Non-vital bleaching PART 1: an audit of practice in the Belfast and Cork restorative departments prior to the release of the 2012 European Cosmetic Directive PART 2: an audit on the perceived clinical impact of the 2012 European Cosmetic Directive in the Belfast and Cork restorative departments.

Intrinsic discolouration of teeth often requires bleaching to improve the aesthetics. There are three techniques available for non-vital bleaching: chairside; walking; and, inside/outside. Before the 2012 Cosmetic Directive was released, an audit of non-vital bleaching practice in the Belfast and Cork restorative departments was undertaken (Part 1). Results showed a variation in clinical procedures from the gold standard and therefore the latter was used to develop a clinical protocol and pro forma for use in the restorative departments. These were designed to be useful in the hospital and general dental practice settings, and should hopefully increase compliance with the gold standard and therefore improve both the consent process and record keeping. With the change in the European Cosmetic Directive Guidelines on October 31, 2012, dentists were confined to using a maximum of 6% hydrogen peroxide in tooth bleaching products provided the first application was by a dentist or under their direct supervision. A high proportion of audit responses in Part 1 involved concentrations of hydrogen peroxide, in both the walking and chairside techniques, that no longer complied with the new Directive. This suggested that the new Cosmetic Directive could significantly impact the practice of non-vital bleaching in the Belfast and Cork restorative departments. This in turn prompted an evaluation on the perceived clinical impact of the European Cosmetic Directive since its release in 2012 (Part 2). Surprisingly, clinicians found similar clinical outcomes following the restriction in the concentration of bleach, although 50% felt that more treatment visits were required to achieve an acceptable result. Moreover, the results of the audit revealed that clinicians were most concerned that the introduction of a ban on treating patients under 18 years of age might exacerbate psychological issues in this vulnerable age group if discoloured teeth were left untreated.

Endodontic 'Solutions'. Part 2: An audit comparing current practice in Belfast with UK and Republic of Ireland Dental Schools.

UNLABELLED: Endodontic lubricants, irrigating solutions and medicaments help reduce the microbial load within root canals. Primary and secondary cases involve different microbes. Each'solution'or combinations thereof could play a significant role but no detailed guidelines exist on their use. An audit was undertaken to compare current practice in Belfast Dental School to the others across the UK and Republic of Ireland (ROI). This audit highlighted three main differences between Belfast and other dental schools. Many other institutions utilized other irrigants besides sodium hypochlorite (NaOCl), different intracanal medicaments, including calcium hydroxide, and higher concentrations of NaOCl. Having gathered this information, we ask, 'Is there sufficient evidence to change the endodontic regime currently used at Belfast Dental School?'. Using the findings from the literature review (Part 1), we introduce new evidence-based protocols for primary and secondary cases for use in Belfast Dental School. CLINICAL RELEVANCE: In the absence of detailed clinical guidelines on the use of endodontic lubricants, irrigants and medicaments in primary and secondary cases, it is important to be aware of current practice in UK and ROI dental schools where dentists and specialists are trained.

Endodontic 'solutions' part 1: a literature review on the use of endodontic lubricants, irrigants and medicaments.

Endodontic lubricants, irrigants and medicaments help prepare and disinfect root canal systems (RCS) but primary and secondary cases involve different microbes and therefore it is unlikely that one protocol will be effective for both case types. Each individual 'solution' or sequence of'solutions' could play a significant role in each case type, but there are no detailed published guidelines in existence. To help inform clinical practice it was decided to undertake a literature review followed by a UK and Republic of Ireland wide audit on current endodontic'solution' usage within dental schools. The literature review was undertaken under the following headings: pre-op oral rinse; file lubricants; root canal irrigants and intracanal medicaments and provides an evidence base for protocol development for both primary and retreatment cases.The audit project and the protocols developed from the findings of both the literature review and audit will be presented in Part 2.

An removal of gutta-percha and root canal sealer: a literature review and an audit comparing current practice in dental schools.

UNLABELLED: Endodontic failures often require non-surgical retreatment. The most common root canal obturating material is gutta-percha (GP), used in conjunction with various sealers. GP removal can be undertaken thermally and/or mechanically with or without solvents, however, no published guidelines exist. Following a literature review, an audit was undertaken comparing current endodontic practice in Belfast Dental School with the other dental schools across the UK and Republic of Ireland. From the findings, Belfast Dental School decided to introduce rotary files and chloroform to its Conservation Clinic with restrictions for use of the latter, although solvent use is not recommended in every case. CLINICAL RELEVANCE: Efficiency in removing both gutta-percha and root canal sealer would maximize the ability to disinfect the root canal system and therefore increase the likelihood of a successful outcome.

Quantification of all-ceramic crown margin surface profile from try-in to 1-week post-cementation.

OBJECTIVES: To use profilometry to assess the margin surface profile of all-ceramic crowns (ACC's) at try-in and 1-week after cementation with dual-cured resin (DC, RelyX ARC, 3M ESPE, St. Paul, MN, USA), self-adhesive dual-cured resin (SADC, RelyX Unicem, 3M ESPE), light-cured resin (LC, RelyX Veneer, 3M ESPE) or chemically cured resin-modified glass ionomer (RMGI, RelyX Luting Plus, 3M ESPE) luting cement. METHODS: Forty, sound, extracted, human, premolar teeth underwent a standardised preparation for ACC's. IPS Empress (Ivoclar-Vivadent, Liechtenstein) crowns of standard dimensions were fabricated and 10 luted with each cement and stored in water for 7 days. Three groups of serial profiles were taken, the first of the tooth preparation, the second of the crown margins at try-in and lastly of the crown margins after cementation and 7 days water storage. RESULTS: There were no significant differences in the crown margin surface profile between the four cement groups at try-in. The change in crown margin position between try-in and post-cementation was significantly greater for DC than for LC and RMGI. SADC was not significantly different to the other cements. There were no significant differences in the crown margin extensions between the four cement groups, however most of the IPS Empress ACC's in this study were underextended but this was not statistically significant. CONCLUSIONS: IPS Empress ACC's seated more fully with LC and RMGI than with DC cement.

In vitro study of mean loads and modes of failure of all-ceramic crowns cemented with light-cured or dual-cured luting cement, after 1 and 30 d of storage.

This study compared the mean loads and modes of failure of teeth restored with all-ceramic crowns (ACCs) cemented with dual-cured (RelyX ARC; 3M ESPE) or light-cured (RelyX Veneer; 3M ESPE) luting cements. Clinically, there are advantages of light-cured cements over the recommended dual-cured cements, namely increased working time, improved handling, colour stability, and a homogenous mix. Forty, sound, extracted, human, premolar teeth underwent a standardized preparation for ACCs. IPS Empress (Ivoclar-Vivadent) crowns of standard dimensions were fabricated and 20 were cemented with each cement. The crowns were stored for 1 or 30 d in water and subjected to a compressive load to failure at 0.017 mm s(-1). There were no significant differences in loads at failure, between each cement group, at each storage period, and there were no significant differences in loads at failure, for each cement, at 1 and 30 d of storage. There were also no significant differences in modes of failure between each cement group. Before recommending light-cured cement as an alternative to dual-cured cement for the cementation of all-ceramic crowns, further research is required to establish the depth of ceramic at which light-cured lutes fail to polymerize completely.