thermocycled specimens. Lightposts were significantly more retentive than Luscent Anchors without thermocycling, but this distinction was not apparent in the thermocycled groups.

CONCLUSION

Glass-fiber and resin posts cemented with resin cement offer acceptable levels of retention and are not susceptible to reduced retention from thermocycling. Thermocycling should be given less emphasis in tests for the retention of root canal posts cemented with resin cements.

A comparison of the retention of tooth-colored posts

OBJECTIVE

The aim of this in vitro study was to compare the retention of five different esthetic post systems of similar dimensions in extracted teeth using titanium posts as controls.

METHOD AND MATERIALS

Sixty recently extracted single-rooted, caries-free teeth were sectioned horizontally and mounted in acrylic resin. The samples were randomly allocated into six groups of 10 for post preparation. Post space preparation was carried out according to the individual manufacturer's instructions. All posts were bonded using Panavia F. A 4-mm hollow, metal sleeve was luted over the free end of each post prior to mounting in a universal testing machine, and the forces required to dislodge the posts using a cross-head speed of 5 mm/min were recorded.

RESULTS

It was found that the parallel-sided Lightposts were significantly more retentive than all of the other posts. Parapost Fibrewhite posts were more retentive than tapered Lightposts and Snowposts. There was no significant difference between the retention of stainless steel Paraposts and any of the other groups.

CONCLUSIONS

Serrated parallel-sided stainless steel posts were no more retentive than either parallel-sided or tapered tooth-colored posts in this study. When all groups were considered, post dimension appeared to influence retention, with parallel-sided posts being more retentive than tapered posts.

Mandibular overdentures: professional time for prosthodontic maintenance during the first year of service using three different implant systems

PURPOSE

The purpose of this study was to evaluate the professional time required for the prosthodontic maintenance events of mandibular implant overdentures during the first year of service using three different implant systems (ITI, Steri-Oss, or Southern).

MATERIALS AND METHODS

Seventy-two mandibular implant overdenture patients were allocated to three equal groups, each treated with a different implant system. Data on prosthodontic maintenance events during the first year were categorized and analyzed according to professional time allocation per procedure.

RESULTS

The total professional time required to perform all the maintenance events ranged between 29.0 and 34.0 hours and did not differ significantly among the three groups, although there were time differences for matrix activation and replacement. When combining the professional time for all maintenance events for the mandibular overdentures alone, or with the opposing maxillary complete dentures, there were no significant differences between groups. For maintenance of the maxillary dentures, there was an unexplained difference between the Southern group and ITI or Steri-Oss groups (P < .05).

CONCLUSION

The prosthodontic maintenance for mandibular implant overdentures required on average 72 to 98 minutes of professional time per patient during the first year of service, depending on the system used.

Mandibular overdentures: comparative evaluation of prosthodontic maintenance of three different implant systems during the first year of service

PURPOSE

This prospective study evaluated the prosthodontic maintenance requirements during the first year of service of mandibular overdentures supported by two unsplinted implants using three different implant systems.

MATERIALS AND METHODS

Seventy-two patients randomly allocated to three equal groups were each provided with a conventional complete maxillary denture and a mandibular overdenture supported by two unsplinted implants. A different implant system was used for each group (Steri-Oss, ITI, or Southern Implants), and their prosthodontic maintenance requirements were compared, primarily for the patrix and matrix. Additional maintenance categories recorded included any type of overdenture fracture, reline or remake of the overdenture, and maintenance of the maxillary denture.

RESULTS

Sixty-eight percent of the patients, regardless of implant system, required prosthodontic maintenance in the first year, most commonly for the matrices. The Southern Implants matrices required less maintenance than those of Steri-Oss or ITI (P < .05). Additional overdenture maintenance was required by 28% of patients, irrespective of implant system. When all categories of prosthodontic maintenance were combined, there were no differences between implant groups. Evaluation of overall prosthodontic success using six-field tables revealed statistically significant differences between the three implant systems, with more ITI and Steri-Oss patients than Southern Implants patients requiring overdenture retreatment (repair).

CONCLUSION

During the first year of service, the matrix maintenance requirements of Southern Implants were significantly lower than those of the ITI or Steri-Oss groups; this was reflected in the number of retreatment (repair) categories recorded. Although the three systems did not differ significantly for overall prosthodontic maintenance, both the Steri-Oss and the ITI titanium matrices showed problems of clinical significance.

Evaluation of pre-fabricated root canal posts

In this in vitro study, properties of a titanium alloy post recently introduced to the market (IntegraPost), were compared with those of a clinically proven stainless steel post (ParaPost). The IntegraPost has a unique, perforated, spherical head and a microknurled shank surface. The posts were tested for rigidity, for retention within the root canals of extracted teeth and for ability to retain composite resin cores. The two post types exhibited similar properties in core and root canal retention, however, the IntegraPost was significantly less rigid than the ParaPost.

Rigidity and retention of ceramic root canal posts

Ceramic root-canal posts offer potential advantages over other types with respect to aesthetics and biocompatibility. Any post must be sufficiently rigid and retentive to withstand functional forces. Ceraposts (1.2 mm coronal diameter, ceramic, tapering, smooth posts) and Paraposts (1.25 mm, stainless-steel, parallel, serrated posts) were tested for rigidity by means of a three-point bending test. To test retention in roots, ceramic posts were cemented using one of three protocols: (1) glass-ionomer cement, (2) silane coupling agent and resin cement, or (3) sandblasted post surface, silane coupling agent, and resin cement. Stainless-steel posts were cemented with resin. The tensile force required to dislodge the posts, following four weeks of storage in water, was recorded. Data were compared using Student's t-test and Mann-Whitney U analysis. Ceraposts were significantly more rigid than Paraposts (p < 0.001). Paraposts cemented with resin were significantly more strongly retained than Ceraposts following any cementation protocol (p < 0.001). Retention of the ceramic posts was significantly greater with a silane coupling agent and resin cement than with glass-ionomer cement (p < 0.001). Sandblasting the ceramic posts produced variable results and needs further investigation before it could be recommended.

Comparison of two vertical condensation obturation techniques: Touch 'n Heat modified and System B

AIM

The aims of this study were firstly to compare the area of canal occupied by gutta-percha, sealer or voids using the System B heating device with that obtained by a modified vertical condensation technique using the Touch 'n Heat: and secondly to compare the temperature changes at the root canal wall and external root surface during obturation with the above techniques.

METHODOLOGY

Forty-five resin blocks, each with a standardized, simulated, prepared main root canal and five lateral canals, were assigned to three equal experimental groups. The canals were obturated using either the System B technique at two different temperature settings, or vertical condensation with a Touch 'n Heat instrument as the heat source. A heat transfer model was used to simultaneously record internal and external root surface temperature elevations during obturation by the three techniques. Data were analysed using unpaired Student's t-test and Mann-Whitney U-test.

RESULTS

Both obturation techniques produced root fillings consisting of over 90% gutta-percha at most levels, although the percentages of sealer and voids 2-3 mm from the working length following System B obturation were higher than those found following modified vertical condensation. Modified vertical condensation resulted in more gutta-percha in lateral canals. Obturation was accomplished more quickly using the System B, and temperature elevations produced during obturation with the System B were significantly less (P < 0.001) than with vertical condensation. An elevation of external root surface temperature by more than 10 degrees C occurred during vertical condensation.

CONCLUSIONS

The results suggest that the System B may produce an acceptable obturation and that the use of a Touch 'n Heat source during vertical condensation may result in damage to the periodontium.

Retention of posts with resin, glass ionomer and hybrid cements

OBJECTIVES

To measure and compare the retention of serrated root canal posts cemented with glass ionomer, resin and resin-modified glass ionomer (hybrid) cements.

METHODS

Fifty single-rooted human teeth were decoronated, treated endodontically and then embedded in resin blocks. Standard post-holes, 10 mm long, were prepared to receive 1.5 mm serrated stainless steel posts. Five equal-sized groups of roots had posts cemented using either a glass ionomer cement, one of two resin cements or one of two resin-modified glass ionomer luting cements. The cements were prepared and used according to the manufacturers' instructions. The tensile force required to dislodge the cemented posts in a testing machine was recorded. Statistical analysis was performed using Student's t-test and Mann-Whitney U-tests at the 99.9% confidence level.

RESULTS

Statistical analysis revealed that posts cemented with resin A were significantly better retained (340.06 N+/-23.13 N) than those cemented with resin B (212.56 N+/-67.62 N), or either of the two resin-modified glass ionomer cements (53.90 N+/-28.42 N, 25.97 N+/-14.70 N), but not statistically better than posts cemented with the glass ionomer cement (286.16 N+/-38.71 N). The retention of posts cemented with either resin B or the glass ionomer cement was significantly better than with either hybrid cement. There was no significant difference in retention between the hybrid cements.

CONCLUSION

The performance of the resin-modified glass ionomer cements was significantly below that of alternative cements in this study. Possible explanations for this finding are discussed. Dentists should be cautious in adopting this new cementing regime.

Effects of sealers and liners on marginal leakage of amalgam and gallium alloy restorations

In an in vitro study, the use of sealers and liners (Fuji varnish, Vitrabond, Vitremer, Paama 2, All-Bond 2, or Resinomer) significantly reduced the amount of marginal leakage around amalgam (Permite C or Lojic Plus) and gallium (Galloy) alloy restorations. This reduction in marginal leakage was produced by all sealers and liners tested, and there were no statistically significant differences between these materials. Unlined restorations of Permite C had significantly less marginal leakage than Galloy or Lojic Plus. Unlined Lojic Plus restorations had the greatest amount of marginal leakage. The experimental method used in the present study proved to be suitable for quantitative comparison of marginal leakage of different dental materials.

Rigidity and retention of root canal posts

OBJECTIVE

To test the rigidity and the retention into roots of parallel root canal posts, one a spiral vented titanium post and the other a spiral serrated, hollow, stainless steel post. A serrated, stainless steel post was used as the control.

MATERIALS AND METHODS

A three-point bending test was used to test rigidity. To test retention, ten posts of each type were cemented into the roots of extracted teeth with a resin cement and the tensile loads required to remove them were compared using Student's t and Mann-Whitney U tests.

RESULTS

The serrated stainless steel posts were significantly more rigid than either of the other types. The titanium posts and the stainless steel hollow posts were not significantly different in rigidity. The serrated, stainless steel posts were significantly better retained than either of the other types. The titanium posts showed greater retention than the hollow posts.

CONCLUSIONS

Within the limits of the study the stainless steel, serrated posts were superior to the two newer types in terms of rigidity and retention into roots.

Effects of lining materials on shear bond strength of amalgam and gallium alloy restorations

In this in vitro study, where alloys were condensed into unset paste lining materials, shear bond strengths were significantly greater than with the unlined controls. The use of varnish or Paama 2 linings did not significantly increase the shear bond strength of amalgam or gallium alloy restorations. The use of Vitrabond, Vitremer, or Resinomer liners significantly increased the shear bond strength compared to unlined restorations. Permite C restorations lined with Resinomer all showed cohesive failure within the mixed alloy/ liner. Of the unlined restorations, Permite C had significantly higher shear bond strength than Lojic Plus. The experimental method used in the present study proved to be suitable for quantitative comparison of the shear bond strength of different dental materials.

Sclerotic bone lesions: report of three cases

This report describes three instances of radiodense bone lesions. These lesions are most commonly associated with teeth with pathological pulpal changes, and are believed to represent an osteoblastic response to inflammation. However, they may also be found adjacent to apparently clinically healthy teeth.

The effect of serrations on carbon fibre posts-retention within the root canal, core retention, and post rigidity

The retention in root canals of serrated carbon fibre Composiposts and stainless steel Paraposts was tested under tensile load. Twenty unrestored human roots were endodontically prepared and root filled. Two groups of 10 roots received 1.4-mm Composiposts or 1.25-mm Paraposts luted with a resin cement. The specimens were then embedded in acrylic resin and mounted in an Instron machine. The tensile force (kg) required to dislodge the posts was recorded and analysed with Student's test. The results revealed that there was no significant difference in the retention of either post (P > .05). The rigidty of 10 1.4-mm serrated Composiposts was tested in a three-point bend test in an Instron machine, and the retention of composite cores to 10 of these posts under tensile force was also tested. The results from these tests were compared to previous data from the authors' laboratory and revealed that the serrations significantly reduced the rigidity of the post (P < .001) and increased the retention of a core material (P < .001).

Rigidity and retention of carbon fibre versus stainless steel root canal posts

Two of the main requirements of a root canal post are that it is rigid so as to resist flexing under functional load, and that it is well retained in the root. This study compared these properties in two different 1-mm diameter root canal posts--smooth carbon fibre posts (Endopost) and serrated stainless steel posts (Parapost). Ten posts of each type were tested for rigidity in a three-point bend test. Ten posts of each type were cemented with resin cement into the roots of endodontically treated, extracted teeth. The tensile force required to remove the posts was recorded. The Paraposts proved to be significantly more rigid under load (P < 0.001) and significantly more strongly retained in the tooth roots (P < 0.005). The Parapost appears to be a mechanically superior post for the restoration of root-filled teeth with narrow diameter root canals.

Comparison of carbon fiber and stainless steel root canal posts

This in vitro study compared physical properties of root canal posts made of carbon fiber-reinforced epoxy resin with those of stainless steel posts. Three-point bending tests were used to derive the transverse modulus of elasticity of the posts. Resin composite cores on the posts were subjected to tensile forces to test the bonds between the cores and posts. Carbon fiber posts appeared to have adequate rigidity for their designed purpose. The bond strength of the resin composite cores to the carbon fiber posts was significantly less than that to the stainless steel posts.

Success and failure in partial edentulism treated with implant-supported bridges

This report describes success and failure in the use of fixed bridges supported by Brånemark implants, placed in the mandible bilaterally in one patient and unilaterally in the other. The non-intrusive nature and excellent functional characteristics of such bridges make them an attractive alternative to a removable partial denture in making good the loss of posterior mandibular teeth. However, there are biomechanical principles which must be considered in the design of such appliances. In particular, designs which minimise bending moments should be chosen to avoid the type of failure described in one of our patients. Repeated loosening of screw components should be considered as a possible indicator of bending overload. Where space permits, this problem is most easily overcome by placing three implants in staggered formation.

Artificial caries around restorations in roots

An artificial caries technique was used to produce caries-like lesions in the cavity walls adjacent to microfilled resin restorations with and without dentin bonding agent, and glass-ionomer cement restorations, in the roots of extracted teeth. The lesions had histological characteristics similar to those of natural lesions and to those of the lesions produced by other experimental methods. The zonal pattern of the lesions was examined by means of polarized light microscopy and microradiography, and the depth of the lesions was measured for assessment of the microleakage around the restorations. Three cavity cleaning regimes-water spray alone, 50% citric acid, and a proprietary cleaner-were compared in conjunction with the three restorative methods. Cavity cleaning with the citric acid or the proprietary cleaner, and the use of a fluoride-releasing restorative material, acted to reduce the depths of the lesions. Glass-ionomer cement restorations in cavities cleaned with citric acid showed lesions significantly shallower than those treated with other restorations. The glass-ionomer cement was soluble in the acidic environment but promoted the precipitation of minerals in the lesions. The use of a dentin bonding agent did not affect the depth of demineralization around the microfilled resin restorations.