Comparison of visual inspection, radiographic examination, laser fluorescence and their combinations on treatment decisions for occlusal surfaces

Purpose: To compare visual inspection (VI), radiographic examination (RX) and the laser fluorescence device DIAGNOdent (L), as well as their combinations in vitro regarding treatment decisions for occlusal surfaces. Methods: 72 extracted human permanent teeth (molars and premolars) were used. Treatment decisions were recorded by three calibrated examiners, and the options available were fissure sealant and conservative restoration. For validation of treatment decisions, the teeth were sectioned and examined in a stereomicroscope. Thereafter, dental slices were scanned and the images were edited to facilitate classification of existing carious lesions. Intra and inter-examiner reproducibility for the determination of treatment plans were calculated using Cohen`s kappa test (95%-CI). Sensitivity, specificity, positive and negative predictive values, and the area under the ROC curve were also calculated. Results: VI and L provided on average the greatest intra- and inter-examiner reproducibility, respectively. Although the combination of diagnostic methods may decrease both intra- and inter examiners reproducibility, combination of VI, L and RX resulted in the greatest sensitivity, being statistically superior to RX and L. There was more inter-examiner agreement for the option of restorative treatment, while the use of sealants as a treatment option yielded the lowest values. Negative predictive values were numerically inferior to positive predictive values, indicating that the examiners preferred not to restore a carious tooth than to proceed operatively in an intact tooth. The combination of the three methods studied showed the best results in determining treatment plans for occlusal surfaces, when compared to the other types of exams. On the other hand, radiographic examination and laser fluorescence were less efficient when used alone.

Failure modes of Y-TZP crowns at different cusp inclines

Objectives To compare the reliability of the disto-facial (DF) and mesio-lingual (ML) cusps of an anatomically correct zirconia (Y-TZP) crown system The research hypotheses tested were (1) fatigue reliability and failure mode are similar for the ML and DF cusps, (2) failure mode of one cusp does not affect the failure of the other Methods The average dimensions of a mandibular first molar crown were imported into CAD software, a tooth preparation was modelled by 1 5 mm marginal high reduction of proximal walls and occlusal surface by 2 0 mm The CAD-based tooth preparation was milled and used as a die to fabricate crowns (n = 14) with porcelain veneer on a 0 5 mm Y-TZP core. Crowns were cemented on composite reproductions of the tooth preparation The crowns were step-stress mouth motion fatigued with sliding (0 7 mm) a tungsten-carbide indenter of 6 25 mm diameter down on the inclines of either the DF or ML cusps Use level probability Weibull curve with use stress of 200 N and the reliability for completion of a mission of 50,000 cycles at 200 N load were calculated Results Reliability for a 200 N at 50,000 cycles mission was not different between tested cusps SEM imaging showed large cohesive failures within the veneer for the ML and smaller for the DF Fractures originated from the contact area regardless of the cusp loaded Conclusion No significant difference on fatigue reliability was observed between the DF compared to the ML cusp Fracture of one cusp did not affect the other (c) 2010 Elsevier Ltd All rights reserved

Effect of simulated masticatory loading on the retention of stud attachments for implant overdentures

P>This study assessed the effect of simulated mastication on the retention of two stud attachment systems for 2-implants overdentures. Sixteen specimens, each simulating an edentulous ridge with implants and an overdenture were divided into two groups, according to the attachment system: Group I (Nobel Biocare ball-socket attachments) and Group II (Locator attachments). Retention forces were measured before and after 400 000 simulated masticatory loads in a customised device. Data were compared by two-way anova followed by Bonferroni test (alpha = 0 center dot 05). Group I presented significantly lower retention forces (Newtons) than Group II at baseline (10 center dot 6 +/- 3 center dot 6 and 66 center dot 4 +/- 16 center dot 0, respectively). However, differences were not significant after 400 000 loads (7 center dot 9 +/- 4 center dot 3 and 21 center dot 6 +/- 17 center dot 0). The number of cycles did not influence the measurements in Group I, whereas a non-linear descending curve was found for Group II. It was concluded that simulated mastication resulted in minor changes for the ball attachment tested. Nevertheless, it reduced the retention of Locator attachments to 40% of the baseline values, what suggests that mastication is a major factor associated with maintenance needs for this system.