The use of overdentures in the management of severe hypodontia associated with microdontia: a case report

Dental anomalies may compromise both esthetics and function in the pediatric patient. The present paper reports a rare case associated with both microdontia and severe hypodontia in a 13 year-old girl. The treatment was accomplished through the use of overdentures, which also served as a bite plane to increase vertical dimension of occlusion and as a potential space maintainer.     

A demographic analysis of vertical root fractures

Teeth with vertical root fractures (VRFs) have complete or incomplete fractures that extends through the enamel, dentin and pulp, down the long axis of the tooth. Several different variables were investigated and statistically evaluated as to their correlation with the presence of VRFs. Specifically analyzed were gender, tooth location, age, radiographic and clinical findings, bruxism, and pulpal status. The data were collected from three different endodontists, from three different geographic locations, comprising a total of 227 teeth. Although VRFs may occur in conjunction with any of the parameters investigated, only certain factors were found to occur in a significant number of cases. The results indicate that VRFs are statistically more prevalent in mandibular molars and maxillary premolars. They are associated with periradicular bone loss, pain to percussion, extensive restorations, and seem to occur more often in females and older patients. However, VRFs are not necessarily related to periapical bone loss, a widening of the periodontal ligament space, associated periodontal pockets, a sinus tract, particular pulpal status, or bruxism.     

Single-step, self-etch adhesives behave as permeable membranes after polymerization. Part III. Evidence from fluid conductance and artificial caries inhibition

PURPOSE: To test the hypothesis that formation of inhibition zones by bonded restorations in artificially-induced carious dentin lesions is related to the permeability of the self-etch adhesives. METHODS: Fluid conductance of four single-step self-etch adhesives (Prompt L-Pop, Etch&Prime 3.0, One-Up Bond F and Reactmer Bond), and a control two-step self-etch adhesive (UniFil Bond) were measured after sound dentin surfaces were:(1) acid-etched; (2) polished to produce smear layers; (3) bonded with the adhesive; each at 20 cm hydrostatic pressure (hp). Osmotic fluid conductance was also determined for the bonded dentin after immersion in 4.8 M CaCl2 at 0 cm hp. For artificial caries inhibition, a non-fluoride releasing (NFR) two-step self-etch adhesive (UniFil Bond) and a fluoride-releasing (FR) single-step adhesive (Reactmer Bond) were used in combination with a NFR composite (Metafil CX) or a FR restorative material (Reactmer Paste). Artificial caries were induced in these restorations, from which 120 +/- 10 microm thick sections and the effect of caries inhibition were quantitatively assessed with polarizing light microscopy and image analysis. RESULTS: Fluid conductance after bonding with the single-step adhesives Prompt L-Pop and Etch&Prime 3.0 were not significantly different from those recorded from smear layer-covered dentin. Although better seals were achieved with One-Up Bond F and Reactmer Bond, fluid conductance at 20 cm hp was significantly higher than the two-step self-etch adhesive UniFil Bond. Osmotic conductance at 0 cm hp were not significantly different from normal fluid conductance at 20 cm hp. The sizes of artificial carious lesions in UniFil Bond were significantly higher irrespective of whether a FR or NFR composite was used. Significant reduction in lesion size occurred in Reactmer Bond with the use of a NFR composite, and even more so with the use of a FR composite.     

Dentists' molar restoration choices and longevity: a web-based survey

STATEMENT OF PROBLEM: The increasing trend toward esthetics has led to controversy as to the longevity of esthetic restorations and the wisdom of having traditional restorations replaced for esthetic reasons. With the assumption that the way dentists treat their own teeth may be a good indication of the accumulated wisdom of the profession, knowledge of dentists' own restorative choices may provide guidance in selecting the most appropriate restorations. PURPOSE: The purpose of this article was to determine restorative choices of dentists for personal molars and estimate restoration longevity. MATERIAL AND METHODS: Information about dentists' molars was obtained from a Web-based survey designed to receive dentists' demographic data and charting of 8 molar teeth with estimated longevity. Approximately 12,000 e-mails asking to access the website were sent to dentists' addresses randomly selected from a commercial database. Nonrespondents received 1 reminder. The responses were statistically analyzed with a chi-square analysis (alpha=.05). RESULTS: Seven hundred fifty-seven valid replies provided information for 6,034 teeth (22% unrestored, 75% restored, 2% missing). Restorations reported included amalgam (36%), gold inlay/onlay (13%), complete veneer crown (CVC) (10%), metal-ceramic crown (MCC) (8%), and composite (7%). Other esthetic options accounted for less than 3%. Restorations with more than 20 years longevity included amalgam restorations (58%), gold inlays/onlays (48%) and crowns (23%). Fifty-six percent of esthetic restorations and 5% of amalgams were placed in the last 5 years. The following restorations were placed in the last year (n=186): 38% esthetic, 29% crowns (18% MCC; 11% CVC), and 17% gold inlay/onlay or amalgam. Significant differences (P<.001) were identified for dentist's gender, year of graduation and practice location. CONCLUSIONS: Most dentists have not replaced traditional metallic restorations with esthetic alternatives. Dentists still choose nonesthetic options for significant numbers of their own restorations.     

Conservative aesthetic techniques for discoloured teeth: 2. Microabrasion and composite

The first article in this series discussed the minimal intervention approach to discoloured teeth, starting with dental bleaching. This second article goes on to explain the technique of microabrasion and the use of direct composite techniques. CLINICAL RELEVANCE: Microabrasion and composite can provide minimally invasive treatments for discoloured teeth.     

Warning: bisphosphonates and osteochemonecrosis of the jaws

The aim of this article is to highlight the link between bisphosphonates and osteonecrotic lesions of the jaws ("osteochemonecrosis") and to alert general practitioners to the implications these drugs may have on their day-to-day practice. We review the use of this class of drug, the indications for which have widened recently, describe their effect on bone metabolism and outline the proposed mechanism for bisphosphonate-induced osteochemonecrosis. Predisposing and initiating factors and management are outlined, and suggestions made as to how the dental profession can help with this increasingly prevalent problem.     

Simple way to secure an occlusal wafer in patients with compromised dentition

The use of occlusal wafers in orthognathic surgery is very tricky. We propose an alternative using bite planes bonded the day prior to surgery and involving the maxillary first premolar to second molar.Bite planes offer many advantages whether one uses the direct method (when orthodontic preparation produces no posterior non-occlusion greater than 3mm), or the indirect method (in the opposite case or in cases of terminal edentulousness) requiring the use of an articulator. Manufacture and placement of the bite planes are much simpler than with wafers; they shorten the surgical procedure and offer the patient enhanced post-operative comfort and hygiene.