Quintessence International, 01/1994

The surge of interest in the use of tooth-colored restorative materials and systems in recent years has been attributed partly to rapid developments in dental materials science and also to patient demand and operator interest. When overall dental appearance is considered, several factors are of significance, including tooth color, shape, and position; restoration quality; and the general arrangement of the dentition, especially of the anterior teeth. Each factor may be considered individually, but all components together act in concert to produce the final esthetic effect. However, although the clinician must be mindful of the patient's desires for a favorable cosmetic result, materials and techniques must be carefully selected, and restorations should be sufficient to withstand the forces of occlusion and mastication and provide long-term function.

Dental restoration of the edentulous mandible opposing natural maxillary teeth is often associated with a number of problems, particularly in the occlusion, and an accelerated rate of alveolar bone resorption in the edentulous mandible resulting from occlusal loading. The advent of osseointegrated implants would seem to provide a new means of treating these cases. Accordingly, the cases of six patients for whom either fixed partial dentures or overdentures supported by Branemark implants were provided, are reviewed. Three of the mandibles were normal and three had bone grafts. Results so far indicate that this is a viable alternative for treating such cases.

A variety of problems faces the prosthodontist attempting reconstruction of maxillary defects. There are various treatment options for patients requiring a partial maxillectomy and an obturator prosthesis. Reduced adaptability makes it difficult for the patient to learn to use a new appliance, unless existing skills can be employed. It is therefore helpful to reproduce familiar features of a patient's existing obturator, especially if this has been used successfully over a transition period.

The trigeminal nerve is the great sensory nerve of the facial portion of the head, and an intimate knowledge of this nerve and its surrounding structures is a prerequisite to the application of profound local anesthesia without complication. In this review article, the classic description of the relevant anatomy is described and is updated with recently published research into anatomic variations that have an impact on the induction of clinical local anesthesia. Causes of both failure and complications of traditional local anesthetic techniques are explained, and recommendations for avoiding these pitfalls are made.

The purpose of this study was to compare the subgingival and interproximal plaque removal of a manual toothbrush to that of an oscillating counter-rotational electric toothbrush. ninety teeth were divided into control, manual, and electric groups and test teeth received a total of 20 seconds of brushing. The teeth were then anesthetized, extracted, stained, dried, and examined with a computer-assisted video analysis system. The control group had 13.88% plaque-free interproximal surfaces, compared to 30.57% for the manual group and 53.23% for the electric group. The mean subgingival plaque-free measurement w as 0.05 mm for the control group, 0.64 mm for the manual group, and 1.36 mm for the electric group. The differences between the means were statistically significant for both measurements.

This paper reports on the bilateral distal movement of maxillary molars in the treatment of a dental Class II malocclusion with an appliance system that combines an active removable appliance with fixed molar bands and a cervical headgear. This combination of forces provides distal molar bodily movement where the molars have erupted or migrated mesially with a resultant loss of arch perimeter. The appliance system presented is a conservative, reliable technique that can be used to increase the maxillary arch length in growing as well as nongrowing patients.

When dentin is exposed, the pulp and the oral environment communicate through the dentinal tubules. The density of the dentinal tubules is an important determinant in dentinal permeability. The purpose of this study was to investigate, with an indirect method, whether tubular density is higher on the axial or on the cervical wall in cavities in restorative dentistry. The results obtained indicated that density of tubules on the cervical wall was usually higher than that on the axial wall. Clinically, the cervical wall of restorations therefore warrants the same meticulous protection routinely provided to the pulpal wall.

For composite resin and ceramic inlays there is little information about the survival of the luting agent. The purpose of this in vitro study was to relate the wear rate of the composite resin luting agent to interfacial gap dimensions and filler particle size. By controlling the gap dimension between the inlay and cavity preparation through use of computer-aided design and manufacture, a relationship was established between wear of the cement and horizontal gap width. It was confirmed that this relationship was linear. In addition, the inclination of the regression line was assumed to indicate the extent of wear. Therefore, the wear resistance of cements could be determined by determining this inclination. The results of this study revealed that ttwo hybrid cements exhibited lower wear resistance than did a microfilled cement.

Prepolymerizing microfilled composite resins have gained acceptance as restorative materials. However, when used as a posterior material, many of them undergo debonding of the organic filler. Such a condition has been attributed to the fact that the filler particles are held to the surface of the resin matrix primarily by mechanical means. Recently, a composite resin has been developed in which the prepolymerized organic particle is bonded chemically to the resin matrix through copolymerization. The material con sists of trimethyol propane trimethacrylate, and the numerous double bonds on the surface provide a means for chemical bonding. A three-bodied wear-testing device was used in conjunction with a series of experimental trimethyol propane trimethacrylate-containing polymers, and it was shown that most of these systems offered greater resistance to wear and marginal deterioration than did conventional systems.

Light-hardened glass-ionomer=resin restorative cement has all the advantages of glass-ionomer cements and the additional feature of rapid hardening by visible light application. The new restorative formulation can be used to restore a carious lesion adjacent to a bonded orthodontic bracket.

Dental procedures are designed to take advantage of and are limited by available materials. As these improve and become more advanced, so must techniques. This article addresses the effects of adhesive dental materials on treatment planning