Evaluation of conventional and digital radiography capacities for distinguishing dental materials on radiograms depending on the present radiopacifying agent.

BACKGROUND/AIM: The radiopacity of an endodontic material can considerably vary as measured on film and a digital sensor. Digital radiography offers numerous advantages over conventional film-based radiography in dental clinical practice regarding both diagnostic capabilities and postintervention procedures. The aim of this study was to investigate the capacity of conventional and charge-conpled device (CCD) based digital radiography to detect material on radiograph depending on the radio-pacifying agent present in the mate- rial. METHODS: Experimental cements were formulated by mixing Portland cement with the following radiopacifying agents: zinc oxide (ZnO), zirconium oxide (ZrO2), titanium dioxide (TiO2), barium sulphate (BaSO4), iodoform (CHI3), bismuth oxide (Bi2O3) and ytterbium trifluoride (YbF3). In addition, 5 endodontic materials comprising Endometh- asone, Diaket, N2, Roth 801 and Acroseal were investigated to serve as control. Per three specimens of each material were radiographed alongside an aluminum step wedge on film (Eastman Kodak Company, Rochester, NY) and a CCD-based digital sensor (Trophy Radiologie, Cedex, France). Radiopacity values were calculated by converting the radiographic densities of the specimens expressed as a mean optical densities or mean grey scale values into equivalent thickness of aluminum. RESULTS: Two-way ANOVA detected no significant differences with respect to the imaging system (p > 0.05), but the differences were significant with respect to radiopacifier (p < 0.001) and the interaction of the two factors (p < 0.05). Paired t-test revealed significant differences between the methods used for pure Portland cement, all concentrations of BaSO4 and CHI3, 10% and 20% additions of ZrO2 and Bi2O3 and 10% and 30% additions of YbF3 (p < 0.05). CONCLUSION: The materials which incorporate CHI3 OR BaSO4 as radiopacifying agents are expected to be significantly more radiopaque on a digital sensor than on film. During clinical practice one should concern to the quality of contrast assessment obtained by digital according to conventional radiography.

Dilemmas in zirconia bonding: A review.

This article presents a literature review on the resin bond to zirconia ceramic. Modern esthetic dentistry has highly recognized zirconia, among other ceramic materials. Biocompatibility of zirconia, chemical and dimensional stability, excellent mechanical properties, all together could guarantee optimal therapeutical results in complex prosthodontic reconstruction. On the other hand, low thermal degradation, aging of zirconia as well as problematic bonding of zirconia framework to dental luting cements and tooth structures, opened the room for discussion concerning their clinical durability.The well known methods of mechanical and chemical bonding used on glass-ceramics are not applicable for use with zirconia. Therefore, under critical clinical situations, selection of the bonding mechanism should be focused on two important points: high initial bond strength value and long term bond strength between zirconia-resin interface. Also, this paper emphases the use of phosphate monomer luting cements on freshly air-abraded zirconia as the simplest and most effective way for zirconia cementation procedure today.

In vitro evaluation of microleakage of various types of dental cements.

INTRODUCTION: Microleakage is defined as the clinically undetectable seepage of oral fluids containing bacteria and debris between cement layer and tooth restoration. OBJECTIVE: This in vitro study investigated the effect of different dental cements (zinc-phosphate, polycarboxylate, glass-ionomer and resin cement) on microleakage in different ceramic crown systems (metal ceramic crown, metal ceramic crown with a porcelain margin, Empress 2 and in Ceram all-ceramic crowns) fixed on extracted human teeth. METHODS: One hundred and sixty intact human premolars were randomized to four groups of forty teeth each, according to the different ceramic crown systems. They were prepared in a standardized manner for metal-ceramic and all-ceramic crowns. Crowns were made following a standard laboratory technique, and each group of crowns were divided into four groups according to the different cement agents and cemented on their respective abutments. The specimens were subjected to thermocycling, placed in methylene blue solutions, embedded in resin blocks and vertically cut in the bucco-oral and meso-distal direction. The microleakage in the area of tooth-cement interface was defined as linear penetration of methylene blue and was determined with a microscope to assign microleakage scores using a five-point scale. RESULTS: A significant association was found between a cement type and degree of microleakage (p = 0.001). No statistically significant differences were found among the different ceramic crown systems luted with the same dental cement. The smallest degree of microleakage was observed in specimens luted with resin cement (X = 1.73), followed by glass-ionomer cement (X=2.45) and polycarboxylate cement (X = 3.20). The greatest degree of microleakage was detected in the crowns fixed with zincphosphate cement (X = 3.33). CONCLUSION: The investigated dental cements revealed different sealing abilities. The use of resin cement resulted in the percentage of 0 microleakage scores. Due to this feature, the resin cement is to be recommended in everyday clinical practice.

The role of occlusal factor in the etiology of temporomandibular dysfunction.

INTRODUCTION: The influence of occlusal condition at the onset of temporomandibular disorders (TMD) has been strongly debated for many years and still is the source of controversy. Up to the eighties in the last century, the occlusal factors such as the presence of uncured malocclusions, discrepancies between intercuspal position and retruded contact position greater than two millimeters, retrusive and nonworking side interferences and loss of posterior teeth were considered to be the primary causes of TMD. OBJECTIVE: The aim of this study was to estimate the role of occlusal factor in the etiology of craniomandibular dysfunction and therapeutic effects of irreversible occlusal therapy (occlusal equilibration) in patients with TMD. METHODS: In the investigation we studied a group of 200 men and women. The average age of the selected patients was between 18 and 25 years. The purpose of TMD signs and symptoms was confirmed in every patient using a special functional analysis and evaluating the craniomandibular index (CMI) according to Fricton and Schiffman. The value of craniomandibular index was determined in the group of 15 patients with signs and symptoms of temporomandibular dysfunction. In the study groups occlusal equilibration (selective grinding) was performed according to Okeson using the central position of the mandible as the referent position in the occlusal therapy. The value of CMI was determined before and 30 days after occlusal equilibration. RESULTS: The results of this study confirmed the significant reduction in the signs and symptoms of TMD after occlusal equilibration. The statistical elaboration of the differences between the values of CMI I (before treatment) and CMI II (30 days after treatment) revealed highly significant differences. The CMI I values in the group ranged between 0.076 and 0.346 with the mean value of 0.188 +/- 0.082.The values of CMI II ranged between 0.038 and 0.19 with the mean value of 0.038 +/- 0.053. CONCLUSION: The study conformed the validity of irreversible occlusal therapy (selective grinding) in patients with TMD.

[Factors influencing bonding fixed restorations].

INTRODUCTION: Crown displacement often occurs because the features of tooth preparations do not counteract the forces directed against restorations. OBJECTIVE: The purpose of this study was to evaluate the effect of preparation designs on retention and resistance of fixed restorations. METHOD: The study was performed on 64 differently sized stainless steel dies. Also, caps which were used for evaluated retention were made of stainless steel for each die. After cementing the caps on experimental dies, measuring of necessary tensile forces to separate cemented caps from dies was done. Caps, which were made of a silver-palladium alloy with a slope of 600 to the longitudinal axis formed on the occlusal surface, were used for evaluating resistance. A sudden drop in load pressure recorded by the test machine indicated failure for that cap. RESULTS: A significant difference was found between the tensile force required to remove the caps from the dies with different length (p < 0.05) and different taper (p < 0.01). The greatest retentive strengths (2579.2 N and 2989.8 N) were noticed in experimental dies with the greatest length and smallest taper. No statistically significant (p > 0.05) differences were found between tensile loads for caps cemented on dies with different diameter. Although there was an apparent slight increase in resistance values for caps on dies with smaller tapers, the increase in resistance for those preparation designs was not statistically significant. There was a significant difference among the resistance values for caps on dies with different length (p < 0.01) and diameter (p < 0.05). CONCLUSION: In the light of the results obtained, it could be reasonably concluded that retention and resistance of the restoration is in inverse proportion to convergence angle of the prepared teeth. But, at a constant convergence angle, retention and resistance increase with rising length and diameter.

Porosity of different dental luting cements.

OBJECTIVE: The aim of this in vitro study was to compare open porosity and pore size distribution of different types of luting cements (zinc phosphate and polycarboxylate produced by Harvard Cement, Great Britain, glass-ionomer product GC Fuji I, GC Corporation, Japan, and Panavia F, resin based composite cement, Kurraray Co. Ltd. Japan) using mercury intrusion porosimetry and use it as an additional parameter for ranging the quality of cements used in prosthetics. METHOD: Samples were hand mixed in accordance with the manufacturer's instructions and formed in cylindrical test specimens. Density of samples was determined using a pycnometer while porous structure was estimated using high pressure mercury intrusion porosimeter enabling estimation of pore diameters in interval 7.5-15,000 nm. RESULTS: The polycarboxylate cement posses the highest porosity and specific pore volume among investigated cements. By comparison of the results obtained for zinc phosphate and glass-ionomer cement, it can be observed that according to some textural properties zinc phosphate cement is better choice (smaller specific pore volume and absence of macropores larger than 1 microm) while according to other textural properties the glass-ionomer has advantage (smaller porosity). The resin based composite cement poses the most desired porous structure for prosthetic application among the investigated cements (the lowest porosity and specific pore volume and all identified pores are smaller than 20 nm). SIGNIFICANCE: Based on results of this study, it is possible to estimate the efficiency of luting cements to protect the interior of tooth from penetration of oral fluids, bacteria and bacterial toxins into unprotected dentine.