Quintessence International, 02/2006

Objective: Patient demands have prompted manufacturers to improve intrinsic optical properties of resin composites and clinicians to refine application procedures. The aim of this study is to present a shading concept based on colorimetric L*a*b* and contrast ratio data of human dentin and enamel. Method and materials: Extracted teeth of the A and B Vita shade groups (n = 8 per group) were sectioned according to 2 different planes to measure specific color (using the CIE L*a*b* system) and opacity (contrast ratio). Standardized samples of enamel and dentin shades of a new composite system (Miris, Coltène Whaledent) were submitted to the same colorimetric evaluation for comparison with natural tissues. Results: Comparison of teeth from the Vita groups A and B having the same chroma showed limited variations regarding a* (green to red) and b* (blue to yellow) values; the only significant variation was the increasing b* values (yellow) with increasing chroma (A1 to A4 and B1 to B3). As for dentin contrast ratio, limited differences were reported, while enamel proved to increase in translucency with age (reduced contrast ratio). Conclusion: These data served as the foundation of the so-called natural layering concept, which makes use of 2 basic composite masses (dentin and enamel) that optically mimic natural tissues. This concept allows for simplified clinical application and layering of composite, as it uses only 1 universal dentin hue with several chroma levels and 3 enamel types for young, adult, and old patients, each exhibiting specific tints and translucency levels. Keywords: CIE L*a*b*, contrast ratio, dentin color, natural layering technique

As the baby boomer generation in the United States ages, more patients are using bisphosphonates for systemic bone diseases like osteoporosis. Because of their ability to inhibit bone resorption and osteoclastic activity, bisphosphonates may also be beneficial in modulating host response for periodontal disease management. This literature review examines the mechanism of action for bisphosphonates and their uses in treating periodontal disease. The dental profession should continue to evaluate this class of drugs and to closely monitor patients who are on bisphosphonate therapy. Keywords: bisphosphonate therapy, osteoporosis, periodontal disease

Objective: The purpose of this study was to compare the seal along dentin and enamel margins produced by 3 self-etching resin bonding systems to that of an etch-and-rinse adhesive system. Potential improvement in adaptation along enamel margins through the experimental use of conventional enamel etching prior to application of the self-etching adhesives was also evaluated. Method and materials: Class V resin composite restorations were placed in prepared cavities in extracted third molars using 3 self-etching dentin adhesive systems: Adper Prompt L-Pop (3M Espe), iBond GI (Heraeus Kulzer), and Tyrian SPE (Bisco), and an etch-and-rinse adhesive, Adper ScotchBond Multi-Purpose (3M Espe). A group of teeth also underwent conventional enamel etching prior to use of the self-etching products. The restored teeth were thermocycled, subjected to a dye challenge, and sectioned. The sections were scored using an ordinal leakage scale (n = 20). Ranked data were analyzed using a 2-way analysis of variance and Tukey multiple comparison. Results: When used as directed, there were no significant differences along dentin margins for any of the adhesives, but Adper Prompt and iBond demonstrated significantly greater leakage than the etch-and-rinse product along enamel margins. The incidence of enamel margin leakage decreased significantly for the same 2 products when enamel etching preceded use of the resin. Enamel etching increased the leakage along dentin margins for all 3 self-etching products, but not significantly. Conclusion: Considerable improvement of all classes of dentin-adhesive resin systems is still needed. Practitioners should await further clinical trials before adopting use of self-etching resins, especially for large occlusal restorations. Keywords: dentin adhesion, enamel adhesion, microleakage, resin composite, self-etching resin

Objective: In-office bleaching has become very popular for patients desiring immediate results. This report discusses the efficacy of in-office bleaching using high-intensity xenon halogen tungsten light on 73 patients in a private practice over 6 months. Method and materials: Thirty-five percent hydrogen peroxide gel was applied to the tooth surfaces, and then both arches were illuminated with the LumaArch unit light for 8 minutes. The entire procedure was completed 3 times for a total application time of 24 minutes. Thereafter, patients returned every 2 weeks for another 24-minute in-office treatment until the patient was satisfied or did not want additional treatment. After completion of bleaching, patients were classified into groups according to the number of treatments they received. When requested, home bleaching was used as a follow-up treatment. The degree of color change and color relapse were evaluated at baseline and immediately, 2 weeks, and 6 months after bleaching. Also evaluated was the number of patients that requested home bleaching. Results: Of the 73 patients who received 1 to 4 in-office bleaching procedures, 58 were satisfied. Twenty-seven patients requested home bleaching. The average color change per appointment was 2.1 to 3.7 units on a 16-scale Vita Classic shade guide. Color relapse was more noticeable at the 2-week interval than at the 6-month postbleaching evaluation. Conclusion: In-office bleaching may be an alternative for patients who do not like home bleaching. In-office treatment may achieve satisfactory results, but often more than 1 visit is necessary to achieve patient satisfaction. Keywords: bleaching, high-intensity xenon halogen tungsten light, home bleaching, in-office bleaching, patient satisfaction, tooth whitening

An unusual presentation of dens invaginatus affecting a microdontic permanent lateral incisor in a 19-year-old female patient is reported and pertinent literature reviewed. The patient was referred to the oral and maxillofacial radiology clinic of the authors' institution for radiographic examination of her maxillary teeth. Dens invaginatus was identified on the maxillary right lateral incisor in the anterior periapical radiographs. The tooth was microdontic and clinically simulated a primary tooth. Dens invaginatus occurs rarely in primary dentition although it is fairly common in permanent teeth. Only 4 instances of dens invaginatus affecting the primary dentition have been reported in the literature. The etiology, pathophysiology, association with other dental anomalies, as well as management aspects of this common anomaly, are discussed. Keywords: dens in dente, dens invaginatus, permanent tooth, pulp vitality

This article reports the utilization of mandibular tori as an alternative source of autogenous bone for ridge augmentation and maxillary sinus lifting to facilitate ideal implant placement. A patient presenting bilateral mandibular tori required replacement of a missing maxillary molar and a mandibular premolar. Both areas showed ridge deficiency that required bone augmentation before implant placement. Mandibular tori were used for horizontal augmentation of the mandibular alveolar ridge and vertical augmentation of the maxillary ridge by elevation of the maxillary sinus. Adequate new bone formation was noted in both areas 6 months after grafting. Bone formed in the grafted areas showed comparable clinical features to those of native bone. Implants were successfully placed and loaded, restoring esthetics and function. Within the limitations of this observation, mandibular tori can be successfully used for ridge augmentation and sinus lifting. However, further controlled studies are needed to determine the overall benefit of this source of autogenous bone. Keywords: bone grafting, dental implants, exostoses, maxillary sinus lifting, ridge augmentation, tori

Objective: The aim of this investigation was to evaluate the clinical performance of 4 types of tooth-colored inlays. Method and materials: Fifteen direct ceramic inlays (Cerec Cos 2.0), 15 direct composite inlays (Brilliant DI, Coltène), 14 indirect ceramic inlays (Vita Dur N), and 14 indirect composite inlays (Estilux, Kulzer) were placed in 37 patients, according to manufacturer instructions. The inlays were evaluated 1 week (baseline), 6 months, and 1, 3, 4, 5, and 10 years after cementation (modified California Dental Association Quality Evaluation System). The ratings were compared using the chi-square test. For comparing the survival rates among the 4 types of inlays, a life-table analysis was done, followed by a log-rank test. Results: Three Vita Dur N inlays were replaced after 1, 4, and 8.5 years; 3 Cerec inlays were replaced after 4.5, 8.5, and 9.5 years; and 3 Brilliant DI inlays needed replacement after 1, 5, and 6.5 years, all because of secondary caries or fractures. Three inlays (Estilux) were replaced because of persisting hypersensitivity or pulpal damage. Six inlays (3 Vita Dur N, 1 Estilux, and 2 Brilliant DI) were repaired for minor fractures. During the observation period, the surface texture of Vita Dur N inlays became significantly rougher. About 80% of the inlays, including repaired inlays, were in function after 10 years. Conclusion: After 10 years of observation, survival of the 4 types of tooth-colored inlays was similar and considered clinically acceptable. The survival rates were within the range of survival for direct composite restorations. Keywords: ceramic, inlay, marginal adaptation, morphology, resin composite, surface texture, survival rate

Objective: The purpose of this in vitro study was to compare the effect of surface coating containing fluoride on patterns and amounts of fluoride release from 5 esthetic restorative materials. Method and materials: Twelve cylinders of each material were prepared in a plexiglass mold. The experimental groups (n = 6) were coated with 1 layer of fluoridated adhesive resin, Prompt L-Pop, while the control groups (n = 6) remained uncoated. Fluoride release into deionized water was measured on days 1, 2, 3, 7, 14, 21, and 28 using an ion analyzer. Results were evaluated statistically using repeated measure analysis of variance and Duncan test. Results: In the uncoated materials, the highest fluoride-releasing material was a resin composite Ariston pHc (140.468 ± 9.80) followed by Photac-fil (101.200 ± 5.56), Ketac-fil (91.098 ± 4.69), Hytac Aplitip (5.122 ± 1.00), and Ecusit (0.310 ± 0.18). Material-coating interaction was found to be significant, but the effect of surface coating was different for each material. Among the coated materials, conventional glass-ionomer cement Ketac-fil released the highest amount of fluoride (93.326 ± 10.86), followed by Photac-fil (83.666 ± 4.72), Ariston pHc (53.862 ± 7.90), Hytac Aplitip (14.634 ± 2.35), and Ecusit (1.355 ± 0.29). Conclusion: Application of fluoridated adhesive affected fluoride release from each material in varying magnitudes. Keywords: compomer, fluoridated adhesive, fluoride release, glass-ionomer cement, resin composite, resin-modified glass-ionomer cement