Impact of three radiographic methods in the outcome of nonsurgical endodontic treatment: a five-year follow-up.

INTRODUCTION: The periapical film radiograph (PFR) and digital periapical radiograph (DPR) techniques have some limitations in the visualization of small periapical lesions (PLs) when compared with cone-beam computed tomography (CBCT). However, the evidence supporting their effectiveness is very limited. This retrospective longitudinal cohort study evaluated the outcome of endodontic treatments measured/monitored by PFR, DPR, and CBCT during a 5-year follow-up and also determined the prognostic factors that influenced treatment success. METHODS: A total of 132 teeth (208 roots) with vital pulps received endodontic treatment. The periapical indexes with scores ≥2 for PFR and DPR and ≥1 for CBCT indicated the presence of PLs. Prognostic factors were determined by bivariate and multivariate analyses. Statistical significance was defined at a P level <.05. RESULTS: CBCT detected a higher number of PLs (18.7%, n = 39 roots), followed by DPR (7.7%, n = 16 roots) and PFR (5.7%, n = 12 roots). Likewise, CBCT was more sensitive than PFR and DPR in detecting deficiencies in extension and density of the root canal filling (P ≤ .001). Of the 17 prognostic factors evaluated, 4 were significantly associated with poor outcome to the treatment (P < .05): root canal curvature, disinfection of gutta-percha, presence of missed canals, and the quality of definitive coronal restoration. CONCLUSIONS: The success outcome of endodontic treatment after 5 years in teeth with vital pulps varied with each radiographic method: 94.3%/PFR, 92.3%/DPR, and 81.3%/CBCT.

Is endodontic treatment performed under general anaesthesia technically acceptable?

OBJECTIVES: Undertaking endodontic treatment under general anaesthesia (GA) is often described as difficult and hazardous, but no study reports on safe and efficacious conditions for endodontic treatment under GA. This study aims to evaluate whether compromises made for the endodontic treatment of permanent teeth under GA are acceptable. It describes the quality of endodontic treatment undertaken in two series of consecutive patients treated either under GA or local anaesthesia (LA). MATERIALS AND METHODS: Post-operative data sheets and periapical radiographs were collected for 255 permanent teeth treated under GA during a 4-year period (GA group, 125 patients with special needs) and for 246 permanent teeth treated under local anaesthesia over 7 months (LA group, 180 healthy patients). The radiographic criteria for quality of endodontic treatment (RCQET) were considered satisfactory when (1) the root filling was within 2 mm of the apex; (2) the filling displayed no voids or defects; and (3) all the visible canals had been obturated. The type of tooth, pulpal status and periapical status were considered independent variables for RCQET. RESULTS: The proportion of satisfactory RCQET reached 63% in both groups and differed by type of tooth, being significantly lower for molars than for other teeth. CONCLUSION: From a technical point of view, compromises made for the endodontic treatment of permanent teeth under GA are acceptable. Further studies should be conducted to evaluate the long-term success of endodontic treatment performed under GA. CLINICAL RELEVANCE: This study supports the feasibility of endodontic treatment for patients treated under GA.

Effect of temporary filling materials on repair bond strengths of composite resins.

Endodontic access cavities sometimes can be prepared through a permanent composite restoration. Between the appointments, temporary cements are used to seal access cavities and may have negative effect on bonding of further composite restoration. The purpose of this study was to compare shear bond strength of composite to composite which had been in contact with various temporary filling materials. Standard cavities were prepared on 160 acrylic resin blocks, obturated with composite resin (Clearfil AP-X, Kuraray, Japan) and randomly divided into eight groups (n = 20). Group 1 received no treatment. From group 2-8, composite surfaces were covered with the following cements temporarily: Zinc-oxide/calcium-sulphate (Cavit-G, ESPE, Germany), two different Zinc-Oxide-Eugenol materials (ZnOE, Cavex, Holland and IRM, Dentsply, USA), Zinc-phosphate cement (Adhesor, Spofa-Dental, Germany), Zinc-polycarboxylate cement (Adhesor-Carbofine, Spofa-Dental, Germany), Glass-Ionomer-Cement (Argion-Molar, Voco, Germany), or light curing temporary material (Clip, Voco, Germany). The cements were removed mechanically after 1 week storage in distilled water at 37 degrees C and composite surfaces were treated with a self-etch adhesive system (SE-Bond, Kuraray, Japan). Composite resin build-ups were created on composite surfaces. Shear bond strength values were measured using universal testing machine at crosshead speed of 1 mm/min. The data was calculated in MPa and statistically analyzed using one-way ANOVA and Tukey tests. Eugenol-containing cements significantly reduced shear bond strengths of composite to composite (p < 0.05), while the other temporary materials had no adverse effect on shear bond strength (p > 0.05). These findings suggested that temporary filling materials except eugenol-containing materials have no negative effect on composite repair bond strengths.

Optimizing the esthetic potential of implant restorations through the use of immediate implants with immediate provisionals.

BACKGROUND: Few things in clinical periodontics are more challenging or potentially more rewarding than gaining an ideal result with implant-supported crowns in the esthetic zone. METHODS: This article describes a novel approach to maintaining soft tissue health and support following immediate implant placement and immediate insertion of minimally functional single-unit screw-retained fixed provisionals. RESULTS: Excellent tissue health, soft tissue profiles, and maintenance of septal bone height are documented with clinical photographs and 1-year follow-up radiographs. CONCLUSION: In addition to maximizing the chances for an optimal esthetic result, this technique also allows precise adjustment and stability of occlusal relationships for provisionals in the perioperative period.

[The incidence of local plaque retentive factors in chronic periodontitis]. / Lokális plakkretenciós tényezok elofordulási gyakorisága krónikus parodontitisben.

One of the leading local risk factors for chronic periodontitis is the presence of plaque retentive factors in the oral cavity. The main objective of the study was to assess how the local irritation and plaque retention caused by untreated carious lesions, subgingival and approximal overhanging crown margins can affect the attachment loss at patients with chronic periodontitis. The incidence of plaque retentive factors were evaluated on 200 panoramic radiographs randomly selected from the archive of the Department of Periodontology. On the radiographs each fully erupted tooth were studied under magnifying glasses (1:2 magnification), and the distance between CEJ and the most coronal bone level was measured with a ruler with mm scales. The quality of restorations were evaluated based on the approximal adaptation of their margins. During the clinical examination the presence of local plaque retentive factors were registered by tooth, and the radiological alveolar bone level were recorded around both the healthy and restored or filled teeth. Statistical analyzes were made with linear regression analysis and ANOVA. Only 177 out of the randomly selected 200 radiographs met the incursion criteria and could be evaluated. The average age of patients was 49.98 years and the average approximal bone loss was 5.439 mm, showing increasing tendency with age. The 177 patients had a total of 3618 teeth and 1407 teeth presented plaque retentive factors including 164 untreated approximal carious lesions, and 1243 faulty restorations with approximal overhangs or open margins. Radiographically 82.5% of the restorations had incorrect approximal marginal adaptation. The majority of the untreated carious lesions occurred in the molar as well as in the front regions. The average bone loss at the teeth with faulty restorations were higher than at the sound teeth. 113 patients had an average bone loss higher than >4 mm. In those patients the differences between sound and restored teeth were smaller than those in the groups of patients with mild bone loss. Nevertheless neither group showed statistically significant differences between restored and sound teeth. In mild to moderate periodontitis local plaque retentive factors, overhanging crown margins or carious lesions are decisive aggregating factors both in gingivitis and periodontitis, especially in the susceptible population. In severe periodontitis according to our data there were only minimal differences between the attachment level around sound teeth and teeth with faulty restorations and local plaque retentive factors.

Predictable provisionalization: achieving psychological satisfaction, form, and function.

UNLABELLED: The dentition is the foundation of the human face and is far more than just a masticatory apparatus. The smile, which is the definition of humankind, crosses all gender, age, cultural, and religious boundaries to express emotion. When enhancing or restoring a smile with aesthetic dentistry, the provisionalization phase is critical in conveying information regarding function, occlusion, phonetics, and the patient's expectations among the members of the restorative team. This presentation details a predictable process for rapidly fabricating provisional restorations with optimal fit and performance. LEARNING OBJECTIVES: This article describes the role of provisionalization and a protocol for fabrication of temporary prostheses for optimal results. Upon reading this article, the reader should: Understand the role of provisionalization on the surrounding soft and hard tissue structures. Recognize the role provisionalization plays in patient education and communication.

Resinas utilizadas para confecçäo de restauraçöes provisórias / Resin materials used in the construction of provisional restorations

As restauraçöes provisórias devem proporcionar proteçäo pulpar, resistência à abrasäo, lisura superficial, margens bem delimitadas, resistência, retençäo e estética. Entretanto, näo existe material capaz de preencher completamente esses requisitos, levando o cirurgiäo-dentista a ponderar sobre as vantagens e desvantagens de cada material ao fazer a seleçäo. A proposta de presente trabalho foi fornecer informaçöes aos profissionais da área de Odontologia sobre os materiais resinosos utilizados na confecçäo de restauraçöes provisórias. A ausência de uma resina que preencha todas as características de um material provisório "ideal", torna a seleção um processo que envolve inúmeros fatores

Material restaurador temporário: estudo comparativo da infiltração marginal / Restored material temporary: a comparative study of the marginal leakage

Objetivo: O objetivo do presente trabalho foi o de avaliar a capacidade de vedamento marginal de alguns materiais seladores temporários, bem como estabelecer uma classificação de eficiência entre eles. Metodologia: Realizou-se a abertura coronária de cinquenta incisivos inferiores e após o preparo biomecânico, introduziu-se um cone de papel absorvente, e uma pelota de algodão foi adaptada na emborcadura do canal. Em seguida, os dentes foram restaurados com Óxido de zinco e eugenol (Grupo 1) ; Cavitec (Grupo 2); IRM (Grupo 3); Resina composta híbrida- Suprafill (Grupo 4) e Vitremer (Grupo 5). Após termociclagem (125 ciclos), os corpos de prova foram imersos em Fucsina básica a 0,5% por 24 horas; lavados e seccionados para verificar o grau de infiltração marginal através de valores numéricos: 0, 1, 2, 3 e 4. Resultados e Conclusões: Os dados obtidos mostraram diferenças estatisticamente significantes entre os grupos (p< 0,001), utilizando o Teste de Kruskal-Wallis, sendo os Grupos 4 e 5 com maior capacidade de selamento

A short-term clinical evaluation of a tricure glass-ionomer system as a transitional restoration and core buildup material.

OBJECTIVE: A general dental practice study investigated the use of a resin-modified glass ionomer material as a transitional restoration and as a core buildup material. The study also assessed a resin-modified glass-ionomer luting system. METHOD AND MATERIALS: Fifty-one badly broken-down vital permanent molar teeth in 44 patients were restored. No dentin pins were placed; however, preexisting pins were retained in 7 teeth. Following baseline and 3-month assessments, complete veneer gold crowns were placed on the selected teeth. The preparations involved ferruling in sound tooth tissue. The completed crowns were reviewed 3 and 12 months after placement. Modified US Public Health Service criteria were used for assessment throughout. Clinical assessment was complemented by examination of photographic records and replicas obtained from silicone impressions. RESULTS: All 51 transitional restorations were found to be clinically satisfactory at the 3-month review. Nineteen (37%) transitional restorations had limited defects that were eliminated in crown preparation. Of the 51 permanent crowns, 46 (90%) were reviewed at 3 months and 44 (86%) at 1 year. All the crowns reviewed at 3 and 12 months were clinically satisfactory. The luting system investigated showed favorable handling characteristics and excellent short-term performance. CONCLUSION: The materials investigated are, over a period of at least 12 months, effective in the restoration of broken-down molar teeth destined to be crowned. With the use of these materials and ferruling, the use of dentin pins may be unnecessary in selected cases.

RESTAURACIONES TEMPORALES DE LARGO PERIODO

Estas restauraciones temporales de largo periodo, proporcionan una guía para el contorno, color y oclusión de la prótesis final. Pueden ser usadas por un período largo y son estéticamente aceptables. Realzan la confianza del paciente en el tratamiento. Como la restauración es hecha en un modelo de yeso éste es más preciso y menos irritante a os tejidos bucales y a la pulpa dental. El uso de los dientes prefabricados de acrílicos, cimo el componente vestibular de una protección provicional de dientes anteriores, permite el incremento en cuanto al control se refiere del color, forma y contorno. Estas restauraciones temporales de largo período protegen a la dentina que se encuentra sencible debido alos desgastes en la preparación del muñon

Determinants of the quality of restorative dental care.

This article reports the results of an analysis to determine the relationships between the quality of restorative dental care for 1,466 patients and 9 categories of dentist characteristics for 102 volunteer Washington practitioners. In this study, patients were recalled and restorations were examined clinically. Questionnaires were administered to patients and dentists. The dependent measure is a weighted average of scores for operative dentistry and crown and bridge. Stagewise regression was used to adjust for differences in patient oral health and assessor bias. Models were postulated in each category of dentist characteristics and beta vectors were estimated by multiple regression. The best predictors formed a significant model (p = 0.000) which explained 26 per cent of the variance.