Quintessence International, 03/2000

Clinicians are increasingly being called on to satisfy the restorative demands of patients who request tooth-colored restorations but are unable to afford an optimum indirect restorative option. Consequently, in clinical practice, the limits of the direct posterior resin composite technique are being stretched. There is a need for techniques that will satisfy the complex variables of clinical practice and allow for successful utilization of posterior resin composite in large cavity preparations. The objective of this article is to explain the rationale behind the materials and techniques involved in the delivery of these complicated restorations.

The clinical diagnosis of secondary caries is by far the most common reason for replacement of restorations, but the scientific basis for the diagnosis is meager. The purpose of this article is to review the literature on secondary (recurrent) caries and present case reports to document the problems encountered in the clinical diagnosis of secondary caries. The literature on secondary caries was critically reviewed and subdivided into clinical diagnosis, location of secondary lesions, histopathology, microleakage, and microbiology. The case reports included restorations that were scheduled to be replaced because of secondary caries or stained margins of composite restorations. The lesions were photographed preoperatively and postoperatively. Based on the limited literature available, secondary caries appears to be a localized lesion similar or identical to primary caries. It is most often localized gingivally on restorations. Narrow gaps, crevices, ditches, and 'microleakage' do not lead to secondary caries, but wide voids may. Secondary caries is difficult to diagnose clinically. Consistency or hardness and discoloration of dentin and enamel are the best parameters. Secondary caries is the same as primary caries located at the margin of a restoration.

Objective: This study evaluated the in-service performance, after 1 year, of a sample of F2000 compomer restorations placed by 10 general dental practitioners as part of handling evaluation of this material. Method and materials: Five general dental practitioners who participated in the handling evaluation were asked to cooperate in the 1-year assessment of the restorations. The practitioners were requested to contact patients and inquire if they were willing to attend at a specified time for examination of their restorations by a trained evaluator who would travel to the various practice locations. A total of 84 restorations were presented for examination. The mean age of the restorations at examination was 14 months. The restorations were assessed for anatomic form, marginal adaptation, surface roughness, sensitivity or discomfort, gingival condition, and presence or absence of secondary caries. Results: Eighty-two restorations were intact. No secondary caries was detected. Optimal scores were obtained in a high proportion of the assessments. All patients reported satisfaction with the restorations, both in appearance and surface texture, and no symptoms were reported. Conclusion: The F2000 compomer restorations, placed in conjunction with its bonding system in general practice conditions, were found to be performing satisfactorily after 1 year.

This article describes a new technique for fabricating cement-retained implant-supported prostheses. The technique involves cementation of the prostheses over customized gold cylinders. Access channels are incorporated in the prostheses to allow future access of the gold screws. This technique can be used in various clinical situations to achieve total passive fit of the framework without compromising retrievability. The technique overcomes the problems encountered with other previously advocated methods for constructing such prostheses. In addition, maintenance of the resulting prostheses is uncomplicated.

The benign cementoblastoma is a rare odontogenic tumor that tends to occur in the jaws of young people. It is most commonly characterized as a circumscribed radiopaque mass attached to the tooth roots and rimmed by a thin radiolucent zone. Early lesions, however, are radiolucent and can be confused with periapical conditions resulting from nonvital teeth. The tumor is seldom recognized until it produces pain or expansion of the jaw. If the diagnosis is established early, the tooth can be saved by endodontic treatment followed by apical root resection and surgical enucleation of the tumor. This case report documents the origin, development, and unlimited growth potential of a cementoblastoma. Radiographs taken at yearly intervals reveal an initial widening of the periodontal ligament space that grew into a 3-cm mixed radiolucent and radiopaque tumor over a 4-year period. The differential diagnosis and some criteria to help distinguish the cementoblastoma from similar-appearing lesions are reviewed.

Objective: The purpose of this study was to examine the effect of xerostomic medications on the salivary output of patients with Sjögren's syndrome. Method and materials: Of 62 patients evaluated in this study, 23 were not using medication, and 39 were using between 1 and 6 medications with xerostomic side effect. Results: The mean ± SEM stimulated parotid output was 0.33 ± 0.07 mL/min per gland for patients who were not using medication and 0.33 ± 0.04 mL/min per gland for patients using (1 to 6) medications. Analyses did not reveal a significant difference in salivary output between these groups. The salivary output of patients using various numbers of medications (1 or 2; 3 or 4; 5 or 6) was also compared. Analysis revealed no significant difference in salivary output related to the number of xerostomic medications used. Conclusion: The use of xerostomic medications may not necessarily affect stimulated parotid flow rate in patients with Sjögren's syndrome. These results suggested that gustatory stimulation may be adequate to overcome the inhibitory effect induced by xerostomic medications.

Objective: The purpose of this study was to determine the effect of retraction cord medicaments (aluminum chloride, ferric sulfate, and ferric subsulfate/ferric sulfate) on the dimensional accuracy and surface detail reproduction of polyvinyl siloxane impressions. Method and materials: Polyvinyl siloxane impressions were made of standardized metal dies (American Dental Association [ADA] specification No. 19) treated with 1 of the 3 retraction cord medicaments. Dimensional accuracy was evaluated by comparing the average length of a line in the impressions to the standard die. Surface detail reproduction was evaluated by viewing the impressions under low-angle illumination at 310 magnification. Reproduction was considered satisfactory if 2 of 3 horizontal lines were reproduced continuously. The dies were also evaluated under the microscope before the impression was made. Results: The medicaments did not significantly effect the dimensional accuracy; mean shrinkage was within ADA guidelines in the treatment groups. All of the medicaments had an adverse effect on surface detail reproduction. These effects were statistically significant compared to the untreated control. Conclusion: Although the changes in dimensional accuracy were within ADA guidelines, the surface detail reproduction was modified such that the impression would be considered clinically unacceptable. For optimal results, care must taken to remove all traces of these retraction cord medicaments prior to recording of a polyvinyl siloxane impression.