Do composite resin polishing systems damage enamel?

Finishing and polishing of composite resin restorations may cause damage to the bordering enamel. Although many studies have investigated the effect of polish on restorative materials, few have quantified the effect on bordering enamel. The objective of this study was to compare enamel loss surrounding composite restorations after finishing and polishing sequences. The null hypothesis was that there would be no difference in enamel loss between different finishing and polishing sequences. Class V preparations on the buccal and lingual surfaces of 15 extracted human molars were restored with a composite resin and assigned to 1 of 2 finishing and polishing sequences, so that each tooth underwent both sequences (n = 15 per sequence). In sequence 1, a tungsten carbide finishing bur and aluminum oxide polishing discs were used; in sequence 2, a diamond finishing bur, aluminum oxide-impregnated finishing cup, and diamond-impregnated polishing cup were used. Tooth surfaces were scanned with an optical scanner after preparation, finishing, initial polishing, and final polishing. The finishing and polishing scans were aligned to the preparation scan using Cumulus software. The depth of enamel surface loss was calculated and statistically analyzed (α = 0.05; paired t test). Most enamel loss (mean [SD]) resulted from the finishing step with the tungsten carbide bur (51.8 [21.3] µm) or diamond bur (43.3 [12.6] µm). Each polishing step increased mean enamel loss by only a few microns. There was no statistically significant difference between the 2 finishing and polishing sequences. The majority of enamel damage during finishing and polishing of composite resin restorations resulted from the finishing burs. Little enamel was removed by either of the tested composite resin polishing systems.

Effect of EDTA conditioning on cervical restorations bonded with a self-etch adhesive: A randomized double-blind clinical trial.

OBJECTIVE: To compare the 18-month retention rates of composite restorations in non-carious cervical lesions [NCCLs] bonded with a self-etch adhesive with and without preliminary conditioning with EDTA. METHODS: Forty-eight patients with two similar-sized NCCL were selected and randomly allocated to one of two groups. Two calibrated operators placed 96 restorations with a one-step self-etch adhesive (Adper Easy One, 3M ESPE). Half of the restorations were placed according to the manufacturer's instructions while, for the other half, the surfaces of the lesions were conditioned with 17% EDTA for 2 min prior to adhesive application. Two blinded and independent examiners evaluated the restorations at baseline, 6, 12, and 18 months, according to the FDI criteria. The comparison between groups in each period was conducted with the Fisher's exact test, and the performance of each group at the different periods was evaluated by McNemar's test (α=0.05). RESULTS: After 18 months, significantly higher retention rates (95% CI) were observed for the EDTA group (95.5 [84.9-98.7]) than the control group (79.6% [65.5-88.9]) (p=0.02). Significant deterioration of the marginal adaptation and marginal discoloration were observed for both groups over the 18-month evaluation. CONCLUSIONS: The preliminary conditioning with EDTA before application of a one-step self-etch adhesive significantly improved the retention rates of composite restorations in cervical lesions. CLINICAL SIGNIFICANCE: Conditioning with EDTA is an alternative that improves the 18-month retention rate of cervical restorations bonded with a self-etch adhesive.

Parental attitudes and experiences of dental care in children and adolescents with ADHD--a questionnaire study.

Attention deficit hyperactivity disorder (ADHD) is a common psychiatric condition characterized by age-inappropriate levels of inattention, hyperactivity-impulsiveness or a combination of these. The aim of this study was to analyze parental attitudes to and experience of dental care, oral hygiene and dietary habits in children/adolescents with ADHD. Twenty- six parents of 31 subjects, 20 boys and 11 girls, aged 5-19 years with ADHD registered at the Gothenburg Child Neuropsychiatric Clinic, were invited. The parents answered a questionnaire regarding different oral problems when visiting the Clinic of Pediatric Dentistry, Gothenburg, for an oral examination of their child. The parents felt the dental care at the Public Dental Service was good, but noted a lack of knowledge regarding child neuropsychiatry among the dental staff which may influence the dental treatment. Fifteen parents reported their children had experienced mouth pain and 15 reported their child had suffered from both discomfort and pain from local anesthesia. Thirteen of the children had a dental trauma and 12 parents reported pain in connection to the dental treatment. Pain related to filling therapy was stated by 11 parents. According to the parents, five children suffered from dental fear but 15 reported the child had a general fear. Pursuant to the parents, the beverage for dinner was mainly milk or water, while sweet drinks were more frequent when thirsty. Seventeen parents reported their children had poor oral hygiene or could not manage to brush their teeth and 14 of the 31 children only brushed once a day or less. The results show that the parents experience a lack of child neuropsychiatric knowledge, care and patience from the dental staff, which may influence the treatment. Oral hygiene/tooth brushing is neglected and the frequent consumption of sugar is difficult for the parents to handle.

The effect of different preparation and etching procedures on the microleakage of direct composite veneer restorations.

OBJECTIVES: The aim of this in vitro study was to compare the microleakage of direct composite veneer restorations prepared by a conventional dental bur or Er,Cr:YSGG (erbium, chromium doped yttrium scandium gallium garnet) laser and etched with different procedures. METHODS: Fifty maxillary incisor teeth prepared for direct veneers with gingival margins in dentin and incisal margins in enamel were randomly divided into five groups (n = 10): group 1 (control), prepared with diamond bur and etched with phosphoric acid; group 2, prepared with diamond bur and etched with Er,Cr:YSGG laser (Waterlase MD/Biolase); group 3, prepared with laser and not etched; group 4, prepared with laser and etched with phosphoric acid; and group 5, prepared and etched with laser. After the application of the etch and rinse adhesive system (Prime & Bond NT/Dentsply), teeth were restored with the nano ceramic restorative material (Ceram X Duo/Dentsply), subjected to thermocycling and immersed in 0.5% basic fuchsin dye for 24 h. The teeth were sectioned longitudinally and dye penetration was evaluated by a binocular stereomicroscope equipped with a measuring device. Data were analyzed by Kruskal-Wallis and Wilcoxon signed ranks tests. The level of significance was set at p = 0.05. RESULTS: Significant differences were observed in enamel of the five groups (p < 0.05). Minimal microleakage was observed in groups 1 and 3. The highest microleakage was evaluated in group 5 (p < 0.05). No significant differences were found among the five groups in dentin (p > 0.05). No differences were recorded between the microleakage values in enamel and dentin within each group and this was valid for all groups (p > 0.05). CONCLUSIONS: The results confirmed that enamel and dentin surfaces prepared with Er,Cr:YSGG laser for direct composite veneer restorations may provide comparable sealing.

Care of patients who are worried about mercury poisoning from dental fillings.

INTRODUCTION: Public concern about adverse health effects from mercury exposure from dental amalgams remains a high-profile issue. Patients with nonspecific neuropsychiatric symptoms may incorrectly attribute their complaints to mercury poisoning, and some alternative medical providers diagnose mercury toxicity using nonvalidated tests or without testing at all. CASE REPORT: We report the case of a 37-year-old female who was referred to our outpatient medical toxicology clinic by her family medicine physician after a wellness doctor involved in her care ordered a dimercaptopropanesulfonic acid (DMPS) challenge urine study that revealed an "elevated" mercury level. DISCUSSION: The use of postchelator challenge urine testing to diagnose mercury poisoning has not been validated. Use of such tests may cause falsely elevated urine mercury levels resulting in misdiagnosis of mercury poisoning and unncessary, expensive, and potentially dangerous chelation therapy. CONCLUSION: Family medicine physicians may encounter patients who are concerned about mercury poisoning after undergoing postchelator challenge urine testing. In patients with a low suspicion for mercury toxicity, reassurance is adequate. In patients with moderate to high suspicion for mercury toxicity, a validated test for mercury, such as a 24-hour urine mercury level, or referral to a medical toxicologist is the most appropriate approach.

Does a specific dental amalgam syndrome exist? A comparative study.

OBJECTIVE: The aim of this article was to investigate whether there is evidence for a specific syndrome of health problems attributed to dental amalgam. MATERIAL AND METHODS: A secondary and retrospective analysis of two different databases was performed: (a) 90 patients (47% female, mean (SD) age 34 (6) years) of a clinical trial to remove amalgam fillings who attribute their health complaints to dental amalgam, and (b) 116 patients (62% female, mean (SD) age 37 (8) years) from an outpatient unit for environmental medicine who attribute their symptoms to environmental sources other than amalgam. RESULTS: The samples differed in age, sex, and educational level. No statistically significant differences between either of the groups were found in overall psychological distress, intensity of the symptoms, or in numbers of self-reported symptoms in the Symptom Check List after controlling for age, sex, and education (Mean Global Severity Index 0.62 versus 0.63). Patients from the amalgam group showed mean values for private and public self-consciousness similar to the population norm, while patients from the comparison group had statistically significantly decreased mean values. While the amalgam group more frequently reported mental symptoms, patients from the comparison group had a higher prevalence of somatic symptoms. CONCLUSIONS: The results showed some differences in symptomatology, while general psychological distress was similar in both groups, indicating no strong evidence for an amalgam-specific syndrome.

Ability of different restorative materials to prevent in situ secondary caries: analysis by polarized light-microscopy and energy-dispersive X-ray.

Secondary caries is the main cause of direct restoration replacement. The purpose of this study was to analyze enamel adjacent to different restorative materials after in situ cariogenic challenge using polarized-light microscopy (PLM), scanning electron microscopy (SEM) and energy-dispersive X-ray analysis (EDS). Twelve volunteers, with a low level of dental plaque, a low level of mutans streptococci, and normal salivary flow, wore removable palatal acrylic appliances containing enamel specimens restored with Z250 composite, Freedom composite, Fuji IX glass-ionomer cement, or Vitremer resin-modified glass-ionomer for 14 days. Volunteers dripped one drop of 20% sucrose solution (n = 10) or distilled water (control group) onto each specimen 8 times per day. Specimens were removed from the appliances and submitted to PLM for examination of the lesion area (in mm(2)), followed by dehydration, gold-sputtering, and submission to SEM and EDS. The calcium (Ca) and phosphorus (P) contents were evaluated in weight per cent (%wt). Differences were found between Z250 and Vitremer, and between Z250 and FujiIX, when analyzed using PLM. Energy-dispersive X-ray analysis results showed differences between the studied materials regarding Ca %wt. In conclusion, enamel adjacent to glass-ionomer cement presented a higher Ca %wt, but this material did not completely prevent enamel secondary caries under in situ cariogenic challenge.

Changed clinical chemistry pattern in blood after removal of dental amalgam and other metal alloys supported by antioxidant therapy.

This study aimed to investigate a possible connection between removal of dental amalgam restorations supported by antioxidant therapy and indicative changes of clinical chemistry parameters. A group of 24 patients, referred for complaints related to amalgam restorations, underwent a removal of their amalgams. All patients were treated with antioxidants (vitamin B-complex, vitamin C, vitamin E, and sodium selenite). An age- and sex-matched control group of 22 individuals was also included. The mercury (Hg) and selenium (Se) concentration in plasma, Hg concentration in erythrocytes, and 17 clinical chemistry variables were examined in three groups: patients before amalgam removal (Before), patients after amalgam removal (After), and control individuals (Control). The Hg and Se values decreased (p < 0.05) in plasma, and the Hg concentration decreased (p < 0.05) in erythrocytes after amalgam removal. The variables serum lactate dehydrogenase (serum LDH) and serum sodium differed significantly both when comparing Control with Before (p < 0.01) and Before with After (p < 0.01). The variables white blood cell count (WBC), blood neutrophil count, blood eosinophil count, blood basophil count, blood lymphocyte count, blood monocyte count, serum potassium, and serum creatinine differed in the Before/After test (p < 0.05). Multivariate statistics (discriminant function analysis) could separate the groups Before and After with only one misclassification.

Influence of local anaesthesia on the quality of class II glass ionomer restorations.

OBJECTIVE: To investigate the influence of local anaesthesia on the quality of class II glass ionomer restorations with discomfort as cofactor. MATERIAL AND METHODS: The study population consisted of 6- to 7-year-old schoolchildren in Paramaribo and its environs. To be included, each child needed to have a proximally situated cavity in a primary molar that was accessible to hand instruments and where no pulp exposure was expected. They were randomly divided into four treatment groups: conventional method with and without local anaesthesia and atraumatic restorative treatment method (ART) with and without local anaesthesia. The restoration quality was scored using the evaluation criteria for ART restorations (successful if restoration is correct or has a minor defect and fails if defects are larger than 0.5 mm, if secondary caries is observed, if the restoration is fractured, partly or totally lost or if the pulp is involved) at 6 and 30 months after treatment. The extent of discomfort was registered by assessing the behaviour (modified Venham score) and observing the heart rate during treatment. RESULTS: For this study 153 children were treated with hand instruments (ART) and 146 children with rotary instruments (conventional method). A total of 198 restorations were evaluated during follow-up periods. There were no significant differences in patient discomfort between the ART and the conventional group and between the anaesthesia and the non-anaesthesia group. The conventional restorations demonstrated significantly higher success rates than ART restorations after 6 (P = 0.001) and 30 months (P = 0.032). There were no significant differences in success rate between the anaesthesia and the non-anaesthesia group. CONCLUSION: Local anaesthesia has no influence on discomfort during treatment. Furthermore, discomfort during treatment does not affect the success rate of restorations.

Microleakage on Class V glass ionomer restorations after cavity preparation with aluminum oxide air abrasion.

This in vitro study assessed the marginal microleakage on class V cavities prepared with aluminum oxide air abrasion and restored with different glass ionomer cements. The cavities were prepared on the buccal and lingual surfaces of 15 sound third molars with an air- abrasion device (Kreativ Mach 4.1; New Image) using a 27.5-microm aluminum oxide particle stream, and were assigned to 3 groups of 10 cavities each. The restorative materials were: group I, a conventional glass ionomer cement (Ketac-Fil); groups II and III, resin-modified glass ionomer cements (Vitremer R and Fuji II LC, respectively). After placement of the restorations, the teeth were stored in distilled water at 37 degrees C for 24 h, polished and then submitted to a thermocycling regimen of 500 cycles, isolated, immersed in 0.2% Rhodamine B solution for 24 h, included and serially sectioned. Microleakage was assessed by viewing the specimens under an optical microscope connected to a color video camera and a computer. The images obtained were digitized and analyzed for microleakage using software that allows for a standard quantitative assessment of dye penetration in millimeters. Statistical analysis was done using the Kruskall-Wallis and Wilcoxon tests. Means of dye penetration (%) were: occlusal - I: 25.76 +/- 34.35, II: 20.00 +/- 42.16, III: 28.25 +/- 41.67; cervical - I: 23.72 +/- 41.84; II: 44.22 +/- 49.69, III: 39.27 +/- 50.74. No statistically significant differences (p>0.05) were observed among either the glass ionomer cements or the margins. In conclusion, class V cavities restored with either conventional or resin-modified glass ionomer cements after preparation with aluminum oxide air abrasion did not show complete sealing at the enamel and dentin/cementum margins.

Microleakage on class V glass ionomer restorations after cavity preparation with aluminum oxide air abrasion

Este estudo in vitro avaliou a microinfiltração marginal em cavidades classe V preparadas com jato de óxido de alumínio e restauradas com diferentes sistemas ionôméricos. As cavidades foram preparadas nas superfícies vestibular e lingual de 15 terceiros molares hígidos e foram divididas em três grupos com 10 cavidades cada um. Os seguintes materiais foram utilizados: no grupo I, cimento de ionômero de vidro convencional (Ketac Fil) e nos grupo II e III, cimentos de ionômero de vidro modificado por monômeros resinosos (Vitremer e Fuji II LC, respectivamente). O preparo cavitário foi realizado por meio da aplicação do jato de óxido de alumínio (Kreativ Mach 4.1; New Image), com partículas de 27,5 µm. Após a restauração das cavidades, os dentes foram armazenados durante 24 h em água destilada a 37ºC, polidos e então submetido a termociclagem (500 ciclos), imersos em Rodamina B a 0,2% por 24 h, incluídos e seccionados. A análise da microinfiltração marginal foi realizada por meio de um microscópio óptico acoplado a uma câmera e a um computador. As imagens obtidas foram digitalizadas e analisadas utilizando um software que permite uma análise quantitativa padronizada da microinfiltração, em milímetros. As médias (%) obtidas foram: oclusal - I: 25,76 mais ou menos 34,35; II: 20,00 mais ou menos 42,16; III: 28,25 mais ou menos 41,67; cervical I: 23,72 mais ou menos 41,84; II: 44,22 mais ou menos 49,69; III: 39,27 mais ou menos 50,74. Os dados foram submetidos à análise estatística, utilizando os testes de Kruskall-Wallis e Wilcoxon. Não houve diferença estatisticamente significante (p>0.05) entre os materiais testados nem entre as margens oclusal e cervical. Conclui-se que em cavidades classe V preparadas com ar abrasão e restauradas com cimentos de ionômero de vidro convencional e modificados por monômeros resinosos não houve completo vedamento marginal.

Microleakage at the composite-repair interface: effect of different surface treatment methods.

This study evaluated microleakage at the composite-repair interface after using different methods of surface treatment. Eighty resin composite specimens (Filtek Z250, 3M Dental Products) aged in artificial saliva for three months were divided into four groups (n=20) according to the following surface treatment methods: untreated control-no roughening or abrasion of the surface; roughening with diamond burs; jet prophylaxis with sodium bicarbonate particles and air abrasion with 50 microm aluminum oxide particles. Each method was examined using scanning electron microscopy (SEM) to evaluate changes in surface topography. All groups were then etched with 37% phosphoric acid, coated with a bonding agent (Single Bond, 3M Dental Products) and received new resin applications. The samples were then thermocycled (800 cycles/5 degrees C to 55 degrees C [+/- 2]) and immersed in 2% methylene blue buffered dye solution (7.0 pH) for four hours. Three examiners measured the extent of microleakage in a stereoscope microscope using four representative scores. For all experimental groups, no significant difference in repair microleakage was identified by the Kruskal-Wallis test (p>0.05). Therefore, different testing methods of surface treatment showed the same effect on dye penetration along the repair interface.

Removal of dental amalgam and other metal alloys supported by antioxidant therapy alleviates symptoms and improves quality of life in patients with amalgam-associated ill health.

OBJECTIVES: The purpose of this study was to evaluate treatment of patients suffering from chronic ill health with a multitude of symptoms associated with metal exposure from dental amalgam and other metal alloys. SETTING AND DESIGN: We included 796 patients in a retrospective study using a questionnaire about symptom changes, changes in quality of life as a consequence of treatment and assessment of care taking. METHODS: Treatment of the patients by removal of offending dental metals and concomitant antioxidant therapy was implemented according to the Uppsala model based on a close co-operation between physicians and dentists. RESULTS: More than 70% of the responders, remaining after exclusion of those who had not begun or completed removal, reported substantial recovery and increased quality of life. Comparison with similar studies showed accordance of the main results. Plasma concentrations of mercury before and after treatment supported the metal exposure to be causative for the ill health. MAIN FINDINGS: Treatment according to the Uppsala model proved to be adequate for more than 70% of the patients. Patients with a high probability to respond successfully to current therapy might be detected by symptom profiles before treatment. CONCLUSIONS: The hypothesis that metal exposure from dental amalgam can cause ill health in a susceptible part of the exposed population was supported. Further research is warranted to develop laboratory tests to support identification of the group of patients responding to current therapy as well as to find out causes of problems in the group with no or negative results.

Iatrogenic tooth abrasion comparisons among composite materials and finishing techniques.

STATEMENT OF PROBLEM: Many different rotary instruments are available for shaping composite restorations. Whether use of these instruments causes undesirable iatrogenic abrasion of either the tooth surface or the composite restorative material is unknown. Assuming that damage occurs, which technique is least damaging is unknown. PURPOSE: This in vitro study quantified the loss of surface enamel and dentin surrounding Class V preparations during composite shaping and finishing procedures. The susceptibility of 2 types of composites to tooth abrasion was also examined. MATERIALS AND METHODS: Standardized Class V cavities were prepared at the amelodentinal junction of 36 human molar teeth. The teeth were randomly assigned to 6 groups of 6 teeth each. They were restored with either a low- or high-viscosity composite (Revolution or Prodigy Condensable, respectively) and finished with aluminum oxide disks, tungsten carbide burs, or ultrafine finishing diamond burs. The preparations were profiled before and after restoration. After each finishing procedure, morphological measurements of surface changes in the dentin and enamel were made and reported as volume (in cubic millimeters); maximum depth, mean maximum depth, and mean depth (in micrometers); and surface area (in square millimeters). The results were subjected to a 2-way analysis of variance for restorative material and finishing technique (P<.05). RESULTS: Aluminum oxide disks removed significantly less enamel than tungsten carbide burs or ultrafine finishing diamond burs, as measured by volume, maximum depth, mean maximum depth, mean depth, and surface area (P<.05). Conversely, aluminum oxide disks removed significantly greater dentin than either tungsten carbide burs or ultrafine finishing burs as measured by loss of volume, mean depth, and surface area (P<.05). There was no significant difference in the loss of surrounding tooth substance based on resin type (low or high viscosity). CONCLUSION: Within the limitations of this study, the 3 finishing systems tested resulted in varying degrees of iatrogenic abrasion of enamel and dentin. The composite material used had no significant effect on abrasion of the surrounding enamel or dentin.

A comparison of post-operative morbidity following outpatient dental care under general anaesthesia in paediatric patients with and without disabilities.

An investigation was undertaken of morbidity after outpatient general anaesthesia for comprehensive dental care in a group of paediatric patients over a 1-year period. Data were collated from the patient's hospital notes and from the response to a questionnaire sent to parents/carers. Clinical data were obtained for 55 cases (age range 3-17 years) for whom parents/carers had returned questionnaires. There were 27 intellectually and/or physically impaired patients, the other 28 being anxious or phobic. After discharge, 44% of all parents/carers reported symptoms post-operatively in their child, the prevalence being similar in both groups. The symptoms were nausea/vomiting (20%), unexpected drowsiness (13%) and the need for pain relief at home (13%). Dental procedures were routine restorations (42%), or a combination of restoration, extractions and preventive care for the remainder. Only four patients had extractions only. One teenager had to be admitted for persistent nausea and vomiting, despite prophylactic measures. In conclusion, post-operative morbidity appears to be low after outpatient general anaesthesia for dental procedures, and is no greater in patients with disabilities.

Evaluation of audio analgesia for restorative care in children treated using electronic dental anesthesia.

The purpose of this study was to evaluate the effectiveness of music and white noise in the management of sensitive children treated using electronic dental anesthesia for restorative care. Sound (music and random noise) was used in combination with electronic dental anesthesia in 16 pediatric patients, who have been found to have low pain tolerances during operative procedures under electronic anesthesia alone. Pain was assessed by means of two scales, the color scale and the sound, eye and motor scale. Behavior was assessed through use of the North Carolina Behavior Rating Scale. The comfort was evaluated mainly during penetration of the dentin-enamel junction of the tooth. A procedure involving music and "noisy" music has been effective in 14 children. The music promoted relaxation, whereas the "noise" in combination with electronic signals suppressed pain. It has been demonstrated that audio analgesia and electronic dental anesthesia are quite compatible and may be used with considerable success in combination in difficult circumstances.

Cerebrospinal fluid protein changes in multiple sclerosis after dental amalgam removal.

A relationship between multiple sclerosis (MS) and dental silver-mercury fillings has been suggested by some investigators, but never proven. This study documents objective biochemical changes following the removal of these fillings along with other dental materials, utilizing a new health care model of multidisciplinary planning and treatment. The dramatic changes in photolabeling of cerebrospinal fluid (CSF) proteins following these dental interventions suggest CSF photolabeling may serve as an objective biomarker for monitoring MS. The clear-cut character of these changes should also encourage more research to better define this possible association between dental mercury and MS.

Artificial secondary caries around two new F-containing restoratives.

Replacement of restorations due to secondary caries is a continuing problem in restorative dentistry. This investigation evaluated the ability of two new light-cured fluoride-containing restorative materials to inhibit caries in vitro. Class 5 cavities were prepared in buccal and lingual surfaces of 20 extracted premolars. The occlusal cavosurface margin of each preparation was on enamel and the gingival cavosurface margin was on root surface. The four materials used were: glass-ionomer cement (Fuji II), composite resin (Silux Plus), light-cured glass ionomer (Vitremer), and compomer (Dyract). After 5 weeks in an acid gel for caries-like lesion formation, the teeth were sectioned longitudinally and examined with polarized light. The results showed that use of a light-cured glass ionomer and/or compomer may prevent both secondary caries around restorations and primary caries in surface enamel adjacent to the restorations.