A comparison of two radiographic assessment protocols for patients with periodontal disease.

OBJECTIVE: Radiographic assessment of patients with generalised severe periodontitis may be undertaken with a panoramic view and supplementary periapicals. The purpose of this study was to estimate the effective radiation dose from this form of radiographic assessment, and to compare it with an estimate of the dose from a series of periapicals of all the affected teeth. DESIGN: Cross-sectional observational study. SETTING: Departments of Periodontology and Radiology, Glasgow Dental Hospital and School. METHOD: Fifty consecutive patients [were recruited] with sufficiently widespread advanced periodontitis to require at least seven periapical radiographs. [Following new local guidelines, a panoramic view was taken.] The adequacy of the image of every affected tooth and the number of supplementary periapicals required was determined by a panel of four examiners who also calculated the number of periapicals which would have been taken if panoramic radiography had not been available. An effective dose of 0.001 mSv for one periapical and 0.007 mSv for a panoramic view was assumed. RESULTS: The panoramic-plus-periapicals approach delivered an estimated additional effective dose to 86% of patients, in the order of 0.001-0.007 mSv. CONCLUSIONS: Within the parameters of this investigation, the anticipated effective radiation dose from a series of periapical radiographs of all selected teeth would, for the great majority of patients, have been less than the dose from a panoramic-plus-periapicals approach.

Comparison of solution- and gel-prepared enamel lesions--and in vitro pH-cycling study.

A variety of methods has been employed to produce artificial caries-like enamel lesions. The aim of this paper was to use a pH-cycling regime to compare the de-/remineralization behavior of lesions prepared by two methods. Lesions were produced by use of either an acidified undialyzed gelatin system or a buffered solution. Enamel sections, each containing four lesions, were allocated to four groups (A, B, C, D) and subjected to a daily pH-cycling regime of 16-hour demineralization and eight-hour remineralization. Groups A & B contained gelatin-prepared lesions, whereas Groups C & D contained solution-prepared lesions. To the remineralizing solutions used in Groups B & D, 2 ppm fluoride was added. The mineral content in the lesions was assessed, by means of microradiography/microdensitometry, at baseline and at intervals for six weeks. The lesions in all four groups exhibited net demineralization. In terms of the total mineral lost from the lesion (the delta z parameter), the demineralization rates of the solution-prepared lesions were significantly greater than those of the corresponding gelatin-prepared lesions. All sections in the non-fluoride groups showed subsurface demineralization in initially sound enamel, whereas only one section in the fluoride groups showed an area of mineral loss. Laminations in the mineral content profiles were apparent only in Group D. The results of this study indicate that the method of lesion preparation affects the subsequent behavior of lesions when exposed to de- and remineralizing protocols.

An in situ enamel section model for assessment of enamel re/demineralization potential.

An enamel-section-carrying intra-oral appliance to predict the results of double-blind anti-caries studies has been developed. Initial validation was against the F concentration effect attained in a clinical trial where three sodium monofluorophosphate (SMFP) dentifrices were used. Original appliance-based work showed significant differences in remineralization between non-F and F dentifrices, but not between different F dentifrices. However, it was shown later that acidified gel-prepared lesions were not as responsive as solution-prepared lesions to de- and remineralizing processes, and lesion remineralization rates were found to be dependent on initial lesion size. An in situ cross-over study was then repeated with use of acid-solution-created lesions, and seven volunteers completed the project. Each brushed twice daily x 2 min with either 0, 1000, or 2500 ppm F, as SMFP dentifrice. After a two-week wash-out, subjects wore the appliances for four weeks. Enamel mineral content was assessed at 0, two, and four weeks via microradiography/microdensitometry, and a statistically significant dose-response was obtained between non-F and F as well as between 1000 and 2500 ppm F pastes, i.e., as per the three-year clinical trial data. Hence, the model's suitability for pre-clinical screening was confirmed. It has also been used in caries microbiological studies, in root caries investigations, and currently in chewing gum cariogenicity experiments.

The effect of baseline lesion mineral loss on in situ remineralization.

The effect of baseline lesion mineral loss on the remineralization of enamel lesions by a sodium fluoride dentifrice was studied in situ by means of an appliance carrying enamel sections. Artificial lesions of various sizes were created, by means of acidified gelatin, and were then mounted on the appliances of five volunteers. Each brushed twice daily for two min with a 1000 ppm F sodium fluoride dentifrice. Measurements of mineral content were made at baseline and at weekly intervals by microradiographic/microdensitometric techniques. Data from all five volunteers showed a linear increase in remineralization rate with increasing lesion size. Thus, in studies which compare the effects of different remineralizing formulations, care must be taken to ensure that initial lesion sizes are matched, or that the results are expressed as a percentage change in mineral content.

The effect of chewing gum use on in situ enamel lesion remineralization.

Two independent cross-over studies investigated the possibility of enhanced early enamel lesion remineralization with the use of chewing gum. The first study involved a sorbitol-containing chewing gum, and the second, which had an identical protocol, tested a sucrose-containing chewing gum. In each study, 12 volunteers wore in situ appliances on which were mounted enamel sections containing artificial caries lesions. Subjects brushed twice daily for two min with a 1100-ppm-F (NaF) dentifrice (control and test) and in the test phase chewed five sticks of gum per day for 20 min after meals and snacks. Microradiographs of the enamel lesions were made at baseline and at the end of the seven-week experimental period. In the sugar-free gum study, the weighted mean total mineral loss (delta z) difference [(wk7-wk0) x (-1)] was 788 vol.% min. x micron for the gum, corresponding to remineralization of 18.2%, vs. the control value of 526 vol.% min. x micron, 12.1% remineralization (p = 0.07). There were no significant differences for the surface-zone (p = 0.20) and lesion-body (p = 0.28) values. In the sucrose-containing gum study, the delta z difference was 743 vol.% min. x micron for the gum, corresponding to a remineralization of 18.3%, vs. the control value of 438 vol.% min. x micron, 10.8% remineralization (p = 0.08). The surface-zone values were not significantly different (p = 0.55). For the lesion body, however, the sucrose-containing gum value of 6.11 vol.% min. was significantly different (p = 0.01) from that of the control (2.81 vol.% min.).

The plane of fracture and shear bond strength of three composite inlay systems.

Composite inlays have been introduced to overcome some of the problems encountered with direct placement techniques. However, some doubt has been expressed about the strength of the bond between the inlay surface and the composite luting cement due to the decreased number of C = C bonds remaining following supercuring of the inlay. This study investigated the bond strength of three composite inlay systems to etched bovine enamel and recorded the plane of fracture of the samples. The bond strength of one system was significantly greater than that of the other groups and was increased by the application of an unfilled resin enamel bonding agent. Unfilled resin application did not significantly alter the other systems tested. In only one of the systems tested was the inlay/composite cement bond found to be the weak link in the bonding procedure. In this group, the application of the manufacturer's specially formulated bond enhancer did not lead to an increase in bond strength.

Silane effects on luting resin bond to a Ni-Cr alloy.

This study investigates the effect of a silane coupling agent on the shear bond strength of four commercially available resin luting systems (two of which rely on mechanical retention and two which have a chemical bond to metal) when bonding a prepared Ni-Cr alloy to etched bovine enamel. Silane application reduced the bond strengths of the two chemically adhesive resins and increased the bond strength of one of the mechanically retained resins. For the other mechanically retained resin, silane application did not significantly increase the bond strength but the plane of fracture changed from resin/metal to resin/enamel: from this an increase in metal resin bond strength can be inferred.

The effect of saliva on enamel and dentine erosion.

The present study aims to assess the ability of saliva, both in vitro and in situ, to prevent surface mineral loss from enamel and dentine when exposed to an erosive challenge. Fifteen groups of four varnished thin tooth sections were stored in saliva collected from individuals taking part in the in situ study and a further eight groups, each containing four sections, were stored in deionised water. In vitro, sections were stored in saliva or water for 14 days. In addition, fifteen subjects each wore an appliance with four varnished sections. Appliances with sections were worn for 14 days. All sections were exposed to 25 ml of erosion solution for 5 min twice daily. Microradiography and image analysis of the recovered sections demonstrated significant protection of surface mineral loss from enamel and dentine by saliva in vitro and in situ compared with deionised water (p < 0.05). Significantly less mineral loss (p < 0.05) was observed for enamel and dentine stored in situ compared with storage in saliva in vitro. Generalised linear modelling demonstrated both the subject and protocol had significant effect on mineral loss. A weak positive correlation (r = 0.64) was noted when in situ and in vitro mineral loss from enamel were compared, demonstrating greater reactivity of the in vitro enamel specimens to the erosion challenge. The dentine data did not show any linear correlation. Saliva protected against mineral loss by erosion and, for enamel, in vitro results demonstrated a weak positive correlation with in situ results.

A clinical study of pulsed Nd: YAG laser-induced pulpal analgesia.

The pulsed Nd: YAG laser is advocated as an alternative means of providing analgesia during routine dental procedures. Since the evidence to support this claim is mainly anecdotal, a clinical trial was carried out using an electric pulp tester (EPT) to measure the extent and duration of any analgesic effect induced by pulsed Nd: YAG laser treatment. A double-blind crossover experiment involving laser and sham treatments was used on 21 subjects. A small (3.6 arbitrary units) but statistically significant increase was observed in the mean responses measured 5 min after laser treatment with 113 mJ pulses at 15 pulses s-1 (pps) for 3 min. The pain thresholds returned to baseline values after 60 min. No statistically significant changes in threshold were found with the sham treatment. The order in which laser and sham treatment was received made no difference to the results.

Dental materials: 1997 literature review.

This review of the published literature on dental materials for the year 1997 has been compiled by the Dental Materials Panel of UK. It continues a series of annual reviews started in 1973. Emphasis has been placed upon publications, which report upon the materials science or clinical performance of the materials. The review has been divided by accepted materials classifications (fissure sealants, glass polyalkenoate cements, dentine bonding, dental amalgam, endodontic materials, casting alloys, ceramometallic restorations and resin-bonded bridges, ceramics, denture base resins and soft lining materials, impression materials, dental implant materials, orthodontic materials, biomechanics and image processing, resin composites, and casting investment materials and waxes). Three hundred and thirty three articles have been reviewed.

Dental materials: 1996 literature review.

This critical review of the published literature on dental materials for the year 1996 has been compiled by the Dental Materials Panel of the UK. It continues the series of annual reviews started in 1973 and published in the Journal of Dentistry. Emphasis has been placed upon publications which report upon the materials science or clinical performance of the materials. The review has been divided by accepted materials classifications (fissure sealants, glass polyalkenoate cements, dentine bonding, dental amalgam, endodontic materials, casting alloys, resin-bonded bridges and ceramo-metallic restorations, ceramics, denture base resins and soft lining materials, impression materials, implants materials, orthodontic materials, biomechanics and image processing, resin composites and casting investment materials and waxes). Three hundred and thirteen articles have been reviewed.

Dental materials: 1996 literature review. Part 2.

This critical review of the published literature on dental materials for the year 1996 has been compiled by the Dental Materials Panel of the UK. It continues the series of annual reviews started in 1973 and published in the Journal of Dentistry. Emphasis has been placed upon publications which report upon the materials science or clinical performance of the materials. The review has been divided by accepted materials classifications (fissure sealants, glass polyalkenoate cements, dentine bonding, dental amalgam, endodontic materials, casting alloys, resin-bonded bridges and ceramo-metallic restorations, ceramics, denture base resins and soft lining materials, impression materials, implants materials, orthodontic materials, biomechanics and image processing, resin composites and casting investment materials and waxes). Three hundred and thirteen articles have been reviewed.

Microleakage of a composite inlay system.

This study investigated the marginal seal of resin composite inlays in dentin and enamel when either unfilled resin or a second or third generation dentin bonding agent is used. Standardized mesial and distal inlay cavities were cut in 135 human third molar teeth. The teeth were randomly divided into 9 groups and inlays fabricated in a hybrid resin composite inlay material. Each group of teeth was then treated with one of 8 dentin bonding agents or an unfilled resin and cemented with a dual curing resin cement. Each group was stored in deionized water for 1 week, thermocycled between 5 degrees C, 37 degrees C and 55 degrees C for 500 cycles, then placed in 2% methylene blue solution for 15 hours. Following this the teeth were sectioned and scored for the degree of leakage observed. Marginal microleakage was minimal at enamel margins, however there was marked leakage, even when a dentin bonding agent was used, on the dentin side. Only two dentin bonding agents proved more effective than unfilled resin and in only one case was the leakage not significantly worse than in enamel.

Effect of composite resin placement and use of an unfilled resin on the microleakage of two dentin bonding agents.

The purpose of this study was to assess, in vitro, the microleakage of Class V restorations using two third generations dentin bonding agents, with a hybrid light polymerized composite resin. One of the bonding agents was of the NPG-PMDM type and the other was a polyhexanide. Restorations were placed in cavities prepared in extracted human premolars using either a bulk or incremental packing technique. The NPG-PMDM-based agent was used with and without an intermediary unfilled resin. The teeth were stored for 1 week at 37 degrees C, thermocycled for 1500 cycles between 55 degrees C, 37 degrees C and 5 degrees C and the restorations examined for leakage using methylene blue dye. The teeth were sectioned through the restorations and the degree of microleakage assessed visually. All groups of restorations showed some degree of leakage at the gingival margin. Statistical analysis showed that there were significant differences in the amounts of leakage (P less than 0.001). There was no difference in leakage between any of the groups that had been restored using the NPG-PMDM system (P greater than 0.05). There was, however, less leakage of the incrementally filled group compared with the bulk-packed group with the polyhexanide agent (P less than 0.05). When the two bonding agents were compared, there was no significant difference in leakage (P greater than 0.05) except for the incrementally-packed polyhexanide and the incrementally-packed NPG-PMDM with unfilled resin (P less than 0.05). Only one specimen in any of the groups leaked at the enamel margin.

Shear bond strength of Mirage Bond to enamel and dentin.

This study determined the shear bond strength of resin composite to bovine enamel etched with Mirage Bond primer containing 2.5% nitric acid. These results were compared with 37% orthophosphoric acid gel. In addition, the bond strength of resin composite to dentin was determined following treatment with the same primer. Resin composite was applied with and without an intermediary unfilled resin, and the specimens were stored for 1 week and then thermocycled prior to testing. The bond strength to enamel was substantially greater than to dentin (P less than 0.001). The results for enamel revealed that there was no significant difference between the etchant regimes (P greater than 0.05) but the intermediary resin significantly improved bond strengths (P less than 0.05). The presence of an intermediary resin also significantly improved the bond strength to dentin (P greater than 0.05).

Effect of Mirage Bond primer on microleakage of resin composite restorations.

This in vitro study assessed the microleakage of Class V restorations using Mirage Bond (NPG-PMDM) with a hybrid light polymerized resin composite. Restorations were inserted in cavities prepared in extracted human premolars using either bulk or incremental packing and with or without an intermediary unfilled resin. The enamel margin of each tooth was etched only with the primer. The teeth were stored for 1 week at 37 degrees C, thermocycled, and the restorations examined for leakage using methylene blue dye. The teeth were sectioned mesiodistally through the restorations and the microleakage assessed visually. All groups exhibited leakage at the gingival margin, but there was a significant difference between the cavities restored by bulk packing of the resin composite. Application of the intermediary resin did not diminish microleakage (P less than 0.01). Nevertheless, there were no other significant differences in microleakage between the groups (P greater than 0.05).