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.

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.

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.

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.

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.

Clinical effects of glass ionomer restorations on residual carious dentin in primary molars.

PURPOSE: To evaluate the mineralization and morphology of residual (infected and affected) carious dentin following the restoration of vital primary molars with viscous glass-ionomer cement (GIC). METHODS: Encapsulated Fuji IX GP and Ketac-Molar Aplicap GICs were placed in cavities that were prepared using the atraumatic restorative treatment (ART) approach. Four suitable exfoliated teeth with intact restorations were sectioned and then examined by electron probe microanalysis (EPMA) and scanning electron microscopy (SEM). RESULTS: EPMA demonstrated the presence of fluorine and strontium that had penetrated into the underlying residual carious dentin from the adjacent GIC. The concentrations of these two elements, and those of calcium and phosphorous, varied with distance from the GIC/dentin interface. SEM showed varying degrees of dentin tubule destruction and intratubular (peritubular) dentin present immediately subjacent to the GIC/dentin interface. Incomplete removal of carious dentin was observed in all specimens, and GIC remained adherent to the tissue.

The effects of two cavity preparation methods on the longevity of glass ionomer cement restorations: an evaluation after 12 months.

BACKGROUND: The authors undertook a study to evaluate the effect of two cavity preparation methods on the initial survival of two more-viscous glass ionomer cements, or GICs, placed in the occlusal surfaces of permanent molar teeth. METHODS: Three dentists placed 149 restorations in 68 adult patients in a hospital clinic. They used either atraumatic restorative treatment, or ART, or conventional cavity preparation methods to place two encapsulated esthetic conventional GICs: Fuji IX GP (GC International Corp., Tokyo) and Ketac-Molar Aplicap (3M ESPE, Seefeld, Germany). For comparison, they used high-copper-content GK Amalgam Alloy (Advanced Technology & Materials Co. Ltd., Beijing) in conventional preparations. They evaluated the restorations using both direct and indirect observation methods. RESULTS: Cavity preparations for which the authors used ART hand instruments took approximately twice as long to complete as did those for which they used conventional rotary instruments. After 12 months, no restorations had failed, but restorations comprising both GICs showed early losses of adjacent sealant material. Both GICs also showed relatively high restoration wear. At 12 months, the mean cumulative net occlusal wear for Fuji IX GP was 77 +/- 47 micrometers, and for Ketac-Molar 83 +/- 51 microm, without statistical significance (P > .05). Color matching improved significantly with time (P < .001), without significant differences in color between the two GICs by 12 months (P = .09). The amalgam alloy had minor surface tarnishing and marginal discrepancies increased with time (P < .00 1). CONCLUSIONS: All of the occlusal restorations were rated as satisfactory after 12 months. The method of cavity preparation did not affect the restoration performance of the GICs. However, their deterioration requires long-term monitoring. Clinical Implications. The more viscous GICs appear initially suitable for restricted use in clinical practice when placed using either of two cavity preparation methods in the occlusal surfaces of permanent molar teeth in adults.

Clinical evaluation of packable and conventional hybrid resin-based composites for posterior restorations in permanent teeth: results at 12 months.

BACKGROUND: Packable resin-based composites and simplified resin bonding systems are marketed to offer many advantages over conventional posterior hybrid composites and total-etch bonding systems. The authors conducted a study to evaluate the initial clinical performances of a packable and a conventional hybrid resin-based composite used with a simplified bonding system. METHODS: A total of 57 Class I and 45 Class II restorations were placed in the permanent teeth of 65 adult patients. The carious lesions were restored with either packable resin-based composite (SureFil, Dentsply DeTrey GmbH, Konstanz, Germany) or conventional hybrid resin-based composite (SpectrumTPH, Dentsply DeTrey GmbH), using a resin adhesive (Non-Rinse Conditioner and Prime & Bond NT, both manufactured by Dentsply DeTrey GmbH). The authors evaluated the restorations using U.S. Public Health Service-Ryge modified criteria (in which Alfa is the highest rating) and by using color transparencies and die stone replicas. RESULTS: Three SureFil restorations failed before their baseline evaluation. There were no failures among the 78 SpectrumTPH restorations evaluated at 12 months. For both resin-based composites, Alfa ratings were 90 percent or higher 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. Occasional mild postoperative sensitivity was reported for four SureFil restorations and one SpectrumTPH restoration. The mean occlusal wear rate was 38 micrometers for the larger SureFil restorations and 25 microm for the smaller SpectrumTPH restorations. CONCLUSIONS: The 12-month clinical performances of the two restorative materials were satisfactory and not significantly different for each of the parameters evaluated. CLINICAL IMPLICATIONS: A packable and a conventional hybrid resin-based composite placed with a simplified bonding system in posterior permanent teeth showed satisfactory and similar results after 12 months.

Comparison of atraumatic restorative treatment and conventional restorative procedures in a hospital clinic: evaluation after 30 months.

OBJECTIVE: The purpose of this study was to evaluate two glass-ionomer cements placed in the occlusal surfaces of permanent molar teeth, using two cavity preparation methods. METHOD AND MATERIALS: Three dentists placed 149 restorations for 68 patients in a hospital clinic. Atraumatic restorative treatment or conventional cavity preparation methods were used for two encapsulated, high-strength conventional glass-ionomer cements: Fuji IX GP and Ketac-Molar. Non-gamma 2 amalgam alloy was used in conventional preparations for comparison. RESULTS: The restorative procedures were uneventful, but cavity preparations made with atraumatic restorative treatment hand instruments took approximately twice as long as did conventional rotary instrumentation. After 30 months, only one glass-ionomer cement restoration had failed. Both glass-ionomer cements showed high early losses of sealant material, but caries was not detected in the exposed fissures. Both glass-ionomer cements also showed relatively high restoration wear. At 30 months, the mean cumulative net occlusal wear was 119 +/- 12 mm for Fuji IX GP and 96 +/- 13 mm for Ketac-Molar; the difference was not statistically significant. Color matching improved significantly by 6 months; there was no significant difference in color match between the two glass-ionomer cements by 12 months. Minor surface tarnishing and marginal discrepancies were present in the amalgam restorations and increased with time. CONCLUSION: The occlusal restorations performed satisfactorily over periods of up to 30 months. However, the continued deterioration of the cements requires longer-term studies to be undertaken.

Rotational path of insertion for removable partial dentures with an anterior saddle.

The provision of removable partial dentures remains a viable treatment modality for many partially dentate patients. Replacing missing anterior teeth with a removable partial denture using a rotational path of insertion provides improved retention and appearance. The use of a rotational path of insertion also provides additional retention for a removable partial denture restoring combined anterior and posterior bounded saddles. Two case reports demonstrate the use of the rotational path of insertion for partial denture design.

Dahl appliances used for the restorative management of localized anterior tooth erosion.

Dahl partial bite-raising appliances have been used over the past 30 years for the management of occlusal tooth tissue loss, particularly in patients who have lost normal occlusal vertical dimension. The more recent use of Dahl-type appliances for individual teeth has changed the restorative management of patients with localized anterior tooth erosion. The Dahl treatment principle can be applied to those patients with and without the loss of occlusal vertical dimension. Palatal bite-raising platforms can be used to re-establish anterior tooth guidance for disocclusion of the posterior teeth without occlusal interferences. The treatment principle is illustrated with clinical cases.

The diagnosis and control of extrinsic acid erosion of tooth substance.

As modern societies increase their acidic food and beverage consumption, erosive tooth wear is an increasing cause of tooth destruction among young people. The primary causes can be exacerbated by xerostomia, which can be induced by dehydration, several systemic diseases, or any of a number of drugs. Initial preventive treatments are directed at eliminating extrinsic acids, reducing xerostomia and other co-factors, and increasing teeth's resistance to acid. Initial restorative treatments should be conservative, using adhesive materials. Treatment of advanced tooth tissue loss is difficult; preventive management is emphasized.

Case report: management of tooth tissue loss from intrinsic acid erosion.

Acid erosive tooth wear is increasingly being reported in many western countries, and is also being recognised as a significant cause of tooth destruction in persons with xerostomia. The primary aetiology is related to a high consumption of dietary sources of acids and also to an increasing awareness of gastric acid as a significant factor in both children and adults. Recommended preventive dental treatments aim to neutralise the effects of acids, reduce the severity of xerostomia, stimulate salivary flow and buffering capacity, and increase the acid resistance of tooth substance. Initial restorative treatments should be conservative, using adhesive dentistry techniques. This treatment approach is illustrated by the oral rehabilitation of a severe erosion case using adhesive onlays, veneers and all ceramic crowns.

Implications of oral biofilms in medically at risk persons.

There is the need to understand the composition of oral biofilms so that appropriate preventive and treatment regimens, including using appropriate antimicrobials, can be developed further. Additionally, when the systemic effects from specific microorganisms in oral biofilms are better understood, more targeted preventive treatment options may be recommended for persons at high risk for potential systemic diseases such as cardiovascular disease, and for aspiration pneumonia. Hence, the possible association between periodontopathic microorganisms, and also between cariogenic microorganisms in high caries risk persons, and systemic diseases requires further research involving metagenomic and large well-designed clinical studies. Effective preventive oral care is important for reducing potential systemic diseases.