Effect of 3 vertical facial patterns on alveolar bone quality at selected miniscrew implant sites.

OBJECTIVE: To evaluate dental alveolar bone quality among young healthy Chinese adults having 3 different vertical patterns. MATERIALS AND METHODS: Three-dimensional cone-beam computed tomography images of 101 subjects (15 low-angle, 48 average-angle, and 38 high-angle) were reconstructed. Facial alveolar cortical bone thicknesses and cortical and cancellous bone densities at 4 selected miniscrew implant sites in both arches, together with cancellous bone densities of third cervical vertebrae, were measured. Bone qualities were compared among the 3 vertical pattern groups. RESULTS: The cortical bone thicknesses at mandibular 5-6 and 6-7 and the cortical and cancellous bone densities at maxillary and mandibular 5-6 and 6-7 were generally greater in the low-angle than in the other 2 groups. There was no similar consistent vertical pattern apparent for bone quality at the 1-1 and 1-2 sites. No significant differences in bone densities for third cervical vertebrae were found among the 3 groups. CONCLUSION: Careful selection of suitable implantation sites and sizes of the miniscrews used should be made to reduce the possible occurrence of implant loosening in patients with average-angle and high-angle vertical facial patterns in particular.

Differences in facial profile and dental esthetic perceptions between young adults and orthodontists.

INTRODUCTION: The principal aim of this study was to investigate differences in perception of soft-tissue facial profiles and dental esthetics between young Chinese adults and orthodontists. METHODS: Eight hundred ninety-two subjects (444 male, 448 female), ages 16 to 24 years, chose 1 image from among 5 profile silhouettes and from among 10 ranked color photographs of the aesthetic component (AC) of the index of orthodontic treatment need that most closely resembled their own profile and dental esthetic appearance, respectively. A panel of 20 orthodontists then independently repeated the same image selection process. Each subject also completed the Eysenck personality questionnaire for psychoticism. We used the Mann-Whitney U test and the Spearman rank correlation test, with statistical significance set at α = 0.05. RESULTS: Only 37.0% of subjects had straight profiles by objective orthodontic assessment, but 85.0% chose straight profiles by subjective self-perception. About 17.5%, mainly females, chose the mild convex as the ideal profile. Only 2.5% of the subjects were ranked 1 on the AC by orthodontists, but 43.6% chose 1, or ideal, by self-perception. Male subjects scored significantly higher than did female subjects for self-perceived facial profiles (more protruded chins) and for the AC (more attractive dental appearance). Subjects with high psychoticism T scores (>50) scored significantly lower for self-perceived facial profiles (more retruded chins) and on the AC (less attractive dental appearance). CONCLUSIONS: Young Chinese adults perceived their facial profiles and dental appearances to be significantly more straight and attractive, respectively, than did the orthodontists. A significant proportion of the young adults, mainly women, preferred a mild convex facial profile. High psychoticism scores might significantly affect the self-perception of orthodontic treatment needs.

Oral manifestations of gastroesophageal reflux disease.

Numerous case-control and other studies involving confirmation of gastroesophageal reflux disease (GERD) by esophageal pH-metry and the assessment of dental erosions have shown significant associations between the two conditions in both adults and children. By contrast, when asked to vote on whether GERD may cause dental erosions, only 42% of physicians strongly agreed that such an association existed in adults, and just 12.5% strongly agreed for children, respectively in two global consensus reports. Part of this divergence between the perceptions of physicians and the findings of research publications may reflect a general lack of oral health education during medical training, and cursory oral examinations being made under less-than-ideal conditions. Adequate salivary secretions are essential for the protection of the teeth and the oropharyngeal and esophageal mucosa. The quantity and quality of the saliva require monitoring as many drugs, including several of the proton pump inhibitors (PPIs), can cause hyposalivation. In addition, PPIs do not always result in adequate acid suppression. Therefore, collaboration between physicians and dentists is strongly advocated to prevent or ameliorate possible adverse oral effects from both endogenous and exogenous acids, and to promote adequate saliva production in patients with GERD.

Apical root resorption in maxillary incisors when employing micro-implant and J-hook headgear anchorage: a 4-month radiographic study.

This study evaluated, over a 4-month study period, the amount of apical root resorption occurring in maxillary central incisors following their retraction when employing either micro-implant or J-hook headgear anchorage. The prospective randomised clinical trial was conducted in Orthodontic Clinic, College of Stomatology, China from 2008-2009. Subjects are patients requiring fixed appliances on waiting list (n=20). In female Han Chinese patients aged from 16-26 years, standardized periapical radiographs from 10 randomly assigned patients with maxillary protrusions comprising the micro-implant group, and from 10 similar patients comprising the J-hook headgear group, were assessed for maxillary central incisor apical root resorption. Measurements before and after orthodontic therapy were also obtained from lateral cephalometric radiographs to calculate incisor horizontal retraction and vertical intrusion distances. Estimated retraction force vectors were calculated in horizontal and vertical directions for both treatment groups. Data analysis employed t-tests and the Pearson correlation test, with α=0.05 for statistical significance. The results showed that when compared with the J-hook group, significantly more apical root resorption shortening of the maxillary central incisors was observed in the micro-implant group (1.27 mm difference, 95% CI=0.70-1.84, P<0.001), which was associated with a significantly larger retraction distance (P=0.004) and a smaller vertical force component (P<0.0001). We are led to conclude that continuous activation of the nickel-titanium coil springs used in the micro-implant group resulted in significantly more apical root resorption shortening and maxillary central incisor retraction than when intermittent J-hook retraction was employed. The employment of continuous duration orthodontic forces presents a risk for increased apical root resorption that requires careful radiographic monitoring.

Corrosion behaviour and surface analysis of a Co-Cr and two Ni-Cr dental alloys before and after simulated porcelain firing.

This study evaluated the corrosion behaviour and surface properties of a commercial cobalt-chromium (Co-Cr) alloy and two nickel-chromium (Ni-Cr) alloys [beryllium (Be)-free and Be-containing] before and after a simulated porcelain-firing process. Before porcelain firing, the microstructure, surface composition and hardness, electrochemical corrosion properties, and metal-ion release of as-cast alloy specimens were examined. After firing, similar alloy specimens were examined for the same properties. In both as-cast and fired conditions, the Co-Cr alloy (Wirobond C) showed significantly more resistance to corrosion than the two Ni-Cr alloys. After firing, the corrosion rate of the Be-free Ni-Cr alloy (Stellite N9) increased significantly, which corresponded to a reduction in the levels of Cr, molybdenum (Mo), and Ni in the surface oxides and to a reduction in the thickness of the surface oxide film. The corrosion properties of the Co-Cr alloy and the Be-containing Ni-Cr alloy (ChangPing) were not significantly affected by the firing process. Porcelain firing also changed the microstructure and microhardness values of the alloys, and there were increases in the release of Co and Ni ions, especially for Ni from the Be-free Ni-Cr alloy. Thus, the corrosion rate of the Be-free Ni-Cr alloy increased significantly after porcelain firing, whereas the firing process had little effect on the corrosion susceptibility of the Co-Cr alloy and the Be-containing Ni-Cr alloy.

Effect of three radicular dentine treatments and two luting cements on the regional bond strength of quartz fibre posts.

The purpose was to investigate by push-out tests and scanning electron microscopy (SEM)/energy-dispersive spectroscopy (EDS) the effect, after first acid etching the post space walls, of three radicular dentine treatments on the regional bond strength of quartz fibre posts placed using two heavily filled resin luting cements. The crowns of 39 extracted maxillary central incisors were sectioned transversely 2 mm coronal to the labial cement-enamel junction and the roots endodontically treated. After standardized post space preparations and etching 15 s with 32% phosphoric acid, 36 roots were randomly divided into six equal groups. Quartz fibre posts (D.T. LIGHT-POST) were placed using three radicular dentine treatments (0.9% sodium chloride (NaCl) for 60 s, 10% sodium hypochlorite (NaOCl) for 60 s, 17% ethylenediaminetetraacetic acid (EDTA) for 60 s followed by 5.25% NaOCl for 60 s) and two resin composite luting cements (ONE-STEP PLUS/DUO-LINK; ONE-STEP PLUS/LuxaCore Dual). Transverse segments (S1-S7), 1.00 mm (SD = 0.05 mm) thick, were sectioned from the coronal 8 mm of each root. Push-out bond strength tests were performed on coronal, middle and apical post space segments (S2, S4, S6) at a crosshead speed of 0.5 mm/min. Data were recorded and analyzed using a two-way mixed ANOVA design (a = 0.05). Three segments (S1, S5, S7) from roots in each group were examined using SEM/EDS. After post space preparation, acid etching and using each of the three radicular dentine treatments, the three remaining roots were sectioned longitudinally for SEM observation of the post space walls. At all root segment sites, the mean bond strengths from using 0.9% NaCl were significantly lower than for the other two radicular dentine treatments (P ≤ 0.02), and DUO-LINK cement had significantly higher mean bond strengths than LuxaCore Dual cement (P ≤ 0.01). There was a significant linear trend for reduced bond strengths from coronal to apical post space segments (P < 0.001), which was supported by the SEM/EDS observations of dentine tubule appearance and resin tag formation. Acid etching followed by either 10% NaOCl or 17% EDTA and 5.25% NaOCl dentine treatments of the post spaces provided good adhesion and resin luting cement tag infiltration of dentinal tubules in the coronal and middle segments in particular.

Optimum post and tooth root diameters for a cast post-core system.

PURPOSE: To investigate the optimum diameter for the tapered post of a cast alloy post-core system relative to the root diameter, when measured at the root face, that is required to minimize both post and root failures. METHODS: 32 extracted maxillary central incisor teeth were each decoronated perpendicular to the long axis at a point 2.0 mm occlusal to the labial cemento-enamel junction. Following endodontic canal obturation, the teeth were assigned randomly to four equal groups for different diameter tapered post space preparations. Then 1.10, 1.50, 1.70, and 2.00 mm diameter cast Ni-Cr alloy post-cores and complete crowns without ferrules were fabricated. Each root was embedded in a large gypsum stone block and the crown loaded palatally at 135 degrees from the long axis in a universal testing machine at a crosshead speed of 1.0 mm/minute until failure. Results were analyzed using one-way ANOVA with Tukey-Kramer post hoc tests, and Fisher's exact test, with alpha = 0.05 for statistical significance. RESULTS: Mean failure resistance loads were: 0.60, 0.91, 1.00, and 1.38 kN (P < 0.001). All of the 1.10 mm posts failed, without any root fractures. Conversely, none of the 2.00 mm posts failed, but all of the roots fractured. The optimum post to root diameter ratio to minimize failures was approximately 1:4.

Fracture resistance after simulated crown lengthening and forced tooth eruption of endodontically-treated teeth restored with a fiber post-and-core system.

PURPOSE: To evaluate the effect of ferrule preparation length on the fracture resistance after simulated surgical crown lengthening and after forced tooth eruption of endodontically-treated teeth restored with a carbon fiber-reinforced post-and-core system. METHODS: 40 extracted endodontically-treated mandibular first premolars were decoronated 1.0 mm coronal to the buccal cemento-enamel junction. The teeth were divided randomly into five equal groups. The control group had no ferrule preparation (Group A). Simulated crown lengthening provided ferrule preparations of 1.0 mm (Group B) and 2.0 mm (Group C). Simulated forced tooth eruption provided ferrule preparations of 1.0 mm (Group D) and 2.0 mm (Group E). After restoration with a carbon fiber post-and-core system, each root was embedded in an acrylic resin block from 2.0 mm apical to the margins of a cast Ni-Cr alloy crown, and loaded at 150 degrees from the long axis in a universal testing machine at a crosshead speed of 1.0 mm/minute until fracture. Data were analyzed using ANOVA with Tukey HSD tests, and Fisher's exact test, with alpha = 0.05. RESULTS: Mean failure loads (kN) for Groups A, B, C, D and E were: 1.13 (SD = 0.15), 1.27 (0.18), 1.02 (0.11), 1.63 (0.14) and 1.92 (0.19), respectively. Significant differences were shown for the effects of treatment method and ferrule length, with significant interaction between these two sources of variation (P < 0.0001). Increased apical ferrule preparation lengths resulted in significantly increased fracture resistance for simulated forced tooth eruption (P < 0.0001), but not for simulated crown lengthening (P > or = 0.24).

Translucency and biaxial flexural strength of four ceramic core materials.

OBJECTIVES: To assess the relative translucencies and flexural strengths of four dental restorative ceramic core materials. METHODS: Eight disk specimens (14 mm in diameterx 0.5+/-0.05 mm in thickness) were prepared for each group of four ceramic core materials (IPS Empress 2 dentin, VITA In-Ceram Alumina, VITA In-Ceram Zirconia, Cercon Base Zirconia), according to the manufacturers' instructions. A color meter was used to measure the relative translucencies of the specimens. The biaxial flexure test (ISO 6872) was then used to measure their flexural strengths. Data for relative translucency (0.0-1.0), fracture load (N) and biaxial flexural strength (MPa) were analyzed by one-way ANOVA, followed by Tukey's multiple comparison test for significant findings (alpha = 0.05). RESULTS: For relative translucency: IPS Empress 2 (0.78+/-0.03), VITA In-Ceram Alumina (0.94+/-0.01), VITA In-Ceram Zirconia (1.00+/-0.01), Cercon Base Zirconia (1.00+/-0.01), P<0.0001. For biaxial flexural strength: IPS Empress 2 (355.1+/-25.7), VITA In-Ceram Alumina (514.0+/-49.5), VITA In-Ceram Zirconia (592.4+/-84.7), Cercon Base Zirconia (910.5+/-95.3), P<0.0001. SIGNIFICANCE: IPS Empress 2 and VITA In-Ceram Alumina were significantly more translucent than the two opaque zirconia-containing core materials. IPS Empress 2 was significantly weaker, and Cercon Base Zirconia was significantly stronger, than the other two ceramic core materials.

Effect of two fiber post types and two luting cement systems on regional post retention using the push-out test.

OBJECTIVE: To investigate regional root canal push-out bond strengths for two fiber-reinforced post types using two adhesive systems. METHODS: The crowns of 24 recently extracted sound maxillary central incisors were sectioned transversely 2 mm coronal to the labial cemento-enamel junction, and the roots treated endodontically. Following standardized post space preparations, fiber-reinforced posts (C-POST; AESTHETI-PLUS) were placed using two adhesive systems (acid-etch ONE-STEP PLUS/C&B CEMENT; self-adhesive RelyX Unicem), in four equal groups. Push-out bond strength tests were performed at four sites in each root. Results were analyzed using split-plot ANOVA, with a=0.05 for statistical significance. RESULTS: AESTHETI-PLUS quartz fiber-reinforced posts showed significantly higher push-out strengths than C-POST carbon fiber-reinforced posts (P<0.0001). The separate acid-etch adhesive system resulted in significantly higher bond strengths than the self-etch self-adhesive system (P<0.0001). Bond strengths decreased significantly from coronal to apical root canal regions (P<0.0001). SIGNIFICANCE: The quartz fiber-reinforced post placed using the separate acid-etch adhesive system provided significantly better post retention than the carbon fiber-reinforced post placed using the self-etch self-adhesive system.

Up-regulation of multiple proteins and biological processes during maxillary expansion in rats.

BACKGROUND: Maxillary expansion (ME) is a common practice in orthodontics that aims to increase the constricted maxillary arch width. Relapse often occurs, however, and better treatment strategies are needed. In order to develop a more effective method, this study was designed to further examine the process of tissue remodeling during ME, to identify the changes in expression of several proteins of interest, and to clarify the molecular mechanism responsible for tissue remodeling. METHODS: Male Wistar rats were randomly divided into control and ME groups. The rats were euthanized at various intervals over 11 days, and the dissected palates were prepared for histological examination. The structure of the midpalatal sutures changed little during the first three days. Proteins from samples in the ground midpalatal tissues obtained on the third day were subjected to two-dimensional polyacrylamide gel electrophoresis (2-DE) and matrix assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS) analysis. Validation of protein expression was performed by Western blot analyses. RESULTS: From day 5, chondrocytes in the inner layer of suture cartilage and osteoblasts at the end of the suture cartilage began to proliferate, and the skeletal matrix increased later adjacent to the cartilage in the ME group. Comparative proteomic analysis showed increases in 22 protein spots present in the ME group. The changes in three proteins closely related to osteogenesis (parathyroid hormone, osteoprotegerin and vimentin) were confirmed by Western blotting. CONCLUSION: Many proteins are over-expressed during ME, and they may play an important role in the remodeling process.

Fracture resistance and microtensile bond strength of maxillary premolars restored with two resin composite inlay systems.

PURPOSE: To compare the in vitro fracture resistance and the microtensile bond strength (muTBS) of premolar teeth restored with two light-cured resin composite inlay systems. METHODS: 50 sound human maxillary premolars were divided randomly into five equal groups. Four groups received mesial-occlusal-distal (MOD) inlay preparations. Restorative treatments comprised: Group 1 (Renew direct resin composite), Group 2 (Renew direct resin composite inlay), Group 3 (Tescera indirect resin composite inlay), Group 4 (non-restored), Group 5 (intact). All teeth were loaded axially until fracture. The same resin-based materials as used in Groups 1-3 were bonded to the superficial coronal dentin of 15 teeth. Beams approximately 1.0 mm x 1.0 mm were prepared and tested in microtensile mode. Results were compared using one-way ANOVA and Tukey's multiple comparison tests. RESULTS: Mean fracture strengths (KN): Group 1, 2.06 (0.76); Group 2, 2.30 (0.49); Group 3, 2.62 (0.68); Group 4, 1.24 (0.44); Group 5, 2.40 (0.71). Group 4 was significantly weaker that the other four groups, P < 0.01. Mean muTBSs (MPa): Group 1, 33.38 (6.24); Group 2, 20.38 (6.24); Group 3, 20.87 (4.62). Group 1 was significantly stronger than the other two groups, P < 0.01.

Comparative evaluation of micro-implant and headgear anchorage used with a pre-adjusted appliance system.

The aim of this study was to compare and evaluate the anchorage effectiveness of using either micro-implants or extraoral headgear with the McLaughlin-Bennett-Trevisi (MBT) system. Thirty young Chinese adults (14 males and 16 females) aged 18-22 years with anterior bimaxillary protrusion were divided randomly into two equal groups, treated with the MBT system anchored by either micro-implants or headgear. Nine measurements obtained before and after treatment from lateral cephalometric radiographs were assessed for the two groups, using the Mann-Whitney U test with alpha = 0.05 for statistical significance. The maxillary incisors in the micro-implant group were significantly more retracted and intruded, while the lower incisors were more lingually inclined, than in the headgear group. The occlusal and mandibular planes were rotated more counterclockwise in the micro-implant group than in the headgear group (P < 0.05). Compared with headgear anchorage, micro-implant anchorage may counteract clockwise rotation of the occlusal and mandibular planes and result in different final positions for the maxillary and mandibular incisors.

Effectiveness and dentin bond strengths of two materials for reinforcing thin-walled roots.

OBJECTIVES: To investigate the effectiveness of two restorative materials for reinforcing thin-walled roots and their microtensile bond strengths to root canal dentin. METHODS: Twenty-one decoronated maxillary central incisor roots were root filled and the canals enlarged to leave approximately 1.0 mm thick dentin walls. The roots were distributed randomly to three equal groups. Group 1 (control): a large tapered cast post-core was fabricated. Group 2 (BIS-CORE): a thick layer of dual-cured composite was placed in the post-hole before fabrication of a small-diameter tapered cast post-core. Group 3 (ChemFil Superior): a thick layer of glass-ionomer was placed, as before. Metal-ceramic crowns were fabricated for all teeth. Microtensile bond strength tests and optical and atomic force microscope observations were employed to examine adhesion between the two restorative materials and the root canal dentin. RESULTS: Mechanical loading (kN) demonstrated that composite 0.64 (S.D. 0.05), but not glass-ionomer 0.49 (0.05), significantly reinforced the fracture resistance of thin-walled roots, P<0.001. Microtensile bond strengths (MPa) were 21.7 (1.6) for composite and 12.9 (1.7) for glass-ionomer, P=002. SIGNIFICANCE: A thick intermediate layer of resin-bonded composite, sandwiched between the root dentin and a small-diameter cast Ni-Cr post or dowel, increased significantly the fracture resistance of the roots.

Effect of a ferrule and increased clinical crown length on the in vitro fracture resistance of premolars restored using two dowel-and-core systems.

This study investigated the effect of a crown-lengthening ferrule on the fracture resistance of endodontically-treated teeth restored with two dowel-core systems. Thirty-two extracted mandibular first premolars were sectioned perpendicular to the long axis at a point 1.0 mm occlusal to the buccal cementoenamel junction. Following endodontic treatment, the teeth were randomly assigned to four groups: cast Ni-Cr alloy dowel-core with no ferrule (Group A1), cast Ni-Cr alloy dowel-core with 2.0 mm ferrule (Group A2), prefabricated carbon fiber-reinforced dowel-resin core with no ferrule (Group B1) and carbon fiber-reinforced dowel-resin core with 2.0 mm ferrule (Group B2). Each specimen was embedded in a self-cured acrylic resin block from 2.0 mm apical to the margins of a cast Ni-Cr alloy crown, then loaded at 150 degrees from the long axis in a universal testing machine at a crosshead speed of 1.0 mm/minute until fracture. The data were recorded and analyzed using ANOVA and Fisher's exact tests, with alpha = 0.05. Mean failure loads (kN) for the A1, A2, B1 and B2 Groups were: 1.46 (S.D. 0.45), 1.07 (0.21), 1.13 (0.30) and 1.02 (0.27). The teeth restored with cast Ni-Cr dowel-cores and 2.0 mm ferrules demonstrated significantly lower fracture strengths, p = 0.04. There were significant differences in the root fracture patterns between the two dowel systems, with the carbon fiber-reinforced dowel-resin core system, being the less severe p < 0.05. Crown lengthening with a 2.0 mm apical extended ferrule resulted in reduced fracture strengths for endodontically-treated teeth restored using two dowel-core systems and cast metal crowns. The carbon fiber-reinforced dowel-resin core system reduced the severity of the root fractures.

Long-term survival of direct and indirect restorations placed for the treatment of advanced tooth wear.

Advanced tooth wear was restored with direct resin-based composites (RBCs) in 17 patients, and with indirect ceramo-metal crowns (CMCs) and full gold crowns in 8 other patients. The mean patient age was 64.9 (8.6 SD) years, with each patient having a mean of 13.8 (5.4) restorations. In this retrospective case series study, the mean restoration age was 5.0 (3.0) years for the direct and 5.9 (2.6) years for the indirect restorations. Over 10 years, cumulative survival estimates were 62.0% for direct and 74.5% for indirect restorations (P = 0.23). Survival estimates were 58.9% for anterior RBCs and 70.3% for anterior CMCs (P = 0.06). RBCs usually failed from fractures, and CMCs from complete losses. RBC failures were usually replaced or repaired, while CMC failures often required root canal therapies or extractions. The findings from this relatively small study require confirmation by large long-term controlled clinical trials.

Fracture resistance of roots with thin walls restored using an intermediate resin composite layer placed between the dentine and a cast metal post.

Thin-walled roots restored using conventional cast metal post-cores are at risk of fracture. Placing a thick intermediate layer of resin-based composite (RBC), sandwiched between the root dentine and a small-diameter metal post or dowel, may improve the fracture resistance of such roots. In this initial laboratory study, two similar groups each of six decoronated maxillary central incisor teeth were prepared with approximately 1.0 mm thick tapered root canal walls. Cast metal alloy post-cores and metal-ceramic crowns were fabricated and cemented for one group with, and for the other control group without, a thick intermediate layer of RBC. The mean force (N) to fracture the roots was 639.3 (SD 51.6) for the intermediate layer of RBC group and 360.8 (42.9) for the control group, P < 0.0001. These significantly different findings require clinical confirmation.

Mathematical analysis of occlusal rest design for cast removable partial dentures.

AIMS: To establish the minimum dimensions for a non-precious cast metal occlusal rest by using mathematical analysis. An occlusal rest in a removable partial denture (RPD) provides vertical support and allows occlusal forces to be transmitted through the long axis of the abutment tooth. METHODS: The stress status of an occlusal rest in a posterior tooth-bounded RPD resembles that of a cantilever beam under a uniformly distributed load. A mathematical model based on a short rectangular cantilever beam was derived by using the yield strengths of a cast cobalt-chromium alloy and a cast titanium alloy (Ti-6Al-4V), with an applied static occlusal force of 400 N. RESULTS: For the cobalt-chromium alloy, the minimum rectangular dimensions for a 2.0 mm long occlusal rest are; when the width is 2.0 mm, the depth or thickness should be at least 1.03 mm. For the titanium alloy, the minimum dimensions are; when the width is 2.0 mm, the depth or thickness should be at least 0.85 mm. A decrease in the occlusal width will increase the bending stress, requiring a thicker rest for compensation, which may lead to dentin exposure during the rest seat preparation. CONCLUSION: The mathematical analysis found that the traditional spoon-shaped occlusal rest seat dimensions comply with the mechanical requirements for non-precious cast metal occlusal rests in RPDs.

Survival of resin-bonded porcelain veneer crowns placed with and without metal reinforcement.

OBJECTIVES: The purpose of this retrospective case study of dental records was to compare the long-term failure rates and modes for resin-bonded sintered feldspathic porcelain veneer crowns (RBPVCs) either containing or without metal substructure reinforcement. METHODS: Two prosthodontists placed 62 RBPVCs fabricated with, and 167 without, metal reinforcement in 143 older adolescent and adult patients treated in a private practice. Clinical judgement determined the type of crown design placed. Preparation margins were generally finished on enamel, and all crowns occluded with opposing teeth. Observations included the patients, operators, crown designs and failure modes. Chi-square or Fisher's exact tests and life table survival statistics were used to evaluate the findings (alpha = 0.05). RESULTS: Over five years, failures occurred in 14.5% of RBPVCs fabricated with, and in 18.6% without, metal reinforcement. Cumulative survival estimates were 74.3 +/- 8.5(Standard Error)% and 72.9 +/- 4.8(SE)%, respectively (P = 0.96). Mandibular posterior crowns comprised 27.1% of the placements, but 47.5% of the failures. Bulk fracture of porcelain occurred in 7.0% of the crowns, all without metal reinforcement. Minor porcelain fractures and debonding were less frequent in both types of crowns. Persistent pulpitis occurred in 3.5% of all teeth. CONCLUSIONS: There was a significant risk of failure for sintered porcelain RBPVCs placed as posterior restorations. Although metal reinforcement was able to reduce the risk of bulk fracture of porcelain, other causes of failure were less affected.

Clinical evaluation of packable and conventional hybrid posterior resin-based composites: results at 3.5 years.

BACKGROUND: The authors evaluated clinical performances of a packable and a conventional hybrid resin-based composite used with a self-etch adhesive system. METHODS: Three dentists placed 105 posterior restorations in 65 adults. They placed a packable (SureFil, Dentsply DeTrey GmbH, Konstanz, Germany) and a conventional (Spectrum, Dentsply DeTrey GmbH) resin-based composite using a self-etch resin adhesive system. The authors evaluated the restorations using Ryge modified criteria, photographs and die stone replicas. RESULTS: After 3.5 years, six large SureFil and two Spectrum restorations had failed from bulk fracture and secondary caries, resulting in cumulative survival rates of 81.3 and 92.0 percent, respectively. Failed SureFil restorations generally were larger than the remaining intact restorations. Other ratings were satisfactory, with no significant differences between the two materials for any restoration parameter. Alfa ratings for both materials were approximately 80 percent or greater for marginal discoloration, anatomical form, surface texture and surface staining. Lower percentages of restorations were rated Alfa for color match, marginal integrity and gingival health. No postoperative sensitivity was reported. Net mean occlusal wear (+/- standard deviation) was 28.9 (+/- 32.9) micrometers for SureFil and 33.8 (+/- 29.6) microm for Spectrum restorations; the difference was not statistically significant. CONCLUSIONS: When used with a self-etch adhesive, the 3.5-year clinical performances of both composites were similar and satisfactory for the restoration of Class I and moderate-sized Class II cavities. Clinical Implications. The two composites placed in this study have an increased risk of bulk fracture when placed in large intracoronal Class II molar preparations.