Quintessence International, 04/1999

This article, through presentation of case studies, defines differences and suggests separate definitions for the terms cosmetic dentistry and esthetic dentistry. Dentistry strives to emulate harmonious form and function for therapy, and modification of appearance is an integral part of dental treatment. Cosmetic dentistry suggests a certain accommodation and is a compromise of current technology. Cosmetic dentistry is commonly selected as an interim procedure that does not necessarily function ideally and does not always emulate the pristine state of a natural dentition. Esthetic dentistry requires less accommodation, incorporates acceptable biologic technology for long-term survival, functions suitably, and mimics the pristine state of the natural dentition. Cosmetic and esthetic dentistry are different in definition, concept, and execution.

Objective: This study examined the reasons given by vocational dental practitioners and their trainers for placement and replacement of restorations. Methods and materials: Each participant was asked to record the reason for placement or replacement of restorations. The age and class of the restoration being replaced were also recorded, as was the material being used and the material being replaced (if known). Results: Details of the reason for placement or replacement was received on 9.031 restorations. Of the restorations placed, 53.9% were amalgam, 29.8% were resin composite, and 16.3% were glass-ionomer cement. The reasons for placement or replacement of the restorations were principally primary caries (41.3%), secondary caries (21.9%), tooth fracture (6.4%), marginal fracture or degradation (6.1%), and noncarious defects (5.8%). Of the amalgam restorations, most were placed to restore Class II and Class I preparations (65.8% and 29.9%, respectively). Of the composite restorations, most were placed in Class III and Class V cavities (35.5% and 26.3%, respectively). Glass-ionomer cement was used predominantly to restore Class V cavities (63.5%). Conclusion: Secondary caries was the most prevalent reason for replacement of restorations, regardless of material. Statistical analysis indicated that amalgam provided significantly greater longevity than composite or glass-ionomer materials.

Teeth in the mandibular anterior region of the mouth, affected by years of periodontal disease and resultant bone loss, frequently require treatment for the patient to be able to chew comfortably and effectively. Often patients choose to keep compromised teeth, despite being persented with treatment options involving a fixed or removable prosthesis. In these situations, mechanical stabilization becomes necessary. Current treatment possibilities include bonding with resin composite or placement of a bonded metal mesh splint, a cast metal resin-bonded retainer, or a fiber-reinforced resin composite splint. Coupled with good oral hygiene practices, these mechanical stabilization techniques can provide increased oral comfort and improved function, especially for geriatric dental patients.

There is increasing reliance on laboratory testing of new products. The clinical significance of many such studies can be questioned. To function clinically, bond strength must develop more quickly than the shrinkage stress. Oxygen inhibition of extremely thin resin layers prohibits establishment of the bond, perhaps particularly relevant for single-component dentin bonding agents. Use of thicker layers of radiolucent hydrophilic bonding materials can lead to difficulties during subsequent radiographic diagnosis and may contribute to degradation at enamel margins. Shrinkage and modulus kinetics are also critical, involving variables such as content and type of monomers, the catalyst system, and the light intensity. In general, a high modulus of elasticity or more rapid polymerization leads to increased shrinkage stress. Combining a single-component adhesive as a dentin primer with a highly radiopaque flowable resin composite as a filled adhesive may help overcome these difficulties.

The tongue is an important oral structure that affects speech, the position of teeth, periodontal tissue, nutrition, swallowing, nursing, and certain social activities. Ankyloglossia (tongue-tie) limits the range of motion of the tongue, impairing its ability to fulfill its functions. In this article, diagnostic criteria needed to evaluate and treat ankyloglossia are suggested, and a method for classifying ankyloglossia is proposed.

Cat-scratch disease is the most common cause of benign lymphadenopathy in children and young adults. A 21-year-old patient presented with a 14-day history of asymptomatic left submental swelling. Clinical and radiographic examination revealed no dental cause. An enlarged, firm nodule was excised. The histopathologic appearance was consistent with cat-scratch disease. This article summarizes the relevant literature and discusses diagnosis and treatment of cat-scratch disease.

Objective: This study was undertaken to verify the hypothesis that dentin surfaces are demineralized during placement of four kinds of chemcially setting cements (zinc phosphate cement, luting lgass-ionomer cement, restorative glass-ionomer cement, and zinc polycarboxylate cement). Method and materials: Sixty cemented dentin disks were observed under scanning electron microscopy and with confocal laser scanning micrscopy after use of an argon-ion etching technique. To determine the surface effects of the cements, 30 dentin surfaces were treated with 1 of 6 freshly mixed cements (5 per group) for 60 seconds. The disks were subjected to rinsing with a water spray and ultrasonic wasing prior to scanning electron microscopic observation. Results: Observation of cemented dnetin specimens revealed that the dentin was not completely demineralized at the interface formed by the cement and dentin and that the extent and depth of demineralization along the interface tended to be nonuniform. Zinc phosphate cement caused the greatest demineralization of dentin, followed by luting glass-ionomer cement. The extent of demineralization with restorative glass-ionomer cement or zinc polycarboxylate cement was less discernible. Confocal laser scanning microscopy generally confirmed scanning electron microscopic observations and revealed that most of the specimens showed close adaptation of the cements to the dentin surfaces. Conclusion: Acid-containing cements have slef-etching properties that are effective, to various degrees, in removing the smear layer and promoting close adaptation to dentin surfaces.