Changes in Tooth Mobility and Position in an Established Dentition Following Placement of a New Restoration.

The aim of this study is to examine and evaluate physiologic tooth mobility and movement in different groups of patients. Four groups of patients were examined and recordings were taken. Group A1 consisted of 12 undergraduate students under the age of 30, A2 consisted of 11 members of staff over the age of 30 and A3 consisted of 9 patients with periodontal disease between the ages of 40-65 years old. The fourth Group B, 14 patients between 30-70 years old, received single-tooth restorations and recordings were taken immediately after, a month and four months following the cementation of the restoration. Patients in the first 3 groups showed no significant change in tooth mobility and movement between appointments. The fourth group demonstrated a non-statistically significant increase in tooth mobility following the cementation of the restoration due to the force applied on the occlusal surface of the tooth during the cementation process, while tooth movement was not observed beyond that of physiological tooth migration. Regardless of the age or the restorations a patient receives over the years, with careful occlusal consideration, no significant changes in tooth mobility and movement should be observed.

A Passive Noise Attenuation Earplug Designed to Minimise Unwanted Air Turbine Driven High-Speed Dental Drill Noise.

INTRODUCTION: Air turbine dental drill noise contains high-frequency components that are of concern for patients and dental staff. Meanwhile, verbal communication between the dentist and patient is essential. Conventional active noise-cancelling headphones are ineffective for dental drill noise and simply suppress all sound and hinder communication. METHOD: A compact passive earplug device was designed specifically to attenuate broadband high-frequency noise ranges from 5 to 8 kHz employing an array of quarter wavelength (QW) resonators. This device was 3D printed and tested against white noise to enhance the objectivity of analysis, using a calibrated ear and cheek simulator to effectively measure its performance. RESULTS: The results showed that the resonators produced an average reduction of 27 dB across the targeted frequency range. When compared with two proprietary passive earplugs, this developed passive device prototype was able to attenuate an average of 9 dB more across the target frequency range whilst delivering louder speech signals of 14 dB more. The results also show that using an array of resonators exhibits an accumulated effect of individual resonator performance. CONCLUSIONS: This low-cost passive device could have a place in the dental clinic to reduce unwanted drill noise equivalent to the white noise high frequency spectra tested.

Mandibular Distalisation for Tooth Wear in Patients Requiring Mandibular Protrusion for Sleep Apnoea.

BACKGROUND: Pathological tooth wear is an increasing concern and may require intervention and occlusal rehabilitation. Often the treatment includes distalisaton of the mandible to restore the dentition in centric relation. Obstructive sleep apnoea (OSA) is another condition treated my mandibular repositioning but in this case by an advancement appliance. The authors have a concern that there could be a group of patients with both conditions where distalisation for their tooth wear management would be contrary to their OSA treatment. This paper aims to look at this potential risk. METHODS: A literature search was carried out using the following keywords (OSA or sleep apnoea or apnea or snoring or AHI or Epworth score) and for tooth surface loss (TSL or distalisation or centric relation or tooth wear or full mouth rehabilitation). RESULTS: No studies were identified which considered the effect of mandibular distalisation on OSA. CONCLUSION: There is a theoretical risk that dental treatment involving distalisation may adversely affect patients at risk of OSA or worsening their condition due to the modification of airway patency. Further study is recommended.

Analysis of Posterior Zirconia Crowns with Vertical Margin Preparations.

BACKGROUND: The interest in vertical crown preparation is growing and several variations are presented in the dental literature but limited clinical outcome data exists for teeth prepared for a vertical finish line. AIM: To audit clinical outcomes for 73 teeth after vertical preparation for knife-edge zirconia crowns. METHOD: Seventy-three teeth had knife-edge zirconia crowns placed after vertical finish line preparation. The outcomes for these teeth were analysed from a retrospective audit of clinical records. RESULTS: The mean follow-up time was 21 months (SD: 10 months; range: 6-40). One tooth had to be extracted due to fracture at cervical level. One crown had to be re-made after margin fracture during try-in. No subsequent endodontic treatment was needed for any of the prepared teeth. No change in alveolar bone height was noted on radiographic follow-up. The mean bleeding score for the crowned teeth was higher than the mean bleeding score for a control tooth, but this was not statistically significant. CONCLUSION: This retrospective evaluation has shown favourable outcomes for 72 teeth after vertical preparation for knife-edge crowns. Longer follow-up is needed but the present results show that the technique is a viable procedure with potential advantages.

Do composite resin restorations protect cracked teeth? An in-vitro study.

Aims: To evaluate whether bonded resin composite restorations can effectively immobilise the tooth segments in teeth with a synthesised crack under loading, by exploring the impact of the restoration type (direct versus indirect composite resin) and restoration design (inlay versus onlay) on the fatigue resistance. Methods: Sound human third molars underwent large mesio-occluso-distal preparations and a groove was cut to simulate a crack. Standardised procedures were adopted and measures were taken during teeth selection so that systematic error and methodology bias were minimised. The teeth were randomly assigned to four groups. The specimens were submitted to cyclic loading and loaded until fracture or to a maximum of 185,000 cycles. The failure mode was recorded. Results: No failure was observed in 'direct' groups up to the 1000 N force. Survival analysis revealed statistically significant higher survival rates for 'direct' groups compared to 'indirect' groups (χ2 = 11.352, df = 1, p = 0.001) while there was no significant difference between 'inlay' and 'onlay' groups (χ2 = 0.015, df = 1, p = 0.901) (pooled data). Conclusions: Within the limitations of this in-vitro study, it can be concluded that the direct composite resin restorations sufficiently protected the cracked teeth regardless of the cavity design. As there was no statistically significant difference in survival rates between inlays and onlays it is not possible to favour one design type over the other.

Survival of Direct Posterior Composites With and Without a Bulk Fill Base.

OBJECTIVES: Direct composite restorations are increasingly popular and a flowable bulk-fill base material (SDR, Dentsply) claims to minimise stress through a more flexible polymerisation process. This retrospective audit of restorations placed in general practice compares SDR based restorations with conventional composite restorations. METHODS: Restorations were all placed by one operator using a similar clinical technique and were audited as Group G, placed with a conventional layering composite (G-aenial, GC) and Group S which had a bulk-fill base of SDR (Dentsply) and then were covered with G-aenial (GC). Data regarding survival, post-operative sensitivity and mode of failure were recorded and analysed. RESULTS: In total 54 Group S restorations and 71 Group G restorations were followed for a minimum of 24 months. Group S had a 92.6% survival and Group G 93%. Group S was more prone to failure by tooth fracture (p=0.033). In both groups failure was more likely in larger cavities, in both those with an increased number of surfaces (p⟨0.001) and cuspal coverage (p=0.004). CONCLUSIONS: There appears to be similar survival of the two techniques in the short-term although there were significantly more tooth fractures in teeth restored with SDR.

Is the shortened dental arch still a satisfactory option?

Aims Dental practitioners may hold the view that missing posterior teeth should be replaced to ensure a healthy masticatory system and satisfactory oral function. However, the shortened dental arch (SDA) concept is still in use, but after 35 years is it acceptable? This review searches the literature for the evidence and opinions regarding the suitability of the SDA as a current treatment modality.Methods Medline and PubMed databases were searched for relevant terms, all the abstracts were assessed and articles selected according to the pre-set exclusion and inclusion criteria.Results The search yielded 1,895 articles and after the assessment of the abstracts and application of the exclusion and inclusion criteria, 44 articles were selected for this review. These included 11 cohort studies, two longitudinal studies, two animal studies, three cross sectional studies, eight clinical studies and 18 case control studies. There appears to be a trend over the past three decades for more papers to be opposed to the SDA concept.Conclusion Evidence that the SDA causes pathology is lacking. Clinicians, healthcare authorities and patients have shown favourable attitudes towards the SDA and this continues, although there is an increase in studies opposing the concept and some are dissatisfied with this option. The concept remains viable particularly for the medically compromised patient or where restorations are considered unsuitable but further more specific studies are warranted.

The management of cracked tooth syndrome in dental practice.

Cracked tooth syndrome is a commonly encountered condition in dental practice which frequently causes diagnostic and management challenges. This paper provides an overview of the diagnosis of this condition and goes on to discuss current short and long-term management strategies applicable to dental practitioners. This paper also covers the diagnosis and management of this common condition and aims to inform clinicians of the current thinking, as well as to provide an overview of the techniques commonly used in managing cracked tooth syndrome.

Management of gingival black triangles.

Gingival black triangles (GBTs) are generally considered to be aesthetically unacceptable, have a multifactorial aetiology and a range of treatment options. This review covers the surgical and non-surgical management of GBTs. Surgical methods address recontouring, preserving or reconstructing the soft tissue including the interdental papilla as well as the alveolar bone. Non-surgical approaches include restorative techniques (including the use of prostheses and gingival-coloured materials), orthodontic movement, tissue engineering and tissue volumisers. This review covers the aetiology and management of GBTs, highlighting the importance of considering the options currently available when treating a lost dental papilla. A lack of longitudinal studies investigating the long-term outcomes of the options in management of GBTs presence is identified.

Dimensional stability ofautoclave sterilised addition cured impressions and trays.

The aim of this study was to investigate the dimensional accuracy of impressions following sterilisation by autoclaving. Dental impressions (75) were of a dentoform containing 6 reference points. The impressions were split into 5 groups of 15, each group used a different impression technique. Groups were divided into 3 subgroups with 5 impressions as control, 5 for disinfection by Perform-ID and 5 being autoclaved. Measurements were made using a travelling light microscope. A minimal significant dimensional difference (0.010.05). The trays and materials tested were suitable for the autoclave sterilisation.

A multi-centred clinical audit to describe the efficacy of direct supra-coronal splinting--a minimally invasive approach to the management of cracked tooth syndrome.

OBJECTIVES: This audit looked at the use of direct composite splinting to manage cracked tooth syndrome (CTS). METHODS: Patients who had been assessed as having CTS were offered the treatment of a directly bonded, composite overlay restoration placed in supra-occlusion. Cases were reviewed up to 3 months later. RESULTS: In all, 151 restorations were followed up in the audit of which 131 were successful at 3 months. The remaining 20 restorations failed due to pulp complications (11), failure of the composite (5) or intolerance to the high restoration (4). Of the 131, patients described transient problems with chewing (94), composite breakage (13), TMD (1), phonetics (1), increased mobility (1) and tender to chewing (1). CONCLUSIONS: This is a successful non-invasive method of managing CTS in the short term for patients willing to accept transient effects.

A review of the success and failure characteristics of resin-bonded bridges.

OBJECTIVES: This literature review was designed to assess and compare the success rates and modes of failure of metal-framed, fibre-reinforced composite and all-ceramic resin-bonded bridges. MATERIALS AND METHOD: A Medline search (Ovid), supplemented by hand searching, was conducted to identify prospective and retrospective cohort studies on different resin-bonded bridges within the last 16 years. A total of 49 studies met the pre-set inclusion criteria. Success rates of 25 studies on metal-framed, 17 studies on fibre-reinforced composite and 7 studies on all-ceramic resin-bonded bridges were analysed and characteristics of failures were identified. RESULTS: The analysis of the studies indicated an estimation of annual failure rates per year to be 4.6% (±1.3%, 95% CI) for metal-framed, 4.1% (±2.1%, 95% CI) for fibre-reinforced and 11.7% (±1.8%, 95% CI) for all-ceramic resin-bonded bridges. The most frequent complications were: debonding for metal-framed, resin-bonded bridges (93% of all failures); delamination of the composite veneering material for the fibre-reinforced bridges (41%) and fracture of the framework for the all-ceramic bridges (57%). CONCLUSIONS: All types of resin-bonded bridges provide an effective short- to medium-term option, with all-ceramic performing least well and having the least favourable mode of failure. The methods of failures were different for different bridges with metal frameworks performing the best over time.

Current concepts on the management of tooth wear: part 4. An overview of the restorative techniques and dental materials commonly applied for the management of tooth wear.

This final article of the four part series on the current concepts of tooth wear will provide the reader with an evaluation of the data available in the contemporary literature with regards to the survival analysis of differing restorative materials, and their respective methods of application to treat tooth wear. It is vital that the dental operator is familiar with the role of differing materials which may be used to restore the worn dentition, some of which may prove to be more suitable for the management of particular patterns of tooth wear than others. The active management of tooth wear unfortunately commits the patient to a lifelong need for considerable maintenance, and it is imperative that this is understood from the outset.

Current concepts on the management of tooth wear: part 3. Active restorative care 2: the management of generalised tooth wear.

Paper 3 of this series on the current concepts of tooth wear management will focus on the provision of active restorative intervention for cases presenting with generalised tooth wear. The use of both contemporary adhesive and traditional conventional techniques applied to treat cases of generalised tooth wear will be discussed, including a consideration of the merits and drawbacks of each approach respectively.

Current concepts on the management of tooth wear: part 1. Assessment, treatment planning and strategies for the prevention and the passive management of tooth wear.

The aim of this series of four articles on tooth wear management is to provide the reader with the necessary information in order to be able to successfully manage cases of tooth wear, regardless of the cause, severity and location of the wear pattern seen. The content will largely focus on contemporary clinical techniques, illustrated where possible by case examples. Emphasis will be placed on 'additive adhesive techniques' utilising fixed prosthodontic protocols; however, cases of tooth wear amongst partially dentate patients involving the use of removable prostheses will also be described. The importance of patient consent and contingency planning will also be discussed. Paper 1 will describe the assessment of the wear patient, including the rationale for the planning of dental care. Also discussed will be the administration of preventative and passive management strategies for cases displaying tooth wear.

Current concepts on the management of tooth wear: part 2. Active restorative care 1: the management of localised tooth wear.

This second of the four part series of articles on the current concepts of tooth wear management will focus on the provision of active restorative care, where the implementation of a preventative, passive approach may prove insufficient to meet the patient's expectations, or indeed prove to be sufficiently adequate to address the extent of the underlying pathology to the desired level of clinical satisfaction. The active restorative management of cases presenting with localised tooth wear (of either the anterior, posterior, maxillary or mandibular variety) will be considered in depth in this paper, including a description of the commonly applied techniques and treatment strategies, where possible illustrated by case examples.

Cracked tooth syndrome. Part 2: restorative options for the management of cracked tooth syndrome.

The second of this two part series on 'cracked tooth syndrome' will focus on the available methods for the immediate, intermediate and definitive management of patients affected by this condition. Included in this article is a comprehensive account of the relative merits/drawbacks of various restorative materials and their respective techniques of application for the treatment of symptomatic, incompletely fractured posterior teeth.

Effect of chewing gum on tooth sensitivity following whitening.

OBJECTIVE: Transient sensitivity is the most common side-effect associated with tooth whitening. The purpose of this randomised, controlled clinical study was to determine if a chewing gum containing Recaldent (CPP-ACP) was effective in reducing tooth sensitivity associated with in-office whitening procedures. MATERIALS AND METHODS: Eighty-eight patients were recruited and had their teeth lightened using a single-visit, in-office whitening treatment with 15% hydrogen peroxide augmented by light for a treatment period of one hour. Following the procedure, each patient was randomly assigned to one of three study groups: Group A, who used a sugar-free chewing gum with CPP-ACP; Group B, who did not use any desensitising agent; and Group C, who used a sugar-free chewing gum without CPP-ACP. The participants were requested to return for a 24 hour follow-up visit, at which the colour changes were measured using a value-oriented Vita classic shade guide. They also reported on the incidence, duration and intensity of tooth sensitivity experienced by completing a post-treatment questionnaire. RESULTS: The average Vita shade unit reduction was 4.8 and 88.6% of the patients were satisfied with their treatment outcomes. However, 85.2% of them experienced tooth sensitivity at some point following the whitening procedures. Both Group A and Group C experienced significantly less intense tooth sensitivity than Group B following the whitening procedures. However, Group A did not have a statistically significant reduction in the incidence, duration or intensity of sensitivity when compared to Group C. All sensitivity ceased at the 24 hour follow-up visits. CONCLUSION: This study suggested that using a sugar-free chewing gum (both with and without CPP-ACP) could reduce the intensity of tooth sensitivity associated with in-office whitening procedures. However, it failed to demonstrate conclusively that using a sugar-free chewing gum with CPP-ACP could provide additional therapeutic benefits.

Cracked tooth syndrome. Part 1: aetiology and diagnosis.

Symptomatic, incompletely fractured posterior teeth can be a great source of anxiety for both the dental patient and dental operator. For the latter, challenges associated with deriving an accurate diagnosis together with the efficient and time effective management of cases of cracked tooth syndrome are largely accountable for the aforementioned problem. The aim of this series of two articles is to provide the reader with an in-depth insight into this condition, through the undertaking of a comprehensive literature review of contemporarily available data. The first article will provide details relating to the background of cracked tooth syndrome including the epidemiology, patho-physiology, aetiology and diagnosis of the syndrome, together with a consideration of factors which may influence the prognostic outcome of teeth affected by incomplete, symptomatic fractures. The second article will focus on the immediate and intermediate management of cracked teeth, and also provide a detailed account of the application of both direct and indirect restorations and restorative techniques used respectively in the management of teeth affected by this complex syndrome.