Rationale and treatment approach in minimally invasive dentistry.

BACKGROUND: Current methods of detecting caries, especially fissure caries, are inaccurate, causing some caries to go undetected until it has reached more advanced stages. Minimally invasive dentistry is a philosophy in which the goal of intervention to conserve healthy tooth structure. The authors review the rationale and role of air abrasion in successful practice in the 21st century that includes the philosophy of minimal intervention. CLINICAL IMPLICATIONS: This objective encompasses a range of clinical procedures that includes assessment of caries risk to reinforce patient self-help, early detection of the disease before lesion cavitation to fortify the oral environment, restoration of fissure caries with maximum retention of sound tooth structure and sealant placement in unaffected areas. This conservative approach minimizes the restoration/re-restoration cycle, thus benefiting the patient over a lifetime.

Retention strength of tin plated gold inlays bonded with two resin cements.

Research has shown bonding of restorations to tooth structure to enhance retention of the restoration to increase the fracture resistance of the tooth, and to reduce microleakage. Resin cements have superior physical properties to traditional cements such as zinc phosphate. The purpose of this study was to compare the retention of gold inlays luted with two resin cements to that of those luted with zinc phosphate cement.

Air abrasion: an old technology reborn.

Recently, air abrasion has experienced a rebirth in restorative dentistry. Originally developed in the late 1940s, the principle of air abrasion is the imparting of kinetic energy to tiny aluminum oxide particles that are projected by a stream of compressed air or gas and expelled from a small nozzle. The force generated by the relatively hard particles striking a relatively hard surface is sufficient to cut into that surface. In the last decade, more than a dozen models of air abrasion units have been introduced into the marketplace and more are on the way. Manufacturers have developed air abrasion instruments that offer a broad range of features, from small table-top units to self-contained systems with compressors, vacuums, and curing lights. The costs range dramatically--from $1,000 to $20,000 or more--depending on the complexity of the features and attachments. Manufacturers make a variety of claims to support the value of this technology to the practicing dentist. A term often used to describe one of the benefits of air abrasion is microdentistry. The claim is that smaller, less invasive tooth preparations may be accomplished using air abrasion than with a traditional bur and air turbine. This may be true in some instances, but it would certainly depend on the operator's experience and ability to visually discern fine detail. Other claims about air abrasion are that it can be used to cut into tooth structure without local anesthesia and that it should be used on all stained grooves or fissures to determine if incipient carious lesions are present. Despite the limited number of clinical studies, the popularity of air abrasion continues to grow. To gain additional insight about these claims and to see what might be on the horizon for this technology, I spoke with three highly respected educators who are recognized for their expertise in air abrasion. What they said should give the reader a better understanding of how air abrasion might augment restorative dentistry procedures and techniques.

Bonded amalgam sealants: two-year clinical results.

The authors used bonded amalgams as pit and fissure sealants without mechanical preparation. They compared the two-year retention of the bonded amalgams with that of resin-based pit and fissure sealants. Clinical examinations at six months, one year and two years revealed no difference between the retention of the two sealants. This technique opens up the possibility of using bonded amalgam in pits and fissures surrounding very conservative preparations in a preventive amalgam restoration.

Root reinforcement with a resin-bonded preformed post.

PURPOSE: This study evaluated the ability of resin-bonded posts to reinforce teeth that are structurally weak in the cervical area against fracture. MATERIAL AND METHODS: Forty canine roots were endodontically treated and randomly distributed into four groups of 10. Parallel-sided preformed posts were cemented into the roots of these teeth after their crowns were removed. The cervical third of the canals were flared to simulate teeth weakened in this area as a result of caries or endodontic therapy. Three resin cements and a zine-phosphate cement, which was used as the control, were used to secure the posts into the roots. Cemented posts were loaded in an Instron testing machine with a gradually increasing force at a 60-degree angle to the long axis of the root until the root fractured. RESULTS: Roots in which the posts were cemented with Panavia were significantly more resistant to fracture than those where zinc phosphate was used (p < 0.05). Because of the inability to determine exactly the point of failure of the zinc-phosphate cement, no statistically significant difference was found when compared with the other two resin cements (ANOVA and Student-Newman-Keuls test).

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.

Retention of posts cemented with various dentinal bonding cements.

This investigation evaluated the retention of preformed posts with four different cements: C & B Metabond, Panavia, All-Bond 2, and Ketac-Cem. Sixty intact maxillary canines were selected for the study. The clinical crowns were removed and endodontic therapy done on each root, which was then prepared to receive prefabricated posts. The 60 samples were divided into four groups of 15, and the posts in each group were cemented with one of the four cements. The roots were mounted in acrylic resin blocks and the posts were separated from the canals with an Instron testing machine. Analysis of the forces needed to dislodge the posts with analysis of variance and Student-Newman-Keuls test disclosed that C & B Metabond cement was the most retentive (p < 0.05). No difference in retention was recorded between Ketac-Cem and Panavia cements. All-Bond 2 cement was the least retentive of cements.

Mechanical retention versus bonding of amalgam and gallium alloy restorations.

The retention of amalgam and gallium alloy restorations in proximal box forms was measured in vitro, and three different adhesives to conventional undercuts were compared. For control, restorations were placed without undercuts or adhesives. No significant difference was found between amalgam and gallium alloys with each of the five methods of retention used. Alloys placed without retention or adhesives were significantly less retentive than all other groups. When Tytin alloy was used, no difference was found in retention among the restorations retained with Panavia or All-Bond adhesive or an occlusal dovetail and retention grooves, but Amalgambond adhesive was less retentive than all three of these methods. When gallium alloy was used, both Panavia and All-Bond adhesive were more retentive than undercuts, but the effect of Amalgambond adhesive was more retentive than undercuts, but the effect of Amalgambond adhesive was comparable to that of undercuts. The results of this study indicate that adhesives could be used in place of traditional undercuts to retain amalgam and gallium alloys, thus saving a considerable amount of tooth structure.

Effect of bonded amalgam on the fracture resistance of teeth.

The purpose of this study was to determine whether amalgam bonded to tooth structure with an adhesive resin cement can increase the fracture resistance of restored teeth. Extracted paired upper premolars were prepared for G.V. Black type mesioocclusodistal amalgam restorations. In one tooth of each pair (the experimental group), the enamel walls were etched with phosphoric acid and were painted with an adhesive resin (Panavia), and amalgam was condensed and carved. For the other tooth in each pair (the control group), amalgam was placed in the same manner but was not etched and lined with resin. The teeth were thermocycled and mounted for testing and then were loaded until fracture. A significant difference (p less than 0.05, the paired Student's t-test) was found in the force needed to fracture the bonded amalgam group (70.5 +/- 21.6 kg) compared with that needed to fracture the conventional amalgam group (60.3 +/- 16.8 kg). SEM examination of fractures at the interface occurred predominantly within the resin.

Effect of bonded gold inlays on fracture resistance of teeth.

The purpose of this study was to determine if bonding gold inlays to tooth structure with an adhesive resin cement would increase the fracture resistance of restored teeth. Extracted paired maxillary premolars were prepared for mesio-occlusodistal inlays, and the inlays were cast in type II gold. In one tooth of each pair, the inlay was sandblasted with aluminium oxide, tin plated, and cemented with an adhesive resin into the etched preparation. For the other (control) tooth in each pair, the inlay was sandblasted and then cemented into the preparation with zinc phosphate cement. The teeth were thermocycled and loaded until fracture. The teeth in the bonded group had a statistically significantly higher fracture resistance than did the teeth in the control group. Scanning electron microscopic examination revealed that failure in the bonded group occurred predominantly within the resin.

Comparison of a subgingivally placed cannula oral irrigator tip with a supragingivally placed standard irrigator tip.

This study compared the depth of irrigation of periodontal pockets achieved by a cannula subgingival irrigator tip and a standard oral irrigator tip. They were tested on periodontally involved teeth recommended for extraction from 17 patients. Before extraction, reference grooves were made circumferentially in each study tooth at the level of the gingival margin. In one group of 5 patients (29 teeth), a cannula was inserted halfway into the pocket at the facial, mesiofacial, distofacial, lingual, mesiolingual and distolingual surfaces and the surface irrigated for 5 s at 5 psi with a solution of plaque-staining dye from an oral irrigator. A 2nd group of 7 patients (29 teeth) was tested similarly with a standard irrigating tip at 80 psi. A 3rd (control) group of 5 patients (26 teeth) rinsed with the dye solution. Teeth were then extracted. The distance on each tooth from the reference notch to the apical extent of the stained plaque, and also to the coronal limit of the connective tissue attachment, was measured at 4 sites (mesial, distal, buccal, lingual) under a dissecting microscope to determine the extent of dye penetration. Mean linear penetration for the control group was only 0.1 mm. Irrigation with the cannula tip penetrated farther into both the medium (3.5-6 mm) and the deep (greater than 6 mm) periodontal pockets (p less than 0.01) than did irrigation with the standard tip.(ABSTRACT TRUNCATED AT 250 WORDS)

A clinical technique for bonding gold castings to teeth.

A clinical technique is presented that allows practitioners to use adhesive bonding techniques to improve the retention and seal of gold castings. At the time of delivery of a gold casting, the preparation is treated with a self-curing enamel and dentinal bonding agent. The internal surface of the casting is sandblasted and electroplated with tin to produce a surface suitable for bonding with a resin cement, which is virtually insoluble and is adhesive to both the metal surface and the treated tooth.

Microleakage in MOD resin composite with three dentin bonding agents.

The extent of microleakage under MOD composites was studied when an aluminum oxalate dentin bonding agent (Tenure), a phosphonated resin bonding agent (Bondlite), and a glass-ionomer cement (Ketac Silver) were used. Three groups of 10 extracted molars were prepared with MOD cavities; one box ended on enamel, the other on cementum. In Group 1, Bondlite was applied to dentin and etched enamel before the sample was restored with a light-cured hybrid composite. In Group 2, a 2-mm increment of Ketac Silver was placed in each box before Bondlite and composite. In Group 3, Tenure was applied to dentin before being restored. Teeth were thermal-cycled, stained in silver nitrate, sectioned, and scored for microleakage. Microleakage along the gingival floor was significantly less at enamel margins than at cementum margins in all three groups. All groups showed severe marginal microleakage on cementum.

Periodontal implications of orthodontic treatment in adults with reduced or normal periodontal tissues versus those of adolescents.

This longitudinal study monitored periodontal status in 20 adults and 20 adolescents undergoing fixed orthodontic treatment. Ten adults had generalized periodontitis and received periodontal treatment, including periodontal surgery, before orthodontic treatment. They also received periodontal maintenance at 3-month intervals during orthodontic treatment. The other 10 adults had normal periodontal tissues. Neither these latter adults nor the adolescents received periodontal maintenance during orthodontic treatment. Periodontal status was determined (1) at six standard sites before fixed appliances were placed (baseline), (2) at 1, 3, 6, 9, 12, and 18 months after appliances had been placed, and (3) 1, 3, 6, and 12 months after appliances had been removed. At each of these visits, these sites were assessed for plaque index, gingival index, bleeding tendency, and pocket depth. Loss of attachment between baseline and 3 months after appliances were removed and tooth loss were also determined. Complete data were obtained for 15 adolescents and 14 adults. During orthodontic treatment the adolescent group showed significantly more (p less than 0.05) periodontal inflammation and supragingival plaque than the adults; after appliances were removed, this pattern was no longer statistically significant. For loss of attachment, there were no significant differences among adolescents, adults with normal periodontal tissues, or adults with reduced but healthy periodontal tissues who had undergone treatment for periodontal disease. For tooth loss, three nonstudy site teeth with pockets deeper than 6 mm and/or furcation involvements were lost because of periodontal abscesses in the adult group treated for periodontal disease.

Reduced radiation-absorbed dose to tissues with partial panoramic radiography for evaluation of third molars.

The radiation-absorbed doses from panoramic radiography, distal molar radiography, and a partial panoramic radiographic technique that exposes only the third molar region to radiation are compared. Doses of radiation to the submandibular salivary gland were comparable by all three techniques, but doses of radiation to the head and neck were reduced greatly by the partial panoramic radiographic technique. Partial panoramic radiography is a diagnostically satisfactory and a radiologically safer technique for evaluation of third molar pathosis than is panoramic or distal molar radiography.

Fracture resistance of teeth restored with class II bonded composite resin.

The purpose of this study was to determine whether composite resin bonded to enamel or to both enamel and dentin can increase the fracture resistance of teeth with Class II cavity preparations. Extracted maxillary pre-molars with MOD slot preparations were restored with composite resin bonded to enamel (P-30 and Enamel Bond) or composite resin bonded to enamel and dentin (P-30 and Scotch-bond). Teeth in a control group were prepared but left unrestored. All teeth were loaded occlusally in a universal testing machine until they fractured. Means of forces required to fracture teeth in each of the three groups were statistically compared (one-way ANOVA and Bonferroni t test). Teeth restored with combined enamel- and dentin-bonded composite resins were significantly more resistant to fracture than were similarly prepared but unrestored teeth and also than teeth restored with enamel-bonded composite resin (p less than 0.05). A significant difference was not demonstrated between the enamel-bonded group and the unrestored group. Further testing is needed to determine the durability of the bonds between tooth and restoration in the clinical setting.