Clinical evaluation of a filled adhesive system in Class 5 restorations

The restoration of the Class 5 lesion has proved to be an excellent model to measure the clinical efficacy of dentin adhesive materials. This is the result of numerous factors, such as the nonretentive nature of the lesion, large areas of exposed dentin with limited enamel margins, and the high degree of flexure from occlusion that is transmitted to the restoration. The role of the adhesive agent has been critical to the successful restoration of the lesion. Numerous improvements have been introduced to correct deficiencies of earlier-generation bonding systems. The addition of filler particles to the resin adhesive has provided significant benefits, especially in marginal adaptation. The clinical performance of OptiBond, a filled dentin adhesive system, was investigated through the restoration of 80 Class 5 abrasion lesions in 35 patients in accordance with the Guidelines for Dentin and Enamel Adhesive Materials of the American Dental Association. At 2 years, all clinical evaluation parameters were rated 94% to 100% alpha. OptiBond has demonstrated therapeutic effectiveness in eliminating the dentin hypersensitivity that often occurs in Class 5 abrasion lesions.

Longevity of glass-ionomer restorative materials: results of a 10-year evaluation

Three restorative materials used for cervical erosion /abrasion lesions were evaluated clinically after 10 years. Thirty adult patients with at least four cervical lesions received one restoration of each of Ketac-Fil, finished immediately, Ketac-Fil, finished after a delay, Chelon-FIl (all glass-ionomer cements), and Cervident (a resin composite). Restorations were placed without any tooth preparations. Eighteen patients returned for their 10-year examinations. Two experienced examiners provided the periodic evaluations. Complete retention at 10 years was 83% for Ketac-Fil, finished immediately; 78% for Ketac-Fil, finished after a delay; 67% for Chelon-Fil; and 17% for Cervident. All three glass-ionomer restorative materials exhibited statistically significantly greater retention that did Cervident. When a noninvasive procedure is desired, glass-ionomer materials are the restorative material of choice for abrasion/erosion lesions because of their long-term retention values.

Tooth wear--dental erosion

This article aims to address the issues arising out of the increasing concern by general dental practitioners of erosion-related tooth wear. The prevalence, common presentation, differential diagnosis, likely aetiology, prevention and management of suspected cases of this form of tooth wear are considered.

Stress-induced cervical lesions: review of advances in the past 10 years

The accumulation of experimental and clinical evidence during the past decade has significantly contributed to the understanding of the role of occlusally generated tensile stress in the etiology of certain noncarious cervical lesions of teeth. More important, this knowledge has led to the understanding of the reasons why traditional restorative treatments of these stress-induced cervical lesions fail. The case of failure can be attributed to the occlusally generated stresses that are concentrated at the cervical region and result in debonding, leakage, retention failure, and, ultimately, restorative failure. With the new understanding, restorative approaches that combine chemical adhesion and restorative materials of appropriate elastic properties show promise of long-term success.

Erosion-abrasion lesions revisited

Oral-hygiene-related abrasion lesions usually occur in patients over 30 years of age. Although abrasions and idiopathic erosions are different regressive alterations of the teeth, the clinical diagnosis is not always evident. Abuse of oral-hygiene devices and abrasive dentifrices can cause dental and gingival abrasions, but their role in the etiology of these lesions should be established clearly before a precise diagnosis is made. This largely influences treatment implications and expectations. This article clarifies the definitions, etiology, pathogenesis, clinical aspects, and treatment of abrasions and similar clinical lesions.

Four-year evaluation of the effect of 10% polyacrylic acid or water rinsing pretreatment on retention of glass polyalkenoate cement

To optimize the bonding of glass polyalkenoate (ionomer) cement to dentin, different conditioning methods have been suggested. The effect of two easily applied conditioning methods, a 10-15 seconds cleaning with a 10% polyacrylic acid or rinsing with copious amounts of water, was compared in class V abrasion/erosion lesions. The cervical lesions were restored, without any form of mechanical cavity preparation, with an anhydrous glass ionomer cement. During a 4-yr period, 137 restorations were evaluated every 6 months. Cumulative loss rates after 4 yr were 15.6% for the polyacrylic acid group and 21.9% for the water rinsing group. The difference was not significant. No secondary caries was registered.

3-year clinical evaluation of modified Gluma adhesive systems in cervical abrasion/erosion lesions

PURPOSE

To study the clinical performance of two candidates for improvement of the original Gluma bonding system.

MATERIALS AND METHODS

Eight teeth with cervical buccal abrasion/erosion lesions were identified in 40 patients. The lesions were conditioned with an oxalic acid solution followed by either a HEMA-glutaraldehyde bonding agent or a formamide-containing bonding agent. The lesions were restored with a hybrid composite. Each patient received the same number of restorations with the two different bonding formulations. All restorations were made by the same operator (JK). Evaluations were based on the USPHS system.

RESULTS

No difference between the two groups as to retention, marginal adaptation and discoloration was observed after 3 years. Eight restorations were lost and a slight increase in marginal discoloration was seen during the observation period.

Clinical evaluation of tooth-colored materials in cervical lesions

PURPOSE

To determine the 18-month clinical performance of four tooth-colored restoratives in non-carious cervical lesions.

MATERIALS AND METHODS

Buccal abrasion lesions in 83 teeth were restored with each of the following materials: Fuji Cap II, Fuji II LC, APH/Universal Bond 3, Lite Fil II A/Imperva Bond. Baseline and an 18-month recall was carried out using the Ryge (USPHS) method for retention, color match, marginal adaptation, cavosurface marginal discoloration, anatomic form and secondary caries.

RESULTS

The USPHS results (% alfa) for the four products were, respectively: color match (9%, 48%, 57%, 55%), marginal discoloration (71%, 76%, 52%, 50%), marginal adaptation (24%, 24%, 33%, 15%), anatomic form (67%, 86%, 95%, 45%) and retention (100%, 95%, 100%, 65%). Results indicated that (1) Fuji Cap II exhibited a poor color match at baseline (2) Color matching of Fuji II LC was comparable to the resin composites and (3) seven Lite Fil II/Imperva Bond restorations (35%) were dislodged after 1 1/2 years.

Clinical evaluation of five adhesive systems: three-year results

Five dentine adhesive systems (four resin-based dentine bonding agents and one polyacid-modified composite resin) were evaluated clinically in non-undercut Class V 'abrasion' lesions. The loss rate of restorations varied from 26 per cent to 95 per cent at three years among the five systems. Products which bonded to dentine via the hybrid layer were markedly more retentive than those which were designed to bond chemically. The two products which attempted to achieve bonding between their carboxyl groups and dentinal calcium were hydrophilic, which probably contributed to their lack of success.

[Clinical picture and orthodontic treatment in a shortened interalveolar distance]

A total of 868 patients aged 25 to 68 with various types of occlusion and dentition defects were examined. 212 (24.4%) patients presented with a shortened interalveolar distance (height of occlusion). Abnormal abrasion of hard dental tissues, dentition defects in the lateral sections of dental arches, abnormal occlusion (deep or prognathic), reduced tolerance of periodontal tissues, and dysfunction of the masticatory muscles (bruxism) were found to be the pathogenetic factors leading to the development of this condition. Dysfunction of the masticatory muscles was detected in 41.5% of patients with shortened interalveolar distance and dysfunction of the temporomandibular joint in 9.9%; moreover, in many of them traumatic occlusion and disorders in the regional circulation in the periodontium of teeth exposed to overexercise were observed. Orthodontic treatment of patients with shortened interalveolar distance was carried out in two stages: the first stage consisted in functional and adaptation restructuring of the maxillodental system by repair of the height of occlusion and normalization of the mandibular position on a plastic cup which the patients wore for 3 months, and then the second stage ensued, at which they were fitted with dentures. Good results were attained in 95.7% patients.

Case report: an unusual cause of toothwear

Dental practitioners often have to treat cases of toothwear, which may be caused by a number of factors including dietary erosion, physical attrition and abrasion due to friction against a foreign body. The authors encountered a young patient with a very unusual cause of toothwear, details of which are reported here.

Marginal sealing ability of three cervical restorative systems

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 freshly 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 difference 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.

Non-carious cervical tooth loss. Part 2: Management

The aetiology, prevalence, diagnosis, prevention and monitoring of non-carious cervical tooth loss (NCTL) has been covered in the first article of this series. The aetiology of NCTL is usually multifactorial and may not be attributable to any single factor. Central to the successful management of NCTL is a correct diagnosis of the cause. This article will focus on the management of NCTL.

Clinical evaluation of resin-modified glass-ionomer restorative cements in cervical 'abrasion' lesions: one-year results

Sixty non-undercut Class V "abrasion" lesions in 13 patients were restored with light-cured Type IIa glass-ionomer cements in accordance with the manufacturer's instructions, 20 each with Fuji II LC, Photac-Fil, and Vitremer. Patients were recalled for examination and photographs 1 week, 6 months, and 1 year posttreatment. Color, marginal discoloration, and retention of the restorations were assessed at each recall period. At 1 year, no loss of restorations was found. Analysis revealed statistically significant darkening in color of the Vitremer restorations, no significant change in color of the Fuji II LC and Photac-Fil restorations, and statistically significant but clinically negligible development of marginal discoloration of all materials.

Dual bite demonstrated by kinesiography: a case report

A 60-year-old man sought treatment for extensive tooth wear resulting from bruxism. He had no signs of temporomandibular joint dysfunction. The kinesiographic study revealed that he had a dual bite, with two intercuspal positions, separated by 3 mm anteroposteriorly and by 7 mm laterally. The dentition was restored with metal-ceramic crowns to restore a normal occlusion. The kinesiographic follow-up studies revealed that, initially, it was difficult for the patient to adapt to a new occlusal design, but 6 years later, the dual bite had disappeared. However, the disoccluding angle had flattened where the second intercuspal position had previously existed, corresponding, clinically, to a change from canine guidance to anterior-canine guidance.

The Class V lesion--aetiology and restoration

The aetiology of non-carious cervical lesions is discussed. These have been variously described as 'abrasion', 'erosion', 'abrasion/erosion', and 'idiopathic cervical'. However, many lesions do not fit the classical appearance or location of an erosive and/or abrasive origin, and there is increasing interest in the possible role of occlusal stress in their aetiology. Non-carious cervical lesions often require restoration, and there are essentially three options using tooth-coloured materials: a restorative glass ionomer cement, a liner/base glass ionomer cement overlayed with a resin composite, or a resin composite bonded by an enamel/dentine-adhesive. The materials and techniques used in these options are discussed, indicating their advantages and disadvantages. Results of available clinical trials of these systems are given, and the link with the stress theory of cervical tooth loss is described. The preferred restorative approaches in order are: resin-modified restorative glass ionomer; resin-modified liner/base glass ionomer with a microfine resin composite overlay; enamel/dentine bonding agent with a microfine resin composite.

Noncarious dental "abfraction" lesions in an aging population

A new classification for noncarious dental lesions has evolved from the dental literature. The name given to these lesions, dental "abfractions," is a theory propounding tooth fatigue, flexure, and deformation through biomechanical loading of tooth structure, primarily at the cervical regions of the dentition. These lesions are typically wedge shaped with sharp line angles, but occlusal abfractions have been observed as circular invaginations. Dental abfractions can occur alone and are sometimes associated with toothbrush abrasion and erosion from endogenous or exogenous acids. Treatment consists of the application of composite resin or glass-ionomer cement restorations and/or the discontinuance of the etiology of these lesions. If esthetics are not a primary concern of the patient and the tooth is not structurally compromised, many of these lesions can be observed, provided that the patient is informed that bruxism or malocclusion problems exist.