Quintessence International, 02/1998

The range of indications for implant-borne prostheses in partially edentulous patients has expanded in recent years as a consequence of advances in regenerative techniques for bone and soft tissues. The esthetic demands of both patien ts and dentists have risen in parallel with these advances. Esthetic compromises in prostheses have become increasingly less tolerable, particularly in the anterior region of the maxilla. If the presenting situation is less than optimal, extensive preprosthetic measures may be required to prepare local tissues for acceptance of esthetically and functionally adequate prostheses. Particularly in difficult situations, collaboration by a team is recommended. The exchange of ideas and experience among specialists should begin as early as the treatment planning stage and extend over the entire course of therapy. The objective should be defined and the various steps of treatment should be coordinated with participation from all team members.

Objective: A restorative material for Class III cavities must, besides being functional, be esthetically satisfactory, providing good working conditions and several shade and color options. A clinical evaluation was initiated to compare the suitability of resin composite and glass-ionomer cement materials for such restorations. Method and materials: Forty-two Class III conservative cavities, esthetically important because of facial extensions, were selected. Resin composite restorations were placed in 21 cavities, and the remaining 21 were restored with glass-ionomer cement. The following characteristics were studied: color or esthetics, anatomic shape, surface texture, staining, marginal infiltration, dental plaque retention, and occurrence of fracture. After 24 months, the restorations were evaluated. Results: The only statistically significant difference between the resin composite and glass-ionomer cement restorati ons in the experimental perid involved color or esthetics. Conclusion: Resin composites and glass-ionomer materials provide excellent functional and esthetic results in Class III cavities when properly indicated.

Objective: This study evaluated the load required to produce failure in Class II bonded amalgam restorations. Method and materials: Five groups of 12 maxillary molars were mounted. Class II mesio-occlusal preparations were cut: group 1, extension through central grooves, wihtout retention grooves; group 2, proximal slot preparation, without retention grooves; groups 3 and 5, slot preparation with long facial and lingual retention grooves; group 4, slot preparation without grooves, with unsupported proximal enamel allowed to remain. Groups 1 to 4 were restored with an amalgam-bonding system and amalgam; in group 5, no amalgam-bonding material was used. Results: Mean (SD) failure loads: group 1, 281 (77) N; group 2 , 246 (101) N; group 3, 238 (84) N; group 4, 254 (100) N; and group 5, 191 (66) N. Conclusion: Although there was a trend toward greater resistance to dislodgement or fracture when an amalgam-bonding technique was used, its use did not significantly increase the resistance to failure when compared to retention grooves alone.

Objective: This study assessed the clinical performance of dentin-bonded crowns, in which ceramic crowns are bonded to underlying dentin with a resin composite-based luting mater ial and a dentin bonding agent. Method and materials: Twenty-five patients who had received such restorations more than 1 year previously were recalled for evaluation of their crowns. Results: Sixty dentin-bonded complete-coverage restorations were assessed. Forty-one of the crowns had been placed on incisor teeth. The mean time since placement of the restoration was 2.43 years. Fifty-seven of the 60 restorations were intact. The three failures had resulted fromcracks in the restorations, which had not clinically debonded. No secondary caries was detected at the crown margins, and anatomic form was assessed as excellent for 56 crowns. Root canal treatment had been required in one case. Color match was rated very good for 47 crowns. All 25 patients were satisfied with their restorations. Conclusion: Dentin-bonded crowns may be found to have a low rate of failure and to provide a high level of patient satisfaction.

Objective: An immediate chairside technique (Latex Candida) for the detection of Candida albicans was compared with a simple tube culturing technique (Oricult) and the traditional laboratory culturing technique in patients with Sjogren's syndrome. Method and materials: Subjects with primary (n = 9) and secondary (n = 9) Sjogren's syndrome (mean age of 56.7 years; all female) and an age- and sex-matched group of control subjects (n = 9) were selected. Three different methods for culturing Candida albicans were performed for each subject. one culturette was plated on a trypticase soy-agar streptomycin-vancomycin medium plate and incubated for 48 hours at 37 degrees C. Another swab was plated on a reagent paper with the Latex Candida test kit. The third swab was placed in a culture media tube using the Oricult kit and incubated for 48 hours at 37 degrees C. Results: All three techniques indicated a significant difference in the prevalence of Candida between the control gr oup and both Sjogren's groups. The Latex Candida technique indicated that 78% of all Sjogren's subjects were positive for Candida, while the other two tests indicated that 83% were positive. Conclusion: The Latex Candida technique was comparable to Oricult and streptomycin-vancomycin culturing techniques for negative results and was correctly positive for 90% of cases.

A perforated root represents a difficult challenge to the clinican, and treatment of such defects often involves surgical and/or advanced restorative techniques. This typically requires a series of lengthy, often stressful appointments, may compromise esthetics, and invariably involves additional costs to the patient. This case report describes the nonsurgical treatment of separate mechanical perforations that resulted from the removal of a faild prefabricated post. The tooth was restored in a minimum number of visits through the use of a novel applicatin of a resin-ionomer material originally designed for routine restorative procedures.

Endemic dental fluorosis is a form of enamel hypoplasia characterized by moderate-to-severe staining of the tooth surface. Since 1916, numberous investigators have used hydrochloric acid alone on fluorosis stains. More recently, 18% hydrochloric acid-pumice microabrasion has been used to achieve color modification. The main disadvantage of this procedure is the high concentration and low viscosity of hydrochloric acid, which can cause damage to oral and dental tissues. To eliminate this problem, quartz particles can be mixed with the hydrochloric acid. The quartz particles prevent teh hydrochloric acid from flowing uncontrollably by altering it to a gel-like form. A modified 18% hydrochloric acid-quartz-pumice abrasion technique was used to remove fluorine stains from vital teeth in a teenager.

Children who present with extensive fractures of anterior teeth pose a difficult clinical problem. Pulpal and periodontal injuries must be carefully assessed and managed. Rapid restoration of the form and contour of the extensively fractured tooth is advisable, not only to improve esthetics but also to prevent unwanted tipping or tilting of adjacent teeth and overeruption of opposing teeth. A modified Essix retainer, simply constructed in the laboratory, can be used to provisionally restore the extensively fractured anterior tooth.