A comparative study of the diagnostic accuracy of cone beam computed tomography and intraoral radiographic modalities for the detection of noncavitated caries.

OBJECTIVES: The aim of this study was to determine the diagnostic accuracy of cone beam computed tomography (CBCT) in the detection of approximal and occlusal noncavitated carious lesions. METHODS: A total of 135 extracted human posterior teeth were used. They were radiographed using the following: conventional film (Kodak Insight), a digital system (PSP plates Digora Optime, Soredex), and a CBCT system (NewTom 3G, Quantitative Radiology). All the images were assessed by two independent observers twice. Receiver operating characteristic analysis (Az) was used. RESULTS: NewTom 3G 9″ CBCT was statistically inferior to conventional film and a digital system for the detection of approximal caries. NewTom 3G 9″ had significantly higher Az values than PSP plate (p < 0.05), but there were no statistically significant differences between the Az values for CBCT and film (p > 0.33) for occlusal surface caries. CONCLUSION: The diagnostic accuracy of all three tested radiographic systems is low, and it is necessary to use other methods to improve early caries detection. CLINICAL RELEVANCE: CBCT has found a wide application in different fields of dentistry. The report from a CBCT examination performed for any of these reasons should include all abnormal findings, and the detection of noncavitated caries lesions is especially important because it facilitates the use of noninvasive treatment.

Evaluation of the retentive characteristics of semi-precision extracoronal attachments.

The aims of this in vitro study were: to evaluate the repeatability of producing the semi-precision attachment; to establish their estimated longevity by a simulated, repeated denture placement/removal procedure of denture; and to investigate the wear of their components. Four types of semi-precision attachments were evaluated. The attachments represented polymer-to-metal type of friction: Vario-Kugel-Snap, Vario-Soft, Strategy OT and ASC-52, which exhibited metal-to-metal type of friction. Tensile dislodging force was applied to sample to register peak load-to-dislodgment and also to determine the displacement curve. Then the cyclic axial loading tests were performed with insertion/separation machine. To detect worn areas, the surface of each sample was examined under a scanning electron microscope. The large variability of initial retentive force and shape of displacement curves was noted within Vario-Soft and Vario-Kugel-Snap group. After the first period of loading (up to 300 cycles), the mechanical properties of all samples were stabilised. The mean retention force of attachments with polymer matrix after 3000 cycles was approximately half the recommended value, while samples of ASC-52 (with metal-to-metal friction) withstood 8000 cycles. Results suggest that the inaccuracies of casting and laboratory procedure have only limited influence on the fit of the semi-precision attachments. The attachment with metal-to-metal type of friction exhibits the highest wear resistance (simulated up to 8 years of usage) compared to attachments with polymeric matrix (up to 3 years). All attachments exhibited wear of metal patrix, what can minimise the chance of re-activation in a long run.

The clinical repair of teeth using direct filling materials: engineering considerations.

This paper reviews the way in which teeth damaged by caries may be repaired clinically. The mechanical effects of caries are described, as are the materials available to repair the damage caused by this disease. Studies are reported which have shown that caries reduces the compressive strength of the tooth to less than 50 per cent of its original value and that, by use of appropriate materials and placement techniques, this can be restored to some 80 per cent of this value. However, very few studies have been carried out which view tooth repair from an engineering perspective. Instead, emphasis is placed on determining clinical durability of repairs. This is related to repair strength but brings in other factors, such as the oral hygiene of the patient. Despite this complication, durability studies show that modern restorative materials perform well under clinical conditions, from which it may be concluded that the repair process allows a structure to be fabricated that is essentially sound from an engineering viewpoint, even if inferior to the original tooth structure provided by nature.

Microscopic evaluation of the interface between glass-ionomer cements and tooth structures prepared using conventional instruments and the atraumatic restorative treatment (ART) technique.

OBJECTIVE: The purpose of this study was to evaluate the effect of cavity preparation using hand instruments and conventional rotary instruments on the bonding of glass-ionomer cements to formerly carious teeth. METHOD AND MATERIALS: In 2 experimental groups (12 teeth each with primary caries) caries was removed and cavities prepared using hand instruments according to the atraumatic restorative treatment (ART) technique or conventional rotary instruments. In the control group (12 caries-free teeth) Class 1 cavities were prepared using conventional instrumentation. Cavities in all teeth were restored with 1 of the commercial glass-ionomer cements designed for use with the ART technique, either Fuji IX (GC) or Ketac Molar (3M Espe). After 21 days of storage in physiologic saline at 37 degrees C, 3 400-microm-thick slices from each tooth were stained using the Mallory method and evaluated using a light transmitting microscope. RESULTS: In all samples, a region of interaction was observed between the cement and dentin and enamel. However, the interface in teeth from which caries had been removed was different from that in the control group. All were stained using Mallory staining, but only teeth which had been carious showed coloration. No differences were found in intensity of color or appearance between the cavity preparation techniques. CONCLUSION: The occurrence of caries in a tooth alters the bonding behavior of glass ionomers to that tooth. The method of caries removal (ART or conventional preparation) does not influence the quality of the interface between a glass ionomer and either dentin or enamel.

[Smoking addiction and patients' motivation to quit it among attenders of the Saldent 2006 conference]. / Nalóg palenia i motywacja pacjentów do rzucenia nalogu wsr6ód uczestników konferencji Saldent 2006.

This paper presents the results of a survey carried out among those attending the Saldent 2006 conference. The questionnaire used for this purpose included questions concerning smoking among dentists, permission to smoke in the dental surgery, patients motivation to quit smoking, knowledge regarding the harmful effect of smoking on the oral cavity and the possible need for teaching preventive measures on the subject during under- and postgraduate education. The results showed that when compared with those obtained 6 years ago smoking among the dentists has declined. Answers to the questions concerning the influence of smoking on oral cavity showed a high awareness of this danger among the questionnaire respondents. Also the high number of dentists who are motivating patients against smoking confirms the opinion that in the planning of antismoking programs dentists can play a significant role.

The release of ions by compomers under neutral and acidic conditions.

Three commercial compomers have been studied for their interaction with aqueous solutions (i.e. water at pH 5.9 and lactic acid at pH 2.7). Light-cured discs of these materials (12.8 diameter x 1 mm depth; Dyract AP, Compoglass F and F2000) were prepared and stored in 5 cm(3) of either water or lactic acid at pH 2.7. After 1 week, mass changes, pH changes and ion-release were determined. For the specimens stored in water, the effect of maturation under neutral conditions was studied by continuing storage for 3 months, followed by storage in lactic acid for a further week after which ion release and pH change were determined. Student's t-test was used to determine statistical significance of any changes observed. All three cured compomers absorbed water and altered the pH of the solutions, though this was statistically significant only in lactic acid. They were found to release Na, Ca, Sr, Al, Si, P and F ions, with greater amounts being released in acidic conditions than neutral ones. More fluoride was released in acid than in water, but the proportion of free (uncomplexed) fluoride to bound (complexed) fluoride was much lower than in neutral conditions. This was attributed to the formation of strong complexes with aluminium. Maturing specimens for 3 months made very little difference to their interaction with the acid solution, except for the total release of fluoride, which was some two to three greater than from the immature specimens.

The interaction of glass-ionomer cements containing vinylphosphonic acid with water and aqueous lactic acid.

A glass-ionomer cement containing an acrylic acid/vinyl phosphonic acid copolymer, has been investigated for its interaction with water and with aqueous lactic acid and the results compared with those from conventional glass-ionomers based on polyacrylic acid. Cylindrical specimens (12 mm high x 6 mm diameter) were placed in 8 cm3 of aqueous lactic acid (20 mmol dm(-3); pH 2.7) for 1 week, at the end of which the pH was determined. Each specimen was then placed in a fresh 8 cm3 volume of lactic acid and the pH determined after a further week. This procedure was continued for a total of 13 weeks for each specimen. Experiments were also carried out on similar specimens exposed to 8 cm3 of water for 1 week only. Further experiments were carried out in which discs of cement were exposed to thin films (0.15 mm) of lactic acid at pH 4.5, with pH values determined at 30 s, 1, 2, 5 and 10 min. After 1 week, cements had changed the pH of the lactic acid to a mean value of 3.63 (SD 0.08) while in weeks 2-13 they changed it to a mean value of 3.31 (SD 0.11). After 1 week in aqueous lactic acid the cements had gained mass by a mean of 1.26% (SD 0.59%) compared with 1.22% (SD 0.14%) in water. After 13 weeks in lactic acid, cements had lost a mean of 2.83% (SD 0.74%) in mass. Thin films of aqueous lactic acid changed from pH 4.5-5.1 at 30 s and to a steady value of 5.6 (SD 0.3) between 2 and 10 min. These results were similar to those for conventional glass-ionomer cements based on carboxylic acid polymers. Hence, it was concluded that the presence of the vinylphosphonic acid units made no significant difference to the interaction of cements with aqueous solutions.

The rate of change of pH of lactic acid exposed to glass-ionomer dental cements.

The rate of change of pH of aqueous lactic acid at pH 4.2-4.5 (i.e. a little below that of active caries in vivo) in contact with disks of various commercial glass-ionomer cements has been determined in two configurations. In the first of them, a thin film set-up, 20 microl of solution was spread across the surface of a cement disk (diameter: 13 mm), and its pH determined by pressing a flat-ended electrode against the film at varying time intervals. In the second, a similar disk was immersed in 1.5 ml of solution, removed after varying time intervals, after which the pH of the solution was measured using a round-ended electrode. The latter measurement was more reliable, in that the pH electrode had time to equilibrate, whereas the former was more realistic because the film was approximately the same thickness as that of saliva on a tooth surface. Both series of experiments showed measurable differences in pH after only 30 s, with the thin-film configuration showing a range of pH changes of 0.5-1.2 units depending on the cement and the small volume configuration showing a range of 0.1-0.5 units, also depending on the cement. After 10 min, in the small volume experiments, the pH had generally increased further. The extent and speed of the change in pH led to the conclusion that ability of glass-ionomers to increase pH is likely to be an important mechanism of caries protection under clinical conditions.

A preliminary study of the effect of glass-ionomer and related dental cements on the pH of lactic acid storage solutions.

Glass-ionomer cements, both self-hardening and resin-modified, have been shown to increase the pH of lactic acid solutions in which they are stored. Similar results have been obtained for a zinc phosphate and a zinc polycarboxylate cement. The pH was increased over a period of 7 days by between 1.54 and 2.65 pH units from an initial value of pH of 2.60, depending on the cement. It is concluded that, as a result of this ability to neutralize surrounding aqueous solutions, these materials may have the beneficial effect in vivo of inhibiting caries development. In the case of glass-ionomers, this mechanism might complement that of fluoride release.

Storage of polyacid-modified resin composites ("compomers") in lactic acid solution.

OBJECTIVES: The aim of this study was to determine the interaction of four polyacid-modified resin composites with aqueous lactic acid solutions, and to compare changes with those for a glass-ionomer cement and a conventional resin composite. METHODS: For each material, namely Compoglass F, Dyract AP, Hytac and Ana Compomer, plus AquaCem (glass-ionomer cement) and Pekafil (conventional composite resin), five cylindrical specimens of 4 mm diameter x 6 mm height were prepared and weighed. They were stored individually in 2.0 cm3 of 0.02 mol l-1 lactic acid solution for 1 week then the pH was determined and the specimens reweighed. The lactic acid solution was replenished, and the specimens were stored for a further week, after which the pH and specimen weights were again measured. This was repeated at 1 week intervals until the specimens were 6 weeks old. Differences were analysed by ANOVA followed by Newman-Keuls post hoc analysis. RESULTS: All four polyacid-modified composites increased the pH of the solutions at all time intervals by at least 0.26 pH units (significant to at least p < 0.01). This effect was similar to that of the glass-ionomer (but significantly less, p < 0.05) while significantly greater (p < 0.05) than that for the composite, Pekafil, which, by contrast, had no effect on pH. The observed rise in pH reduced significantly over time (ANOVA, p < 0.05). After 1 week, all pH changes were accompanied by net reductions in specimen mass, indicating susceptibility to acid erosion. Hytac was significantly more resistant to this erosion than the other materials; conversely, it had the least effect on solution pH. SIGNIFICANCE: These results show that polyacid-modified resin composites neutralise lactic acid in vitro but suffer erosion in the process.

The long-term interaction of dental cements with lactic acid solutions.

A study of the interaction of dental cements with lactic acid solutions has been carried out in which individual cement specimens were repeatedly exposed to 20 mmol dm(-3) lactic acid for periods of a week. After each week of storage, the mass of the specimens was recorded and the pH of the solution determined. The glass-ionomers showed an initial increase in mass, followed by a decline that became steady from 6 weeks. Zinc polycarboxylate and zinc phosphate cements, by contrast, showed no early gain in mass, but eroded steadily more or less from the start of their exposure to lactic acid. For all cements, acid erosion followed linear kinetics, at rates ranging from 0.5%/week for the zinc phosphate to 0.28%/week for one of the glass-ionomers, Chelonfil (ESPE, Germany). At the end of six months, the zinc phosphate had lost 14.2% of its initial mass, the zinc polycarboxylate 9.9% and the glass-ionomers between 6.2 and 7.2%. Erosion was accompanied on every occasion by neutralization of the acid solution. Both erosion and neutralization continued steadily throughout the experiment. The effectiveness of neutralization was in the following order: zinc polycarboxylate>zinc phosphate>glass-ionomer. The pH change in Week 1 was much greater for the glass-ionomers and the zinc polycarboxylate than in all subsequent weeks.

[Orthodontic management in cases of maxillary fused teeth]. / Postepowanie ortodontyczne w przypadkach zebów zrosnietych w szczece.

In the light of own cases the authors present congenital dental anomalies--fused teeth. This abnormality was present in three boys aged 9, 10, 11 years, involving upper permanent incisors. In all these cases extraction was done for orthodontic indications. Various methods of management are discussed in these often difficult cases, and the results of orthodontic treatment.

Results of epidemiological examinations of the temporomandibular joint in adolescents and young adults.

An epidemiological investigation of the temporomandibular joint in 800 persons was undertaken, including two groups of 400 persons aged 15-18 and 19-22 years. The numbers of boys and girls was about the same. Interview and clinical examination comprised morphological and functional features of the stomatognathic system. The TMJ examination carried out included mandibular movements, pain and sound symptoms. The results of the examinations were noted, counted by electronic methods and statistically analysed. From the material, two groups were selected: without TMJ symptoms (OTMJ group) and with TMJ disorders (TMJ group). TMJ disorders were evident in 67.62% of the examined persons and this was common to both age groups. In groups with TMJ disorders a significant incidence of girls was found. In groups with TMJ disorders the number of statistically significant pathological features in the stomatognathic system increased with age. TMJ disorders appeared in both age groups in various forms, separately or in combination, with different frequency. With reference to the number and kind of symptoms obtained on interview and/or on clinical examination, four degrees of intensity of TMJ disorders have been defined and their incidence discussed.