Marginal and Internal Adaptation of Cervical Restorations Using Direct, Direct-indirect, and Indirect Techniques

OBJECTIVE

This study aimed to evaluate the external and internal adaptations of cervical restorations using different restorative techniques.

METHODS

Forty extracted and intact human premolars received standardized cervical preparations to simulate non-carious cervical lesions. The teeth were randomly divided into four groups (n=10) according to the restorative technique: D, direct composite restoration without a base (Palfique LX5, Tokuyama Dental Corp Inc, Tokyo, Japan); DB, direct composite restoration with a flowable composite liner (Estelite Flow Quick -High Flow, Tokuyama Dental Corp Inc); DI, direct- indirect composite restoration bonded with flowable composite; and I, indirect restoration bonded with flowable composite. Marginal adaptation of the restorations was observed in different segments of the margins using a scanning electron microscope. Analyses of internal adaptation were performed using micro-computed tomography. The Kruskal-Wallis and Mann-Whitney tests were used for statistical analysis of the data (α=5%).

RESULTS

No significant differences were found in the marginal adaptation of the groups (p>0.05), although a significantly higher percentage of continuous margin was found in the proximal segment than in the cervical segment (p<0.05). No significant differences were detected between the groups in terms of internal adaptation (p>0.05).

CONCLUSION

All the restorative techniques evaluated for the restoration of cervical lesions performed similarly in terms of marginal and internal adaptation.

Achieving ultimate anterior esthetics with a new microhybrid composite

Direct bonding is one of the most commonly used forms of restoration for the conservative esthetic improvement of anterior teeth. The major challenges involve selecting composites that have adequate strength as well as provide lifelike optical properties that render the restoration functionally sound and esthetically pleasing. Properties such as high sculptability, wide shade range, varying opacities and translucency, as well as high polishability are essential for gaining absolute control over the restorative process and the attainment of natural-looking results. This article discusses a new composite restorative system and its application in the direct esthetic and functional rehabilitation of the anterior dentition.

Efficacy of pamidronate in breast cancer with bone metastases: a randomized, double-blind placebo-controlled multicenter study

PURPOSE

To evaluate the efficacy of pamidronate 60 mg i.v. q 4 weeks in women with advanced breast cancer with skeletal metastases.

PATIENTS AND METHODS

404 woman with skeletal metastases from breast cancer in Sweden and Norway were included in a randomized, placebo-controlled, multicenter study. Except for the study medication, other palliative treatment was chosen at the discretion of the physician. Skeletal related events, i.e. increased pain, treatment of hypercalcemia, pathologic fractures of long bones or pelvis, paralyses due to vertebral compression, palliative radiotherapy for skeletal metastases, surgery on bone and change of antitumor therapy were recorded every third month as well as a self-estimated pain-score using visual Analog Scales and analgesic consumption.

RESULTS

There was a significantly increased time to progression of pain (p < 0.01), to hypercalcemic events (p < 0.05) as well as for the cumulative number of skeletal related events (p < 0.01) in favor for the pamidronate group. No statistically significant reduction of pathologic fractures of long bones or pelvis, or pareses due to vertebral compression occurred. No statistically significant differences were found for the need of radiotherapy and surgery on bone. The pamidronate group faired better regarding performance status (p < 0.05). There was a statistically not significant lower consumption of opioid analgesics in the pamidronate group (p = 0.14).

CONCLUSION

Pamidronate 60 mg i.v. q 4 weeks reduces skeletal events and improves the quality of life in women with bone metastases from breast cancer.

Protocol for predictable restoration of anterior teeth with composite resins

The composite resins have reached a high degree of excellence and are now used with predictable results in restoring the anterior dentition. This article discusses the development of these resins and the histologic and optical considerations (polychromatic characteristics, hue translucency and opacity, chroma, value, strength and polishability). In restorative materials, the use of universal or all-purpose restorative resins is considered: i.e. materials that combine the junctional strength necessary for the posterior regions and the high gloss polishability necessary to emulate enamel in the anterior. The restorative sequence of cervical, middle, and incisal thirds describes the materials best suited for each third, along with aids to create the intricate refinement of hue, chroma, and value. The learning objective of this article is to review the principles involved in these restorations and to provide a protocol for their clinical implementation.

Ceromer/FRC technology: the future of biofunctional adhesive aesthetic dentistry

With recent advancements in adhesive technology, restorative materials have evolved to an enhanced level of aesthetics while enabling more conservative cavity preparations and promoting reinforcement of the remaining tooth structure. These restorations have included both anterior and posterior treatment modalities applied directly and indirectly. With a growing awareness on the part of many patients of the possible cosmetic treatment alternatives came the desire for aesthetic, metal-free, durable restorations. This presentation discusses the material properties and clinical protocol of a new material which combines a ceramic optimized polymer with a fiber-reinforced framework for durable, aesthetic anterior and posterior restorations.

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.

Optimizing the esthetics of Class IV restorations with composite resins

Direct bonding is the most commonly-used treatment for the conservative esthetic restoration of anterior teeth. Class IV defects deserve special attention because of their high incidence in anterior teeth. One of the major challenges for the practitioner treating defects in this category is disguising the fracture line, through the correct use of masking and restorative resins, to make the restoration imperceptible to the eye. This paper discusses the morphologic, histologic, and optical characteristics, as well as the polychromy of sound natural teeth, and the way they correlate with composite restoratives.

Predictable aesthetic reconstruction of fractured anterior teeth with composite resins: a case report

Full-coverage rehabilitation is generally the treatment modality indicated for restoration of severely fractured anterior teeth. However, the advanced formulations of composite resins present improved physical properties, an expanded range of shade selection, and high sculptability, allowing predictable restoration of the anterior dentition and replication of the polychromatic characteristics of natural teeth. The learning objective of this article is to present the utilization of composite resin materials in the treatment of fractured maxillary anterior incisors, implementing the concepts of polychromatic characteristics, hue, translucency, opacity, chroma, value, strength, and polishability. Also presented are several practical clinical observations that will assist the practitioner in attaining predictable aesthetic results with composite resin material.

Protocol for predictable restoration of anterior teeth with composite resins

The composite resins have reached a high degree of excellence and are now utilized with predictable results in restoring the anterior dentition. This article discusses the development of these resins and the histologic and optical considerations (polychromatic characteristics, hue, translucency and opacity, chroma, value, strength, and polishability). In restorative materials, the use of universal or all-purpose restorative resins is considered, ie, materials that combine the functional strength necessary for the posterior regions and the high gloss polishability necessary to emulate enamel in the anterior. The restorative sequence of cervical, middle, and incisal thirds describes the materials best suited for each third, along with aids to create the intricate refinement of hue, chroma, and value. The learning objective of this article is to review the principles involved in these restorations and to provide a protocol for their clinical implementation.

Shortie matrix and complex Class IV composite resin restoration

Clinicians face a dilemma treating anterior teeth severely damaged by caries or fracture. The ideal treatment in many cases would be a full veneer crown. A restorative procedure that satisfies biologic and esthetic considerations is generally not difficult for the experienced clinician. But such a treatment path may be reevaluated because of financial considerations, tooth prognosis, and planned treatment of teeth. Perhaps the most critical issue in the restorative procedure is the role the faciolingual contour of the junctional epithelium (epithelium attachment) plays in matrix adaptation. This article offers the clinician the rationale and technique to utilize the Original Tofflemeier matrix #2 in large Class IV cavity preparation.

The invisible Class IV restoration

Advances in bonding technology have allowed the dentist to create truly esthetic restorations. However, some clinical situations still present difficult esthetic challenges. A common area of difficulty is the maxillary Class IV, where the interface between restorative material and tooth structure is frequently visible. Using a combination of composite resins, the authors present a technique for solving this problem to create esthetic, natural-looking Class IV restorations.