Abstracts
of the August 2006 Issue
Comparative plaque removal efficacy of a dual-action power
toothbrush
and a manual tooth:
Effects by tooth type.
Svetlana Farrell,
dds, phd,
Geza T. Terézhalmy,
dds, ma, Robert
D. Bartizek, ms
&
Aaron R. Biesbrock,
dmd,
phd,
ms
Abstract: Purpose: To
evaluate the plaque removal efficacy of a dual action power
toothbrush (Crest SpinBrush Pro Clean) relative to an ADA
reference manual toothbrush. In addition to overall plaque
removal, emphasis was put on plaque reduction around the
gingival margin, interproximal areas of the tooth and in the
posterior segment of the dentition. Methods:
The study was a randomized, examiner-blind, two-treatment,
four-period, crossover design. After an informed consent, 50
healthy volunteers were randomized to four treatment sequences
and used each toothbrush twice according to their assigned
treatment sequence. At every visit, plaque removal was assessed
at baseline and after a single brushing using the Rustogi-modified
Navy Plaque Index that allows estimation of interproximal plaque
and plaque at the gingival margin. Self-reported and
examiner-observed adverse events were collected at every visit.
Mean Plaque Index (MPI) scores were calculated for the whole
mouth, gingival region, interproximal region and different areas
of the dentition using an analysis of covariance for crossover
design with baseline plaque score as the covariate.
Results: 49 subjects provided complete data and were
included in the analysis. Baseline MPI scores were not
significantly different between the groups for any investigated
tooth region or dentition area. Following a single brushing, the
power toothbrush provided a reduction of 43% (P< 0.001) for the
whole mouth MPI, 43% (P< 0.001) for the gingival margin MPI and
65% (P< 0.001) for the interproximal MPI relative to a manual
brush. Use of the power toothbrush resulted in a significant
reduction of whole-mouth and gingival margin MPI across all
areas of the dentition compared to a manual toothbrush (P<
0.001). The power toothbrush also had superior interproximal
plaque removal efficacy compared to the manual toothbrush for
molars (P< 0.001, with 118% greater removal score). Both brushes
were well tolerated. (Am J Dent 2006;19: 195-200).
Clinical significance: The dual action
power toothbrush, Crest SpinBrush Pro Clean, was found to
deliver significantly superior plaque removal benefit compared
to an ADA reference manual toothbrush in a single-use model,
especially in areas of limited access such as the gingival
margin, interproximal region and posterior area of the
dentition.
Address: Dr. Aaron Biesbrock, The Procter &
Gamble Company, 8700 Mason-Montgomery Road, Mason, OH
45040-9462, USA. E-mail:
biesbrock.ar@pg.com
The bonding area of
intra- and extra-coronal tooth preparations
Werner H. Mörmann,
prof, dr med dent
&
Andreas Bindl,dr
med dent
Abstract: Purpose: To
assess the accuracy of preparation surface area measurements (mm2)
using the Cerec digital mouth camera in vitro and to
analyze a collection of 514 Cerec camera in vivo optical
impressions of preparations from 274 patients according to the
size of preparation/bonding area (mm2)
Methods: The surface area (mm2) of model
preparations with known dimensions namely of one occlusal (1)
and one mesio-occluso-distal (2) cavity as well as of one
central incisor (3) and one molar (4) crown preparation was
calculated from linear (a) design dimensions, (b) slide-gauge
and (c) coordinate-measuring-machine data as benchmark
measurements and from repeated (n=10) (d) laser-scan (control),
(e) Cerec-camera mounted on a support, (f) handheld Cerec-camera
measurements. Data of (d), (e) and (f) was statistically
analyzed. From a collection of data sets clinically recorded
with the Cerec camera, the surface areas of 514 preparations
from 274 patients were analyzed according to the type of tooth
and type of preparation. Results: Occlusal
cavity mm2 data 1(d) 48±0.4, 1(e) 48±0.2, 1(f) 48±0.6
and mod cavity mm2 data 2(d) 137±2, 2(e) 138±1, 2(f)
138±4 did not differ between (d), (e) and (f) (P> 0.05)
confirming the hypothesis for inlay cavities. Incisor crown
preparation mm2 data 3(d) 82±0.4 differed (P< 0.001)
from 3(e) 85±0.2 and 3(f) 85±0.6 as well as molar crown
preparation mm2 data 4(d) 133±0.6 differed by 3.5%
(P< 0.001) from 4(e) 137±0.4 and 4f) 138±1. Clinical cavity and
crown preparation area data obtained from in vivo Cerec
camera recordings differentiated between type of tooth and type
of cavity. 2D data of "classic", "reduced" and "endo" type crown
preparations did not differentiate clearly. (Am J Dent
2006;19:201-205).
Clinical significance: The Cerec camera
showed minimal 2D measuring incertitude for cavities and a low
calculable incertitude of 3.5% for crown preparations providing
quantitative preparation area data with adequate accuracy.
Address: Prof. Werner H. Mörmann, Department of
Preventive Dentistry, Periodontology and Cariology, Center for
Dental and Oral Medicine, University of Zurich, Plattenstrasse
11, Zurich, CH-8032, Switzerland.
E-mail:
werner.moermann@zzmk.unizh.ch
Clinical evaluation of an all-ceramic
restorative system: 24-month report
Douglas Barnes,
dds, ms,
James C. Gingell,
DDS, MS,
David George, dds,
mba, Erika Adachi,
dds, Steven
Jefferies, dds, ms
& Veeraraghavan Sundar,
phd,
mba
Abstract: Purpose: To clinically
evaluate an all-ceramic restorative system (Finesse All-Ceramic)
when used in conjunction with an ultra-low fusing porcelain
(Finesse) using bonded esthetic resin cements (Enforce & Calibra).
Methods: 40 posterior and anterior crowns,
20 all-ceramic inlays and onlays, and 26 veneers were placed in
43 patients. Standard ceramic preparations were performed
followed by conventional polyvinylsiloxane (Aquasil) impression
techniques using cord retraction. The bonded resin cement was
used to place the restorations following manufacturer’s
instructions. A majority of restorations (95-100%) were
evaluated to be optimal at baseline (B), 6, 12, and 24 months
using a modified Ryge criteria for the following categories:
color match, marginal adaptation, porcelain staining, secondary
caries, postoperative sensitivity, and retention.
Results: There were sufficient shades available to
obtain desired esthetic result with 98% of all restorations
being rated Alfa for shade match to Vita Lumin shade guide. The
overall 2-year success rate (inlay/onlays, crowns, and veneers)
was 98.75%. (Am J Dent 2006;19: 206-210).
Clinical significance: Clinical performance of Finesse
All-Ceramic low-fusing, pressable all-ceramic system was
acceptable at the 2-year recall. The clinical performance was
consistent with other pressable, all-ceramic systems
commercially available today.
Address: Dr.
Douglas M. Barnes, Advanced Education in General Dentistry,
Baltimore College of Dental Surgery, Dental School, University
of Maryland, 666 West Baltimore Street, Baltimore, Maryland,
21201-1586 USA. E-mail:
dbarnes@umaryland.edu
Influence of the length of
instrumentation and canal obturation on the success of
endodontic therapy. A 10-year clinical follow-up
Tomislav Tamarut,
dds, phd, Maja
Kovacevic, dds, phd
& Sneježana Glavičič,
dds, ms
Abstract: Purpose: To
clinically test the periapical healing of the method of
recurrent electronic root canal measurement and the method of
root canal obturation by the guttapercha-eucapercha method.
Methods: During 10 years of endodontic
practice of the first author, endodontic interventions were
performed on approximately 4500 patients, aged 12-75 years. The
success of therapy was followed-up in 257 teeth with diagnosis
K04.0 to K04.5 (according to the X international classification
of diseases) for whom a preoperative and control radiograph
during the investigation period existed. Root canal preparation
started with the “crown-down pressureless technique” and
proceeded with the method of recurrent electronic root canal
measurement. Obturation was done by the guttapercha-eucapercha
method up to the apical constriction. Results:
The result of therapy success was approximately 95% overall (t-test,
ANOVA); for the diagnosis: necrosis and pulp gangrene (K04.1):
64%; for the acute apical periodontitis (K04.4): 88%; for the
inflamed pulp (K04.0) and pulp degeneration (K04.2) 95%; chronic
apical periodontitis (K04.5): 98%, and abnormally formed hard
tissue in the pulp (K04.3):100%. (Am J Dent 2006;19:
211-216).
Clinical significance: The results
confirmed that every endodontic diagnosis needs a specific
therapeutic approach that depends on the spread of tissue
inflammation which influences the length of instrumentation. The
length could be determined by the method of recurrent electronic
root canal measurement.
Address: Dr. Maja Kovacevic, 51000 Rijeka,
Mihanoviceva 13, Croatia.
E-mail:
Maja.Kovacevic@mamed.medri.hr
Effect of Er:YAG laser irradiation distance on superficial
dentin morphology
Aline Evangelista de Souza-Gabriel,
dds, ms,
Michelle Alexandra Chinelatti,
dds, ms, Maria
Cristina Borsatto,
dds, phd,
Jesus Djalma Pecora,
dds, phd,
Regina Guenka Palma-Dibb,
dds, phd
& Silmara Aparecida Milori
Corona, dds,
phd
Abstract: Purpose: To
assess in vitro the effect of Er:YAG laser irradiation
distance on dentin surface morphology, by SEM.
Methods: 60 sound human third molars were
employed to obtain discs (
1mm thick), that were polished to standardize the smear layer.
Discs were randomly assigned to six groups (n=10) and
sequentially bisected. Five groups (including both disc halves
of each sample) received Er:YAG laser irradiation (80mJ/2Hz) for
20s, according to the irradiation distance (11, 12, 14, 16 or
17mm) and one was the control group. In the lased-groups, one
disc half was separated for superficial analysis without
subsequent acid-etching and the other half received phosphoric
acid for 15 seconds. In the control group, one disc half was
treated with phosphoric acid and no superficial treatment was
done in the other half. Specimens were prepared for SEM.
Results: Er:YAG laser-irradiated specimens,
regardless of the irradiation distance, showed an irregular and
scaly surface, with intense ablation of the intertubular dentin,
mainly when the irradiation was performed in the focused mode
(12 mm). The smear layer was removed and dentin tubules were
opened, however, no tubule enlargement was found, unlike the
group that only received acid application. The irradiation with
17 mm resulted in a surface appearance more homogeneous than
those presented with other distances closer to the focus. The
subsequent acid-etching on the lased surfaces decreased the
superficial irregularities with partial exposure and enlargement
of dentin tubules, in all the tested irradiation distances. (Am
J Dent 2006;19: 217-221).
Clinical significance: The typical
topographical features of dentin surface after Er:YAG laser
irradiation, such as irregularities, intertubular dentin removal
and dentin tubule exposure were intensified when laser was
performed in the focused mode (12 mm).
Address: Dr. Aline Evangelista de Souza-Gabriel,
Department of Restorative Dentistry, University of São Paulo (USP),
Ribeirão Preto School of Dentistry, Av. do Café, S/N, Monte
Alegre, CEP: 14040-904 Ribeirão Preto, SP, Brazil. E-mail:
aline.evangelista@gmail.com
Effect of low O2-gas transmission
rate barrier films on Knoop hardness
and toothbrush abrasion of resin cements
Youkei Asaka,
dds, Masashi
Miyazaki, dds, phd,
Hiroyasu Kurokawa,
dds, phd, Toshiki Takamizawa,
dds, phd
& B. Keith Moore,
phd
Abstract: Purpose: To
investigate the influence of utilizing films with different
oxygen transmission rates (O2-GTR) on Knoop hardness
and toothbrush abrasion of resin cements for luting.
Methods: Four dual-activated, composite-type resin
cements, and a chemically activated PMMA-type resin cement, were
used. Three different types of barrier films (Techbarrier HI,
Harden Film N130, and Lix-2) were used. Resin cement was mixed
and inserted into a cylindrical mold (4 mm in diameter, 3 mm in
height), then chemically activated. The specimens were stored in
the dark at 37±1°C, 90±5%RH conditions for 1 hour. Knoop
hardness on the top surface of the resin cement was measured
with a micro- hardness tester. The top surface of specimens (8
mm in diameter, 3 mm in height) polymerized under the same
conditions were used for toothbrush abrasion testing. One-way
ANOVA followed by Tukey HSD test (P< 0.05) were done.
Results: When the cement surface was covered by low
O2-GTR film, a significant increase in Knoop hardness
and resistance to toothbrush abrasion was observed for the dual
activated, composite-type resin cements, but not for the
chemically activated PMMA type resin cement. From the results of
this study, the use of low O2-GTR matrix barrier
films for the dual activated, composite-type resin cements could
be effective in eliminating the oxygen inhibited layer on the
cement surface. (Am J Dent 2006;19: 222-226).
Clinical significance: The use of a low O2-GTR
barrier film has the potential to eliminate the oxygen inhibited
layer from dual activated, resin cement surface exposed to the
oral environment resulting in increased surface hardness and
resistance to toothbrush abrasion.
Address: Dr. Masashi Miyazaki, Department of
Operative Dentistry, Nihon University School of Dentistry,
1-8-13, Kanda Surugadai, Chiyoda-Ku, Tokyo 101-8310, Japan.
E-mail:
miyazaki-m@dent.nihon-u.ac.jp
Prevention of demineralization by CO2
and Er,Cr:YSGG laser irradiation of overdenture abutments
Luke A. Darling,
ba, Ronald L.
Ettinger, bds, mds,
ddsc,
James S. Wefel, phd,
Steven H. Cooper,
dds, ms & Fang Qian,
phd
Abstract: Purpose: To
assess the effects of Er,Cr:YSGG and CO2 laser
irradiation on the prevention of demineralization of overdenture
abutments. Methods: 32 human canines,
premolars, and molars were acquired, cleaned, and scaled. They
were randomly divided into two groups. Each tooth had two
windows on the occlusal cut dentin. One window on each tooth was
irradiated by either Er,Cr:YSGG or CO2 laser, while
the other window served as a control. After pH cycling at pH 5.5
for 18 days and pH 4.7 for 16 days, the teeth were sectioned and
analyzed using polarized light microscopy with water as the
imbibing medium. Results: The Er,Cr:YSGG
irradiated dentin had a mean lesion depth of 207 ± 27 µm while
its control had a mean lesion depth of 209 ± 34 µm. The CO2
laser irradiated dentin had a mean lesion depth of 185 ± 24 µm
while its control had a mean lesion depth of 205 ± 22 µm. Based
on paired t-tests Er,Cr:YSGG laser irradiation of dentin
did not reduce demineralization when compared to the controls
(P= 0.81), while CO2 laser irradiation of dentin
showed that it helped reduce demineralization when compared to
the controls (P= 0.025). (Am J Dent 2006;19: 227-230).
Clinical significance: The results suggest
that CO2 laser irradiation may be a way to help
reduce dentin demineralization on cut overdenture abutment
teeth. This methodology does not rely on patient compliance.
Address: Dr. Ronald Ettinger, Department of
Prosthodontics and Dows Institute for Dental Research, College
of Dentistry, University of Iowa, Iowa City, IA 52242 USA. E-mail:
Ronald-Ettinger@uiowa.edu
HEMA diffusion from dentin bonding agents through various
dentin thicknesses in primary molars
Ayşegül Çetingüç,
phd, Seval
Ölmez, prof
& Nilüfer Vural,
phd
Abstract: Purpose: To
evaluate in vitro HEMA diffusion amounts from three
dentin-bonding systems in primary molars with various remaining
dentin thicknesses. Methods: Occlusal
cavities were prepared with remaining dentin thickness of 0.5, 1
and 2 mm respectively. Chambers that contain 1 ml of distilled
water were attached to each tooth. The groups were treated with
Total Etch + Syntac Single Component, Syntac Single Component
and Clearfil SE Bond. Water eluates were removed after 72 hours
for analyses by HPLC. Results: The
cumulative HEMA release amounts were significantly different
between all groups (P< 0.05). Decreasing dentin thickness and
acid-etching significantly increased pulpward diffusion of HEMA.
(Am J Dent 2006;19: 231-235).
Clinical significance: Acid-etching
significantly increases pulpward release of HEMA from dentin
bonding systems in primary molar teeth. However, the dentin
bonding systems can be considered safe for clinical use in
primary teeth even in deep cavities since the released HEMA
amounts are below the level of cytotoxicity.
Address: Dr. Aysegül Çetingüç, Department of
Pediatric Dentistry, Faculty of Dentistry, Hacettepe University,
Sihhiye, Ankara 06100, Turkey. E-mail:
aysegulcetinguc@yahoo.com
Clinical evaluation of an ormocer, a nanofill composite and a
hybrid composite at 2 years
Begüm Güray Efes,
dds, phd, Can
Dörter, dds, phd
& Yavuz Gömeç, dds,
phd
Abstract: Purpose: To
evaluate the 2-year clinical performance of an ormocer, a new
nanofill composite and as a control a conventional hybrid
composite restorations in small Class I cavities of permanent
molars. Methods: 90 Class I maxillary
cavities were prepared in 90 patients. Cavities were restored
incrementally in oblique layers with ormocer (Admira), nanofill
(Filtek Supreme), or hybrid (Renew) composite material.
Restorations were examined using the United States Public Health
Service modified Ryge criteria at baseline, after 6 months, 1
year and 2 years. The changes in the parameters during the
2-year period were assessed with Friedman test analysis.
Comparison of the baseline scores with those at the recall
periods was evaluated by Wilcoxon signed rank test; the level of
significance was set at P< 0.05. Results:
None of the restorative materials exhibited secondary caries or
postoperative sensitivity at the 6-month, 1-year or 2-year
recall (P> 0.05). After 2 years, except the one failed Admira
restoration, no other criteria was clinically unacceptable. (Am
J Dent 2006;19: 236-240).
Clinical significance: In small Class I
cavities, when minimally invasive preparation techniques were
applied, despite the high configuration factor of the cavity,
packable ormocer, nanofill and hybrid composite resulted in high
clinical performance at the end of 2 years.
Address: Dr. Begüm Güray Efes, Istanbul
University, Faculty of Dentistry, Dept. of Operative Dentistry,
34390, Capa, Istanbul, Turkey. E-mail:
begumguray@yahoo.com
Direct bonding with precoated brackets
and self-etching primers
Ascensión Vicente,
dds, phd
& Luis A. Bravo,
md, dds, ms, phd
Abstract: Purpose: To
evaluate the shear bond strength and the adhesive remnant on the
tooth after the debonding of APC Plus precoated brackets, when
conditioning the enamel with phosphoric acid and Transbond Plus
Self Etching Primer (TSEP), in comparison with uncoated brackets
bonded with Transbond XT. Methods: The
brackets were bonded to extracted premolars, which were divided
into three groups: (1) Acid/Transbond XT, (2) Acid/ APC Plus and
(3) TSEP/APC Plus. Shear bond strength was measured using a
universal test machine. The crosshead speed was 1 mm/minute. The
adhesive remnant on the tooth was quantified using an image
analysis equipment. Results: No significant
differences were found in the bond strengths of the three groups
evaluated (P> 0.05). The two groups in which APC Plus system was
used left significantly less adhesive on the tooth than
Transbond XT. TSEP/APC Plus left significantly less adhesive
than Acid/APC Plus (P< 0.017). (Am J Dent 2006;19:
241-244).
Clinical significance: APC Plus system is
a good alternative to traditional bonding. The use of this
system together with TSEP reduces the number of steps during
bonding without compromising the bond strength.
Address: Dr. Ascensión Vicente, Docent Unit of
Orthodontics, Dental Clinic, University of Murcia,
Hospital Morales Meseguer, 2ª planta, Calle
Marqués de los Vélez, s/n, 30008 Murcia, Spain. E-mail:
ascenvi@um.es
Post-operative pain and use of analgesic agents following
various dental procedures
Liran Levin,
dmd, Alon Amit,
dmd & Malka
Ashkenazi, dmd
Abstract: Purpose: To
evaluate the incidence and duration of post-operative pain and
the use of analgesic agents in adults with regard to gender,
type of injection, dental procedure performed, and tooth
history. Methods: Frequency and duration of
post-operative pain and use of analgesic agents were examined in
255 patients, aged 18-42 years, who received routine dental
treatment, including amalgam and composite restorations, root
canal treatment (instrumentation), root canal filling (obturation),
posts, and extractions. Teeth were anesthetized by either local
infiltration (for maxillary teeth) or inferior alveolar nerve
block (for mandibular teeth). Information regarding
post-operative pain and use of analgesic agents was obtained
though a phone call, 24 hours after treatment. Results:
The overall incidence of post-operative pain was 40.4% (103
patients) of whom 36.9% (38 patients) reported a low level of
pain. Pain-relieving medication was used by 32% of the patients
who reported post-operative pain (12.9% of the population).
Incidence and severity of post-operative pain were significantly
correlated with specific dental treatment: the highest after
root canal filling (52.8%, 21% reported a low level of pain) and
lowest after restorations (36.1%, 42.4% reported a low level of
pain). Post-operative pain was reported more often by females
(52.2%) than males (33.7%) (P= 0.012). Incidence of
post-operative pain was not correlated with depth and extension
of the restoration performed. However, the severity of
post-operative pain as indicated by analgesic usage was more
frequent following deep restorations (over 3 mm). (Am J Dent
2006;19: 245-247).
Clinical significance: Prediction of
post-operative dental pain following a specific dental procedure
and the need for post-operative analgesics should be an integral
part of clinical practice for every dental professional. The
possibility that more than 40% of patients who have dental
treatment experience post-operative pain suggests that
clinicians should be more aware of the problem and be prepared
to prevent and manage the pain.
Address: Dr. Liran Levin, Department of Oral
Rehabilitation, The Maurice and Gabriela Goldschleger School of
Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel. E-mail:
liranl@post.tau.ac.il
Effect
of ammonium hexafluorosilicate on dentin tubule occlusion for
the treatment of dentin hypersensitivity
Toshiyuki Suge,
dds, phd,
Akiko Kawasaki,
dds, phd,
Kunio Ishikawa,
phd,
Takashi Matsuo,
dds, phd
&
Shigeyuki Ebisu,
dds, phd
Abstract:
Purpose:
To evaluate the occluding ability of ammonium hexafluorosilicate
(SiF). Methods:
Dentin disks prepared from human extracted teeth were grouped as
follows to prepare different situations of dentin
hypersensitivity: (1) those sonicated for 20 minutes; (2) those
treated with 0.5 mol/L EDTA for 2 minutes; (3) those treated
with 6% citric acid for 2 minutes; (4) those treated with 50%
citric acid for 2 minutes. Then, SiF or diamine silver fluoride
(AgF) was applied to the dentin disks and the dentin tubule
occlusion was observed with scanning electron microscopy (SEM).
The percent of open tubules before and after SiF or AgF
treatment were measured by NIH image using SEM photographs.
Also, the dentin permeability was measured.
Results: SEM
micrographs demonstrated that the dentin tubules were completely
occluded by the precipitate after SiF treatment. Also, the
dentin permeability was reduced to 10.3%. In contrast, most of
the dentin tubules remained open after AgF treatment. EDXA
analysis showed that the precipitate in the dentin tubules that
forms after SiF treatment contains Si, Ca and P, indicating a
silica-calcium phosphate complex. (Am J Dent 2006;19:
248-252).
Clinical significance:
Ammonium hexafluorosilicate occluded dentin tubules completely
with a silica-calcium phosphate mineral without changing the
color of the teeth, and may be useful for the treatment of
dentin hypersensitivity.
Address: Dr.
Toshiyuki Suge, Department of Conservative Dentistry, Institute
of Health Biosciences, the University of Tokushima Graduate
School, 3-18-15 Kuramoto, Tokushima, 770-8504 Japan.
E-mail:
suge@dent.
tokushima-u. ac.jp |
