Comparison of the abrasive properties of two different systems for interproximal enamel reduction: oscillating versus manual strips.

BACKGROUND: The aim of the present investigation was to evaluate enamel reduction efficiency, abrasive property decay, and enamel effects between oscillating mechanical and manual systems for interproximal enamel reduction (IPR). METHODS: Three oscillating strips and three manual strips were tested on twelve freshly extracted premolars blocked in an acrylic cylinder pot by means of a material testing machine. Each strip underwent one test of 8 cycles (30 s each). Both abrasive tracks and teeth surfaces were qualitative evaluated before and after IPR by means of SEM analysis. Efficiency and abrasive property decay of both IPR systems were investigated by the amount of enamel reduction within the eight-cycle testing. Independent t-test was used to evaluate differences in variables between the two systems. RESULTS: Mechanical IPR system showed higher efficiency in terms of enamel reduction (p < 0.005) when compared with manual IPR system (0.16 mm and 0.09 mm, respectively). Quantity of removed enamel decreased throughout the 8 cycles for both systems. Less presence of enamel debris and detachment of abrasive grains were observed on mechanical strips rather than manual strips. SEM analysis revealed more regular surface of teeth undergone mechanical IPR procedures. CONCLUSION: Oscillating diamond strips showed more controlled efficiency when compared with the manual IPR system leading to a more regular enamel surface.

The Ethics of Interproximal Reduction.

Interproximal reduction (IPR) has become particularly popular with the use of removable aligners. Clinical and ethical factors concerning the use of interproximal reduction to facilitate orthodontic alignment are discussed. CPD/Clinical Relevance: An understanding of the aetiological factors of a malocclusion is essential to enable full discussion of the risks and benefits, or the alternatives to IPR.

Surface roughness of the restored enamel after orthodontic treatment.

INTRODUCTION: After fixed appliance treatment, one concern is to restore the enamel surface as closely to its original state as possible. A variety of cleanup processes are available, but all are time-consuming and carry some risk of enamel damage. The purpose of this study was to examine tooth surfaces restored with different cleanup protocols. METHODS: Ninety-nine premolars extracted for orthodontic purposes were used. The 2 materials tested were Sof-Lex disks (3 M ESPE AG, Seefeld, Germany) and fiberglass burs (Stain Buster, Carbotech, Ganges, France). These were used alone and in combination with high- and low-speed handpieces, with which they were also compared. Eight groups were ultimately tested. All groups were compared with intact enamel, which served as the control group. From each group, 10 samples were examined with profilometry and 1 with scanning electron microscopy. Adhesive remnant index scores were recorded to ensure equal distributions for the groups. The time required for the cleanup processes and profilometry test results were also recorded. RESULTS: The fastest procedure was performed with high-speed handpieces, followed by low-speed handpieces. Sof-Lex disks and fiberglass burs required more time than carbide burs but did not result in significantly longer times for the cleanup procedure when combined with tungsten carbide-driven low- or high-speed handpieces or when used alone with low-speed handpieces. Although Sof-Lex disks were the most successful for restoring the enamel, it was not necessary to restore the enamel to its original surface condition. Generally, all enamel surface-roughness parameters were increased when compared with the values of intact enamel. The average roughness and maximum roughness depth measurements with Sof-Lex disks were statistically similar to measurements of intact enamel. CONCLUSIONS: No cleanup procedure used in this study restored the enamel to its original roughness. The most successful was Sof-Lex disks, which restored the enamel closer to its original roughness.

A minimally invasive procedure for esthetic achievement: enamel microabrasion of fluorosis stains.

Esthetic alterations (such as fluorosis) that result from intrinsic dental staining in enamel and dentin can be controlled or softened by noninvasive methods such as dental bleaching or enamel microabrasion. Part of the enamel is removed during microabrasion; however, this wear is clinically insignificant and does not harm the dental structure. This article presents a case in which the microabrasion technique was used to remove fluorosis staining. Based on the results of this case report, it can be concluded that this technique is efficient and can be considered a minimally invasive procedure.

Operative dentistry and the abuse of dental hard tissues: confocal microscopical imaging of cutting.

We reviewed studies wherein the cutting of dental tissues, simulating interactions that would occur under clinical circumstances in the mouth, have been observed directly-first by real time, video rate, stereoscopic, three-dimensional scanning electron microscopy; and second and more conveniently, by video rate confocal optical microscopy. We have observed, directly, both the interactions of slow-moving cutting instruments emulating "chisels" and high-speed events, including the effects of rotary burs and air-propelled abrasive particles and soft powder slurries. The observational data contribute to our basic understanding of the functional behavior of dental tissues and formed a useful background for the practitioner of operative dentistry.

Primary tooth enamel loss after manual and mechanical microabrasion.

PURPOSE: This study's purpose was to assess the amount of dental enamel loss on primary incisors after manual or mechanical microabrasion with a phosphoric acid/pumice paste. METHODS: Ten exfoliated primary maxillary incisors were bisected faciolingually and the resulting 20 halves were randomly assigned to 2 groups: group 1 (N = 10)-manual technique (plastic spatula); and group 2 (N = 10)-mechanical technique (rubber cup attached to a low-speed handpiece). Microabrasion was performed on the buccal surface using an abrasive paste prepared with 37% phosphoric acid and pumice. Ten 20-second applications alternated with 20-second risings were performed in each group. Enamel thickness measurements made under stereomicroscopy before and after microabrasion were analyzed statistically by analysis of variance and pairwise t test. RESULTS: There was a statistically significant difference (P = .003) between the manual and mechanical techniques. The mechanical technique produced a mean enamel loss of 274.16 microm (66% of total enamel thickness), while the mean enamel loss with the manual technique was 152.59 microm (39% of total enamel thickness). CONCLUSION: Manual microabrasion using a plastic spatula removed less enamel, but was sufficient to eliminate most superficial stains and defects, and may be a viable option for the microabrasive technique on primary teeth.

Association of enamel microabrasion and bleaching: a case report.

Enamel microabrasion may be indicated for certain clinical situations, since it is a proven method for removing superficial intrinsic enamel discoloration defects such as fluorosis-like stains; in addition, it is safe, conservative, and easy to perform. However, this method removes enamel structure, causing teeth to become yellowish. This yellowing can be treated with enamel microabrasion and bleaching. This article describes and documents how these two methods were utilized to correct tooth color for a young patient.

An in vitro study on the effect of an oscillating stripping method on enamel roughness.

BACKGROUND: The aim of the present study was to assess the changes in enamel roughness parameters before and after stripping with an oscillating diamond strip system. METHODS: Sound premolars extracted for orthodontic reasons were embedded up to their cervical area in a polyvinylsiloxane putty, creating four groups of four teeth with three interproximal areas each (mesial/distal). The same regions of interproximal enamel surfaces were studied by 3D optical interferometric profilometry before and after stripping with the Ortho-Strips system (Intensiv Dental SA, Montagnola, Switzerland) (n teeth = 16, n contact points = 12, n sites measured = 24). The roughness parameters tested were the amplitude parameters Sa and Sz, the hybrid parameter Sdr, and the functional parameters Sci and Svi. The parameter differences (ΔSa, ΔSz, ΔSdr, ΔSci, ΔSvi) were calculated per region and statistically analyzed by one-sample Mann-Whitney rank sum test (a = 0.05). RESULTS: High statistically significant differences were found in ΔSa, ΔSz, and ΔSvi median values (0.453, 3.870, and 0.040 µm, respectively); a significant difference in ΔSdr median value (1.514%); and no statistically significant difference in ΔSci (0.110 median value). CONCLUSIONS: Under the conditions of the present study, the Ortho-Strips system seems to significantly increase the amplitude parameters Sa and Sz; the hybrid parameter Sdr, associated with the developed interfacial area ratio; and the functional parameter Svi, which depicts the volume of the deepest valleys. Under the conditions of the present study, the Ortho-Strips seems to significantly increase four of five measured roughness parameters.

Assessing the clinical effectiveness of an aerosol reduction device for the air polisher.

BACKGROUND: Because of the growing concern of the infectious nature of aerosols produced by air polishers, the Centers for Disease Control and Prevention and the American Dental Association have made recommendations to minimize dental aerosols. In addition, a device was developed in 1997 to reduce the aerosol generated during air polishing. METHODS: The authors conducted a blinded clinical study to determine the effectiveness of an aerosol reduction device during air polishing. All 30 subjects underwent two minutes of air polishing, one with the aerosol reduction device on one side of the mouth and one without the device on the opposite side. Microbial samples were collected on blood agar plates positioned 12 inches from the subject's mouth and from one plate attached to the dental hygienist's face mask. The sample plates were then inverted and incubated for three days at 37 C. RESULTS: Using the paired t-test, the authors found that the air polisher without the aerosol reduction device generated a significantly greater mean quantity of colony-forming units, or CFUs, 12 inches from the subject's mouth (mean +/- standard deviation, 148.00 +/- 145.00 CFUs) than the air polisher with the aerosol reduction device (20.10 +/- 53.90 CFUs) (P < .0001). In addition, the air polisher without the aerosol reduction device generated a significantly greater number of CFUs on the face mask plate (40.90 +/- 33.80 CFUs) than the air polisher with the aerosol reduction device (8.80 +/- 15.10 CFUs) (P < .0001). CONCLUSION: The data suggest that the aerosol reduction device is effective in reducing the number of microorganisms generated during air polishing. CLINICAL IMPLICATIONS: Air polishing with the aerosol reduction device may decrease the potential for disease transmission.

Lasers and air abrasion. New modalities for tooth preparation.

Hard tissue lasers and air abrasion units have a place in the modern dentist's armamentarium. Speed, comfort, ease of approach, public relations, and patient appeal are some of the advantages. The dentist's own comfort and satisfaction, knowing that he or she is doing the best dentistry without frightening the already fearful patient, should help the dentist decide which one of the modalities to incorporate into his or her practice.

Surface treatment techniques for resin composite repair.

PURPOSE: To compare bond strengths of fresh resin composites to previously polymerized ("aged") composites following various surface treatments. MATERIALS AND METHODS: Eighty Pertac Hybrid (PH) and an equal number of Silux Plux (SLX) specimens were fabricated and stored for 1 week prior to surface treatment. The specimens were then polished and stored for an additional 24 hours prior to final surface treatment. The surface treatments included use of one of the following: (1) diamond bur (DB), (2) microetcher with 50 microns Al2O3@80 psi pressure (ME), (3) high-pressure air abrasion with 27 microns Al2O3@psi, (KCP), or (4) low-pressure silicate ceramic deposition using 30 microns particles@34 psi (CJ-S) with a microetcher. Half of the samples were treated with a silanating agent. Fresh resin composite (same type as used for the aged specimen) was bonded to the treated surfaces, and specimens were then stored 24 h and thermocycled 300 x at 5 degrees and 55 degrees C prior to testing for shear bond strength. Two-way ANOVA was used to determine significant differences between mean shear bond strengths for both composite materials. RESULTS: Significant differences were found between the groups for both surface treatment and silane use (P < 0.05). The interaction between the two main effects was also significant (P < 0.05). Overall, the highest bond strengths were found when the low-pressure silicate ceramic deposition system (CJ-S) was used, with or without silane.

A new technique for the controlled removal of mottled enamel: measurement of enamel loss.

AIM: To describe and investigate a simple, effective new method for controlled removal of unsightly, malformed surface enamel. SUBJECTS AND METHODS: 22 mottled incisor teeth were chosen from a group of 12 patients, aged 9-15 years. One half of the labial surface of the tooth was covered with a layer of unfilled bis-GMA resin so that it remained unaffected by the procedure. The other half was treated by etching the enamel with 35% phosphoric acid for 30 seconds, washing and drying. The frosted, etched enamel was removed with a composite finishing bur (Jet 7901) running dry in an air turbine, until a shiny enamel surface reappeared. The enamel was then smoothed with a pumice and water slurry in a slow-rotating rubber prophylaxis cup. The bis-GMA resin was peeled off, and an elastomeric impression of the tooth (now with one half of its labial surface treated, and the other untreated) was taken. The treatment of the remainder of the labial aspect was then completed. The thickness of the mid-labial enamel removed was measured directly from the impression by surface imaging, using a confocal microscope. RESULTS: The mean thickness of enamel removed was 164 microns (SD +/- 85 microns). CONCLUSIONS: This technique results in equivalent amounts of enamel removal to that claimed for other more complex and time-consuming methods.

Enamel stripping and the spring aligner appliance--an update.

Irregularity of the mandibular incisors in an otherwise good occlusion is quite common in young adult patients. Through use of enamel stripping in the incisor region, it is possible to create sufficient space to align the teeth with a mandibular sectional removable appliance, commonly known as the spring aligner. This article reviews the methods of enamel stripping and describes the author's preferred technique of enamel stripping and the various modifications of the spring aligner appliances that can be prescribed by the general practitioner to correct mandibular anterior crowding.

Evaluation of cutting patterns produced in primary teeth by an air-abrasion system.

OBJECTIVE: The aim of this in vitro study was to assess the effect of tip diameter, nozzle distance, and application time of an air-abrasion system for cavity preparation on the enamel of primary teeth. METHOD AND MATERIALS: Forty exfoliated primary teeth were air abraded with a microabrasion machine used with a handpiece with an 80-degree-angle nozzle, 50-micron abrasive particle size, and 80-psi air pressure. The effects of 0.38- or 0.48-mm inner tip diameter, 2- or 5-mm distance from tip to tooth surface, and 15 or 30 seconds of application time on cutting efficiency were evaluated. Cutting width and depth were analyzed and measured from scanning electron micrographs. RESULTS: Statistical analysis revealed that the width of the cuts was significantly greater when the tip distance was increased. Significantly deeper cavities were produced by a tip with a 0.48-mm inner diameter. The application time did not influence the cuts. CONCLUSION: The cutting patterns found in this study suggest that precise removal of enamel in primary teeth is best accomplished when a tip with a 0.38-mm inner diameter is used at a 2-mm distance.

Enamel microabrasion.

A significant number of patients complain of discoloured teeth. The enamel microabrasion technique described in this article is a simple conservative method for improving the appearance of discoloured enamel.

High velocity air microabrasion for conservative tooth preparation: the principle and the clinical procedure.

Various technologies within the dental armamentarium are applied to achieve the precise tooth preparations required for the different types of restorations. This article reintroduces the air microabrasion technique, which was first presented in 1945. The popular use of this technique had been postponed, pending the decrease in cost and development of compatible restorative materials to repair the tooth structure. With increased patient demand for less invasive preparation techniques and the decrease of the equipment cost, the use of air microbrasion for tooth preparation has been recognized. The history of the technology, its function, indications, advantages, and limitations are discussed, and a step-by-step clinical procedure is presented. The learning objective of this article is to familiarize the readers with this preparation procedure, enhancing the knowledge of preparation options.

Change in the pulp chamber temperature with different stripping techniques.

BACKGROUND: The aim of this study is to evaluate the change in pulp chamber temperature during the stripping technique. METHODS: Seventy-eight proximal surfaces of 39 extracted human teeth were stripped by two techniques: double-sided perforated stripping disk (PSD) and handheld stripper (HS). The teeth were divided into three groups: incisors (group 1), premolars (2), and molars (3). A J type thermocouple was inserted into the pulp chamber for temperature evaluation during the stripping procedure. RESULTS: Temperature rise was observed in all groups. The average temperature increase for the incisors was 2.58°C (±0.27°C) with PSD and 1.24°C (±0.3°C) with HS; for the premolars, 2.64°C (±0.29°C) with PSD and 0.96°C (±0.39°C) with HS; and for the molars, 2.48°C (±0.38°C) with PSD and 0.92°C (±0.18°C) with HS. There was significant difference (p<0.001) in pulp temperature variation among the stripping techniques evaluated. Greater variations in the temperature were observed for the stripping technique with PSD for all groups (3.1°C in incisors and premolars, 3.2°C in molars). Stripping performed with HS had minor differences in pulp temperature (1.7°C in incisors, 1.9°C in premolars, and 1.2°C in molars) than those in PSD group. However, the temperature variation was less than the critical threshold (5.5°C) in all groups. The results for teeth group comparison showed no significant difference in the temperature variation. CONCLUSIONS: The stripping technique with PSD produced significant increase in pulp temperature, with no differences between the types of teeth. However, it may not be clinically relevant, and both stripping techniques can be used safely.

Interproximal enamel reduction as a part of orthodontic treatment.

OBJECTIVE: Interproximal enamel reduction is a part of orthodontic treatment for gaining a modest amount of space in the treatment of crowding. Today interproximal enamel reduction has become a viable alternative to the extraction of permanent teeth, and helps to adjust the Bolton Index discrepancy. The aim of the study is to evaluate various interproximal enamel reduction techniques, its indications, contraindications and complications presented in recent scientific studies. MATERIAL AND METHODS: Papers published in English language between 2003 and 2012 were searched in PubMed, ScienceDirect and The Cochrane Library databases, as well as the Web search Google Scholar. Initial searches were made to find peer-reviewed systematic reviews, meta-analyses, literature reviews, clinical trials, which analysed at least one interproximal enamel reduction method. 31 published data fulfilled the inclusion criteria. RESULTS: According to the study, abrasive metal strips, diamond-coated stripping disks, and air-rotor stripping are the main interproximal enamel reduction techniques. Indications for use are mild or moderate crowding in dental arches, Bolton Index discrepancy, changes in tooth shape and dental esthetics within the enamel, enhancement of retention and stability after orthodontic treatment, normalization of gingival contour, elimination of black gingival triangles, and correction of the Curve of Spee. Complications of interproximal enamel reduction are hypersensitivity, irreversible damage of dental pulp, increased formation of plaque, the risk of caries in the stripped enamel areas and periodontal diseases. CONCLUSION: Interproximal enamel reduction is an important part of orthodontic treatment for gaining space in the dental arch, and for the correction of the Bolton index discrepancy.

Integrating techniques to re-establish dentogingival esthetics.

The aim of this article was to report the clinical case of a male patient of 20 years with hyperpigmented gingiva and moderate fluorosis, whose smile was reestablished by the use of a laser assisted depigmentation procedure, an enamel microabrasion technique, followed by at-home bleaching and subsequent remineralization therapy. The association of these techniques presented excellent results and the patient was satisfied. All techniques are painless, fast and easy to perform, in addition to preserving the hard and soft dental structure. Treatment showed immediate and permanent results; these techniques must be divulged among professionals and their patients.