Factors Associated with Reevaluation of the Stepwise Excavation Procedure: An 8-Year Retrospective Study.

Although the stepwise excavation procedure (SWP) has been shown to be an effective caries treatment technique, studies reporting its application outside of controlled clinical trials are limited. We performed a retrospective study from patient record data to assess the proportion of patients who had an SWP reevaluated within 18 months at The University of Iowa College of Dentistry (UICOD) between 2004 and 2012, and evaluated the association between different variables and this outcome. A total of 1,985 SWPs were performed in 1,326 patients, with 518 patients having had reevaluation within 18 months. Bivariate analysis and logistic regression modeling revealed strong associations between explanatory variables such as provider type, tooth type, patient age, number of recalls and the calendar year in which the SWP was done and reevaluation status. There was also evidence of association with dental insurance status. Other characteristics such as gender, distance traveled to the UICOD, number of surfaces treated and tooth arch did not show any significant association. In general, patients were more likely to have reevaluation when seen by faculty members or residents, the procedure was performed in molars/pre-molars, they were older, they had more recalls and were seen earlier in the study period. These results suggest that decisions to use SWP should consider patient demographics and treatment characteristics such as provider level, tooth type, patient age and number of recalls. The impact of treatment year may reflect program heterogeneity or temporal changes in external societal factors.

Ethanol-wet bonding and chlorhexidine improve resin-dentin bond durability: quantitative analysis using raman spectroscopy.

PURPOSE: To directly test the effectiveness of ethanol-wet bonding (EW) in improving monomer infiltration into demineralized dentin through quantitative measurement of bis-GMA and TEG-DMA molar concentrations within hybrid layers, and to comprehensively evaluate the effect of EW and chlorhexidine on durability of resin-dentin bonds compared to conventional water-wet bonding (WW). MATERIALS AND METHODS: A three-step etch-and-rinse adhesive (70% bis-GMA/28.75%TEG-DMA) was applied to coronal dentin using a clinically relevant ethanol-wet bonding protocol (EW) or the conventional water-wet bonding (WW) technique. Bis-GMA and TEG-DMA molar concentrations at various positions across the resin/dentin interfaces formed by EW and WW were measured using micro-Raman spectroscopy. The experiment was repeated at the same positions after 7-month storage in phosphate buffer solution containing 0.1% sodium azide. The µTBS and hybrid layer morphology (TEM) of bonding groups with and without chlorhexidine application were compared immediately and after 1-year storage in terms of nanoleakage, collagen fibril diameter, collagen interfibrillar width, and hybrid layer thickness. RESULTS: Specimens bonded with EW showed significantly higher monomer molar concentrations and µTBS throughout the hybrid layer immediately and after storage, providing direct evidence of superior infiltration of hydrophobic monomers in EW compared to WW. Microscopically, EW maintained interfibrillar width and hybrid layer thickness for resin infiltration and retention. The application of chlorhexidine further preserved collagen integrity and limited the degree of nanoleakage in EW after 1-year storage. CONCLUSION: EW enhances infiltration of hydrophobic monomers into demineralized dentin. The results suggest that a more durable resin-dentin bond may be achieved with combined usage of a clinically relevant EW and chlorhexidine.

Ceramic materials for porcelain veneers: part II. Effect of material, shade, and thickness on translucency.

STATEMENT OF PROBLEM: Information regarding the differences in translucency among new ceramic systems is lacking. PURPOSE: The purpose of this study was to compare the relative translucency of the different types of ceramic systems indicated for porcelain veneers and to evaluate the effect of shade and thickness on translucency. MATERIAL AND METHODS: Disk specimens 13 mm in diameter and 0.7-mm thick were fabricated for the following 9 materials (n=5): VITA VM9, IPS Empress Esthetic, VITA PM9, Vitablocks Mark II, Kavo Everest G-Blank, IPS Empress CAD, IPS e.max CAD, IPS e.maxPress, and Lava Zirconia. VITA VM9 served as the positive control and Lava as the negative control. The disks were fabricated with the shade that corresponds to A1. For IPS e.maxPress, additional disks were made with different shades (BL2, BL4, A1, B1, O1, O2, V1, V2, V3), thickness (0.3 mm), and translucencies (high translucency, low translucency). Color coordinates (CIE L∗ a∗ b∗) were measured with a tristimulus colorimeter. The translucency parameter was calculated from the color difference of the material on a black versus a white background. One-way ANOVA, the post hoc Tukey honestly significant difference, and the Ryan-Einot-Gabriel-Welsch multiple range tests were used to analyze the data (α=.05). RESULTS: Statistically significant differences in the translucency parameter were found among porcelains (P<.001) according to the following rank: VM9>PM9, Empress Esthetic>Empress CAD>Mark II, Everest, e.max CAD>e.max Press>Lava. Significant differences also were noted when different shades and thickness were compared (P<.001). CONCLUSIONS: Different ceramic systems designed for porcelain veneers present varying degrees of translucency. The thickness and shade of lithium disilicate ceramic affect its translucency. Shade affects translucency parameter less than thickness.

Current strategies in dentin remineralization.

Partial caries removal procedures are used clinically in an attempt to conserve tooth structure and prevent pulp damage. Within this approach, the caries-infected dentin is removed, and the partially demineralized caries-affected dentin is preserved and sealed with materials that enhance remineralization. Fluoride-releasing glass ionomers have been commonly used for this purpose. Recent studies have shown potential for other cements and bioactive adhesive materials to promote dentin repair through various strategies. These strategies include ion releasing of Ca-P and the guided tissue remineralization or biomimetic remineralization of dentin. The latter is potentially useful in the remineralization of the demineralized acid-etched dentin that is incompletely infiltrated by adhesives in dentin bonding. The purpose of this Critical Appraisal is to provide the clinician with a summary of current literature that clarifies understanding of the process of dentin remineralization and to describe current strategies in this area.

Violence and crime among male inpatients with severe mental illness: attempting to explain ethnic differences.

BACKGROUND: Studies report that in the U.K., among men with severe mental illness (SMI), those of black Caribbean ethnicity display increased risk of aggressive behaviour, criminal convictions, and schizophrenia. The study aimed to compare aggressive behaviour and criminal convictions among men with SMI of white British, black Caribbean and black African ethnicity, and to explore factors associated with differences across ethnicities. METHOD: Sample 1 included 1,104 male inpatients with SMI. Sample 2 included a representative sub-sample of 165 who completed interviews, and authorized access to medical and criminal files. Ethnicity was self-ascribed. RESULTS: Staff-rated violence prior to admission, self-reported aggressive behaviour, and convictions for non-violent and violent crimes differed among men with SMI of different ethnicities. Relative to men with SMI of white British ethnicity, those of black African ethnicity showed decreased risk of aggressive behaviour, and those of black Caribbean ethnicity showed elevated risk of convictions for non-violent, and marginally, for violent crimes. Relative to men with SMI of black African ethnicity, those of black Caribbean ethnicity showed elevated risk of aggressive behaviour and criminal convictions. Proportionately more of the men of both black African and black Caribbean ethnicity, than those of white British ethnicity, presented schizophrenia spectrum disorders. Multivariate analyses failed to identify factors that would explain differences in aggressive behaviour, and criminal convictions across ethnic groups. CONCLUSIONS: Differences in four different measures of aggressive and antisocial behaviour among men with SMI of different ethnicities were observed but factors associated with these differences were not found.

Ceramic materials for porcelain veneers. Part I: Correlation between translucency parameters and contrast ratio.

STATEMENT OF PROBLEM: Different parameters are used in the literature to describe translucency, making it difficult for clinicians to find clear information on ceramic translucency and compare studies. PURPOSE: The purpose of this study was to assess the correlation between the contrast ratio (CR) and translucency parameter (TP) when the translucency of different types of ceramic systems is compared. MATERIAL AND METHODS: Disks 13 mm in diameter and 0.7 mm thick were fabricated for the following materials (n=5): VITA VM9, VITA PM9, IPS Empress CAD, IPS e.max CAD, IPS e.maxPress, and Lava Zirconia. VITA VM9 served as positive control, while Lava Zirconia served as negative control. The luminous reflectance (Y) and color coordinates (CIE L* a* b*) of the specimens were measured with a tristimulus colorimeter. The CR (CR=Yb/Yw) was calculated from the reflectance of the light of the material on a black backing (Yb) to the reflectance on a white backing (Yw). The TP (TP=[(Lb*Lw*)(2+)(ab*-aw*)(2+)(bb*-bw*)(2) ](1/2)) was calculated from the color difference of the material on a black versus a white background. One-way ANOVA based on ranked data and the Pearson and Spearman rank correlation tests were used to analyze the data (α=.05). RESULTS: A significant correlation between CR and TP was found when all specimens were included (P<.001). The coefficient of -0.99 indicated a strong decreasing relationship between the 2 variables. CONCLUSIONS: Either CR or TP can be used to evaluate the relative translucency of ceramic systems.

Effect of polishing direction on the marginal adaptation of composite resin restorations.

PROBLEM: Polishing composite resin restorations may lead to marginal defects and gap formation. PURPOSE: To assess the effect of polishing direction on the marginal adaptation of composite resin restorations using two composite resins and two polishing systems. MATERIALS AND METHODS: Forty extracted human molars were sectioned along their mesio-distal axis. Buccal and lingual enamel was flattened and a triangular preparation, 0.87-mm deep and 3-mm wide, representing two 60° bevels, was performed. Specimens were randomly assigned to eight groups (N = 20) and restored with two composite resins: a nanofilled (Filtek Supreme Ultra, 3M ESPE, St. Paul, MN, USA) or a microhybrid (Point 4, Kerr, Orange, CA, USA) and finished with two polishing techniques: polishing discs (Sof-Lex XT, 3M ESPE) or rubber polishers (HiLuster Plus, Kerr, Bioggio, Switzerland). On each specimen, both margins were polished with the same technique, one margin from composite resin to tooth and the other from tooth to composite resin. Replicas were made for field emission scanning electron microscope observation (200×) and quantitative margin analysis was performed based on four criteria. Data were analyzed with a paired-sample t-test, a two-sample t-test, and one-way analysis of variance or their nonparametric analog. RESULTS: Significant differences were found in most groups between polishing directions with better marginal adaptation from composite resin to tooth than from tooth to composite resin. Differences between composite resins and polishing techniques seemed to be dependent on certain combinations of composite resin, polishing technique, and polishing direction. CONCLUSION: Polishing from composite resin to tooth leads to better marginal adaptation than polishing from tooth to composite resin. CLINICAL SIGNIFICANCE: The results obtained from this in vitro study suggest that polishing direction influences the marginal adaptation of composite resins and that polishing from composite resin to tooth structure should be clinically performed whenever possible on accessible margins to preserve marginal integrity and esthetics.

Consumers' choice of dentists: how and why people choose dental school faculty members as their oral health care providers.

This study aimed to better understand how and why people choose dental school faculty members as their oral health care providers. Increasing financial constraints in U.S. dental schools have led their administrators to seek alternative funding sources, one of which can be revenues from dental school faculty practice. To effectively promote faculty practice, it is necessary to understand how and why one chooses a dental school faculty member as his or her oral health care provider. A survey of 1,150 dental school faculty practice patients who recently chose their dentist was conducted, and 221 responded. The information sources these respondents said they used and rated highly were other dentists, friends, family members, clinic website, the Internet, and the insurance directory. Dentist-related attributes that were perceived to be important were quality of care, professional competence of dentist, and explanation of treatment/patient participation in the treatment decision. Dental practice-related attributes perceived to be important were the ability to get appointments at convenient times, reasonable waiting time to get appointments, and attitude/helpfulness of staff. This study found that traditionally popular (family, friends) and newly emerging information sources (the Internet, clinic website, and insurance directory) were both used and perceived to be important by patients of the dental school faculty practice. Dental schools and dentists can use this study's findings to select appropriate communication channels to promote their practices and to focus on attributes that dental consumers value the most.

Development and evaluation of an interactive dental video game to teach dentin bonding.

Written and clinical tests compared the change in clinical knowledge and practical clinical skill of first-year dental students watching a clinical video recording of the three-step etch-and-rinse resin bonding system to those using an interactive dental video game teaching the same procedure. The research design was a randomized controlled trial with eighty first-year dental students enrolled in the preclinical operative dentistry course. Students' change in knowledge was measured through written examination using a pre-test and a post-test, as well as clinical tests in the form of a benchtop shear bond strength test. There was no statistically significant difference between teaching methods in regards to change in either knowledge or clinical skills, with one minor exception relating to the wetness of dentin following etching. Students expressed their preference for an interactive self-paced method of teaching.

Restoring erosion associated with gastroesophageal reflux using direct resins: case report.

Gastroesophageal reflux disease (GERD) is a condition where stomach acids are chronically regurgitated into the esophagus and oral cavity, resulting in pathology, such as esophagitis, varices or ulcers. Continual exposure of the teeth to these acids can also cause severe dental erosion. This condition frequently is asymptomatic, and the only evident sign may be the irreversible erosion of tooth structure. The dentist often is the first health care professional to identify the affected dentition. Knowledge of this cause and effect relationship between GERD and dental erosion will better prepare the practitioner to refer patients for appropriate diagnosis and treatment of the underlying medical condition and provide treatment for the affected teeth. This article presents a case report where dental erosion was present due to GERD. After management of the disease with medication, dental treatment of the eroded dentition is described, including diagnosis, treatment planning and restorative reconstruction.

Impression matrix technique for cusp replacement using direct composite resin.

UNLABELLED: Placement of Class II composite resin restorations often presents unique challenges in achieving proper contour and contact. Although the use of sectional bands has provided solutions to these problems, their use typically is limited to more ideal cavity preparations. With more extensive loss of tooth structure, recreating the natural tooth contours and contacts with direct resin composite can be difficult. Typically an indirect restoration is the treatment of choice when a cusp is lost. However, situations may arise that require the use of direct resins for cusp replacement. This article describes the use of an impression matrix to facilitate the replacement of missing tooth structure and allow the dentist to use sectional bands in certain cusp loss situations. CLINICAL SIGNIFICANCE: When applicable, the impression matrix provides a significant saving in time and effort in cusp replacement with direct composite resins.

Evaluation of a glass-fiber-reinforced, bonded, inlay-supported fixed partial denture--4-year results.

Glass-fiber-reinforced composite resin systems may be used as conservative alternatives to conventional fixed partial dentures (FPDs) for the replacement of a single missing tooth. This article describes a clinical technique and 4-year evaluation of an inlay bonded FPD. The patient presented with a missing maxillary right second premolar. A high-caries risk and moderate-to-advanced attachment loss around the abutment teeth, which were clinically stable, were noted. The patient had a strong desire to maintain his remaining dentition. Advantages of supragingival margins and minimal tooth structure removal made the bonded inlay bridge a viable alternative to a conventional FPD for this compromised restorative situation. The clinical performance of this glass-fiber-reinforced resin inlay FPD at the 4-year follow-up is provided. The restoration has served satisfactorily for more than 4 years and holds promise as a conservative, esthetic alternative to the conventional FPD in certain clinical cases.

Shade-match perception of porcelain-fused-to-metal restorations: a comparison between dentist and patient.

BACKGROUND: Patient satisfaction with the shade match of restorations has not been appraised carefully in the dental literature. This study compared patients' and a prosthodontist's satisfaction with the shade o f existing porcelain-fused-to-metal, or PFM, restorations. METHODS: The authors selected a convenience sample of 212 patients for this study. Patients and a prosthodontist were asked independently, under standardized conditions, to express their satisfaction with the shade match of the patient's restoration. Kendall's tau-b statistic was used to measure the strength of the association between the shade satisfaction rating of the patient and that of the prosthodontist. The authors also examined patient satisfaction with respect to sex, treatment location and clinician. RESULTS: The prosthodontist was less satisfied than the patient with the shade match in a significant number of cases. The authors found no difference in patient satisfaction with respect to sex. They did find that patients were more satisfied with the shade match of restorations placed by a prosthodontist or placed under the supervision of a prosthodontist than they were with restorations placed by general practitioners. CONCLUSIONS: Patients were more satisfied with the shade match of their PFM restorations than was the prosthodontist. Patients also were more satisfied with restorations placed by a prosthodontist or placed under the supervision of a prosthodontist in a hospital or academic setting. Clinical Implications. Patient satisfaction with shade match is important when constructing or replacing a restoration, and the level of satisfaction might be different from that of the clinician. When selecting restoration shades, clinicians should take into consideration the opinions of their patients.