Effects of cyclic loading and toothbrush abrasion on cervical lesion formation.

This study sought to determine the effect of cyclic loading and toothbrush abrasion (with and without abrasive slurries) on cervical lesion formation. The roots of extracted human third molars were embedded in acrylic resin, leaving 2 mm of root structure and crowns exposed. Teeth were divided into 6 groups (n = 10) with the following treatments: no treatment (control), cyclic load in distilled water, brushing with distilled water, cyclic load followed by brushing with distilled water, brushing with toothpaste slurry, and cyclic load followed by brushing with toothpaste slurry. Cyclic loading and toothbrushing machines subjected the teeth to 1.6 million cyclic loads and 30,000 brushing strokes, the equivalent of 4 years of function and brushing for an average patient. The teeth were scanned with a 3-dimensional optical profilometer to determine the volumetric loss of tooth structure. Load cycling had no significant effect on cervical tooth loss. Brushing with toothpaste resulted in significantly greater cervical tooth loss than brushing with water, which in turn was significantly greater than no treatment at all.

Six-year clinical evaluation of bonded and pin-retained complex amalgam restorations.

This clinical study compared the performance of complex amalgam restorations retained with self-threading pins or bonded with a filled, 4-META-based resin. Sixty amalgam restorations (28 pin-retained and 32 bonded), each replacing at least one cusp, were placed. Self-threading stainless steel pins (Coltene-Whaledent) were used in the pin-retained group. A filled, 4-META-based bonding resin (Amalgambond Plus with HPA powder) was used in the bonded group. For both groups, any retention form remaining after removal of an old restoration was left in place but not enhanced. At six years, 11 restorations had failed; eight of which were pin-retained and three bonded. Using Fisher's exact test to compare the groups at six years, there was no significant difference in failure rate, marginal adaptation, marginal discoloration, secondary caries, tooth sensitivity or tooth vitality. At six years, there was no difference in the performance of pin-retained amalgam restorations and bonded amalgam restorations.

Microleakage and sealant penetration using a vibrating probe.

PURPOSE: To evaluate the effect of a vibrating probe on sealant penetration into pits and fissures. METHODS: Thirty-six extracted human third molars were used. The occlusal surface of each molar was cleaned with a rubber cup and pumice slurry. Scotchbond Etchant (35% phosphoric acid gel) was applied to the occlusal fissures of each molar for 20 seconds. Fissures were then sealed as follows: Group 1: Concise Light Cured White Sealant was applied without vibration; Group 2: same as in Group 1 but with vibration; Group 3: Single Bond Adhesive was applied, then Concise Light Cured White Sealant was applied without vibration; Group 4: same as in Group 3, but sealant was applied with vibration; Group 5: Concise Light Cured White Sealant was applied without vibration, then Z-100 composite was burnished over the sealant and light-cured; Group 6: same as in Group 5, but sealant was applied with vibration. Microvibe vibrating probe was used for sealant vibration. After 24-hour immersion in 2% basic fuchsin dye solution, specimens were sectioned, and dye and sealant penetration were scored using a stereomicroscope and color slides. Selected sectioned samples were observed under the SEM. RESULTS: No statistically significant differences between the groups were observed for either dye or sealant penetration scores. In all groups, sealant penetration was more influenced by the shape, depth and residual debris of fissures than by the use of a vibrating probe.

Three restorative materials and topical fluoride gel used in xerostomic patients: a clinical comparison.

BACKGROUND: The authors compare the incidence of recurrent caries around two glass ionomer restorative materials and one amalgam material. METHODS: The authors placed 111 restorations in nine xerostomic patients. Patients were given oral hygiene instructions and fluoride gel to use daily. The authors evaluated the restorations clinically and with photographs and impressions at six months, one year and two years according to criteria for marginal adaptation, anatomical form, caries in adjacent tooth structure and caries at the cavosurface margin. The authors divided patients into users and nonusers of fluoride. RESULTS: At the two-year recall appointments, the authors evaluated 95 (86 percent) of the 111 restorations. They analyzed two-year data using an analysis of variance for repeated measures and Fisher's post hoc test. The study results showed no significant differences among materials in regard to caries at the cavosurface margin among fluoride users. However, among fluoride nonusers, patients with amalgam restorations had a significantly higher incidence of caries at the cavosurface margins than did patients with either of the two glass ionomer restorations. The authors found no statistically significant difference between restorations with regard to marginal integrity or anatomical form. However, one patient exhibited failure of glass ionomer restorations owing to material loss. CONCLUSIONS: Less caries developed at the margins of glass ionomer restorations compared with amalgam restorations in xerostomic patients who did not routinely use a neutral topical sodium fluoride gel. CLINICAL IMPLICATIONS: Fluoride-releasing materials may reduce caries surrounding restorations in high-risk patients who do not routinely use topical fluoride. Patients who routinely used topical fluoride gel did not develop recurrent caries, and clinicians should encourage the use of fluoride gel on a daily basis.

Conservative cavity preparations.

When a caries lesion is detected, non-surgical means of treatment (fluorides, antimicrobials, and patient education) should be used unless it is a frank caries lesion. In that case, the lesion should be treated restoratively, but the patient should also be educated and treated to reduce caries risk. When the frank caries lesion is relatively small, the restorative treatment should simply involve removal of carious dentin and overlying unsupported enamel and placement of the restorative material. Of course, for weakened areas of the tooth, more extensive restorations may be indicated.

¿Es actualmente la extensión por prevención un concepto válido? / Is currently the extension for prevention a valid concept?

Se analizan y discuten los diferentes conceptos de extensión por prevención de la preparación que se han desarrollado desde 1881 hasta 1999. La introducción de nuevos conocimientos en diversas áreas de la odontología hicieron que los postulados de Black en ese particular se cuestinaran tanto en la enseñanza como en la práctica clínica