The Carolina bridge: a novel interim all-porcelain bonded prosthesis

Numerous bonded bridge designs have been advocated over the years for the temporary or permanent replacement of missing teeth. Both metal and all-porcelain designs of bonded bridges have been advocated, with varying degrees of success. However, all of these designs involve some degree of tooth preparation, making them irreversible in nature. The Carolina bridge, a novel all-porcelain bonded pontic, requires no significant tooth preparation, making it an outstanding option as an interim prosthesis. The key to success is the availability of adequate surface area interproximally to ensure optimally strong resin composite connectors. CLINICAL SIGNIFICANCE: This article describes the indications, contraindications, and clinical technique for the placement of an ultraconservative all-porcelain bonded bridge for the interim replacement of single incisors.     

Effectiveness of project ACORDE materials: applied evaluative research in a preclinical technique course.

Two instructional strategies, the traditional lecture method and a standardized self-instructional (ACORDE) format, were compared for efficiency and perceived usefulness in a preclinical restorative dentistry technique course through the use of a posttest-only control group research design. Control and experimental groups were compared on (a) technique grades, (b) didactic grades, (c) amount of time spent, (d) student and faculty perceptions, and (e) observation of social dynamics. The results of this study demonstrated the effectiveness of Project ACORDE materials in teaching dental students, provided an example of applied research designed to test contemplated instructional innovations prior to use and used a method which highlighted qualitative, as well as quantitative, techniques for data gathering in applied research.     

36-month clinical evaluation of two adhesives and microhybrid resin composites in Class I restorations

PURPOSE: To compare the clinical performance of a self-etching adhesive with that of a popular etch-and-rinse adhesive in Class I posterior composite restorations. METHODS: 60 Class I resin composite restorations (30 per group) were placed in matched pairs using either the self-etch adhesive Xeno III and the microhybrid resin composite Esthet-X or the etch-and-rinse adhesive OptiBond Solo Plus and Point 4 microhybrid resin composite. Subjects were interviewed via telephone 1 week after restoration placement to assess early post-operative sensitivity. In addition, the restorations were evaluated clinically for post-operative sensitivity, marginal quality, wear, and other characteristics immediately after placement and at 6, 12, 18, and 36 months from baseline. RESULTS: During the first week after placement, subjects reported that 23% of restorations in each group had post-operative sensitivity. Sensitivity decreased greatly with time, and differences between the two groups were never statistically significant. Marginal integrity and discoloration were similar for each group at each recall evaluation. Wear of both resin composites increased over time, but mean wear remained at less than 100 microm for each resin composite at 3 years.     

Irradiance effects on the mechanical properties of universal hybrid and flowable hybrid resin composites.

OBJECTIVES: A potential problem with high-intensity lights might be failure of polymer chains to grow and cross-link in a desired fashion, thereby affecting the structure and properties of the polymers formed. The purpose of this study was to evaluate mechanical properties of resin composites polymerized using four different light-curing units. METHODS: A conventional quartz-tungsten-halogen (QTH) light, a soft-start light, an argon-ion laser, and a plasma-arc curing light were used to polymerize disk-shaped (9.0mm diameter x 1.0 mm high) and cylinder-shaped (4mm diameter x 8 mm high) specimens of a universal hybrid and a flowable hybrid composite. Biaxial flexure strength, fracture toughness, hardness, compressive strength, and diametral tensile strength were determined for each composite. RESULTS: The use of the plasma-arc curing light, a high-intensity light, resulted in significantly lower hardness for the universal hybrid composite compared with the hardness obtained using the conventional QTH and the soft-start units. Hardness was the only mechanical property that was adversely affected by the use of a high-intensity light. SIGNIFICANCE: High-intensity lights might affect some resin composite mechanical properties, but this effect cannot be generalized to all resin composites and all properties.     

Microhardness evaluation of in situ vital bleaching on human dental enamel using a novel study design.

OBJECTIVES: The aim of this 'in situ' study was to evaluate the microhardness of dental enamel following treatment with an in-office and an at-home vital bleaching agent through a novel approach using samples temporarily bonded 'in vivo'. METHODS: Human dental enamel slabs (n=88) were subjected to sequential polishing and initial Knoop microhardness tests were performed. The slabs were fixed to the facial surfaces of the maxillary first molars of 44 human volunteers. They were divided into four groups (n=11) according to the treatment group: G1- in-office-CP37+ at-home-CP10; G2- in-office-CP37+ at-home-PLA; G3- in-office-PLA and at-home-CP10; G4- in-office and at-home-PLA. After 3 weeks of treatment, final microhardness measurements were performed. RESULTS AND SIGNIFICANCE: ANOVA and Tukey's HSD hoc analysis (alpha=0.05) revealed no differences among initial or final microhardness values (p>0.05); however, significant differences occurred between initial and final values for each group (p<0.01), The evaluation of microhardness revealed a reduction of 6.8% for G1, 4.1% for G2, 3.4% for G3 and 3.5% for G4. In-office bleaching with 37% carbamide peroxide, an at-home bleaching with 10% carbamide peroxide, and a combination of both resulted in lower enamel microhardness when measured immediately post-treatment. However, long-term effects of these treatments are not known, and are believed to be clinically insignificant due to the relatively small reductions observed in enamel microhardness. Interestingly, the carrier, Cabopol 934P, also resulted in similar reduction in enamel microhardness even when administrated alone as a placebo.     

Effects of blood contamination on resin-resin bond strength.

OBJECTIVE: Incremental placement and curing of resin composites has been recommended. However, this requires longer operating time, and therefore, increased risk of contamination. The purpose of this study was to evaluate the effects of blood contamination on microtensile bond strengths (microTBS) between resin interfaces and to determine the best decontamination method to re-establish the original resin-resin bond strength. MATERIALS: The top surfaces of 64, 4-mm composite blocks (Z-250, Renew, APX, Pertac II) were untreated as the control, or were treated as follows: blood applied and dried on the surface (Treatment 1), blood applied, rinsed, dried (Treatment 2), blood applied, rinsed, and an adhesive applied (Single Bond, One-Step, Clearfil SE, Prompt L-Pop) (Treatment 3). Fresh composite was applied and light-cured in 2-mm increments. After 24 h storage in water, the specimens were sectioned into 0.7-mm thick slabs, trimmed to a cross-sectional area of 1 mm(2), and loaded to failure at a crosshead speed of 1 mm/min using an Instron universal testing machine. Data were analyzed using two-way ANOVA and Fisher's PLSD test (p<0.05). RESULTS: Control values ranged from 45.1 MPa for Pertac II to 71.5 MPa for APX. Untreated blood contamination resulted in resin-resin bond strengths of only 1.0-13.1 MPa. Rinsing raised bond strengths to over 40 MPa for each material. Use of an adhesive further increased bond strengths except for Pertac II. SIGNIFICANCE: Rinsing blood from contaminated surfaces increases the resin-resin bond strength significantly and the application of an appropriate adhesive increases the bond strength to control levels.