Quintessence International, 10/1994

The increase in the demands made by patients for esthetic or metal-free restorations, together with the ever-growing interest shown by the dental profession for tooth-colored materials and techniques, led to the current development of posterior adhesive restorations. This paper reviews critical elements such as adhesion to dental hard tissues as well as current properties of bases/liners, filling materials, and luting materials. A rationale for the successful of currently available restorative systems is presented.

Tissue integration of one-stage, nonsubmerged ITI implants over a 5-year period is documented. Fifty-four implants were placed in 38 partially edentulous patients. No implants had detectable mobility after a healing phase of at least 3 months, and there were no clinical signs of peri-implant infection. Radiogaphs revealed no peri-implant radiolucencies and all implants were in favorable positions for fixed prosthetic restorations. Following completion of the prosthetic treatment, all patients were placed in 3-month oral hygiene recall programs. Annual dental examinations included evaluation of each implant according to fixed criteria. Three years after implant placement, 51 of 53 implants (96.2%) were evaluated as successful (one patient was lost to the study). Acute peri-implant infections were associated with two implants; both were classified as late failures. The results demonstrated that one-stage transgingivally healing ITI implants integrate dependably in the tissue and that successful tissue integration can be maintained for at least 3 years.

The adhesive amalgam restoration technique combines the good properties of amalgam with the principles of tooth structure preservation and marginal seal inherent to adhesive materials. In spite of lack of longitudinal data, results of early clinical and laboratory tests are encouraging. If the present research is substantiated by clinical confirmation of their results, bonded amalgam restorations will become routine. The purpose of this article is to present a brief literature review on adhesive amalgam restoration and to introduce guidelines for its use.

A new technique that improves interproximal access in direct provisional crylic resin restorations is presented. In this technique a clear Mylar strip is placed interproximally and lifted off with an overimpression prior to the beginning of the tooth preparation procedures. Preparation of the tooth and fabrication of the provisional restorations then continues in the usual direct manner. The Mylar strip, now embedded in the overimpression, becomes incorporated as a seaprator between the adjacent provisional restorations. The acrylic resin provisional restorations are easily snapped apart and finished individually. The advantages of the technique and the need for marginal perfection around the full perimeter of the tooth are also discussed.

Two brothers diagnosed with ectodermal dysplasia were treated for 5 years during their mixed-dentition periods for problems arising from absence of teeth (oligodontia) and abnormally formed teeth. An individualized approach to restorative and prosthodontic management allowed dynamic and evolving treatment attuned to their concern about their appearance.

The ability of a dental transcutaneous electronic nerve stimulator to control pain from injection of local anesthesia was compared to the pain-controlling ability of topical anesthesia. Two maxillary infiltration injections were completed on 21 patients, one injection after electronic anesthesia, the other after topical anesthesia. Patients reported the level of pain caused when the needle pierced their tissue and the solution was injected and their overall evaluation of the injection. No difference was reported for piercing of the tissue; however, the level of pain was very low. Significantly less pain was reported for the injection of local anesthesia solution and the overall evaluation of the injection was more favorable when electronic anesthesia was used. The patients preferred the electronic technique three to one over the topical anesthesia.

A case report involving traumatized maxillary incisors is presented. The right central and lateral incisors were avulsed by direct trauma and were not found. The left central incisor was luxated and the left lateral incisor was fractured at the coronal portion. Placement of implant fixtures was selected as treatment to prevent resorption of alveolar bone and to maintain the integrity of intact adjacent teeth. The right incisors were replaced with two osseointegrated implants. The left central incisor was endodontically treated and a cast post and core was bonded into the root canal. All three of these teeth were restored with porcelain-fused-to-metal crowns. A composite resin restoration was placed on the left lateral incisor. The esthetic and functional results were satisfactory.

Dental science has much to offer law enforcement agencies in the detection and solution of crime. The permanent teeth develop throughout the first two decades of life, and physiologic variations, pathoses, and the effects of dental therapy may be recorded in the hard tissues of the remaining dentition throughout life and beyond. It is the role of the forensic dentist to extract this information and use it in the identification of the unknown body. The teeth may also be used as weapons and, under certain circumstances, may leave information as to the identity of the biter. Analysis of bite marks is the second major responsibility of the forensice dentist. The general practitioner has a major role to play in providing the accurate dental records on which much of forensic activity is based.

Ectrodactyly, atypical anhidrotic ectodermal dysplasia, and cleft lip and palate are the principal manifestations of ectrodactyly-ectodermal dysplasia-clefting syndrome. Intraorally, the common manifestations of the syndrome are hypodontia, enamel hypoplasia, and generalized microdontia. In addition, the patient may suffer from xerostomia and have a deeply fissured tongue. The oral mucosa appears, in some patients, to have an increased susceptibility to candidiasis. This case report describes a patient who exhibits many of the manifestations of the syndrome and explains ways in which many of the anomalies of the dentition can be esthetically and functionally corrected.