Quintessence International, 03/2005

Objective: The purpose of this in vitro study was to determine the effect of residual cariesdisclosing dyes on a dentinal adhesive system and accompanying resin composite, using microleakage as the quantifying criterion. Method and Materials: The dye pretreatment groups (10 teeth in each group, n = 60) were as follows: Group 1, Caries Detector; group 2, Cari-d-tect; group 3, Seek; group 4, Snoop; group 5, To Dye For; and group 6, control (no dye pretreatment). Circular preparations were cut on the facial or lingual surface of each tooth. Caries-disclosing dyes were placed on the preparations; this was followed by treatment with 35% phosphoric acid etchant, application of a Single-Bond adhesive, and insertion of Z-100 hybrid resin composite. Following thermocycling, the teeth were sealed with nail varnish, placed in methylene blue dye, invested in acrylic resin, labeled, and sectioned. Leakage was examined (20$ magnification) by dye penetration at the occlusal and gingival surface positions of the specimen blocks using an ordinal ranking system. The data were analyzed using two-way analysis of variance with P < .05 as the significance level. Results: Results of the study showed that, at the occlusal surface position of the restorations, significantly greater leakage was exhibited by To Dye For compared to Snoop. At the gingival surface position, significantly greater leakage was exhibited by: (1) Caries Detector, Cari-d-tect, Seek, and To Dye For compared to the controls; and (2) To Dye For compared to Snoop. When comparing the same dye pretreatment groups with respect to occlusal versus gingival surface positions, significantly greater leakage was exhibited at the gingival surface positions, except for the control group. Conclusion: Our data showed that all dye groups leaked (except Snoop at the occlusal surface position), and significantly greater leakage was exhibited at the gingival surface position of all groups except the control. Snoop revealed the least leakage of all the dyes tested. Keywords: caries disclosing dye, dental adhesives, dental caries, microleakage, resin composites

Objective: To compare enamel and dentin microleakage of three single-bottle dentin-bonding agents (DBA) (One-Step, Single Bond, and Dentamed P&B) on teeth that were then subjected to thermocycling and occlusal loading. Method and materials: Class 5 cavities were prepared on the buccal and lingual surfaces of 30 extracted human molars and divided into three groups. The occlusal margins were in enamel, and the cervical margins were in cementum. DBA were applied strictly according to the manufacturers' recommendations, and the preparations were restored with resin composite. Specimens were subjected to 2,000 intermittent occlusal loads and 3,000 thermocycles and then immersed in 0.5% basic fuchsin dye for 72 hours. Four consecutive sections were cut for each specimen and examined under a stereomicroscope. The extent of dye penetration was measured and recorded using a nonparametric scale from 0 to 4. Results: The Mann-Whitney U test showed a significant difference at cementum margins between One-Step and Dentamed P&B, as well as between Single Bond and Dentamed P&B, and an insignificant difference between Single Bond and One-Step. There was no significant difference in dye penetration at enamel margins between the three DBA. Conclusion: Under combined use of occlusal loads and thermocycling, the sealing ability of single-bottle DBA at dentin margins ranged from good for One-Step to moderate for Single Bond to poor for Dentamed P&B. At enamel margins, all materials performed equally well. Keywords: dentin-bonding agents, microleakage, occlusal loading, thermocycling

Objective: The aim of this study was to compare the effectiveness and caries-preventive effects of a fluoride varnish (Fluor Protector; 0.1% fluoride) and a chlorhexidine varnish (Cervitec; 1% chlorhexidine and 1% thymol) on initial caries of occlusal fissures and to monitor the durability of the varnishes by the use of a fluorescence system, DIAGNOdent (Dd). Method and materials: Nineteen subjects underwent professional tooth cleaning at the beginning of the study. Afterward, fluorescence measurements (baseline) were obtained from 56 test sites and 28 control sites on the central fossae of molars. Each subject had Fluor Protector and Cervitec application on randomly assigned experimental teeth, and applications were followed by Dd measurements. Measurements were repeated after 1 and 6 months. Results: There was an increase in fluorescence values immediately after application of varnish in the two test groups. One month after varnish application, Dd scores for group Fluor Protector were not significantly different from Dd scores obtained immediately after application (P = .108), whereas Dd scores for group Cervitec decreased significantly (P = .007). For both test groups, there was a significant decrease between the values obtained immediately after application and those acquired after 6 months. There was also a significant decrease between 1 month and 6 months for test groups and a slight but significant increase for the control group (P = .011). No significant difference was found between the Fluor Protector and Cervitec groups after 6 months. Conclusion: It was concluded that the Dd system may be used to monitor the existence of these two varnishes. Keywords: chlorhexidine, dental caries, diagnosis, fluoride, laser fluorescence

The esthetic treatment of anterior teeth with porcelain veneers is a conservative and lasting treatment option. When the tooth is severely discolored, the clinician must choose a ceramic system very carefully, because translucent materials, such as hot-pressed ceramic, require excessive reduction of the dental structure to mask the discoloration. This article describes a technique in which discolored teeth were masked in a conservative and esthetically pleasing way with feldspathic porcelain veneers. Keywords: dental acid etching, dental ceramics, luting cements, porcelain veneer

Objectives: The aim of this study was to compare the onset and duration of pulpal anesthesia by maxillary infiltration using 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:200,000 epinephrine, and 4% articaine with 1:100,000 epinephrine. Method and Materials: Twenty healthy patients randomly received 1.8 mL of one of the three local anesthetics during operative dentistry procedures of low complexity on three maxillary posterior teeth. Onset and duration were determined using an electric pulp tester. Results: The mean values for pulpal onset were 2.8, 1.6, and 1.4 minutes and for pulpal duration were 39.2, 56.7, and 66.3 minutes, respectively, for 2% lidocaine with 1:100,000 epinephrine, 4% articaine with 1:200,000 epinephrine, and 4% articaine with 1:100,000 epinephrine. Statistical analysis by the Kruskal-Wallis nonparametric test showed significant differences with better results (shorter onset and longer duration periods) for both articaine solutions compared with the lidocaine solution. Although 4% articaine with 1:100,000 epinephrine clinically presented the shortest onset and the longest duration periods, there was no statistically significant difference between the articaine solutions. Conclusion: Both articaine solutions produced shorter onset and longer duration of pulpal anesthesia by maxillary infiltration than the lidocaine solution did. Statistical analysis did not confirm better clinical results of 4% articaine with 1:100,000 epinephrine than with 4% articaine with1:200,000 epinephrine. Keywords: articaine, dental anesthesia, dental pulp, epinephrine, lidocaine

Objectives: To evaluate the distribution of morphologic types of subgingival calculus at different parts of the proximal root surface. Method and materials: Ninety extracted teeth from 29 chronic periodontitis patients were collected. The mean pocket depths and periodontal attachment levels of the extracted teeth were 5.93 ± 1.51 mm and 7.82 ± 1.75 mm, respectively. The proximal root surfaces below the gingival margin were divided into three parts in an apicocoronal direction, and each of these portions was further divided into three parts in a buccolingual direction. Subgingival calculus present was classified as: 1 = crusty, spiny, or nodular; 2 = ledge or ring; 3 = thin, smooth veneers; 4 = finger- or fernlike; 5 = individual calculus islands/spots; or 6 = supramarginal upon submarginal deposits. The distribution of different morphologic types of subgingival calculus on each division of the mesial and distal proximal root surfaces was evaluated with a magnifier. Results: Regardless of the morphologic type, calculus deposits were observed at around 30% of proximal root surfaces. The coronal thirds of the root surfaces were found to have significantly more calculus deposits than the middle thirds (P < .05). In general, it was observed that most of the deposits were of the thin, smooth veneer type on all root surfaces. Conclusion: Within the limits of this study, the distribution of various calculus types was similar on different parts of the root surface; however, calculus was found more frequently on the coronal thirds than on the more apical regions. Keywords: dental calculus, incisor, premolar, tooth root

Cardiovascular diseases are the leading cause of death in the United States and most other Western countries. In the United States alone, more than 1 million annual deaths and as many as three times that number of serious consequences can be attributed to these conditions. To provide care to patients with cardiovascular disease, oral health care providers must understand the disease, its treatment, and its impact on the patient's ability to undergo and respond to dental care. Keywords: cardiac arrhythmia, coronary artery disease, dental management, heart failure, hypertension, oral disease, thromboembolism

Objective: The purpose of this study was to compare the periodontal status and prevalence of sulcular Candida albicans between subjects with primary Sjögren's Syndrome (SS-1) and healthy control subjects. Material and Methods: Ten SS-1 subjects and 10 age- and sex-matched control subjects were recruited. All subjects met the comprehensive European Community Criteria for primary Sjögren's Syndrome. Periodontal probing depth (PD), clinical attachment loss (CAL), plaque and gingivitis were scored on index teeth in each subject. Gingival crevicular fluid (GCF) volume was measured from the same teeth using Periopaper strips. Candida albicans presence was determined by plating paper strips directly into culture media tubes (Oricult kit). Results: Despite having similar mean PD measures and gingivitis and plaque scores, SS-1 subjects who had Sjögren's Syndrome for a mean of 8.8 years had significantly more CAL (5.4 mm vs 2.7 mm; P < .01) and GCF (101.3 ± 4.25 µL vs 33.0 ± 1.91 µL; P < .001) than healthy control subjects. Candida albicans was detected in the sulci of only one SS-1 subject and in none of the control subjects. Conclusion: These data indicate that the cohort of the SS-1 patients in this particular study have significantly more gingival recession and GCF than do control subjects. The increased attachment loss in SS-1 patients is not attributed to an increase in colonization of the gingival sulci by Candida albicans organisms. Keywords: Candida albicans, gingival crevicular fluid, periodontal disease, Sjögren's Syndrome

Traumatic injury to teeth presents a considerable challenge for the practitioner. Very often a variety of oral tissues are involved, such as enamel, dentin, periodontal ligament, alveolar bone, and mucosa. Extraoral lesions are often another focus of attention for the patient and the practitioner. To cover all these various demands and necessities in a proper and adequate manner, a sound knowledge and experience of many different dental fields is needed. This case report presents the treatment of an 8-year-old girl during which surgical, restorative, endodontic, and orthodontic practices cooperated to achieve an adequate rehabilitation of the patient. Keywords: endodontics, orthodontics, restorative dentistry, surgery, traumatic injury