Investigation and treatment of patients with teeth affected by tooth substance loss: a review

Restorative Materials Exposed to Acid Challenge: Influence of Temperature on In Vitro Weight Loss

Consumption of acidic beverages and foods could provoke erosive damage, both for teeth and for restorative materials. Temperatures of consumption could influence the erosive effects of these products. The aim of this in vitro study is to assess the influence of an acidic challenge on the weight loss of different restorative materials. Resin composites and glass-ionomer cements (GIC) were tested. The medium of storage was Coca-Cola (Coca-Cola, Coca-Cola Company, Milano, Italy) at two different temperatures, 4 and 37 °C, respectively for Group A and Group B. For each group, nine specimens were prepared for each material tested. After 7 days, weight was assessed for each sample, and the percentage weight loss was calculated. For all the resin composites (Groups 1−13), no significant weight losses were noticed. (<1%). Conversely, GICs (Groups 14 and 15) showed significant weight loss during the acidic challenge, which was reduced in the case of these materials that included a protective layer applied above. Significant differences were registered with intra-group analysis; weight loss for specimens immersed in Coca Cola at 37 °C was significantly higher for almost all materials tested when compared to specimens exposed to a cooler medium. In conclusion, all the resin composites showed reliable behaviour when exposed to acidic erosion, whereas glass-ionomer cements generally tended to solubilize.

Influence of Enamel Exposure to Acidic Drink on Shear Bond Strength of Different Fissure Sealants

In the present study, we evaluated the influence of bovine enamel exposure to acidic drinks (Coca-Cola, Coca-Cola Company, Milano, Italy, pH = 2.37) on shear bond strength of three sealants (Fissurit; Grandio Seal and Admira Fusion-Voco Gmbh, Cuxhaven, Germany). For each sealant, two adhesive techniques were tested to investigate the impact of the adhesive application on shear bond strength of sealants after immersion in acidic drink and in the control: Group 1-Control: enamel surface was not in contact with acid drinks, acid etching application and self-adhesive technique for fissure sealant; Group 2-enamel surface was not in contact with acid drinks, acid etching, and adhesive applications, an etch-and-rinse technique for fissure sealant; Group 3-enamel surface was immersed in acid drink, acid etching application and self-adhesive technique for fissure sealant; Group 4-enamel surface was immersed in acid drink, acid etching, and adhesive applications, an etch-and-rinse technique for fissure sealant. For each specimen, the sealant composite resin was applied to the enamel surface and tested with a universal testing machine. Shear bond strength was measured in MPa and with an optical microscope to determine failure modes, quantified with adhesive remnant index (ARI). Enamel acidification variably influenced bond strength values of the different sealants. When no enamel pretreatment was applied, no significant differences were found among the sealants (p > 0.05). However, the mere application of acid etching without adhesive procedures resulted in lower bond strength (p < 0.001). The acid pretreatment affected significantly the bond strength of all sealants tested (p < 0.001), but no significant differences were recorded between the subgroups.

Survival of Cast Gold and Ceramic Onlays Placed in a School of Dentistry: A Retrospective Study

PURPOSE

This study was done to compare the survival rates of cast gold and ceramic onlays placed in a dental school setting.

MATERIAL AND METHODS

An electronic search was conducted in the patient records at Adams School of Dentistry, University of North Carolina at Chapel Hill for onlay codes that were in the database (From 1998 until 2018). Progress notes and radiographs were scrutinized to establish the survival time of the restorations. Any complications that occurred during the life time of the restorations were noted. The survival was summarized by categorization based on ranges of survival time in years; group 1: 1 to 5 years, group 2: 6 to 22 years. The mean survival time and standard deviation were calculated. One-way ANOVA was used to determine whether there was a statistically significant difference in the survival times between gold and ceramic onlays.

RESULTS

The mean survival rate of cast gold onlays (86.6%) was comparable to that of ceramic onlays (81.1%). The gold onlays in Group 1 had a higher mean survival time (2.43 years) than the ceramic onlays (2.03 years). This difference was statistically significant (p = 0.002). The ceramic onlays in Group 2 had a mean survival time of 19.75 years while gold onlays had a mean survival time of 17.63 years. This difference was not statistically significant (p = 0.91).

CONCLUSION

It was concluded that while the survival rate of ceramic onlays (81.1%) was inferior to that of cast gold onlays (86.6%), it was comparable.

Effect of different tetra pack juices on microhardness of direct tooth colored-restorative materials

PURPOSE

To examine the effect of apple and orange juices on the surface hardness of direct tooth-colored restorative materials.

MATERIALS AND METHODS

The materials included resin-modified glass ionomer cement (Vitremer 3M™ ESPE™ Core buildup restorative) and composite resin (Filtek™ 3M™ ESPE™ Z350). A total of 45 disks of each restorative material were prepared. The disks were divided into groups of 15, which were immersed for 7 days in deionized water (G1/G4, control group), apple juice (G2/G5), or orange juice (G3/G6). The pH of the apple juice was approximately 4.8 and the pH of the orange juice was approximately 4.9. Surface hardness tests were performed before immersion and at various times following immersion. Statistical analysis included two-way ANOVA with repeated measurement and Tukey's test.

RESULTS

Exposure to juices significantly reduced the hardness of both materials (p < 0.05), while deionized water did not affect the surface hardness of either material. The ionomer cement experienced a greater reduction than the composite resin (p = 0.000). There was no significant difference in the effect of apple and orange juices.

CONCLUSION

Juice box-type fruit juices reduced the hardness of direct tooth-colored restorative materials. Material selection should be considered when planning restorations in patients who have experienced tooth surface loss. In terms of the materials evaluated in this study, the composite material provides greater durability under acidic conditions.

Communicating effectively with patients suspected of having bulimia nervosa

BACKGROUND

The dental team often is confronted with the clinical appearance of erosion affecting the hard and soft oral tissues. An investigative process often is needed to determine the cause of such erosion, because factors other than eating disorders may be involved. The authors present a protocol that should be considered in the assessment of dental erosion. Guidelines provide direction for the clinician toward opening a dialogue with a patient when the suspected cause of erosion is an eating disorder.

TYPES OF STUDIES REVIEWED

The authors review publications related to the causes of dental erosion and the patterns that are involved with both chemical and mechanical destruction of oral tissues. They also discuss the oral-tissue effects related to eating disorders. The authors stress the importance of assisting parents in obtaining adequate treatment for pediatric patients.

RESULTS

Cases of eating disorders among female college students, athletes, preadolescent children and men are well-documented. However, dental staff members often do not feel comfortable beginning a dialogue with patients who are suspected of having an eating disorder. This article focuses on the proper protocol for approaching such patients and beginning a dialogue. In addition, the authors provide suggestions for limiting further erosive damage to the tissues. They also discuss other causes of erosion that should be considered when assessing any type of oral erosion.

CLINICAL IMPLICATIONS

The dental team is in a prime position to assist patients who have eating disorders. Timely treatment by mental health and other medical professionals is crucial. The authors suggest a dialogue for approaching these patients and offer educational material to reduce further tissue destruction.