Minimal intervention dentistry and older patients part 2: minimally invasive operative interventions

As described in the first paper of this two part series, the expansion of our older population and the concomitant reduction in levels of edentulism will result in an increase in the number of patients presenting in general practice with complex restorative challenges. The application of the concepts of minimal intervention dentistry and minimally invasive operative techniques may offer a powerful armamentarium to the general dentist to provide ethical and conservative treatment to older patients.

Clinical Relevance: When it is unavoidable, operative intervention should be as minimally invasive as practicable in older patients to preserve the longevity of their natural dentition.

Resinas para facetas estéticas de próteses fixas. III. Análise conjunta das variáveis alteração dimensional e alteração de peso em função de materiais, condição de armazenamento e tempos.

The authors analysed the simultaneous effects of the dimensional and weight alteration of resins utilized for esthetic facets submitted to warehousing conditions and periods of time. The resins showed different behaviour and a neat correlation between dimensional alteration and weight. The condition of immersion promoted dimensional alteration 50% lower and an alteration of weight three times higher.

Estudo comaprativo da resistência da união esmalt/resina/metal. Efeito de resinas de fixação, artifícios retentivos e ligas metálicas.

The purpose of this study was to compare the enamel/resin/metal bond tensile strength by using human canines, in which castings were bonded. These castings were obtained by Co-Cr or Ni-Cr alloys and showed four types of mechanisms of retention: 50 micrograms aluminum oxide abrasive, electrochemical etch, acrylic beads metal mesh. The castings were bonded utilizing Comspan Opaque and Panavia Ex. The specimens were subjected to tensile forces after 24 hours in an Instron machine. The castings subjected to 50 micrograms aluminum oxide abrasive and bonded utilizing Panavia EX showed the biggest bond tensile strength.

Cariostatic effect of fluoride-containing restorative systems associated with dentifrices on root dentin

Objective. The aim of this in vitro study was to evaluate the interaction between two sources of fluoride (restorative systems and dentifrices) in inhibiting artificial root caries development. Methods. One hundred and eighty tooth segments were embedded in polyester resin, and sanded flat. Cylindrical cavities 1.0 mm-deep and 1.5 mm-diameter were prepared in root dentin and randomly restored by fluoride-containing restorative systems: Ketac-fil/Espe (Ke), Fuji II LC/GC Corp (Fj), F2000/3M (F2), Surefil/Dentsply (Su) or a control: Filtek Z250/3M (Z2). Ten experimental groups were made to test the association among the five restorative systems and two dentifrices: with F - (Sensodyne Baking Soda) or without F- (Sensodyne Original) (n = 18). After surface polishing, a 1 mm-wide margin around the restorations was demarcated and initial dentin surface Knoop microhardness values (KHNi) were obtained. The specimens were submitted to a pH-cycling model, and to applications of slurries of dentifrice. Afterwards the final dentin surface Knoop microhardness values (KHNf) were measured. Results. The differences between KHNi and KHNf, and the covariate KHNi were considered by the ANCOVA and Tukey's test (α = 0.05). The interaction between restorative system and dentifrice was statistically significant (p = 0.0026). All restorative systems provided some protection against artificial caries challenge when associated with the fluoride-containing dentifrice treatment. The means (standard deviation) of reductions in Knoop hardness values for systems associated with the fluoride-containing dentifrice were: Ke: 40.0(1.02)a, Fj: 41.9(1.02)b, F2: 43.3(1.04)c, Su: 43.5(1.00)c, Z2: 44.0(1.02)c; and with the non-fluoride-containing dentifrice were: Ke: 42.9(1.02)a, Fj: 44.7(1.01)b, F2: 45.2(1.09)bc, Su: 46.0(0.99)c, Z2: 46.6(0.99)c (statistical differences were expressed by different letters). Conclusion. The cariostatic effect shown by the fluoride-containing dentifrice could enhance that shown by Ketac-fil and Fuji II LC, and could mask that shown by F2000. © 2002 Elsevier Science Ltd. All rights reserved.

Fluoride release by restorative materials before and after a topical application of fluoride gel

The release of fluoride from restorative materials (Vitremer, Ketac-Fil, Fuji II LC and Freedom) was evaluated during two 15-day periods, before and after a topical application of acidulated phosphate fluoride gel (APF). For each material, 6 specimens were made, which were immersed in 2 ml of deionized water. The fluoride concentration dosages in the solutions were read at intervals of 24 hours for 15 days. After this period, the specimens of each material received treatment with APF gel for 4 minutes and the fluoride released was analyzed at 24-hour intervals during the following 15 days. The analysis of variance and the Tukey test (p < 0.05) showed that the total mean fluoride released during the initial 15 days was greater for Vitremer and Ketac-Fil and lower for Fuji II LC and Freedom; and in the final 15 days there was a difference in release readings, with the greatest value for Vitremer, followed by Fuji II LC, Ketac-Fil and Freedom. The comparison of the results between the 1st day and the 16th day (after gel application) showed a greater fluoride release on the 16th day for Vitremer, Fuji II LC and Freedom and was equal for Ketac-Fil. Although all the materials evaluated gained fluoride with the application of APF, the data suggest that the resin-modified ionomers are more efficient in releasing fluoride to the medium than the other materials.

Effect of curing regime on the cytotoxicity of resin-modified glass-ionomer lining cements applied to an odontoblast-cell line

Objective: The aim of this in vitro study was to evaluate the cytotoxicity of resin-modified glass-ionomer lining cements submitted to different curing regimes and applied to an immortalized odontoblast-cell line (MDPC-23). Methods: Forty round-shaped specimens of each experimental material (Fuji Lining LC and Vitrebond) were prepared. They were light-cured for the manufacturers' recommended time (MRT = 30 s), under-cured (0.5 MRT = 15 s), over-cured (1.5 MRT = 45 s) or allowed to dark cure (0 MRT). Sterilized filter papers soaked with either 5 μL of PBS or HEMA were used as negative and positive control, respectively. After placing the specimens individually in wells of 24-well dishes, odontoblast-like cells MDPC-23 (30,000 cells/cm2) were plated in each well and incubated for 72 h in a humidified incubator at 37 °C with 5% CO2 and 95% air. The cytotoxicity was evaluated by the cell metabolism (MTT assay) and cell morphology (SEM). Results: Fuji Lining LC was less cytotoxic than Vitrebond (p < 0.05) in all the experimental conditions. However, the cytotoxicity of Fuji Lining LC was noticeably increased in the absence of light-curing while the same was not observed for Vitrebond. The length of light-curing (15, 30 or 45 s) did not influence the toxicity of both lining materials when they were applied on the odontoblast-cell line MDPC-23. Significance: The light-activation plays an important role in reducing the cytotoxicity of Fuji Lining LC. Following the manufacturer' recommendation regarding the light-curing regime may prevent toxic effect to the pulp cells. © 2005 Academy of Dental Materials.

Shear bond strength fatigue limit of rest seats made with dental restoratives

Purpose: This study compared the shear bond strength (SBS) to enamel of rest seats made with a glass-ionomer cement (Fuji IX GP Fast), a resin-modified glass-ionomer cement (Fuji II LC), and a composite resin (Z100 MP) under monotonic and cyclic loading. Materials and Methods: Rest seats were built up onto the lingual surfaces of 80 intact human mandibular incisors. Specimens (n=10) were stored in distilled water at 37°C for 30 days and subjected to shear forces in a universal testing machine (0.5 mm/min) until fracture. The SBS values were calculated (MPa) using the bonding area (9.62 mm2) delimited by adhesive tags. A staircase approach was used to determine the SBS fatigue limit of each material. Specimens were submitted to either 10,000 cycles (5 Hz) or until specimen fracture. A minimum of 15 specimens was tested for each material. Scanning electron microscopy was used to examine the mode of failure. Data were statistically analyzed with one-way ANOVA and Tukey HSD tests (α = 0.05). Results: Z100 MP yielded higher (p < 0.05) SBS (12.25 MPa) than Fuji IX GP Fast (7.21 MPa). No differences were found between Fuji II LC (10.29 MPa) and the other two materials (p > 0.05). Fuji II LC (6.54 MPa) and Z100 MP (6.26 MPa) had a similar SBS limit. Fuji IX GP Fast promoted the lowest (p < 0.05) SBS fatigue limit (2.33 MPa). All samples showed cohesive failure patterns. Conclusion: Fatigue testing can provide a better means of estimating the performance of rest seats made with dental restoratives.

Microhardness and fluoride release of restorative materials in different storage media

This study evaluated the surface microhardness and fluoride release of 5 restorative materials - Ketac-Fil Plus, Vitremer, Fuji II LC, Freedom and Fluorofil - in two storage media: distilled/deionized water and a pH-cycling (pH 4.6). Twelve specimens of each material, were fabricated and the initial surface microhardness (ISM) was determined in a Shimadzu HMV-2000 microhardness tester (static load Knoop). The specimens were submitted to 6- or 18-h cycles in the tested media. The solutions were refreshed at the end of each cycle. All solutions were stored for further analysis. After 15-day storage, the final surface microhardness (FSM) and fluoride release were measured. Fluoride dose was measured with a fluoride-specific electrode (Orion 9609-BN) and digital ion analyzer (Orion 720 A). The variables ISM, FSM and fluoride release were analyzed statistically by analysis of variance and Tukey's test (p<0.05). There was significant difference in FSM between the storage media for Vitremer (pH 4.6 = 40.2 ± 1.5; water = 42.6 ± 1.4), Ketac-Fil Plus (pH 4.6 = 73.4 ± 2.7; water = 58.2 ± 1.3) and Fluorofil (pH 4.6 = 44.3 ± 1.8; water = 38.4 ± 1.0). Ketac-Fil Plus (9.9 ± 18.0) and Fluorofil (4.4 ± 1.3) presented higher fluoride release in water, whereas Vitremer (7.4 ± 7.1), Fuji II LC (5.7 ± 4.7) and Freedom (2.1 ± 1.7) had higher fluoride release at pH 4.6. Microhardness and fluoride release of the tested restorative materials varied according to the storage medium.

Accuracy of impression techniques for implants. Part 1 - Influence of transfer copings surface abrasion

Purpose: This study evaluated the influence of surface abrasion of transfer copings to obtain a precise master cast for a partially edentulous restoration with different inclinations. Materials and Methods: Replicas (N = 30) of a metal matrix (control group) containing two implants at 90° and 65° in relation to the benchtop were obtained using a polyether impression material and three impression techniques: square impression copings splint with dental floss and autopolymerizing acrylic resin (TRS), square impression copings abraded with aluminum oxide (TA), and square impression copings abraded with aluminum oxide and adhesive-coated (TAA). The replicas obtained in type V stone were digitalized, and the images were exported to AutoCAD software to perform the readings of possible degree alterations in implant inclinations. The results were submitted to analysis of variance (ANOVA) and Tukey test (α < 0.05). Results: Comparing the techniques with regard to the 90° implant inclination, no statistical difference was observed between the three techniques and the control group. Analyzing the three techniques with regard to the 65° implant inclination, no significant difference was seen between technique TA and the control group. Conclusions: Technique TA presented more accurate master casts than TRS and TAA techniques. The angulated implant (65°) tended to generate more imprecise master casts than implants perpendicular to the surface. © 2008 by The American College of Prosthodontists.

Correlation of the hybrid layer thickness and resin tags length with the bond strength of a self-etching adhesive system.

The objective of this study was to measure the thickness of the hybrid layer (HLT), length of resin tags (RTL) and bond strength (BS) in the same teeth, using a self-etching adhesive system Adper Prompt L Pop to intact dentin and to analyze the correlation between HLTand RTL and their BS. Ten human molars were used for the restorative procedures and each restored tooth was sectioned in mesio-distal direction. One section was submitted to light microscopy analysis of HLT and RTL (400x). Another section was prepared and submitted to the microtensile bond test (0.5 mm/min). The fractured surfaces were analyzed using scanning electron microscopy to determine the failure pattern. Correlation between HLT and RTL with the BS data was analyzed by linear regression. The mean values of HLT, RTL and BS were 3.36 microm, 12.97 microm and 14.10 MPa, respectively. No significant relationship between BS and HLT (R2= 0.011, p>0.05) and between BS and RTL (R2= 0.038) was observed. The results suggested that there was no significant correlation between the HLT and RTL with the BS of the self-etching adhesive to dentin.

Effect of storage in artificial saliva and thermal cycling on Knoop hardness of resin denture teeth

Purpose: This study aimed to evaluate the effect of different storage periods in artificial saliva and thermal cycling on Knoop hardness of 8 commercial brands of resin denture teeth. Methods: Eigth different brands of resin denture teeth were evaluated (Artplus group, Biolux group, Biotone IPN group, Myerson group, SR Orthosit group, Trilux group, Trubyte Biotone group, and Vipi Dent Plus group). Twenty-four teeth of each brand had their occlusal surfaces ground flat and were embedded in autopolymerized acrylic resin. After polishing, the teeth were submitted to different conditions: (1) immersion in distilled water at 37 ± 2 °C for 48 ± 2. h (control); (2) storage in artificial saliva at 37 ± 2 °C for 15, 30 and 60 days, and (3) thermal cycling between 5 and 55 °C with 30-s dwell times for 5000 cycles. Knoop hardness test was performed after each condition. Data were analyzed with two-way ANOVA and Tukey's test (α= .05). Results: In general, SR Orthosit group presented the highest statistically significant Knoop hardness value while Myerson group exhibited the smallest statistically significant mean (P< .05) in the control period, after thermal cycling, and after all storage periods. The Knoop hardness means obtained before thermal cycling procedure (20.34 ± 4.45 KHN) were statistically higher than those reached after thermal cycling (19.77 ± 4.13 KHN). All brands of resin denture teeth were significantly softened after storage period in artificial saliva. Conclusion: Storage in saliva and thermal cycling significantly reduced the Knoop hardness of the resin denture teeth. SR Orthosit denture teeth showed the highest Knoop hardness values regardless the condition tested. © 2010 Japan Prosthodontic Society.

Analysis of hybrid layer thickness, resin tag length and their correlation with microtensile bond strength using a total etch adhesive to intact dentin.

The objective of this study was to evaluate the use of a two-step total etch and rinse adhesive, the correlation between the hyybrid layer thickness (HL) and bond strength (BS), and between resin tag length (RT) and bond strength in the same teeth, and also to evaluate the fracture patterns of the tested specimens. Ten human molars were used for the restorative procedure and then sectioned in two halves (mesio-distally). The materials used were Adper Single Bond 2, 3M ESPE, Ultra etch gel, Ultradent and Filtek Z250, 3M ESPE. One half were utilized to measure the HL thickness and RT length through light microscopy analysis (400x), and the other half was subject to a microtensile test to measure the BS. The fractured surfaces were analyzed by scanning electron microscopy and fracture patterns classified. The Pearson correlation test was applied (p = 0.05). The results of the analyses of each specimen then were correlated: mean HL thickness = 4.39 (0.48) microm, mean length of RT = 9.94 (1.69) microm, mean BS = 23.98 (10.24) MPa. A statistically significant correlation between HL thickness and bond strength was found (r = 0.93). The two step etch and rinse adhesive system, showed a strong correlation between HL thickness and bond strength. The most common fractures were adhesive, followed by cohesive in resin.

Retention and processing methods of nasal prosthesis

Patients with congenital malformations, traumatic or pathological mutilation and maxillofacial developmental disorders can be restored aesthetically and emotionally by the production and use of facial prostheses. The aim of this study was to review the literature about the retention and processing methods of facial prostheses, and discuss their characteristics. A literature review on Medline (PubMed) database was performed by using the keywords maxillofacial prosthesis, silicone, resin, pigment, cosmetic, prosthetic nose, based on articles published from 1956 to 2010. Several methods of retention, from adhesives to the placement of implants, and different processing methods such as laser, CAD/CAM and rapid prototyping technologies have been reported. There are advantages and disadvantages of each procedure, and none can be classified as better compared to others.

Correlation between hybrid layer thickness, resin tag length and microtensile bond strength of a self-etching adhesive system

The purpose of this study was to evaluate the correlation between the hybrid layer thickness, resin tag length and resin bond strength of a self-etching adhesive system to sound dentin tissue in vivo. After performing restorative procedures and tooth extractions, ten specimens were sectioned in a mesiodistal direction. One dental section was used for light microscope analysis, in which both the resin tag length and hybrid layer thickness were measured, while the other section was analyzed using a microtensile test (0.5 mm/min). The fractured surface of the latter section was characterized using a stereoscopic magnifying glass (40x magnifcation). The results were subject to statistical analysis using the Pearson Correlation Test (a = 0.05). The hybrid layer thickness, resin tag length and resin bond strength mean values were 2.19 microm (0.34), 4.34 microm (0.28) and 9.73 MPa (5,55), respectively. In addition, correlation tests between the resin tag length and the resin bond strength (r=0.014) and also between the hybrid layer thickness and bond strength (r=0.43), showed no statistically significant correlation. The microtensile bond strength of Adper Prompt L Pop self-etching adhesive system does not depend on hybrid layer thickness or resin tag length.

Development of the National Bureau of Standards casting resin /

Includes bibliographical references (p. 10).