Quintessence International, 05/2004

Bonded amalgams were used as pit-and-fissure sealants without mechanical preparation. They were compared with resin-based pit-and-fissure sealants for retention over a 5-year period. Clinical examinations at 6 months, 1 year, 2 years, and 5 years revealed no difference between the two techniques. Although amalgam sealants may not be practical by themselves, they can be used to seal pits and fissures surrounding very conservative preparations, in the "preventive amalgam restoration." Conventional amalgam retentive features and 90-degree cavosurface margins may not be necessary when bonding is used with amalgam.

In spite of advances in materials and techniques for direct posterior composite restorations, some problems remain, such as occlusal wear rate, marginal breakdown, and marked operator technique sensitivity. To enhance longevity of these restorations, finishing and polishing procedures are commonly indicated. Although these procedures offer advantages, they also have some drawbacks, such as higher marginal breakdown and increased susceptibility to wear following finishing procedures. Faced with the disadvantages brought by finishing and polishing procedures, it seems reasonable to try and find a technique to omit them. This paper presents clinical cases exhibiting a restorative technique that prevents, or at least reduces, the need for instrumentation of the restoration. In cases when finishing procedures are necessary, the restorations should be sealed with a specific resinous agent to impart new strength to the instrumented surface and improve marginal integrity. In addition, the suggested technique promotes a better occlusal anatomy than that attained with the traditional technique.

Objectives: This study investigated the effectiveness of three different dentin adhesive systems on the adhesion of resin composite to both dentin and enamel. Method and materials: The flat dentin and enamel surfaces of 60 extracted human molar teeth were exposed by wet grinding with 600-grit silicon carbide paper. One total-etch self-priming adhesive system (Prime & Bond NT), one two-step self-etching primer adhesive system (Clearfil SE Bond), and one "all-in-one" self-etching adhesive system (Prompt L-Pop) were evaluated. Each bonding system was applied according to the manufacturer's instructions and followed by composite (TPH Spectrum) application. Twenty-four hours after bonding, the teeth were subjected to shear testing. There were 10 replicates for each group. Results: Prompt L-Pop exhibited significantly higher bond strength values to enamel (27 ± 4.2 MPa) than all other groups. There were no statistically significant differences for shear bond strength to dentin among adhesives. Prompt L-Pop showed the statistically significantly higher bond strength to enamel than dentin.There were no statistically significant differences between the enamel and dentin bond strengths of Clearfil SE Bond and Prime & Bond NT. Conclusions: The self-etching adhesive systems produced high bond strengths to human coronal dentin and ground enamel surfaces.These materials seem to be very promising for further clinical applications, and the results are very encouraging for the clinical success of these simplified adhesive systems. The self-etching adhesive systems produced even better bond strengths to both enamel and dentin than conventional total-etch systems, especially the "all-in-one" system, which produced the highest bond strength to enamel.

A 53-year-old man exhibited a large dentigerous cyst associated with a deep vertical impaction of his left mandibular third molar where a close anatomic relationship existed between the root and the mandibular canal. After consultation, it was decided to perform marsupialization of the cyst, to extrude the third molar orthodontically, and then to extract it. This combined orthodontic-surgical approach was successful.

Displacement of impacted third molars is frequently mentioned

Population-based oral cancer screening appears to be a promising health promotion strategy (especially in high-risk individuals) with significant increases in quality-adjusted life years saved. However, the current protocol, conventional visual inspection, and palpation of oral soft tissues for the early detection of pre-malignant or malignant changes, appears to be deficient. The adjunctive application of technology to highlight such lesions may increase the diagnostic yield. The purpose of this pilot study was to collect data, which might support the hypothesis that oral soft tissues exhibit features similar to the cervical epithelium following an acetic acid wash and visual inspection under chemiluminescent illumination. The data provides strong evidence to support the hypothesis. Epithelium with hyperkeratinization, hyperparakeratinization, and/or chronic inflammatory infiltrate reflects the diffuse, low-level, blue-white chemiluminescent light more strongly and appears amplified. Similarly, epithelium with an altered nuclear-cytoplasmic ratio also reflects the diffuse, low-level, blue-white chemiluminescent light. In such cases, the lesions become clinically discernible and appear "acetowhite." Large-scale studies are required to further refine issues related to the selectivity and specificity of the technology.

Glandular odontogenic cyst (GOC) is a rare developmental cyst of the jaws. It is included in the World Health Organization (WHO) histologic typing of odontogenic tumors under the terms glandular odontogenic cyst or sialo-odontogenic cyst. The most common site of occurrence is the anterior mandible, and it occurs mostly in middle-aged people. A predilection for men is observed. Clinical findings are not specific, and an asymptomatic swelling is frequently observed. A unilocular or multilocular, well-defined radiolucency is usually seen. The microscopic features of GOC, particularly the morphology of the epithelium, strongly suggest an origin from the remains of dental lamina. GOC has an unpredictable and potentially aggressive nature, which may indicate a high tendency of recurrence. The treatment of choice is still controversial, varying from a curettage to local block excision. A long-term follow-up should be carried out. The aim of this article is to report a case of glandular odontogenic cyst that recurred four times and to emphasize the importance of long-term follow-up. The origin, epidemiology, clinical and radiographic aspects, and treatment of the GOC are also discussed.

Objective: To evaluate the efficacy of oral moisturizing gel (Oral Balance) in xerostomic patients with primary Sjögren's syndrome (SS). Method and materials: Twenty-one xerostomic patients with primary SS were subjected to a single-blind trial in which the efficacy of Oral Balance gel in reducing xerostomia and xerostomia-related oral symptoms was compared with that of a placebo. Both gels were packaged identically and were indiscernible in appearance and taste. Xerostomia was confirmed for all the patients through measurement of stimulated whole saliva. Patients began using the Oral Balance gel three times a day for 90 days, and were then switched to a gel placebo to be used in the same way for the same length of time. Clinical response was evaluated through the patients' subjective assessment (improved, worsened, or unaltered) of both gels. Results: Neither the Oral Balance gel nor the gel placebo affected the salivary output of the patients. The Oral Balance gel presented a substantial statistically significant advantage in the control of burning mouth, mastication, and swallowing. No statistically significant relief of the isolated sensation of oral dryness was established. Conclusion: Oral Balance is a useful tool in the management of dryness-related oral symptoms in primary SS, but there is room for enhancing the overall properties of topical preparations designed to reduce oral complaints in xerostomic patients.

Dental prostheses are frequently used to avoid psychologic, speech, or swallowing problems in preschool children with considerable tooth loss. Two cases of preschool children are presented, involving multiple loss of primary teeth.The purpose of this study was to promote the correct development of the maxilla and mandible by using removable dental prostheses and to guide the eruption of the permanent molars. Removable acrylic prostheses were provided for two children, with a special metallic s-shaped handle (ansa), which guided the eruption of the first permanent molars. These prostheses were modified as the children grew. By replacing missing teeth, several oral functions were re-established, development of the maxilla and mandible was promoted, and each child could develop socially from a psychologic point of view. The use of removable dental prostheses in preschool-aged children presenting with considerable tooth loss can be a viable and successful treatment option.

This case report describes the complex occlusal rehabilitation of a patient with signs and symptoms of temporomandibular disorders with utilization of an occlusal acrylic splint as a means of initial treatment for neuromuscular reprogramming and repositioning of the condyle within the mandibular fossa for occlusal stability, thus allowing adaptation to a new occlusal vertical dimension.

Objective: The technique of resin-bonded fixed partial dentures (RBFPD) is a well-accepted clinical technique to replace missing teeth. The survival rates reported in the literature vary widely, and the conclusions are sometimes conflicting. This study presents the clinical long-term performance of silicoated RBFPDs and also determines the main cause of failure. Method and materials: Sixty-one patients with a total of 74 RBFPDs were either examined or requested to complete a questionnaire regarding their fixed partial dentures. Sixty-four were placed in the anterior region, and 10 in the posterior region. No more than one missing tooth in the posterior area and two missing teeth in the anterior region were replaced with RBFPDs. A retentive preparation was made on the abutment teeth. All the RBFPDs were adhesively seated. Results: Eighteen RBFPDs failed after a mean observation time of 7.8 years (nine retention losses of one or more retainers, six carious lesions, and three veneer fractures occurred). Seven RBFPDs were rebonded, whereas the remaining 11 failures had to be replaced with conventional FPDs. Fifty-six RBFPDs were primary restorations, and seven secondary RBFPDs were used after the loss of the primary restoration. A mean survival rate better than 69% after a 13-year observation period was calculated. Including the rebonded restorations, a mean functional survival rate of 83% was estimated. A total of 18 failures (24.3%) of all restorations were observed, the main cause being loss of retention. Conclusion: Silicoated RBFPDs are a viable treatment means with an acceptable success expectancy.

Objective: This in vitro study aimed to evaluate the effect of bleaching agents on dentin microhardness during and after bleaching. Method and materials: Specimens were randomly assigned to seven groups (n = 15): Nite White Excel 2 Z [NW] 10% and 22%; Rembrandt [REM] 10% and 22%; Opalescence [OPA] 10% and 20%; and a placebo agent. The 42-day whitening treatment consisted of daily application of the agents to the dentin surfaces for 8 hours, followed by immersion in artificial saliva for 16 hours. After the bleaching treatment, specimens were kept immersed in artificial saliva for 14 days. Microhardness was measured at baseline, 8 hours, and 7, 14, 21, 28, 35, and 42 days of bleaching and during the posttreatment period (7 and 14 days). Results: The analysis of variance for split-plot showed a significant effect on the interaction between bleaching agent and time. Tukey's test and regression analyses revealed that during the bleaching period, the agents NW 10%, NW 22%, and OPA 20%, which did not differ from each other, did not alter dentin microhardness, showing constant microhardness values. There were no differences among REM 10%, REM 22%, and OPA 10%, which showed significant reductions in microhardness after day 14 compared to other agents. After bleaching procedures, there was an increase in dentin microhardness for all groups. Conclusion: Throughout the bleaching treatment, depending on the agent applied, dentin showed a transitory decrease in microhardness values. In the posttreatment period, artificial saliva presented a remineralizing effect on the bleached surfaces.