Quintessence International, 02/1990

This report describes the surgical and orthodontic management of a 3-year old girl with an unerupted primary maxillary second molar impacted by an odontoma and a dentigerous cyst. Following surgical removal of the odontoma and dentigerous cyst, further surgical intervention and orthodontic traction were required to bring the primary maxillary second molar into correct occlusion with resultant proper functioning and good periodontal health.

A technique for restoration of carious primary maxillary incisors with a hybrid visible light-curing composite resin and a dentinal bonding agent is described, Careful use of this technique and the new materials can provide a restoration that is esthetic and resistant to fracture and displacement. The technique requires careful preparation of the operative field and precise handling of the restorative materials. The method is illustrated by the placement of bonded composite resin crowns in a 3-year-old boy.

Ulcerations are common occurrences in the mouth. Causes include physical trauma, radiation, chemical injury, and microbial infection (bacterial, viral, and fungal). Some ulcerations, such as recurrent aphthous stomatitis, Behçet's syndrome, and erythema multiforme, are of uncertain etiology, whereas others (eg. pemphigus, pemphigoid) are apparently of immunologic origin. Malignant neoplasms also may present as ulcerations. Because the natural history and treatment varies with the diagnosis, the practitioner should become familiar with the clinical appearance of the various types of ulcerations so that appropriate treatment can be instituted.

Inflammatory papillary hyperplasia is a benign lesion of the palate seen most often in patients with a history of ill-fitting dentures or poor oral hygiene. The specific cause is unknown. Inflammatory papillary hyperplasia can occur at any age. However, it is most often seen in patients in the third to fifth decades. It occurs more frequently in males and whites. The best treatment is surgical removal. The prognosis is excellent, once the lesion is removed. The patient presented in this case report is a 10-year-old black girl without a history of a dental prosthesis. It is conjectured that poor oral hygiene and a habit of mouth breathing contributed to the occurrence of inflammatory papillary hyperplasia in this patient. The lesion was surgically removed, and the patient was followed up for a period of 18 months without recurrence of the lesion.

Patients receive varying types and amounts of restorative treatment, depending on the prescribing dentist. The aim of this study was to enhance the understanding of the variation of the restoration replacement practices of dentists. Three dentists in private practice in similar semirural communities with comparable practice demographics were asked to gather data on all restorations they replaced over a period of 1 month. They recorded the tooth number, number of restored surfaces, restorative material being replaced, number of surfaces in the replacement restoration, the replacement restorative material, and the reasons for the replacement restoration. Statistically significant differences were found among the dentists as to the reasons for posterior restoration replacement, replacement materials used, and increase in size of the replacement restorations. Differences were attributed to individual practice philosophies, demonstrating that clinical information was not the sole determining factor as to type of replacement restorations that patients received.

Glass-ionomer cements, with their ability to bond to dentin, have been reported to produce less microleakage than several other restorative resin materials. This matched-pair study reports the effect on microleakage of placement of a light-curing glass-ionomer cement used as a liner when extended out to the dentinal cervical cavosurface margin or held short of that margin. Pairs of circular Class V cavities involving 50% enamel, with bevel, and 50% cementum were cut in 31 extracted third molars. After placement of the glass-ionomer cement, etching of the bevel, and placement of a resin bonding system, microfilled resin was placed over the bonding agent in one increment, light-cured, finished, and given 500 thermocycled 500 times between 5 and 55 degrees C. A silver nitrate staining technique was used to evaluate microleakage measured in graticular units (gu) along the dentinal interface under stereomicroscopy. The extension of the glass-ionomer liner out to the dentinal cavosurface margin did not significantly improve microleakage performance compared to performance of the liner when it was placed short of that margin and covered by a resin veneer. From other considerations, such as the potential for mechanical breakdown of the glass-ionomer cement when exposed to the oral environment and abrasion, and the possibility for improved esthetics, the clinician should consider holding the glass-ionomer liner short of the dentinal cavosurface margin and covering it with a composite resin veneer of a thickness consistent with structural integrity.

Two composite resin materials were clinically evaluated after 12 years in vivo. Although the Class III restorations did not have the benefit of acid etching and bevels, all 32 restorations in the nine patients who were located were intact, and none needed to be replaced. Stain was the most prominent problem, both at the margins and on the surface of the restorations. Neither wear or marginal integrity appeared to be a problem.

The use of a bar, joined to lone-standing abutment teeth, that spans an edentulous space is an important treatment option for many partially edentulous situations. The splint bar provides positive vertical support for the removable partial denture while rigidly splinting the abutment teeth. This article defines the situations in which this treatment should be considered and describes the technique to achieve a successful result.

The Type II restorative esthetic glass-ionomer cement has not been generally regarded as a useful esthetic restorative. However, as long as its relatively slow-setting chemistry is understood and accepted and provision is made to maintain the water balance for the first 24 hours, it can be just as useful as composite resin. Taking into account the fluoride release, its tissue compatibility, and the chemical union with underlying tooth structure that is available, it is suggested that it has a valuable place in restorative routines. Manufacturers have been encouraged recently to try to produce a fast-setting cement that can be polished at the insertion appointment. A varnish to seal newly placed restorations is supplied by most manufacturers, but these are not completely waterproof. A low-viscosity, single-component, light-activated resin bonding agent has been shown to work satisfactorily as a sealant, and, with its use, it is possible to develop adequate translucency and optimal physical properties in the oral cavity.

The most conservative cavity preparation, which takes full advantage of chemically adhesive composite resin, involves removal of only the infected outer carious dentin that is stainable by the caries detector. This preparation exposes in the cavity floor either the turbid layer at the top of the inner carious dentin or the underlying transparent layer. Examination by scanning electron microscope revealed that etching the cavity floor demineralized the intertubular dentinal surface slightly and produced tapered, cylindrical holes or ring-shaped holes at the dentinal tubule apertures of the turbid or transparent layer, respectively. The holes were blind with solid floors of intratubular crystal deposits of the transparent layer, suggesting that etching increases permeability little. Placement of the adhesive resin on the etched cavity floors produced a resin-impregnated dentinal layer and tapered, cylindrical or tubular-shaped resin tags, which apparently improved the bond and tubule aperture seal.

This paper explores the possibility that the inflammatory response in pulpal tissues noted in some early studies when dentin was treated with phosphoric acid was not caused by the acid. It suggests that the inflammatory response was caused by the prolonged exposure to zinc oxide-eugenol and documents many reports that show ZOE to be a relatively toxic material. The paper also suggests that biocompatibility studies as performed today may be inappropriate.

Dental care systems are predominantly based on the engineering and curative approach to the body, which does not necessarily improve dental health. In many western countries, including some developing countries, tooth loss is still prevalent amid sophisticated systems of dental care. The two major dental diseases, dental caries and periodontal disease, are almost entirely preventable. Against this background, a dental care system should encourage those working in it to apply known effective methods to improve and maintain the oral health of the population. The perceptions of people toward dental health have long been disregarded by the profession, to the extent that individuals are victim-blamed, irrespective of the existing socioenvironmental factors that may influence an individual's attitude towards dental services. The community must be involved in the planning and decision-making processes of any health service program to facilitate cooperation by the population