Brenda Bohaty

Adhesive/Dentin Interface: The Weak Link in the Composite Restoration

Results from clinical studies suggest that more than half of the 166 million dental restorations that were placed in the United States in 2005 were replacements for failed restorations. This emphasis on replacement therapy is expected to grow as dentists use composite as opposed to dental amalgam to restore moderate to large posterior lesions. Composite restorations have higher failure rates, more recurrent caries, and increased frequency of replacement as compared to amalgam. Penetration of bacterial enzymes, oral fluids, and bacteria into the crevices between the tooth and composite undermines the restoration and leads to recurrent decay and premature failure. Under in vivo conditions the bond formed at the adhesive/dentin interface can be the first defense against these noxious, damaging substances. The intent of this article is to review structural aspects of the clinical substrate that impact bond formation at the adhesive/dentin interface; to examine physico-chemical factors that affect the integrity and durability of the adhesive/dentin interfacial bond; and to explore how these factors act synergistically with mechanical forces to undermine the composite restoration. The article will examine the various avenues that have been pursued to address these problems and it will explore how alterations in material chemistry could address the detrimental impact of physico-chemical stresses on the bond formed at the adhesive/dentin interface.

Posterior composite restoration update: focus on factors influencing form and function

Restoring posterior teeth with resin-based composite materials continues to gain popularity among clinicians, and the demand for such aesthetic restorations is increasing. Indeed, the most common aesthetic alternative to dental amalgam is resin composite. Moderate to large posterior composite restorations, however, have higher failure rates, more recurrent caries, and increased frequency of replacement. Investigators across the globe are researching new materials and techniques that will improve the clinical performance, handling characteristics, and mechanical and physical properties of composite resin restorative materials. Despite such attention, large to moderate posterior composite restorations continue to have a clinical lifetime that is approximately one-half that of the dental amalgam. While there are numerous recommendations regarding preparation design, restoration placement, and polymerization technique, current research indicates that restoration longevity depends on several variables that may be difficult for the dentist to control. These variables include the patient’s caries risk, tooth position, patient habits, number of restored surfaces, the quality of the tooth–restoration bond, and the ability of the restorative material to produce a sealed tooth–restoration interface. Although clinicians tend to focus on tooth form when evaluating the success and failure of posterior composite restorations, the emphasis must remain on advancing our understanding of the clinical variables that impact the formation of a durable seal at the restoration–tooth interface. This paper presents an update of existing technology and underscores the mechanisms that negatively impact the durability of posterior composite restorations in permanent teeth.

Physico-mechanical properties determination using microscale homotopic measurements: Application to sound and caries-affected primary tooth dentin

Microscale elastic moduli, composition and density have rarely been determined at the same location for biological materials. In this paper, we have performed homotopic measurements to determine the physico-mechanical properties of a second primary molar specimen exhibiting sound and caries-affected regions. A microscale acoustic impedance map of a section through this sample was acquired using scanning acoustic microscopy (SAM). Scanning electron microscopy was then used to obtain mineral mass fraction of the same section using backscattered images. Careful calibration of each method was performed to reduce system effects and obtain accurate data. Resorption, demineralization and hypermineralization mechanisms were considered in order to derive relationships between measured mineral mass fraction and material mass density. As a result, microscale mass density was determined at the same lateral resolution and location as the SAM data. The mass density and the acoustic impedance were combined to find the microscale elastic modulus and study the relationship between microscale composition and mechanical properties.

The Effect of Parental Stress on the Oral Health of Children

Purpose: Examine the hypothesis that parenting stress was associated with poorer oral health in children. Methods: Ninety primary care-givers of children aged 5–12 years seen for routine dental visits completed the Parenting Stress Index (PSI) and demographic measures. The childs oral health was assessed by the number of decayed, filled, and missing teeth, and by the difference between recommended and actual times for return visits. Results: Lower levels of care-giver age, education, and Child Domain scores on the PSI predicted poorer dental health. Older children were significantly more likely to return on time for their next visit. Conclusions: In this economically stressed sample, children whose parents rate them as easy to care for and children of younger and less well-educated parents were more likely to have poorer oral health. Research on a more diverse population would determine if the results from this study can be generalized to other populations.

Dentin/Adhesive Interface in Teeth

Clinical studies have demonstrated an alarmingly high failure rate for posterior composite dental restorations. The premature failure of moderate-to-large composite restorations can be traced to a breakdown of the bond at the tooth surface/composite material interface and increased levels of cariogenic bacteria at the perimeter of these materials. In this chapter, we discuss the dentin/adhesive bond, with a focus on the failure of current adhesives to consistently seal and adhere to the dentin. The concept of forming a resin-reinforced hybrid layer for improved adhesion is presented. The complex role of water in dentin/adhesive bonding is then described. Finally, mechanisms leading to mechanical property changes at the interface are discussed.

Dental anomalies in pediatric patients with familial adenomatous polyposis

Familial adenomatous polyposis patients often present with non-malignant extra-intestinal manifestations which include dental anomalies that may be evident prior to the appearance of the colonic adenomas. The aims of this study were to describe the prevalence and type of dental anomalies and the relationships between gene mutations and dental anomalies in these patients. Twenty-two pediatric familial adenomatous polyposis patients and 46 controls, who were age and gender matched participated. Familial adenomatous polyposis patient’s had a dental examination with panoramic radiograph and medical record review for age at diagnosis, the presence of the adenomatous polyposis coli gene mutation, and determination of other extra-intestinal manifestations on the body. The control group was identified from a retrospective chart review and selected if there was a current panoramic radiograph. The only significant difference between familial adenomatous polyposis patients and controls were the presence of jaw osteomas and sclerosis (p = .0001). Patients with a mutation in, or upstream of codon 1309 had a higher frequency of osteomas (77.8%) and jaw-bone sclerosis (44.4%), and 77% of these had at least one dental anomaly. This preliminary study showed an association between a genetic variant at, or upstream of codon 1309, and radiographic dental anomalies.

Is histologic esophagitis associated with dental erosion: a cross-sectional observational study?

BackgroundGastroesophageal reflux disease (GERD) affects 15–25% of children and adolescents in the United States. The diagnosis of GERD in children is complex as reported symptoms or symptom profiles have been found to be unreliable. Frequently, the diagnosis must be confirmed by objective tests such as pH monitoring or histological evidence of esophagitis on an esophageal biopsy. Dental erosion has been shown to be associated with GERD as an atypical complication and has the potential to be a marker of GERD. The purposes of this study were to compare the frequency and patterns of dental erosion in children and adolescents with and without histologic esophagitis.MethodsTwenty-five subjects were recruited from patients scheduled for an upper gastrointestinal endoscopy. Information regarding potential GERD symptoms, food habits, and dental hygiene habits were obtained. Intra-oral photographs were taken, and a dental exam for erosion was performed. The results of a standard biopsy taken from the lower third of the esophagus during an endoscopy were used to divide subjects into either the control group or the GERD group (i.e. those with histologic esophagitis).ResultsTwenty-two subjects yielded 586 evaluable teeth. No significant difference was found between frequency or erosion patterns of those with and without histologic esophagitis. Dental erosions were more frequent in primary teeth.ConclusionsDental erosions do not appear to be associated with histologic esophagitis indicative of GERD.