Quintessence International, 11/1995

The availability of high-technology systems that use computer-aided design and computer-aided machining is on the increase. One such system is the Procera system, which is currently providing cost-effective, high-quality dental restorative services to dental laboratories and to dentists. A reduction in cost to the dentist, and ultimately to the patient, is a major advantage of the Procera system. Cost benefits combined with its continued success in producing crowns and fixed partial dentures that meet professional standards of care should enhance the acceptance of this new technology.

The clinical and histologic responses of exposed pulpal tissue after direct capping appear to be more closely related to bacterial infiltration than to direct material toxicity. Dentinal bonding agents have been suggested as a replacement for calcium hydroxide for pulpal protection. In this pilot study, direct pulp capping with a glutaraldehyde-containing dentinal adhesive was performed on eight permanent premolars and molars. The teeth were immediately restored with a resin composite restoration. The clinical technique included the use of a calcium hydroxide paste to cover the exposure site during completion of the preparation. Enamel and dentin were etched with phosphoric acid. All teeth remained vital and without symptoms during the initial observation period of 2 to 6 months.

The purpose of this study was to test the effect of treatment in a gravity steam autoclave, high-vacuum steam autoclave, or an unsaturated chemical vapor sterilizer on endospores present on strips or placed inside of dental anesthetic cartridges held within sharps containers. Strips with 1.7X10 5 Bacillus stearothermophilus endospores were used the cartridges were soiled with an equal number of spores or spores mixed with blood. If sterilization was not accomplished after the initial period, additional exposure time was added. Neither the presence of blood or anesthetic solution nor the position of the container affected the efficiency of sterilization. Soiled cartridges were much more difficult than strips to sterilize. Intact cartridges could not be sterilized by two runs in a gravity steam autoclave or an unsaturated chemical vapor sterilizer or one run in a high-vacuum steam autoclave. Sterilization occurred after two runs in the gravity steam autoclave and unsaturated chemical vapor sterilizer only when one end of the cartridge was removed prior to processing. Results indicated that unopened spore-soiled cartridges are not readily sterilized by commonplace office sterilizers, even after extended exposure.

The records of 1,797 patients were retrospectivelye xamined to analyze the possible relationships between postoperative complications following mandibular third molar extraction and parameters such as age, sex, inication for surgery, position of the molar, surgical experience, surgical technique, and postoperative care. Older patients tended to suffer more often from complications. Surgery performed while there were signs of pericoronal inflammation also resulted in more complications. There was no statistically significant difference in the mean complication rate arising from surgery performed by staff members and the rate when surgery was performed by residents. There seems to be no reason for patients to return routinely for removal of resorbable sutures or other postoperative care because this practice does not result in a decrease in postoperative symptoms.

Amalgambond Plus with HPA (high performance additive) was evaluated for its ability to bond a resin composite and an to deep primary dentin. Tensile bond strengths for resin and amalgam were 6.40 ± 2.17 MPa and 2.95 ± 0.92 MPa, respectively. There was a statistically significant difference between groups. The modes of failure of the specimens were 100% adhesive for amalgam and 76% adhesive-cohesive and 24% adhesive for resin composite. The clinical performance of amalgam and resin composite mesio-occlusodistal restorations bonded with Amalgambond Plus was also evaluated over 15 months. Periapical radiographs were taken to support the clinical examination. The following parameters were assessed: marginal adaptation, secondary caries, postoperative hypersensitivity, and retention. Both types of restoration exhibited excellent marginal adaptation and retention and no secondary caries or hypersensitivity.

Papillon-Lefevre syndrome is a rare autosomal-recessive congenital differentiation disorder; the external signs are hyperkeratosis of the palms and soles. Intraorally, the most salient manifestations are dystrophic periodontal that affect both the primary and permanent dentitions and frequently lead to premature tooth loss. Two children were treated with acitretin 0.5 mg/kg of body weight per day from November 1992 to November 1993, and another child since October 1993. Concurrently, the children received professional oral hygiene care (scaling, root planning, and curettage). The combination of retinoid therapy and periodontal treatment improved the dermatologic and periodontal conditions.

Difficulty with speech is a common complaint of patients with xerostomia resulting from salivary gland dysfunction. The purpose of this pilot study was to assess and compare speech tasks in three patient groups with salivary gland dysfunction arising from different etiologies (primary Sjogren's syndrome, secondary Sjogren's syndrome with systemic lupus erythematosus, and irradiation therapy for head and neck cancer) and a matched control group. Diadochokinetic speech tasks were quantified clinically and videofluoroscopically. The results indicated that significantly fewer speech tasks were completed, with or without water, but the groups with salivary gland dysfunction than by the control group. Videofluoroscopy provided excellent quantitative analysis, yielding results similar to those of the clinical measurement. In a subjective self-assessment, subjects with salivary gland dysfunction reported more problems with speech than did control subjects.

Forty acrylic resin duplicates of an endodontically treated and extracted human molar were restored with two resin composite materials for core restorations. Two different manipulation techniques, bulk insertion and syringe application, were used. In a simulated clinical setup, the core buildups produced by the different manipulation techniques were investigated for voids. In 20 duplicates, a post was placed to simulate a metal post and resin composite core buildup. The syringe technique produced significantly fewer incorporated voids for both resin composite core materials than did the bulk insertion technique. It was not possible to demonstrate a relationship between the presence of voids and the presence of a metal post.

The purpose of this in vitro study was to evaluate the enamel and dentinal marginal sealing ability of three different cervical restorative systems. Class V preparations were made at the cementoenamel junction of 36 extracted premolars. The teeth were randomly divided into three groups of 12 and restored with either a polyacid-modified resin composite (compomer), resin composite, or resin-modified glass-ionomer cement. The restored teeth were stored in saline at 37 degrees C for 1 week, thermally stressed for 500 cycles, and subjected to dye penetration testing. The results showed that there was no significant differene in dentinal margin sealing ability among the three materials evaluated. When the margins were in enamel, the resin composite restorations had significantly less leakage than did compomer or resin-modified glass-ionomer cement restorations. The marginal sealing ability of all three materials was significantly poorer in dentin than in enamel. s a w .