Quintessence International, 10/1992

Most dentists are well aware of the value of the rubber dam in allowing technical excellence; however, few recognize the potential for protecting the dentist and staff against the ever-growing number of carriers of the hepatitis and human immunodeficiency viruses. The effectiveness of the rubber dam as an isolation barrier is dependent on the consistency of its application. Sporadic rubber dam application is therefore a weak link in an infection control program. This paper describes additional modified utilizations of rubber dam, uses that are generally not attempted with restrictive orthodox application methods. In addition,practical hints on other means of retention are offered, with the emphasis on nuisance-free and easy application.

Assessment of occlusal fissure systems and restorations of amalgam in 100 extracted teeth were carried out by four examiners. An initial assessment, made with the naked eye, was repeated with binocular magnification (x 3). The data indicated that restorative decision-making behavior was modified when magnification was used, with an increase in the number of restorations planned for replacement and an increase in the number of tooth surfaces planned for restoration. Statistical analysis indicated that one of the examiners was particularly sensitive to the use of magnification and modified his treatment planning behavior considerably. As part of the process of adapting to the use of magnification, clinicians should review their decision-making behavior.

Vital tooth bleaching has become a popular and successful treatment. This treatment may be performed under controlled conditions in the dental office or it may be used under monitored, prescribed conditions with a 10% or 15% carbamide peroxide solution, applied by the patient at home. This paper presents the use of both types of systems in a unique application to modify the color of the natural dentition to match that of existing restorations.

Bonded glass-ionomer-silver-cermet cement and visible light-hardened glass-ionomer liner and base material have proven to be reliable dentinal and enamel restoratives since the mid-1980s. When used within their limitations, they offer advantages over mechanically interlocked silver amalgam material. A light-hardened glass-ionomer-resin cement restorative material, which appears to have greater wear resistance and fracture toughness than prior glass-ionomer cements, has been introduced. This paper describes use of the new material and discusses its potential future implications.

Trauma to primary incisors is common and poses a challenge to dentists who treat children. Often, the clinical appearance of such teeth does not indicate the underlying pathosis. In this case, a dentigerous cyst developed in association with an injured primary incisor, resulting in loss of a permanent tooth.

For those patients presenting with one or more missing incisors, a sequential technique utilizing specific arch wires to level and align the irregular incisor teeth may be used. Auxiliary coil springs are then fitted to redistribute the space prior to the preparation of a prosthesis, the fabrication of which is facilitated by parallel and upright abutments. The space obtained allows esthetically proportioned pontics. Two cases that illustrate this technique are presented.

Orthodontic therapy with fixed appliances bears a high risk of plaque accumulation, resulting in demineralization and new carious lesions. Rather than treat incipient lesions in orthodontic patients, most general dental practitioners decide to await future developments. A new concept for comprehensive restorative and endodontic treatment is presented, and its orthodontic implications are discussed.

The Self Assessment Manual and standards if produced by the Faculty of General Dental Practitioners of the Royal Colege of Surgeons of England and the Department of Health as part of a clinical audit program. It is a self-help manual containing a set of clinical standards in 15 aspects of patient care. The standards are concerned with clinical otucomes, rather than techniques, and are intended to be educational, not regulatory. The book's contents and applications are described in detail, together with its political background and possible use in an international context.

Two formulations of posterior composite resin (P-30 and Bisfil-P) were evaluated and compared to a high-copper, disper sed-phase amalgam (Dispersalloy). One hundred twenty-eight restorations were placed in 27 patients so that each patient received at least one of each material. After 3 years of clinical service, all three restorative materials produced clinically acceptable restorations, according to US Public Health Service and Leinfelder criteria. The amalgam restorations, however, underwent less wear (44 um) than did the posterior composite resin restorations (60 to 74 um). Stratification of data by type of tooth, class of restoration, and size of restoration produced the same ranking of wear from lowest to highest: Disp ersalloy, Bisfil-P, and P-30. Resin restorations showed 45% more wear in moars than in premolars, and more wear was associated with moderately sized restorations than with conservative restorations. The surface texture of restorations of composite resin with porous strontium glass filler was nearly as smooth as that of enamel and was significantly smoother than that of the restorations of composite resin with zinc glass filler or of unpolished amalgam.

A simple and safe method of achieving hemostasis after tooth extraction in patients on anticoagulant therapy is described. The use of a tissue sealant turns a complicated, difficult, and risky dental procedure into a simple one, suitable for any dental clinic. Sixty-one teeth were extracted in 23 sessions. Only four cases of very slight postsurgical bleeding were reported. Dental treatment of the majority of these medically compromised peopl e can be performed by private practitioners, without referring the patients to specialty care centers.