Quintessence International, 11/1992

This article presents a case report describing the indirect fabrication of composite resin crowns for the restoration of primary anterior teeth. A 3-year-old with a confirmed diagnosis of hypohidrotic ectodermal dysplasia was provided with composite resin crowns that were both esthetic and functional. The indirect method decreases clinical time, provides a durable restoration, and allows treatment of patients who lack the cooperative ability to endure prolonged direct bonding appointments. The indirect technique may be feasible for the restoration of carious teeth as well as the presented case

Glass-ionomer-silver-cermet cement has proved to be a worthy alternative to silver amalgam for restoring certain Class I lesions in primary teeth. Such restorations are now known to last up to 8 years without need for repair or replacement. Cermet cement has also been used for interim restoration of permanent teeth in special cases, with ideal results. The procedure for placing a glass-ionomer-silver-cermet cement Class I restoration is described.

Successful treatment of chronic myofascial pain-dysfunction syndrome by disocclusion time-reduction therapy has been shown to be effective in 1 to 3 months, with the major muscular changes occurring in the first 30 to 40 days following initial therapy. Disocclusion time reductions have been previously reported to quickly reduce or eliminate numerous symptoms of chronic myofascial pain-dysfunction syndrome. Proper modification of an existing occlusal scheme from one that contains lengthy disocc lusion time to one with short disocclusion time can be accomplsihed by implementing the method of occlusal adjustment known as immediate complete anterior guidance development. This paper describes the proper clinical occlusal adjustment methodology using a computerized device that shows the measurement and subsequent reduction of excessive disocclusion time. This directly lessens elevated contractile muscle activity, which leads to rapid muscular recovery of the involved dysfunctional muscle groups.

In this series of case reports, unusual clinical procedures in the implementation of post and core restorations are demonstrated and their difficulties are discussed. First a method for preparing an immediate post and amalgam core, while utilizing the provisional self-curing acrylic resin crown as a matrix for the condensation of amalgam, is presented. The second technique is the fabrication of a cast post and core restoration that fits an abutment root as well as the existing corwn of a four-unit fixed restoration. The third case illustrates the clinical procedures involved in preparing an immediate post and core restoration through an opening in the crown, when the extended fixed restoration cannot be removed

Irreversible iatrogenic damage sometimes occurs during dental treatment. In certain cases, intentional extraction, repair, and replantation can be used to save the damaged tooth. This case report describes the suuccessful replantation of a premolar that had sustained a large root perforation.

After 3 years, 78.0% of 64 reexamined fissure restorations (extended sealants) and small occlusal restorations were clinically acceptable or excellent, and 21.9% had to be repaired or replaced because they had fractured (6.3%) or were o longer clinically acceptable by some other criterion (15.6%). The conservative preventive resin restorati on seems to be an effective treatment for small occlusal defects. Meticulous dental hygiene by the patient and regular examinations by the dentist are mandatory.

Thirty large mesio-occlusodistal cavities with their margins totally in enamel were restored using the three-sited light-curing technique in five different ways: group I = Mark I version of a light-reflecting wedge; groups 2 and 3 = i nterproximal curing with transparent, nonreflecting wedges; groups 4 and 5, Mark II version of the light-reflectin g wedge with increased resiliency. In groups 3 and 5, the light that was not conducted by the transparent wedges was shielded by a piece of aluminum foil. It was found that, when used directly and unshielded, both Mark I and Mark II versions of the light-reflecting wedge induced significantly better marginal adaptation than the transparent, nonreflecting wedge, especially gingivoproximally. With both the nonreflecting and reflecting wedges, the shielding had no effect on the overall percentage of excellent margin. However, gingivoproximally, the shielding significantly improv ed the marginal quality in the nonreflecting wedge groups, leading to the conclusion that the first increment should be cured as throughly as possible from a gingivoproximal direction, preferably indirectly via light-conducting wedges. Direct irradiation from a lingual or buccal direction is less favorable.

Human third molar teeth were divided into three groups: untreated control; enamel treated with 35% hydrogen peroxide for 2 hours; and enamel treated with 10% carbamide peroxide gel for 14 days. All teeth were ground to present a flat enamel surface, to which cylinders of light-cured composite resin were bonded. Shear bond strengths were determined for each specimen. The mean shear bond strengths of resin-enamel bonds after pretreatment with both 35% hydrogen peroxide and 10% carbamide peroxide were signifcantly lower than those for untreated controls. External bleaching with these materials prior to resin bonding procedures may reduce the quality of resin-enamel bonds.

To assess the biocompatibility of a third-generation dentainl adhesive that uses a smear layer conditioner (Scotchbond 2), Class V cavities were prepared and restored in vivo, following a standardized protocol, in 32 human premolars to be extracted for orthodontic reasons. Histologic observation showed seven slight, five moderate, and one severe reaction short term, while 11 slight and three moderate reactions were observed long term. It appeared that the intensity of the reactions decreased with time. Bacteria were observed on only five teeth, and no corelation could be established between the presence of bacteria and the intensity of the reactions. It seemed that the conditioning of the smear layer, although it might have rendered the residual dentin more permeable, limited percolation phenomena by increasing adhesion. Although only one severe reaction was observed, it is mandatory in a clinical setting to place a protective lining near the pulp.