Anterior fiber-reinforced ribbon composite resin bridge-A case report.

The case describes the fabrication of a unilaterally fixed anterior fiber-reinforced composite bridge in a 14-year-old girl. Using this technique, it is possible to temporarily replace a missing anterior tooth until a definitive restoration can be inserted.

In vitro evaluation of the apical seal of two different retrograde filling materials.

To determine whether the selection of retrograde filling material or the choice of instruments in root tip resection influences the seal of the retrograde root filling. Seventy-two single-rooted teeth were used. Root resection was performed using a Lindemann bone cutter, a Lindemann bone cutter with A-shaped cutting design or a diamond-coated bur. Retro-cavities were prepared by piezo-tips and filled with Super-EBA or MTA. Teeth were made transparent and dye penetration was assessed. Teeth filled with MTA, irrespective of the resection instrument, showed no measurable dye penetration. All groups filled with Super-EBA showed an apical leakage. There were no significant differences between the three groups filled with Super-EBA (P = 0.09). The comparison of MTA versus Super-EBA showed significant superiority in apical seal in favour of MTA (P < 0.0001). To use MTA as a retrograde filling material showed superior results in terms of the tightness of the apical seal as compared to Super-EBA.

Clinical effectiveness of basic root canal treatment after 24 months: a randomized controlled trial.

INTRODUCTION: The purpose of this study was to investigate the effectiveness of basic root canal treatment (BRT) with tactile working length determination in terms of radiographic and clinical outcome parameters compared with endodontic treatment with standard radiographic working length control. METHODS: This was a clinical, multicenter, controlled, open-label trial to evaluate BRT effectiveness after 24 months. The primary end point was the apical extension score of the radiographic quality parameter of root canal fillings. The secondary radiographic end point was the periapical index, and the secondary clinical end point was tooth tender to percussion. The safety end point was tooth loss as a consequence of endodontic failure. Statistical analyses of binary and categoric data were calculated using cross tables and the chi-square test. RESULTS: BRT with tactile working length determination compared with standard radiographic working length control did not significantly differ in terms of radiographic and clinical outcomes after 24 months. The apical extension of the root canal fillings and the periapical anatomic structures showed no significant differences according to radiographic analyses (P = .5). Corresponding results were found in clinical aspects of tooth tender to percussion (P = .6) and tooth loss (P = .7). CONCLUSIONS: Tactile working length determination in BRT resulted in comparable treatment outcomes compared with standard endodontic treatment with radiographic working length control and turned out to be an accurate method in BRT.

Effects of bleaching agents on surface roughness of filling materials.

The aim of this study was to use a non-tactile optical measurement system to assess the effects of three bleaching agents' concentrations on the surface roughness of dental restoration materials. Two composites (Grandio, Venus) and one glass ionomer cement (Ketac Fil Plus) were used in this in vitro study. Specimens were treated with three different bleaching agents (16% and 22% carbamide peroxide (Polanight) and 38% hydrogen peroxide (Opalescence Boost)). Surface roughness was measured with an optical profilometer (Infinite Focus G3) before and after the bleaching treatment. Surface roughness increased in all tested specimens after bleaching treatment (p<0.05). Our in vitro study showed that dental bleaching agents influenced the surface roughness of different restoration materials, and the restoration material itself was shown to have an impact on alteration susceptibility. There seemed to be no clinical relevance in case of an optimal finish.

Fluoride bioavailability in saliva and plaque.

BACKGROUND: Different fluoride formulations may have different effects on caries prevention. It was the aim of this clinical study to assess the fluoride content, provided by NaF compared to amine fluoride, in saliva and plaque. METHODS: Eight trained volunteers brushed their teeth in the morning for 3 minutes with either NaF or amine fluoride, and saliva and 3-day-plaque-regrowth was collected at 5 time intervals during 6 hours after tooth brushing. The amount of collected saliva and plaque was measured, and the fluoride content was analysed using a fluoride sensitive electrode. All subjects repeated all study cycles 5 times, and 3 cycles per subject underwent statistical analysis using the Wilcoxon-Mann-Whitney test. RESULTS: Immediately after brushing the fluoride concentration in saliva increased rapidly and dropped to the baseline level after 360 minutes. No difference was found between NaF and amine fluoride. All plaque fluoride levels were elevated after 30 minutes until 120 minutes after tooth brushing, and decreasing after 360 minutes to baseline. According to the highly individual profile of fluoride in saliva and plaque, both levels of bioavailability correlated for the first 30 minutes, and the fluoride content of saliva and plaque was back to baseline after 6 hours. CONCLUSIONS: Fluoride levels in saliva and plaque are interindividually highly variable. However, no significant difference in bioavailability between NaF and amine fluoride, in saliva, or in plaque was found.

Class III atraumatic restorative treatment (ART) in adults living in West Africa--outcomes after 48 months.

OBJECTIVES: This observational study assessed the effectiveness of class III restorations using the atraumatic restorative treatment (ART) approach in permanent anterior teeth over a 48-month period. METHODS: Dental auxiliaries placed a total of 117 class III ART restorations in 2004, using a cosmetically improved glass-ionomer (Ionofil® Plus; VOCO, Cuxhafen, Germany), in 67 patients with a mean age of 27.3 years in the rural Jahali Health Center, The Gambia. Independent examiners evaluated the restorations after 24 and 48 months using the clinical ART evaluation criteria. RESULTS: Seventy-six of the restorations could be observed over 48 months in 51 patients. After 48 months, 53 of 76 restorations were classified as clinically acceptable (without or with minor intervention (repair) needed), and 23 restorations were classified as insufficient. There was no statistical difference in a clustered performance rating between restorations placed in central and lateral incisors (P=1.0). CONCLUSIONS: The adoption of the ART approach to class III caries cavities made restorative dental care in anterior teeth available in a West African region. The long-term performance was comparable to other studies. Longitudinal clinical studies with greater populations are required to substantiate these results.

Effects of bleaching agents on human enamel light reflectance.

OBJECTIVES: Tooth whitening has been associated with splitting-up chromogenic molecules by hydrogen peroxides. Though micromorphological alterations are well documented, little is known about optical changes as a function of shifting in wavelengths. Therefore, the aim of the current study was to measure reflectance changes after bleaching in vitro by using a spectrometer. METHODS: Forty-eight enamel slabs (diameter = 5 mm) were prepared from the sound enamel of extracted human teeth that were: 1) fully impacted, 2) from juveniles ages 10 to 16 years, 3) from adults 35 to 45 years of age and 4) from seniors older than age 65. In all specimens, the baseline total reflectance measurement was performed with a computer-assisted spectrometer (Ocean Optics, Dunedin, FL, USA) within wavelengths (wl) from 430 nm to 800 nm. Four enamel samples of each age group were exposed to either 10% or 15% carbamide peroxide (Illuminé Home, Dentsply, Konstanz, Germany) or 35% hydrogen peroxide (Pola Office, SDI Limited, Victoria, Australia). After surface treatment, all slabs underwent total reflectance measurement again. Statistical analysis was calculated at wl 450, 500 and 750 nm using the Student's paired t-test and one-way variance analysis. RESULTS: Total reflectance significantly increased after bleaching at all enamel maturation stages, irrespective of the bleaching agent concentration, for wl 450 nm (blue) and 500 nm (green) with p<0.0001. At 750 nm (red), significant changes only occurred in enamel from adults and seniors (p<0.04). However, the efficacy of bleaching was significantly increased in the blue and green light spectra as compared to the red spectra (p<0.0001). CONCLUSIONS: The results of the current study showed that the exclusive assumption of the "chromophore effect" in dental bleaching could not be sustained, because whitening of the dental enamel works at different maturation stages, even in impacted teeth. This effect is irrespective of the bleaching protocol used and the bleaching agent concentration.

Performance of atraumatic restorative treatment (ART) depending on operator-experience.

OBJECTIVES: Oral health care is not of major interest in developing countries because of lack of infrastructure and professional manpower. Therefore, atraumatic restorative treatment (ART) was introduced by the World Health Organization to be performed by dental auxiliary personnel. The aim of this study was to evaluate the performance of ART depending on operator-experience in The Republic of The Gambia. METHODS: One hundred twenty-eight newly inserted restorations were followed up for 12 months using the clinical ART index in a prospective and blinded study design. The patients were randomly assigned to operators. The clinical performance was compared among three groups: trainees, experienced Community Oral Health Workers (COHW), and professional dentists. The difference in success rates was calculated at a 95 percent confidence interval. RESULTS: There was a statistically significant difference between trainees and dentists in performing leakage/gap-free one-surface restorations (P < 0.05). No significant differences were found between the two groups of auxiliaries (trainees versus experienced COHWs, P > 0.05). Finally, both groups--experienced COHWs and dentists--performed restorations not showing statistically significant differences (P > 0.05). CONCLUSIONS: For The Republic of The Gambia--especially for areas with underdeveloped medical infrastructure--training and assignment to perform ART can be recommended for auxiliary dental staff of Community Oral Health Workers.

Development of a basic root canal treatment (BRT) for primary oral health care--evaluation after one year.

OBJECTIVES: Atraumatic Restorative Treatment (ART) was a major step forward in community dentistry but treatment options for deep carious lesions or pulp involvement still focus on tooth extraction in under-served areas worldwide. To bridge the gap between ART and extraction this pilot study aimed to develop and follow-up a basic root canal treatment for rural dental health facilities in the Republic of The Gambia (West Africa), faced with an environment lacking technical equipment and developing primary oral health care. METHODS: 25 single rooted teeth with acute irreversible pulpitis were root canal treated with a standardised endodontic instrument kit and a specific procedure. A step-back technique was used with intermittent chlorhexidine 0.2% and saline irrigation. Root canal obturation was performed using a single-cone technique with gutta-percha using Grossman's root canal cement. Coronal filling was carried out by using ART. Clinical examinations were documented before treatment, one day, five days, six months and twelve months postoperatively. RESULTS: None of the root canal fillings had to be revised due to postoperative complications. In 9 out of 25 teeth, transitory apical pain disappeared after a few days. After six months, all ART fillings appeared clinically acceptable, two fillings had to be corrected. Four class II restorations and three class IV restorations needed replacement after 12 months. Patients' assessment of health related quality of life improved significantly, especially concerning dental pain, chewing ability and fitness for work. CONCLUSIONS: Preliminary clinical follow-ups showed encouraging results for the basic root canal treatment approach. Longitudinal clinical studies with greater populations are required to substantiate these results. Modifications in the coronal filling technique are preferable to improve the clinical performance of extended ART cavity restorations.

Fluoride availability from natural resources in The Gambia--implications for oral health care.

INTRODUCTION: Changing food patterns in combination with ineffective oral hygiene measures and insufficient bioavailability of fluoride from drinking water and other sources seem to impair the dental health status in developing countries, especially in the younger population. Therefore, preventive programmes in controlling dental caries progression should be based on local conditions. METHODS: For mapping the drinking water fluoride content throughout The Gambia, samples of water from rural community wells, public water taps, commercial mineral water, and from the Gambia-River were measured. Additionally, fluoride concentrations of locally extracted table salt and green tea were determined. RESULTS: Showed the need for supplementary fluoride intake, because natural dietary fluoride availability is very low. CONCLUSION: Age-related recommendations for oral health care and for additional fluoride bioavailability are given, taking into account local socio-economic conditions in the Republic of The Gambia and similar developing countries.

Micromorphology of enamel surface after vital tooth bleaching.

The aim of the present study was to assess microroughness changes of enamel surfaces after bleaching procedures with 10% and 16% concentrations of carbamide peroxide by confocal laser scanning microscopy. Twenty caries-free incisors, extracted for periodontitis reasons, were sectioned into two halves of experimental and control specimens. The teeth were divided into two groups, and the experimental specimens were exposed to either 10% or 16% carbamide peroxide for 4 hours per 7 days. Measurements were made at three randomly selected 140 x 100 microm areas of 10 experimental and control specimens per group at the same crown level. Microroughness was measured in "total roughness" (Rt) and "average roughness" (Ra) descriptor values. The statistical analysis showed significantly higher microroughness according to Rt values and Ra values for both groups of carbamide peroxide exposed enamel surfaces.

Conversion of a fused hip to total hip arthroplasty.

BACKGROUND: Arthrodesis of the hip remains a viable treatment for severe unilateral arthritis after traumatic injury or infection in a young but otherwise healthy individual. The goal of the present study was to review the long-term clinical and radiographic results after conversion of a fused hip to a total hip arthroplasty and to identify the risk factors that would lead to a higher rate of failure. METHODS: We performed a retrospective review of the charts and radiographs of 187 patients (208 hips) who had conversion of a fused hip to a total hip arthroplasty. The mean duration of follow-up after the conversion to total hip arthroplasty was 9.2 years (range, two to twenty-six years). RESULTS: The mean age at time of the arthroplasty was fifty-one years. The mean time-interval between the arthrodesis and the conversion to a total hip arthroplasty was twenty-seven years. According to the information in the charts, at a mean duration of follow-up of 9.2 years after the total hip arthroplasty, 79% of hips were either pain-free or had minimal pain, 83% had good-to-excellent function, and 79% had good-to-excellent range of motion. Complications, which included fifteen nerve palsies, occurred in twenty-four hips. Twenty-eight hips had heterotopic ossification, but it was not associated with a recurrence of ankylosis or a marked reduction of motion. Revision arthroplasty was performed in twelve hips. The probability of survival of the implant was 96.1% (95% confidence interval, 91.5% to 98.2%) at ten years, 89.9% (95% confidence interval, 85.3% to 96.1%) at fifteen years, and 72.8% (95% confidence interval, 36% to 90.6%) at twenty-six years. CONCLUSIONS: Conversion of a fused hip to a total hip arthroplasty has a favorable outcome. However, the technically demanding nature of the procedure should not be underestimated. Patients should be cautioned with regard to the possibility of a higher rate of complications than that seen with primary total hip arthroplasty.

Total hip arthroplasty in ankylosing spondylitis: an analysis of 181 hips.

The results of cemented total hip arthroplasty (THA) in patients with ankylosing spondylitis were studied to determine the utility of THA for these patients. A total of 103 patients with ankylosing spondylitis underwent 181 THAs; 72 patients (69.9%) had bilateral surgery. The mean follow-up was 10.3 years. The mean age of patients at surgery was 47 years. Before surgery, 42 hips (23.2%) were ankylosed. Revision surgery was carried out in 25 hips (13.8%). Heterotopic ossification was present in 21 hips (11.6%); however, no patients had functional impairment or reankylosis. At final follow-up examination, 173 hips (96%) had an excellent (low) pain score, and 53 hips had a normal or near-normal function score (29.2%). The probability of survival of the implant was 71% at 27 years. THA provides long-term improvement in hip function for patients with ankylosing spondylitis.