An in-vitro investigation of variables influencing mercury vapor release from dental amalgam.

Controversy regarding patient exposure to mercury from dental amalgam is more than 150 years old. Researchers continue to investigate the amount of mercury vapor released from amalgam both in vivo and in vitro. In this investigation, an in vitro testing method previously described in the literature was used to quantify the effect of operator-controlled variables on mercury release from dental amalgam. The variables tested were alloy morphology (spherical, admixed or atomized irregular particle), operator skill (inexperienced, novice and expert), operator technique (overfill and evenly fill) and cavity design (standard Class I, double volume and double surface area). Preparations fabricated in sections of acrylic rod were filled with dental amalgam, placed in 25 mL glass bottles and sealed. Mercury vapor concentrations were measured using a Jerome M-411 at specified times. Standardized mean concentrations for each time and total mercury released over time were calculated and analyzed with ANOVA and Tukey HSD. Statistically significant differences ((alpha = 0.05) were identified for all variables tested. Total mercury vapor release was consistently found to be greater for admixed as compared to spherical amalgam. Amalgam restorations prepared by an inexperienced operator demonstrated statistically less mercury vapor than a novice or experienced clinician for both spherical and admixed morphologies. A statistically significant difference in mercury vapor using different condensation and carving techniques was found for the spherical amalgam but not for the admixed material. Restoration design demonstrated significant differences in total mercury vapor dependent on volume and exposed surface area of the amalgam restoration. In this in vitro investigation, mercury vapor release from amalgam was dependent on alloy morphology, operator experience, operator technique and restoration design.

Evaluation of a hydrogen peroxide disinfectant for dental unit waterlines.

BACKGROUND: The purpose of this study was to investigate the use of a hydrogen peroxide-based dental unit waterline, or DUWL, treatment to reduce the colonization and growth of heterotrophic bacteria. METHODS: Twenty-three dental units with self-contained water systems were randomly selected. Three of the units and tap water served as controls. Twenty-four water samples were taken at baseline and once a week for five weeks. They were serially diluted, spread-plated in duplicate onto R2A agar plates and incubated at 37 C for seven days. RESULTS: At baseline, the tap water control had a mean count of 0 colony-forming units/milliliter, or CFU/mL, the three control DUWLs had a median count of 8,440 CFU/mL and the 20 treated DUWLs had a median count of 9,760 CFU/mL. By week 1, 19 (95 percent) of the 20 treated DUWLs had counts of less than 200 CFU/mL, and by week 4, the median count for all of the treated DUWLs was 0 CFU/mL. The measurement at week 5 showed that the reduction to below 200 CFU/mL had been maintained. Scanning electron micrographs from processed DUWL tubing samples revealed a similar pattern of results, with biofilm accumulation more evident in the untreated control specimens. CONCLUSIONS: Following the parameters of this study, the authors used a hydrogen peroxide-based disinfectant to achieve the ADA goal of no more than 200 CFU of heterotrophic, mesophilic bacteria per milliliter of unfiltered output water. CLINICAL IMPLICATIONS: An easy-to-use hydrogen peroxide-based DUWL disinfectant demonstrated effectiveness in improving the quality of water used for intraoral procedures. Protocol compliance meets the ADA year 2000 goal.

Effect of light source position and bevel placement on facial margin adaptation of resin-based composite restorations.

PURPOSE: To evaluate the effect of direction of first cure and the presence or absence of a facial margin bevel on the adaptation of facial margins of Class III resin-based composite (RBC) restorations. MATERIALS AND METHODS: Custom polyvinyl siloxane (PVS) light shields were fabricated for both the mesial and distal surfaces of 20 extracted incisors. Class III cavities were prepared in the mesial and distal surfaces of the incisors. On the facial, lingual, and gingival margins of 20 of the preparations a 0.5 mm wide enamel bevel was placed. The lingual and gingival, but not the facial, margins were beveled on the other 20 preparations. The PVS light shield was adapted to the tooth and trimmed to allow 1-2 mm of the facial margin to be exposed on 10 of the beveled and 10 of the non-beveled preparations. For the remaining 20 preparations the PVS light shield was trimmed to allow access of the curing light only from the lingual. Teeth were restored with Prisma TPH RBC. Using the appropriate shield, restorations in the facial first cure group were cured first from the facial and then from the lingual. Restorations in the lingual first cure group were cured only from the lingual. Restorations were finished flush with enamel margins and thermocycled following storage. Samples were exposed to a 50% solution of silver nitrate followed by light exposure. Teeth were sectioned and microleakage was evaluated at three levels (incisal, middle, and cervical). Four evaluators (blinded to direction of cure) independently scored microleakage using a categorical evaluation scale. Statistical analysis included non-parametric descriptive statistics, Cohen's kappa, chi-square analysis, and Kruskal-Wallis ANOVA. RESULTS: Samples prepared without a facial bevel revealed significantly more (P = 0.01) microleakage than preparations with a facial bevel. At the most incisal level, restorations cured first from the facial revealed significantly more (P < 0.001) microleakage than restorations cured first from the lingual. At the middle and cervical levels, restorations cured first from the facial revealed significantly less (P < 0.001) microleakage than restorations cured first from the lingual. When a facial bevel was present, samples cured first from the facial showed significantly less (P < 0.001) microleakage than those cured only from the lingual.

Cerium oxide as a silver decolorizer in dental porcelains.

OBJECTIVES: Silver-base alloys are known to produce an esthetically unpleasant yellow-green tint in the dental porcelain when making PFM restorations. Cerium oxide is used in dental porcelains to simulate the natural fluorescence found in human dental enamel, and has also been used in the glass industry as a decolorizer. The purpose of this study was to determine the effect of CeO2 additions on the resistance of dental porcelain to staining from silver contamination. METHODS: Five batches of porcelain were prepared according to Weinstein et al. (1962) with 0.00, 0.05, 0.10, 0.15 and 0.20 wt% additions of CeO2. To determine the resistance of these porcelains to silver staining, 0.10 wt% additions of the silver oxides were triturated into the prepared CeO2 porcelains prior to sample fabrication. This procedure provided a more quantitative method of staining than firing directly on silver alloys. Silver oxide was added in two valence states as Ag2O and AgO to test for any possible effects on staining. Samples were pressed into a 17 mm diameter mold, and fired to 960 degrees C under vacuum. Three additional samples were prepared from the non-cerium porcelain frit to produce a non-stained control group. Color measurements were made with a spectrophotometer on the ten experimental groups and the control group. The CIE L*a*b* color difference, delta E*, was calculated between the control and the experimental groups. RESULTS: There was a significant decrease in the silver staining of dental porcelains when CeO2 additions of 0.10 wt% or greater were used. SIGNIFICANCE: Cerium oxide additions in the range of 0.10 to 0.20 wt% caused a three-fold reduction in the staining of dental porcelain samples which had been doped with 0.10 wt% of AgO or Ag2O.

Color distribution of three regions of extracted human teeth.

OBJECTIVES: Knowledge of human tooth color and its distribution are critical to the understanding of shade matching in esthetic dentistry. The color of human teeth shows a gradation from the gingival to the incisal region. There have been many reports in the literature on the distribution of color in teeth, but not in the CIE 1976 L*a*b* system. This study was conducted to determine the color distribution in three regions in a sample of human teeth and express the results in Munsell notation, CIE 1976 L*a*b* and CIE delta E* color differences. The hypothesis of this research was that it is possible to detect significant differences in the color parameters of the three distinct regions in teeth. METHODS: All of the teeth used in this study were extracted, cleaned and stored in artificial saliva. Prior to measurement, the teeth were removed from the solution and mounted in a holder to ensure consistent measurements. Spectral data were collected using a GE recording spectrophotometer, CIE chromaticity coordinates calculated using CIE illuminant C and 1931 observer data, and conversions made to L*, a*, b* and Munsell notation. The results were analyzed by ANOVA and Scheffé's multiple comparisons test. RESULTS: The mean L*, a*, b*s were 72.6, 1.5, 18.4 for gingival, 72.4, 1.2, 16.2 for middle, and 71.4, 0.9, 12.8 for incisal. Average Munsell parameters were 1.2 Y 7.1/2.7 for gingival, 1.3 Y 7.1/2.4 for middle, and 1.4 Y 7.0/1.9 for incisal. The mean CIE delta E* between the gingival and incisal regions of the 95 teeth showed a clinically significant difference of 8.2. SIGNIFICANCE: The distribution of color was identified for three regions of the tooth. A statistical analysis determined that there are statistically significant color differences between the regions, and these differences are also clinically significant. This information is beneficial when esthetic restorations are required.