Quintessence International, 06/2001

Considerable knowledge has accumulated over the years on the structure and function of the dental pulp and dentin. Some of this knowledge has important clinical implications, but for some research findings the clinical involvement has yet to be demonstrated. This review will be limited to those parts of the normal structure and physiology of the pulp and dentin that have been shown to result in, or are likely lead to, tissue reactions associated with the clinical treatment of these tissues. Although certain normal structures will be highlighted in some detail, a basic knowledge of pulpal and dentinal development and structure is a prerequisite for an understanding of this text.

Calcific metamorphosis (CM) is seen commonly in the dental pulp after traumatic tooth injuries and is recognized clinically as early as 3 months after injury. Calcific metamorphosis is characterized by deposition of hard tissue within the root canal space and yellow discoloration of the clinical crown. Opinion differs among practitioners as to whether to treat these cases upon early detection of CM or to observe them until symptoms or radiographic signs of pulpal necrosis are detected. In this review, the clinical, radiographic, and histopathologic appearance of CM is described; a review of the literature is presented to address these issues in an attempt to establish a sound rationale for treatment. Approximately 3.8% to 24% of traumatized teeth develop varying degrees of CM. Studies indicate that of these, approximately 1% to 16% will develop pulpal necrosis. Most of the literature does not support endodontic intervention unless periradicular pathosis is detected or the involved tooth becomes symptomatic. It may be advisable to manage cases demonstrating CM through observation and periodic examination.

Objective: To promote denture retention and denture comfort, denture materials should possess adequate wettability. This in vitro study investigated the wettability of nine commercially available dental materials. Method and materials: Four denture base materials, two denture hard lining materials, and three denture soft lining materials (with and without varnish treatment) were tested. The wettability measurements were made using the dynamic contact angle analysis technique. The equilibrium and hysteresis angles obtained were used for the comparisons. Results: The equilibrium contact angle ([theta]e) ranged from 63.9 (Permaflex + varnish) to 81.0 degrees (Mollosil + varnish). The differences observed among the materials tested were statistically significant. The contact angle hysteresis ranged from 16.0 (SR 3/60 Triplex) to 51.2 degrees (Mollosil), and there was a statistically significant difference among the materials. Conclusion: The heat-polymerized soft lining materials exhibited the greatest equilibrium contact angle, the autopolymerized soft liner had the lowest value, and the denture base materials had intermediate values. The soft liners showed greater contact angle hysteresis than all other materials. The use of varnish altered the wetting characteristics.

Objective: The objective of the present study was to clinically evaluate the hybrid materials Vitremer and Dyract when used as pit and fissure sealants. Method and materials: The materials were applied in pairs on the mandibular permanent first molars of 100 children, 7 to 8 years old. Results: After 12 months of sealing, the clinical evaluation presented rates of 95.9% and 85.7% of complete retention for Dyract and Vitremer, respectively, indicating a statistically significant difference. The hybrid materials presented a statistically significant protective effect against caries compared with the control group at 6 and 12 months. Conclusion: The hybrid materials were able to control occlusal caries.

Bulimia nervosa is among the most common health problems in contemporary society. It is a self-induced weight loss syndrome associated with distinct dental manifestations involving physical and psychologic symptoms. It is characterized by recurrent binge-purge episodes that occur at least once a day. This article describes the complete-mouth rehabilitation of a bulimic patient with a generalized enamel erosion of her dentition and a poor esthetic appearance. Porcelain-fused-to-metal restorations were used as the definitive treatment. Good esthetics and high self-esteem were the final results. Comprehensive restorative therapy was applied in this clinical case report to achieve both function and esthetics in a demanding situation.

The implication of a traumatic injury to a permanent molar tooth as a complication by tongue piercing with ornamental jewelry is reported. An appropriate restorative management of the fractured tooth is described. The dentist's role in prevention and treatment of unfavorable complications is outlined. The rationales for selection of specific treatment modalities, in view of the degree of damage to hard dental tissues, are discussed. The range of hard tissue injuries resulting from tongue jewelry varies from a simple crack propagating into the enamel to a fractured tooth. A variety of factors must be considered before employing the available restorative methods.

Dr Brent Benkelman has practiced oral surgery in Manhattan, Kansas, since 1971. Having grown up in a tiny farming town in western Kansas, he opted for the lifestyle of a smaller community after graduating from the University of Missouri at Kansas City School of Dentistry in 1966 and completing his training