All-ceramic post core, and crown: technique and case report.

UNLABELLED: The functional and esthetic restoration of severely compromised anterior teeth is a challenge to clinicians in their daily practice. The duplication of the optical characteristics of an intact tooth, including shade, translucency, and fluorescence, is often made difficult by the use of metal infrastructures, such as post-and-cores and copings. The development of reinforced ceramics and non-metallic post systems made possible the generation of metal-free ceramic restorations in severely compromised anterior and posterior teeth. This article discusses one available technique for the generation of a single all-ceramic restoration involving the use of a zirconia- or leucite-reinforced post-and-core system and of an all-ceramic crown system. A representative clinical case is presented illustrating the potential of the technique. CLINICAL SIGNIFICANCE: Modern ceramic restorative systems offer the possibility to closely match the natural optical characteristics of lost tooth structure. Posts, cores, and copings fabricated in ceramic materials represent a promising alternative to metals in the restoration of severely compromised anterior teeth.

Influence of post placement in the fracture resistance of endodontically treated incisors veneered with direct composite.

STATEMENT OF PROBLEM: Veneer preparations are considered to weaken endodontically treated maxillary incisors. Prefabricated posts have been controversially indicated to reinforce endodontically treated teeth before final restoration. PURPOSE: This in vitro study evaluated whether (1) veneer preparation in enamel or in enamel/dentin weakens endodontically treated maxillary incisors, (2) bonding of direct composite veneer restores the original strength of the unprepared teeth, and (3) use of prefabricated metal posts increases fracture resistance of prepared and restored teeth. MATERIAL AND METHODS: Ninety extracted human maxillary central incisors were submitted to conventional root canal treatment. Specimens were randomly divided into 8 experimental groups (veneer preparation in enamel or dentin with/without post and with/without direct composite veneer restoration) and a control group (n = 10). Specimens were loaded to fracture, and the data were analyzed statistically. RESULTS: Statistical analysis revealed that a conservative veneer preparation does not significantly reduce maxillary incisors' fracture resistance. For prepared incisors, bonding of direct composite veneer restored their original strength, and the use of posts did not increase their fracture resistance. CONCLUSION: Conservative veneer preparations involving enamel and enamel/dentin did not significantly reduce the fracture resistance of endodontically treated maxillary incisors. In addition, restoration of the intraenamel preparations with direct composite resulted in teeth more resistant to fracture than teeth having restorations in dentin. The use of posts did not improve fracture resistance of endodontically treated maxillary incisors reduced and veneered with direct composite.

An in vitro study of the effect of restorative technique on marginal leakage in posterior composites.

The purpose of this in vitro study was to compare marginal leakage of class 2 light-cured composite resin restorations, with different insertion and polymerization techniques. Fifty sound premolars extracted for prosthetic purposes were used in the study. Conservative class 2 (MOD) preparations were made in all teeth, with one proximogingival margin on enamel and the other on cementum. All the preparations and restorations were performed by the same operator utilizing the same restorative materials. After restoration the teeth were thermocycled and their gingival margins exposed to a dye. Results showed that the kind of matrix system had no significant influence upon the degree of marginal leakage on enamel. On cementum, oblique and horizontal incremental insertion and polymerization techniques using the collimator cone exhibited the least leakage, while the clear matrix band/reflective wedge technique presented the greatest leakage.

The use of liners under amalgam restorations: an in vitro study on marginal leakage.

OBJECTIVE: Marginal leakage of amalgam restorations may lead to secondary caries and pulpal damage. The purpose of this study was to determine the effect various cavity liners might have on microleakage. METHOD AND MATERIALS: Mesio-occlusodistal amalgam restorations with margins on enamel and dentin were treated with different liner materials (an adhesive system, a topical fluoride gel, a cavity varnish, and a glass-ionomer cement) in vitro. Following restoration, the teeth were submitted to thermocycling in a stained solution and sectioned to allow assessment of microleakage. RESULTS: On enamel, the control group (no liner) and the glass-ionomer-lined group had equivalent leakage scores and were superior to every other group. On dentin, only the glass-ionomer specimens had superior performance. The cavity varnish and fluoride-lined specimens exhibited the highest leakage scores. CONCLUSION: The use of liners does not reduce microleakage on amalgam restorations when the cavity margins remain on enamel. On dentin margins, a glass-ionomer liner can reduce microleakage.

Nonvital tooth bleaching: guidelines for the clinician.

The combination of intracoronal and extracoronal bleaching represents a conservative treatment to restore esthetics to darkened or stained nonvital teeth. Notwithstanding the eventual risks and difficulties accompanying such technique, nonvital teeth often can be successfully lightened. This article presents a few guidelines for bleaching nonvital teeth as well as a clinical case to illustrate the indications and clinical protocol for the technique.

Clinical evaluation of composite resin tunnel restorations on primary molars.

Twenty children, presenting 66 proximal carious lesions in 60 primary molars, were selected to receive composite resin tunnel restorations. Thirty of these teeth were expected to exfoliate within 6 months (group I); in the remaining 30 teeth exfoliation was expected within 1 year (group II). All teeth received tunnel preparations, which were then restored with a posterior composite resin. The restorations were evaluated after 6 months and after 1 year through each of the following methods: bitewing radiographic examination, clinical examination with a probe and mirror, and direct examination of proximal surfaces after tooth extraction. The occlusal portions of the restorations were considered to be excellent both after 6 months and 1 year. Radiographic examinations and direct examinations (performed after extraction of teeth) did not reveal the same percentages of secondary caries in the proximal portion of restorations. Fracture of the marginal crest reached 3% during the first 6 months, but fracture was absent during the subsequent 6 months.

Reattachment of a tooth fragment with a "new" adhesive system: a case report.

A maxillary central incisor fractured, invading the biologic width. The biologic width was surgically restored, and in the same session the fragment was reattached to the tooth remnant with a "new" dentinal adhesive system. Short-term results indicate that esthetics, function, and oral health have been maintained.

Clinical and radiographic evaluation of cermet tunnel restorations on primary molars.

Fifty-one restorations of the tunnel type were performed with "cermet" cement on primary molars. The restorations were assessed clinically, radiographically, and by direct examination of the proximal surface 6 months (group I) and 12 months (group II) after placement. The incidence of fractured marginal ridges was found to be 3.8% in group I and 4.2% in group II. All restorations had their occlusal portion intact and were caries-free. Clinically detectable occlusal wear was found in 7.7% of teeth in group I and in 4.2% of teeth in group II. No correlation was found between direct and radiographic assessment of proximal caries. White spots, without carious penetration, were detected on 53.8% of proximal surfaces at 6 months and on 60.0% of proximal surfaces at 12 months.

Amalgam repair: a case report.

Through the report of a clinical case, the feasibility and advantages of repair and recontouring of complex amalgam restorations are discussed. In this patient, the kind of alloy used for the fractured restoration and the age of the restoration were known factors. Additional mechanical retention was prepared in both the "old" amalgam and the dentin, and the repair was made with a high-copper alloy. The bond at the repair site was stable at the 2.5-year recall examination.

Composite resin veneers: a new technique.

A new technique for the fabrication of composite resin direct veneers is presented. In this technique, a transparent acrylic resin matrix is fabricated before preparation of the facial surface of the tooth, to allow the adequate reproduction of contour, shape, and surface texture originally exhibited by the tooth. Advantages, as well as limitations, of the procedure are also presented.

The sandwich technique, an alternative treatment for tetracycline-stained teeth: a case report.

A patient whose teeth had been severely stained by improper use of tetracycline was treated through a direct system of facial veneering. The technique associates the use of a light-activating glass-ionomer cement with two kinds of light-activating composite resin. Satisfactory esthetics were obtained immediately.

The "sandwich" technique as a base for reattachment of dental fragments.

Esthetics and function were restored to a fractured maxillary central incisor by reattaching the tooth fragment with the "sandwich" technique (glass-ionomer cement and composite resin). After 3 years, the tooth showed optimal fragment rehydration, presence of pulpal vitality, absence of sensitivity, and a discrete color alteration in the line between the fragment and the dental remnant.