A multidisciplinary approach to the functional and esthetic rehabilitation of amelogenesis imperfecta and open bite deformity: a case report

The treatment of amelogenesis imperfecta (AI) with an anterior open bite (AOB) is a challenge for the clinician and often requires a multidisciplinary team of specialists. Most often, patients suffering from these conditions are young and a good functional and esthetic long-term result must be aspired. This clinical report illustrates the orthodontic, maxillofacial, restorative, and prosthodontic rehabilitation of a 20-year-old woman with a hypoplastic form of AI and an AOB malocclusion, having received treatment for the last 6 years. It included adhesive resin composite restorations, orthodontical and maxillofacial surgery with a one-piece Le Fort I osteotomy, and a genioplasty. Subsequent prosthodontic therapy consisted of 28 all-ceramic crowns whereby a solid interdigitation, a canine guidance, and consistent and regular contacts between tooth crowns could be achieved to assure a good functional and esthetic oral situation. The tooth preparation techniques guaranteed minimally invasive treatment. The patient was affected very positively. CLINICAL SIGNIFICANCE: This article describes an interdisciplinary approach to the successful treatment of a patient with a hypoplastic form of amelogenesis imperfecta over a period of 6 years. It starts with a discussion of the conservative steps taken during adolescence and concludes with the final prosthetic rehabilitation with all-ceramic crowns after reaching adulthood.

Posterior Vertical Bite Reconstructions of Erosively Worn Dentitions and the "Stamp Technique" - A Case Series with a Mean Observation Time of 40 Months

PURPOSE In the present case series, the authors report on seven cases of erosively worn dentitions (98 posterior teeth) which were treated with direct resin composite. MATERIALS AND METHODS In all cases, both arches were restored by using the so-called stamp technique. All patients were treated with standardized materials and protocols. Prior to treatment, a waxup was made on die-cast models to build up the loss of occlusion as well as ensure the optimal future anatomy and function of the eroded teeth to be restored. During treatment, teeth were restored by using templates of silicone (ie, two "stamps," one on the vestibular, one on the oral aspect of each tooth), which were filled with resin composite in order to transfer the planned, future restoration (ie, in the shape of the waxup) from the extra- to the intraoral situation. Baseline examinations were performed in all patients after treatment, and photographs as well as radiographs were taken. To evaluate the outcome, the modified United States Public Health Service criteria (USPHS) were used. RESULTS The patients were re-assessed after a mean observation time of 40 months (40.8 ± 7.2 months). The overall outcome of the restorations was good, and almost exclusively "Alpha" scores were given. Only the marginal integrity and the anatomical form received a "Charlie" score (10.2%) in two cases. CONCLUSION Direct resin composite restorations made with the stamp technique are a valuable treatment option for restoring erosively worn dentitions.

Direct restorative materials use in Australia in 2002

Background: This study aimed to determine the reasons for dentists' choice of materials, in particular amalgam and resin composite, in Australia. Method: A questionnaire was developed to elicit this information. The names and addresses of 1000 dentists in Australia were selected at random. The questionnaire was mailed to these dentists with an explanatory letter and reply-paid envelope. Results: A total of 560 replies were received. Regarding choice of material, 99 per cent of respondents cited clinical indication as an influencing factor, although patients' aesthetic demands (99 per cent), patients' financial situation (82 per cent), and lecturers' suggestions (72 per cent) were also reported to influence respondents' choice of materials. Twelve per cent of respondents used composite 'always', 29 per cent 'often', 32 per cent 'sometimes', 23 per cent 'seldom' and 4 per cent 'never' in extensive load-bearing cavities in molar teeth. For composite restorations in posterior teeth, 84 per cent 'always', 'often' or 'sometimes' used the total etch technique, 84 per cent used a thick glass-ionomer layer and 36 per cent never used rubber dam. Fifty-nine per cent of respondents reported a decreased use of amalgam over the previous five years. Sixty-eight per cent of respondents agreed with the statement 'discontinuation of amalgam restricts a dentist's ability to adequately treat patients'. Seventy-five per cent considered that the growth in the use of composites increased the total cost of oral health care. Conclusions: Of the respondents from Australia 73 per cent place large composite restorations in molar teeth and their choice of material is influenced greatly by clinical indications, and patients' aesthetic demands.

Effect of different adhesive systems on microleakage in class II composite resin restorations

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Effect of the Insertion and Polymerization Technique in Composite Resin Restorations: Analysis of Marginal Gap by Atomic Force Microscopy

This in vitro study evaluated the marginal gap at the composite tooth/resin interface in class V cavities under the influence of two insertion techniques and a curing system by means of atomic force microscopy (AFM). Forty enamel and dentin cavities were prepared on the buccal surface in bovine teeth with quadratic forms measuring 2 mm X 2 mm and depth of 1.5 mm. The teeth were then divided into four groups: group A, 10 cavities were restored in one increment, light cured by halogen light; group B, 10 cavities filled with bulk filling, light cured by the light emitting diodes (LED); group C, 10 cavities were restored by the incremental technique, light cured by halogen light; group D, 10 cavities were restored by the incremental technique, light cured by the LED. The teeth underwent the polishing procedure and were analyzed by AFM for tooth/restoration interface evaluation. The data were compared between groups using the nonparametric Kruskall-Wallis and Mann-Whitney tests (p < 0.05). The results showed a statistically significant difference between groups A and B and groups A and C. It was concluded that no insertion and polymerization technique was able to completely seal the cavity.

Surface conditioning of a composite used for inlay/onlay restorations: Effect on mu TBS to resin cement

Purpose: To assess the effect of the composite surface conditioning on the microtensile bond strength of a resin cement to a composite used for inlay/onlay restorations.Materials and Methods: Forty-two blocks (6 x 6 x 4 mm) of a microfilled composite (Vita VMLC) were produced and divided into 3 groups (N = 14) by composite surface conditioning methods: Gr1 - etching with 37% phosphoric acid, washing, drying, silanization; Gr2 - air abrasion with 50-Im Al203 particles, silanization; Gr3 - chairside tribochemiCal silica coating (CoJet System), silanization. Single-Bond (one-step adhesive) was applied on the conditioned surfaces and the two resin blocks treated with the same method were cemented using RelyX ARC (dual-curing resin cement). The specimens were stored for 7 days in water at 37 degrees C and then sectioned to produce nontrimmed beam samples, which were submitted to microtensile bond strength testing (mu TBS). For statistical analysis (one-way ANOVA and Tukey's test, = 0.05), the means of the beam samples from each luted specimen were calculated (n = 7).Results: mu TBS values (MPa) of Gr2 (62.0 +/- 3.9a) and Gr3 (60.5 +/- 7.9a) were statistically similar to each other and higher than Gr1 (38.2 +/- 8.9b). The analysis of the fractured surfaces revealed that all failures occurred at the adhesive zone.Conclusion: Conditioning methods with 50-Im Al203 or tribochemical silica coating allowed bonding between resin and composite that was statistically similar and stronger than conditioning with acid etching.