Quintessence International, 05/2002

Direct adhesive resin composite restorations in posterior teeth are now a reality thanks to improvements in these restorative materials and adhesive techniques. However, correct selection and application of materials are vastly important to clinical success. Two restorative techniques are described in detail, in one, a low-viscosity resin composite is placed incrementally, and in the other a condensable resin composite is placed in bulk. The former allows for greater security, because it is more traditional and has already proved to have clinical longevity; the latter has the advantage of being a quicker and simpler procedure. However, both techniques provide restorations that faithfully copy the dental tissues and have all the advantages of adhesive procedures.

Objective: The purpose of this study was to assess the effects of topical fluoride agents on enamel erosion in vitro. Method and materials: Ten premolars extracted for orthodontic purposes were sectioned buccolingually and then longitudinally into two parts, so that four specimens were obtained from each tooth. The specimens were randomly assigned to one of four groups. The following topical fluoride agents were applied to the specimens: 1% titanium tetrafluoride (0.32 MF) for 1 minute; Duraphat (2.26% F) and Elmex (1.25% F) for 4 minutes. In the control group, no solution was applied. The specimens were treated with an artificial caries solution for 4, 8, 12, and 16 days. Calcium (Ca++) concentration was determined by an atomic absorbtion spectrophotometer, while fluoride (F-) concentration was determined with an ion-selective electrode. One-way analysis of variance tests were performed on cumulative concentrations of calcium and fluoride at days 4, 8, 12, and 16. Results: Specimens treated with titanium tetrafluoride lost significantly less calcium than did specimens in the other two test groups at all time periods. Titanium tetrafluoride-treated specimens released significantly less fluoride than did Duraphat- or Elmex-treated specimens at day 16. Conclusion: Titanium tetrafluoride was found to be more effective than the other fluoride agents in preventing artificial enamel lesion formation.

When all-ceramic systems are used, a respect for biocompatibility, an understanding of the patient's esthetic demands, and a justifiable reliance on the strength of the selected system are integral to success. Severely damaged molar teeth in two patients were restored with all-ceramic onlays that were prepared with a copy-milling system for ceramics. The onlay patterns were fabricated directly in the mouth with autopolymerizing resin. For these patients, the use of biologic, all-ceramic, copy-milled restorations resulted in clinical success as well as recovered function and esthetics.

Direct and indirect fiber-reinforced resin composite fixed partial dentures are a new way to produce minimally invasive, esthetic, and cost-effective metal-free tooth replacements. These treatment alternatives have a number of indications, for example, chairside tooth replacements, long-term provisional fixed partial dentures, economically feasible tooth replacements for patients who cannot afford more traditional treatment regimens, and tooth replacements for medically compromised patients who are unable to withstand the physical stress associated with fabrication of traditional fixed prostheses. This article presents four typical cases in which fiber-reinforced fixed partial dentures seemed to be the preferable treatment modality.

Enamel microabrasion is a proven method of removing intrinsic and superficial defects from teeth, establishing esthetics with minimal loss of dental enamel. This article reports one case in which two different microabrasion techniques were used to remove fluorotic stains from teeth.

Objective: The purpose of this in vitro study was to evaluate the microhardness of human dentin exposed to two 10% carbamide peroxide agents at different bleaching times. Method and materials: Opalescence 10% and Rembrandt 10% were tested. A placebo agent was used as a control group. The bleaching and placebo agents were applied to the surface of human dentin fragments for 8 hours and then stored in individual receptacles with artificial saliva for the remaining 16 hours each day. Microhardness testing was performed at baseline, after 8 hours, 7, 14, 21, 28, 35, and 42 days of treatment, and 7 and 14 days posttreatment. Results: Analysis of Variance and the Tukey test revealed significant differences in microhardness values for dentin treated with the agents within each time interval. There was a decrease in the microhardness values of dentin for both bleaching agents after 8 hours of treatment. Fourteen days after the completion of treatment, the microhardness values for dentinal surfaces treated with either Opalescence or Rembrandt reached the baseline values; the dentinal surfaces treated with a placebo exhibited an increase in microhardness values posttreatment. Conclusion: Ten percent carbamide peroxide bleaching agents decreased dentinal microhardness over time, but after 14 days in artificial saliva storage at the completion of treatment, the baseline microhardness values were recovered.

Health care providers are at risk for infection with bloodborne pathogens, including hepatitis B virus, human immunodeficiency virus, and hepatitis C virus. Recommended infection control practices are applicable to all settings in which dental treatment is provided. Dentists remain at low risk for occupationally acquired human immunodeficiency virus. Dental health care workers, through occupational exposure, may have a 10 times greater risk of becoming a chronic hepatitis B carrier than the average citizen. Tuberculosis is caused by Mycobacterium tuberculosis. In general, persons suspected of having pulmonary or laryngeal tuberculosis should be considered infectious if they are coughing, are undergoing cough-inducing or aerosol-generating procedures, or have sputum smears positive for acid-fast bacilli. Although the possibility of transmission of bloodborne infections from dental health care workers to patients is considered to be small, precise risks have not been quantified by carefully designed epidemiologic studies. Emphasis should be placed on consistent adherence to recommended infection control strategies, including the use of protective barriers and appropriate methods of sterilization or disinfection. Each dental facility should develop a written protocol for instrument reprocessing, operatory cleanup, and management of injuries. Such efforts may lead to the development of safer and more effective medical devices, work practices, and personal protective equipment.

Implant restorations must fulfill the functional and esthetic demands of the patient. The discrepancy in the diameters of an implant and a natural tooth often leads to compromise. The use of prefabricated abutments that can be individually modified offers certain advantages. Selection and modification of the abutment are simpler when a waxup of the restoration is used as a guideline. This article describes a laboratory technique in which the implant abutment is selected and modified according to the waxup of the restoration.

Periodontal disease is a chronic disease that is perceived by many patients to be nonthreatening. Periodontal therapy has been shown to be less effective if a regular periodontal maintenance schedule is not followed after completion of active therapy. Periodontal maintenance is an integral part of successful periodontal therapy.

A patient with a successfully treated primary osteosarcoma of the tibia experienced an isolated maxillary metastasis, which is an extremely rare entity. Once the tumor was confirmed histopathologically, a total maxillectomy and adjuvant chemoradiation therapy were carried out. There has been no local recurrence or distant metastasis for 1 year. A multimodality therapeutic approach is essential when these patients are treated. Surgery is the gold standard of treatment in operable cases. Adjuvant treatment is required to prevent local recurrence and distant metastasis.