Anticipating failure in extensive restorative treatment of the periodontally compromised patient.

If even one supporting tooth fails, a complex restorative treatment may have to be redone. Improved design of a restoration can anticipate failure and offer alterations to existing appliances.

Clinical success of class V composite resin restorations without mechanical retention.

The authors describe a study in which they placed 126 Class V composite resin restorations without mechanical retention, divided into three groups of 42, in 23 patients. They followed the performance of the restorations over a three-year period. For all three groups, restorations were placed using All-Bond 2 dental adhesive and Z100 composite resin; A.R.T. Bond and Brilliant Dentin composite; and Prisma Universal Bond 3 and Variglass VLC polyacid-modified composite resin. The authors evaluated retention as well as color stability, wear resistance, sensitivity, sulcular depth, loss of attachment, bleeding on probing and crevicular fluid flow. Based on their results, the authors propose that restoration of Class V lesions without using mechanical retention could be expected to succeed in seven of 10 restorations over a three-year period using these restorative systems.

Tensile dislodgment evaluation of two experimental prefabricated post systems.

This study tested the tensile dislodgment forces of two experimental post designs that are threaded 7 mm into the most coronal aspect of the root. Experimental post systems ParaPost XT-7 (XT-7), and ParaPost XT-10 (XT-10) were compared to the Flexi-Post (FP) and to the Standard ParaPost (SP). The XT-7 prototype post measured 7 mm in length, while all other post systems were 10 mm. The XT-7 and the FP are active post systems that are threaded throughout their entire length. The SP is a passive serrated post system, and the XT-10 is a combination active/passive design that has a 7 mm coronal thread with a passive serrated apical end. All systems tested were titanium alloy except the SP system, which was stainless steel. The purpose of this study was to compare an active and a passive post design to the experimental designs of the XT-7 active post and the combined active/passive design of the XT-10. This study clearly demonstrated highest retention for the active post system, least retention for the passive post, with an intermediate retentiveness for the combined design.

Fracture strength of type IV and type V die stone as a function of time.

STATEMENT OF PROBLEM: During the removal of casts from the impression there is the risk of stone fracture. PURPOSE: This study evaluated the fracture resistance of four die stone materials at different time intervals. MATERIAL AND METHODS: Additional silicone impressions were made of a maxillary master cast. Two Type V, one Type IV die stones and one Type IV resin reinforced stone were tested. A total of 80 casts were prepared, separated, and tested on the Instron Universal Testing Machine at 1/2, 1, 12, and 24 hours to measure resistance to fracture. RESULTS: Significant differences to fracture resistance of the different die stone materials were observed at all time intervals except at 24 hours. The data were analyzed with ANOVA at alpha = 0.005 and n = 5. CONCLUSION: It is recommended to wait at least 12 to 24 hours when separating casts from impressions to avoid fracturing casts. Residual moisture content in a stone cast may contribute to fracture.

Accuracy of polyether and addition silicone after long-term immersion disinfection.

STATEMENT OF PROBLEM: Some studies have demonstrated that short-term immersion disinfection does not affect the accuracy of polyether or addition silicone materials. Impressions are often disinfected for longer than recommended time periods. PURPOSE: This study evaluated these materials after simulating overnight disinfection. MATERIAL AND METHODS: Impressions were made of a master model with Extrude Extra material with Extrude Wash addition silicone and Impregum F material in combination with Permadyne Garant polyether material. Nondisinfected impressions served as controls, whereas the disinfected samples were immersed for 18 hours in a full strength 2% acid glutaraldehyde solution. Anteroposterior and cross arch dimensions of the working cast and occlusogingival, mesiodistal, and buccolingual dimensions of working die were assessed. The data were analyzed with one-way analysis of variance at "alpha" = 0.05. RESULTS: No significant differences were observed for anteroposterior and cross arch dimension when compared with the master model. However, significant differences were found for occlusogingival dimension at 18 hours of disinfection for both materials. The addition silicone 18-hour disinfection group was significantly less accurate in the mesiodistal dimension. CONCLUSION: Accuracy of both impression materials was adversely affected with 18 hours of immersion disinfection. Long-term (18 hours) immersion disinfection will affect the fit of fixed partial prostheses.

Use of an intra-pontic attachment as cosmetic support for a removable appliance.

When using an introcoronal precision attachment in a combined Fixed and Removable Prosthodontic case, the retention and appearance can be greatly improved. When taking into consideration these advantages one must not forget the disadvantages and possible violation of the biological principles of tooth preparation. Because in order to obtain a restoration with adequate contours it is necessary to reduce a significant amount of tooth structure. In this case the attachment is used in a catelever pontic avoiding any excessive tooth reduction. In metal-ceramic restorations it is important that a glazed surface be achieved upon completion because it enhances material strength and reduces plaque retention. This clinical report presents a step-by-step procedure using an intra-pontic attachment as a retainer for a removable partial denture. The procedural sequence assures optimal marginal integrity and glazed porcelain surfaces upon completion. A post-solder technique is recommended to assemble multi-abutment metal ceramic fixed partial dentures.

Bond strength and accuracy of combined reversible-irreversible hydrocolloid impression systems.

This study investigated the bond strength and accuracy of irreversible and reversible hydrocolloids that were modified by the manufacturer to bond to each other for use in the combination impression technique. One conventional type irreversible hydrocolloid was used because of previously reported favorable results obtained in several investigations. Tensile strength of each individual material was tested as well as the adhesive bond between reversible and irreversible hydrocolloids. Tensile bond strength was then measured for each combination of materials. Subsequently, all the materials were tested individually and in combination for dimensional accuracy.

Surface characteristics of polyether and addition silicone impression materials after long-term disinfection.

It has been demonstrated that short-term disinfection can affect the surface properties of impression materials. This study evaluated advancing contact angle, receding contact angle, inhibition and mass loss of a polyether impression materials, and two different viscosities of an addition silicone impression material after long-term immersion disinfection (18 hours). The brand names of the impression materials tested were Impregum F, Extrude Extra, and Extrude Wash, and all were tested by use of the Wilhelmy technique; first, for the nondisinfected state, which served as controls, and then after 1 and 18 hours of disinfection in a full-strength solution of acid glutaraldehyde. Weight changes before and after the disinfection process were also measured to detect weight loss and mass change over time. All materials exhibited some degree of inhibition. Polyether lost 0.4% mass in air, which indicated loss of a volatile component. Polyether and addition silicone were both relatively hydrophobic and could be disinfected with acid glutaraldehyde for up to 18 hours without affecting wettability.

A method for true coordinate three-dimensional measurement of casts using a measuring microscope.

Exact 3-dimensional measurements are more useful for researchers and clinicians than are relative distance measurements. Through the use of a measuring microscope and a personal computer, the technique presented in this article provides meaningful and accurate (0.005 mm) 3-dimensional measurements of casts in true coordinates (x, y, z). By fabricating the master cast with reference landmarks, leveling the casts before measurement, removing the cast between repeat measures, and mathematically rotating the data points, this technique places all the landmarks in a standardized reference plane that allows for the comparison of dimensional changes between different casts.

Crown retention with use of a 5% glutaraldehyde sealer on prepared dentin.

STATEMENT OF PROBLEM: A previous study showed that a resin sealer decreased casting retention with zinc phosphate cement. PURPOSE: This study determined whether a nonresin sealer applied to prepared dentin affected the retention of cemented castings. MATERIAL AND METHODS: Extracted molars were prepared with a flat occlusal, 20-degree taper and 4 mm axial length. The axial surface area of each preparation was determined and samples were distributed to achieve equivalent groups. Gluma Desensitizer sealer was used to seal the dentin before provisionalization and again before crown cementation. An Olympia alloy casting was produced for each preparation and cemented with a seating force of 20 Kg with either Mizzy's zinc phosphate, Ketac-Cem glass ionomer, or Resinomer material in combination with One Step adhesive. Castings were thermocycled, then removed along the path of insertion with an Instron testing machine. A two-factor analysis of variance was used with alpha = 0.05 and n = 9.10. RESULTS: Mean dislodgment stresses for unsealed and sealed conditions were 6.3 and 6.4 MPa for zinc phosphate, 9.1 and 10.1 MPa for glass ionomer, and 12.1 and 12.6 MPa for the resin cement. The means for the three cements were statistically different (p < 0.001). The effect of sealer (p = 0.369) and cross product interactions (p = 0.820) were not significant. CONCLUSIONS: The use of the glutaraldehyde-based system as a desensitizing treatment for prepared teeth had no effect on crown retention for any of the three cements evaluated and the modified resin cement produced the highest mean dislodgment stress that exceeded the strength of the tooth.

Retention of provisional crowns fabricated from two materials with the use of four temporary cements.

STATEMENT OF PROBLEM: Practitioners often choose resin materials and temporary cements with little understanding about their effect on provisional crown retention. PURPOSE: This study evaluated the retention of provisional restorations made with 2 materials and cemented with 4 temporary cements. METHODS AND MATERIAL: Recently extracted molars were prepared with a flat occlusal surface, 4-mm axial length and 20-degree angle of convergence. Specimens were distributed into equivalent groups. Provisional crowns were constructed for each preparation with polymethyl methacrylate (Temporary Bridge Resin) or bis-acrylic composite (Protemp Garant) and later cemented with Temp-Bond, Temp-Bond NE, Temrex, and an experimental calcium hydroxide temporary cement. A second group with Temrex was evaluated using half the recommended liquid. A cementing force of 2.5 kg for 5 minutes was used. After initial bench set followed by 24 hours in room temperature water, the crowns were removed with an Instron mechanical testing machine at 0.5 mm/min. A 2-factor ANOVA was used with alpha=.05 (n = 10). Mode of debonding was analyzed with a nonparametric chi-square test of association. RESULTS: Mean dislodgment stresses ranged from 670 to 1072 kPa for polymethyl methacrylate crowns and 554 to 884 kPa for those made of composite. Differences were nearly significant for the type of provisional material (P =.061) and the cross-product interaction (P =.376) was not significant, whereas there were significant differences among the cements (P =.002) and the mode of debonding (P =.0034). CONCLUSIONS: Excluding Temp-Bond to eliminate a cross-product interaction demonstrated that the polymethyl methacrylate crowns were 19.3% more retentive than the composite crowns (P =.015). There was no statistically significant difference among the 4 temporary cements when the manufacturer's mixing instructions were followed (P =.186). However, the thicker consistency Temrex was more retentive than the recommended Temrex mix and Temp-Bond.

Absence of adult dental anomalies in familial hypophosphatasia.

This paper is a supplemental report on 3 previous publications about a family in which 3 male children manifested gingival recession, alveolar bone resorption and premature exfoliation of their deciduous teeth without apical root resorption and without clinical signs of inflammation. Laboratory blood and urine studies in conjunction with an analysis of periodontal microflora and family pedigrees established a diagnosis of hypophosphatasia in these 3 children, as well as their father, the paternal grandmother and paternal great-uncle. Clinical data also revealed that a son of the paternal great-uncle and his daughter were similarly affected. The family pedigree is consistent with an autosomal dominant mode of transmission. The 3 brothers are now between the ages of 18 and 22 yr and all have complete permanent dentitions. Aside from some periodontal manifestations of prior dentoalveolar trauma, most of the findings of the periodontal assessment are within normal limits. All 3 exhibit moderate to severe caries and some degree of gingival inflammation, but minimal periodontal pathosis.

An accuracy evaluation of four removable die systems.

STATEMENT OF PROBLEM: The advent of implant dentistry has redefined the need for accuracy of working cast models. Die stone expansion and errors introduced by removable die casts may exceed the accuracy required for the passive fit of implant prostheses. PURPOSE: Several removable die systems claim improved accuracy because of their design and/or technical advancements. This study evaluated the 3-dimensional accuracy of 4 removable die systems. All 4 systems tested use either 1 or 2 pins as the repositioning device. MATERIAL AND METHODS: Four removable die systems were evaluated (Belle de St. Claire, Pindex, DVA, and conventional brass dowel system). Master model impressions were made with polyvinyl siloxane material and were later cast with type IV die stone material. Comparative dimensional analysis between the master model and the solid and sectioned casts was made by placing the cast in a standardized position and fabricating an individual custom base for each cast. Landmarks were measured with a traveling microscope, and by mathematically rotating the casts. Discrepancies beyond that of stone expansion or residual stress release at the time of die separation were due to the inability to precisely reposition the removable die of the sectioned cast. Data were analyzed with multivariate analysis of variance and paired t tests at alpha = .05 (n = 10). RESULTS: Significant differences were found among die systems tested (P = .005). When sectioned dies were compared with the master model, the accuracy of all 4 die systems was within 0.055 mm of the master model. Once sectioned, the Pindex system had the least linear expansion in the y dimension, and the brass dowel system demonstrated the least reseating discrepancy in the z (occlusogingival) dimension. CONCLUSIONS: All 4 die systems provided a similar degree of dimensional accuracy, although Pindex showed the least horizontal movement and the brass dowel system produced the least occlusogingival reseating discrepancy.

Dimensional stability and detail reproduction of irreversible hydrocolloid and elastomeric impressions disinfected by immersion.

STATEMENT OF PROBLEM: Because irreversible hydrocolloid impressions imbibe blood and saliva, immersion rather than spray disinfection may be more effective. Polyether has been shown to be dimensionally sensitive to immersion disinfection. PURPOSE: The aim of this study was to determine whether irreversible hydrocolloid and polyether impressions could be disinfected by immersion without sacrificing accuracy and surface quality. MATERIAL AND METHODS: Impressions were made of a master mandibular arch containing a crown preparation. Changes between the master and working casts were assessed. Irreversible hydrocolloids (Jeltrate; Palgaflex), a polyether (Impregum F), and an addition silicone (President) were used. Disinfectants were an iodophor (Biocide), a glyoxal glutaraldehyde (Impresept de), and a phenol glutaraldehyde (Sporicidin). The control was without disinfection. Casts were formed in Type IV gypsum. The roughness of working dies was also recorded and an analysis of variance was used for statistical evaluation. Results. Casts from disinfected irreversible hydrocolloid and elastomeric impressions maintained accuracy for anteroposterior and cross arch dimensions where differences from the master was less than 0.1%. Buccolingual and mesiodistal dimensions of working dies (disinfected and control) were 6 to 8 microm larger than the master for addition silicones and 11 to 16 pm for polyethers. The occlusogingival dimension of dies for control and disinfected polyether was 9 pm longer than the master compared with -3 microm for addition silicone. The range of mean surface roughness of working dies made from irreversible hydrocolloids was 1.4 to 1.7 microm and ranged from 0.5 to 0.7 microm for elastomeric impressions. Conclusion. Immersion disinfection of Jeltrate material with iodophor and Palgaflex material with glyoxal glutaraldehyde produced casts and dies as accurate as the control. Control and disinfected elastomeric impression produced dies as clinically accurate and smooth as the master. Disinfection of irreversible hydrocolloid impressions with the glyoxal and phenol glutaraldehyde produced a surface smoother than controls.

Effect of mixing technique on surface characteristics of impression materials.

STATEMENT OF PROBLEM: Previous studies have shown a relationship between the disinfection process, wettability, and mass change of impression materials. Hand-mixed high viscosity impression materials usually result in a material with numerous voids, which contribute to surface roughness and affect the surface characteristics of the material. PURPOSE: This study evaluated the effect of mixing technique on advancing contact angle, receding contact angle, imbibition, and mass loss of various high and low viscosity polyether and polyvinyl siloxane materials. The null hypothesis tested was no differences exist between the different mixing systems. MATERIAL AND METHODS: The Wilhelmy technique was used for deriving wetting properties of the materials used (Impregum F and Penta, Permadyne Syringe, Garant and Penta, Dimension Penta and Garant L, Aquasil). Conditions included no disinfection (0 hours) and 1, 5, and 18 hours of immersion disinfection in a full-strength solution of 2% acid glutaraldehyde disinfectant (Banicide). Weight changes before and after disinfection were measured to detect weight loss or mass increase over time. Weight loss in air was also measured to detect mass loss. Data were analyzed with a one-way analysis of variance at alpha = 0.05. RESULTS: All materials displayed some degree of imbibition of the disinfectant and experienced mass loss with polymerization, except the light viscosity polyvinyl that gained 0.18% at 5 hours. No significant differences were found in wettability among the polyether materials after 1 hour of disinfection. Less imbibition was observed for high viscosity mechanically mixed materials compared with the hand-mixed materials for both polyether and polyvinyl siloxane at 1-hour disinfection time. CONCLUSIONS: Polyether materials were more wettable than polyvinyl. Imbibition of high viscosity polyether and polyvinyl materials after 1 and 18 hours of disinfection were affected by the mixing system used.