Effects of glass ionomer and microfilled composite subgingival restorations on periodontal tissue and subgingival biofilm: a 6-month evaluation

BACKGROUND

This 6-month study evaluated the effects of resin-modified glass-ionomer cement (RMGI) and microfilled composite (MC) subgingival restorations on periodontal tissues and subgingival biofilm.

METHODS

Fifty-four periodontally healthy patients were assigned as follows: group 1 (N = 18), root exposure (RE) without non-carious cervical lesions (NCCL) treated with coronally positioned flap (CPF); group 2 (N = 18), RE with NCCL treated RMGI restorations plus CPF; group 3 (N = 18), RE with NCCL treated with MC restorations plus CPF. Probing depth (PD), visible local plaque score (PL), and local bleeding on probing (BOP) were assessed at baseline and 6 months after surgeries. Restored and non-restored root recoverage (RR) was assessed at 6 months. Each experimental tooth was subgingivally sampled (baseline and 6 months) and analyzed by checkerboard DNA-DNA hybridization.

RESULTS

Clinical results showed no significant differences among the groups regarding PL, BOP, and PD at baseline and 6 months. The RR means were similar among the groups at 6 months. Intragroup analyses revealed that the proportions of 10 periodontopathogens decreased at 6 months for the control group. For the RMGI group, there was a significant decrease in the proportions of nine periodontopathogens. For the MC group, there was a significant increase in the proportions of Fusobacterium nucleatum polymorphum and Gemella morbillorum and a decrease in five periodontopathogens. Intergroup analyses showed an increase in the proportion of F. nucleatum polymorphum for the MC group.

CONCLUSIONS

In a 6-month evaluation, well-finished RMGI or MC subgingival restorations did not negatively affect periodontal health. Furthermore, RMGI seems to exert more positive effects on the subgingival biofilm composition than MC.

Sickle cell disease and dental treatment

Sickle cell disease (SCD) and sickle cell trait (SCT) are found most frequently in individuals of African, Middle Eastern and Indian ethnicity. Population migration has made this disease more common worldwide, including Ireland. We present an overview of this disease, focusing on management and practical implications for dental practitioners.

Oral health disparities in the United States

Oral health disparities refers to the existence of differences in the incidence, prevalence, mortality, and burden of oral diseases and other adverse health conditions, as well as the use of health care services, among specific population groups in the United States. Existence of disparities in oral health status, accessing and using the oral health care delivery system, and receiving treatment depending on gender, race or ethnicity, education, income, disability, geographic location, and sexual orientation have been documented. Different states have initiated a series of steps as tools to document, assess, develop strategies, and monitor progress in efforts to eliminate or reduce oral health disparities in the United States.

Occlusal disease management system: the diagnosis process

The goal of every dentist is to preserve the health of his or her patients' masticatory system, as well as to anticipate the long-term results when restorative treatment is provided. These goals cannot be accomplished in the presence of occlusal disease. During the routine oral examination, the signs and/or symptoms of occlusal disease must be noted and the patient educated about the need for further diagnosis and treatment. Better care can be provided to patients if occlusal disease and/or temporomandibular disorders are detected early and properly treated. Treating occlusal disease can lead to a long, healthy life of the dentition as well as to restorative success.

A clinical evaluation of a resin composite and a compomer in non-carious Class V lesions. A 3-year follow-up

PURPOSE

To compare the clinical performance of a resin composite and a polyacid-modified resin composite (compomer) in non-carious cervical lesions using a one-step self-etch adhesive.

METHODS

Thirty patients, each with two non-carious cervical lesions (60 restorations), received one composite (Pertac-II) restoration and one compomer (Hytac) restoration, both used in conjunction with a self-etch adhesive (Prompt L-Pop) and placed following the manufacturer's instructions. Evaluations were at baseline, 6, 12 and 36 months after placement for retention, margin adaptation, marginal discoloration, anatomic form, secondary caries and postoperative sensitivity. Statistical analysis with the Pearson Chi-square test was undertaken.

RESULTS

Retention rates were 86.6% for composite and 86.7% for compomer at 36 months. 3.3% of composite and 6.7% of compomer restorations showed a deficiency in marginal adaptation. Both materials showed a slight marginal discoloration of 7.7%. More deterioration in anatomic form occurred with the compomer (11.5%) than the composite (3.8%). None of the restorations exhibited secondary caries or postoperative sensitivity problems. There was no significant difference in performance between the materials in any of the categories evaluated.

Esthetic and functional dental rehabilitation in a patient with gastroesophageal reflux

Gastroesophageal reflux disease (GERD) is a common disorder of the gastrointestinal tract in children and adults. The purpose of this report is to describe the case of a patient with GERD and the effects of the disease on the oral cavity, as well as to discuss functional and esthetic rehabilitation using composite resin. The authors also conducted a review of the literature on GERD etiopathogenesis, clinical signs and symptoms, diagnostic methods, and treatment.

Risk stratification and dental management of the patient with thyroid dysfunction

The thyroid gland produces hormones critical to the maintenance of the cellular metabolic rate. The actions of these hormones are far-reaching, affecting thermoregulation and calorigenesis; the metabolism of carbohydrates, fats, and proteins; and oxygen utilization. Thyroid hormones also appear to act synergistically with epinephrine and enhance tissue sensitivity to catecholamines. Signs and symptoms of hypothyroidism include listlessness, fatigue, cold intolerance, dry skin, hair loss, constipation, weight gain, muscle soreness, and slow heart rate. Signs and symptoms of hyperthyroidism include irritability, heat intolerance, tremors, increased sweating, frequent bowel movements, and quickened heart rate. The effect of inadequately treated or undiagnosed hyperthyroidism on the heart carries perioperative risks. To provide competent dental care to patients with thyroid dysfunction, clinicians must understand the disease, its treatment, and the impact the disease and its treatment may have on the patient's ability to undergo and respond to dental care.

[Proceeding with patients having mental impairment and those affected by congenital development anomalies during orthodontic treatment]

The aim of the work was to describe the specificity of proceeding with patients having mental impairment and those affected by congenital development anomalies during orthodontic treatment. At the same time, an attempt has been made at solving some problems concerning the treatment of patients with special needs. Based on available references three model syndromes of congenital development anomalies with coexisting mental impairment have been described: Down, Lejeune and Williams syndromes. It results from the descriptions and discussions included in this work that the possibilities of optimal cooperation and most effective treatment of patients affected by congenital birth defects and by mental impairment are conditioned, among other things, by: good contact between a doctor, a patient and a parent (guardian), availability and application of the best treatment solutions as well as coordinated implementation of a common therapeutic plan by members of an interdisciplinary team in specialized medical health centres.

[Results of the use of whole ceramic prosthetic constructions from zirconium oxide for recovery of the teeth with deep subgingival defects]

30 patients (13 men and 17 women) with deep subgingival defects were selected for treatment, their mean age was equal to 39.7+/-3.2 years; for their teeth recovery 38 stump inlays from zirconium oxide were made. The patients were distributed in 3 groups depending upon the material used for inlay fixation; for 2 years in the dynamic regime (after 6, 12 and 24 months) clinical evaluations were done of the quality of tooth recovery. Medium-term results of the quality of tooth recovery clinical evaluations by inlays from zirconium oxide have shown that this method is perspective for teeth recovery with deep subgingival defects. Such qualities of metal-free ceramics as practicality, biocompatibility, stability and excellent aesthetic characteristics have provided high quality of the treatment. At the same time stability and longevity of the prosthetic constructions were formed not only by mechanic characteristics of the used materials but also by such fixating cements properties as the degree of edge protection and resorption resistance. Adhesive inlay fixation with the use of such cements as Panavia F and Fuji plus have demonstrated stabile joint with perfect edge conformity.

[Restorative treatment of cervical tooth lesions in aspect of biomechanics]

The study describes an appropriate treatment approach to the cervical tooth lesions from biomechanical point of view. The occlusal loading plays an essential role in development and failure of restorative treatment of this kind of defects. Resulting from these loading the stresses and issuing strain accumulate just in cervical region of the teeth and they influence both the marginal adaptation and sealing of the restoration. The shear and tensile stresses are responsible for breaking the bonds between the tooth tissues and restoration, leading to its destruction. The state of stress is dependent, above all, on direction of loading forces and on E (the elasticity modulus of applied material). For cervical filling a flexible material should be chosen, characterized by the low E modulus, due to less injurious distribution of interfacial stresses. It is necessary to equilibrate occlusal contacts before all filling procedures. Elimination of lateral and oblique forces can be achieved by occlusal equilibration.

Five-year clinical evaluation of One-Up Bond F in non-carious cervical lesions

PURPOSE

To evaluate the retention and marginal staining of restorations placed in non-carious cervical lesions using the all-in-one self-etching system, One-Up Bond F and Palfique Estelite resin composite.

METHODS

Fifty-one non-undercut non-carious cervical lesions received restorations with One-Up Bond F and Palfique Estelite in 15 subjects (mean age 57.7 years) by one operator. Teeth were cleaned with pumice and water, restored following the manufacturer's instructions and evaluated at 6 months, 1, 2, 4 and 5 years for retention and presence of marginal staining.

RESULTS

At 1 year, 42 restorations were evaluated, and all were intact with three restorations showing slight marginal staining. At 2 years, 37 restorations were evaluated from 11 subjects, and all were intact. Marginal staining was observed around nine restorations. At 4 years, 27 restorations and at 5 years, 24 restorations could be evaluated. Marginal staining showed a significant increase at the enamel and cervical margins over the 5 years of the study, with two restorations showing severe, nine mild and 13 no staining. Although a number of restorations could not be evaluated, the retention rate of 92% at 5 years showed One-Up Bond F/Palfique Estelite resin composite for the restoration of non-carious cervical lesions produced an excellent outcome. Marginal staining was limited to a small number of subjects and is unlikely to be a problem if margins are refurbished at recall visits.

Prosthodontics and implants: from xenodontics to biodontics

To date, the restoration, repair, and replacement of lost and damaged teeth used metals and plastics, nonbiological materials. This type of dentistry has been referred to as "xenodontics." This article discusses the progress in developing a tissue-engineered tooth derived from stem cells. The use of biologically derived replacements for lost and missing teeth is called "biodontics." The technical difficulties that dentists had to overcome historically in restoring, replacing, and repairing lost and damaged teeth are reviewed. The inventiveness and creativity of our professional ancestors in using materials available to restore damaged teeth and to make artificial teeth and denture bases are discussed. This section concludes with the introduction of plastics for both the fabrication of prosthetic teeth and denture bases. The history of root implants is introduced, concluding with the use of titanium. This article concludes by noting that, for the most part, dental schools are just beginning to include implants or computer-aided design (CAD) and computer-aided manufacturing (CAM) into the curriculum and that this process should be accelerated to ensure our graduates are fully prepared to practice efficiently and successfully.

Sedation with 50% nitrous oxide/oxygen for outpatient dental treatment in individuals with intellectual disability

Persons with intellectual disability have difficulty in cooperating with outpatient care, and many are referred for general anaesthesia. Intellectual disability has traditionally been a contraindication for conscious sedation. We evaluated the behavioural impact, effectiveness, and tolerance of sedation in this population using a fixed 50% nitrous oxide/oxygen mixture as a single agent. We used dental treatment as a model of outpatient care; 349 patients (192 males, 157 females; mean age 22y [SD 14]; range 3-81y) were recruited over a 12-month period at seven centres. Sedation was deemed successful if planned dental treatment was completed. Behaviour was scored with the modified Venham scale. Out of 605 sessions, 91.4% were successful. No serious adverse effects occurred. Minor adverse events (such as nausea) occurred in 10.1% of sessions. We conclude that the use of safe and effective conscious sedation may reduce the indications for general anaesthesia.

Aesthetic anterior composite restorations: a guide to direct placement

Mastering anterior direct composite restorations is a necessity for the contemporary clinician who appreciates and understands the art and science of cosmetic dentistry. In the esthetic zone, composite bonding procedures are considered the most conservative and least invasive technique to return missing, diseased, and unsightly tooth structure to enhanced color, form, and function. Composites' attractiveness and popularity are easy to explain because these restorations have excellent esthetic potential, very good to excellent prognosis, and a reasonable fee. Composites are the most versatile restorative material available to the dental professional, especially for the esthetic-conscious patients. For composite restorations to mimic natural tooth structure, the clinician must have a comprehensive understanding of the material science and techniques involved in direct bonding procedures.

Matrices and scaffolds for drug delivery in dental, oral and craniofacial tissue engineering

Current treatments for diseases and trauma of dental, oral and craniofacial (DOC) structures rely on durable materials such as amalgam and synthetic materials, or autologous tissue grafts. A paradigm shift has taken place to utilize tissue engineering and drug delivery approaches towards the regeneration of these structures. Several prototypes of DOC structures have been regenerated such as temporomandibular joint (TMJ) condyle, cranial sutures, tooth structures and periodontium components. However, many challenges remain when taking in consideration the high demand for esthetics of DOC structures, the complex environment and yet minimal scar formation in the oral cavity, and the need for accommodating multiple tissue phenotypes. This review highlights recent advances in the regeneration of DOC structures, including the tooth, periodontium, TMJ, cranial sutures and implant dentistry, with specific emphasis on controlled release of signaling cues for stem cells, biomaterial matrices and scaffolds, and integrated tissue engineering approaches.

[Establishment and evaluation of a scale method for rating children's behavior in dental clinic in China]

OBJECTIVE

To establish and evaluate a scale method for rating children's behavior in dental clinic in China.

METHODS

DV records were taken for 210 children under 8-year-old, who visited the department of pediatric dentistry of Peking University School and Hospital of Stomatology during Jun to Aug in 2004. The Venham's clinic anxiety rating scale and cooperative behavior rating scale were translated into Chinese, and modified according to these records. Twenty-four pieces of records were selected randomly, and 11 pediatric dentists and assistants assessed the child behavior in the 24 records. The intraclass correlation coefficient (ICC) and Spearman's correlation coefficient (SCC), which denoted inter-rater reliability and intra-rater reliability, were calculated.

RESULTS

The ICC was 0.929 and the SCC was 0.963.

CONCLUSIONS

The scale has good inter-rater reliability and excellent intra-rater reliability, and it is competent for rating the children's behavior in dental clinic in China.

[Problems of the cervical defects]

The problem of cervical defects is a repeatedly discussed issue. Nowadays, thanks to the dental materials excessive development, the problem of cervical defects once again, has become the center of dentist' interest. The presented article summarizes the historical and current opinion views of cervical defects etiology, as well as their treatment opportunities. It's no more a secret, that successful treatment of cervical defects requires the elimination of the causing agent, without which the failure of any cervical restoration becomes unavoidable.

The impact of oral disease and nonsurgical treatment on bacteremia in children

BACKGROUND

The authors examine the role of dental disease and nonsurgical dental procedures in the incidence and duration of bacteremia in children.

METHODS

The authors randomized a group of children to receive amoxicillin or a placebo before dental rehabilitation in an operating room setting. They collected eight blood draws at the following times: two minutes after intubation (draw 1); after dental restorations, pulp therapy and cleaning (draw 2); 10 minutes later (draw 3); and five draws during and after dental extractions (draws 4-8). The authors compared dental disease parameters and the type of dental procedures performed with the incidence and duration of bacteremia.

RESULTS

The authors enrolled 100 children (aged 1-8 years) in the study. The incidence of bacteremia from draw 2 was 20 percent in the placebo group and 6 percent in the amoxicillin group (P = .07), and the incidence from draw 3 was 16 percent in the placebo group and zero percent in the amoxicillin group (P = .03). Subjects with higher gingival scores were more likely to have a bacteremia for draw 2 (P = .01). The authors found that subjects in the group with bacteremia for draw 3 had undergone more pulpotomies than did subjects in the group without bacteremia for draw 3 (3 +/- 2.5 standard deviation [SD] versus 1.5 +/- 1.6 SD, P = .04), while they found almost no differences for draw 2.

CONCLUSIONS

This study suggests that gingival disease has an impact on bacteremia after dental restorations and prophylaxis. Although antibiotics have an impact, they do not eliminate bacteremia altogether.

Dental practice during a world cruise: treatment needs and demands of crew

AIMS

To describe dental treatment needs and demands of crew on a cruise ship during a world cruise.

METHODS

The routine dental documentation of a two months period at sea on a cruise ship carrying 999 crew was analysed. Age, gender, diagnosis, treatment performed, percentage of emergency and routine procedures, number of appointments, duration of appointment and time since last visit to the dentist were recorded. Oral health-related quality of life (OHRQoL) was measured using the 14-item Oral Health Impact Profile.

RESULTS

Subjects were n = 56 crew with a mean age of 37 (+/- 12.0) years. Out of 114 patient contacts n = 29 (25%) were for emergency treatment. Caries and its sequelae accounted for 85% of time spent treating emergencies and 50% of routine treatment time. The two most frequent treatment options during emergency appointments were extractions and endodontics. In routine cases fillings and periodontal treatment were dominating. Per 1000 persons per month crew required 14.5 emergency plus 42.5 routine appointments. 80 % of crew had seen a dentist within 12 months before their shipboard dental appointment. Oral health-related quality of life was most impaired in case of emergency patients with a particular emphasis on the diagnosis of pulpal disease.

CONCLUSION

High numbers of dental emergencies largely due to caries indicated that International Labour Organisation (ILO) recommendations requiring seafarers to be dentally fit were not adhered to. It is suggested that some doctors performing pre-sea medical examinations may not adequately diagnose caries. A pre-sea examination by a dental professional has the potential to reduce the number of emergency port referrals to dentists. Treatment costs and attitude to preventive dental care were identified as barriers impeding the access of low-wage crew to the ship's dental clinic. Cosmetic dentistry and prophylaxis attracted those crew with an interest in prevention and the ability to pay the fees. In large cruise ships there is a substantial demand for both emergency and routine dental care among crew.