Harald O. Heymann

Non-carious cervical lesions

Non-carious cervical lesions are commonly encountered in clinical practice and present in a variety of forms. A knowledge of the aetiology of these lesions is important for preventing further lesions, halting progression of lesions already present, and determining appropriate treatment. The most commonly cited aetiological factors thought to lead to the development of cervical lesions are erosion, abrasion and tooth flexure. Evidence supports a multifactorial aetiology for non-carious cervical lesions. The purpose of this paper is to review the evidence for each of these aetiological factors as it relates to the development of non-carious cervical lesions. Specific features of cervical lesions linked to these factors, including their morphology, location, prevalence and distribution by age and sex will be discussed. Suggestions for future research into the cause and prevention of non-carious cervical lesions will be presented.

Examining Tooth Flexure Effects on Cervical Restorations: A Two-Year Clinical Study

This study evaluated the clinical performance of dentinal adhesives in seven various material/technique combinations. No statistically significant differences were observed among the restorative combinations, or among technique variables after two years in terms of retention, sensitivity or USPHS categories. However, other factors related to tooth flexure--such as occlusal stress, patient age, restorative material and restoration location--showed statistically significant associations with retention failures. These results support a tooth flexural theory of restoration retention.

Clinical Evaluation of an All-in-one Adhesive in Non-Carious Cervical Lesions with Different Degrees of Dentin Sclerosis

This randomized clinical trial compared the performance of an all-in-one adhesive (iBond) applied in sclerotic and non-sclerotic non-carious cervical lesions with that of a three-step etch-prime-bond adhesive (Gluma Solid Bond, SB). One-hundred and five lesions were randomly assigned to four groups according to adhesive, sclerosis scale and technique: 1) SB applied to lesions with sclerosis scale 1 and 2 (n=26); 2) iBond applied to lesions with sclerosis scale 1 and 2 (n=28); 3) iBond applied to lesions with sclerosis scale 3 and 4 (n=25) and 4) iBond applied with prior acid-etching to lesions with sclerosis scale 3 and 4 (n=26). A microfilled composite (Durafill VS) was used as the restorative material. The restorations were evaluated for retention, color match, marginal adaptation, anatomic form, cavosurface margin discoloration, secondary caries, pre- and post-operative sensitivity, surface texture and fracture at insertion (baseline), 6, 18 months and at 3 years using modified USPHS evaluation criteria (Alfa=excellent; Bravo=clinically acceptable; Charlie=clinically unacceptable). There was a high percentage of Bravo scores for marginal adaptation (4%-32%) and marginal discoloration (18%-60%) in Groups 2, 3 and 4, but all groups had <5% Charlie scores at 6 months and <10% Charlie scores at 18 months for retention and marginal discoloration, respectively. However, it should be noted that 13% of the restorations in Group 4 were not retained at three years.

Polishing porcelain veneers: an SEM and specular reflectance analysis.

Abstract Techniques for placement of etched porcelain laminate veneers require that the glazed porcelain veneer be cemented prior to finishing and polishing. Finishing the veneer margins corrects the inherent marginal defects but results in removal of the glaze from the porcelain. This invites a poor tissue response unless the porcelain can be polished to a smooth surface. Using scanning electron microscopy (SEM) and specular reflectance, the surface texture of autoglazed porcelain was compared with that of polished porcelain. Emphasis was placed on those instruments which are suitable for gingival and interproximal finishing. Finishing with a fine diamond instrument followed only by diamond polishing paste produced an unacceptable surface. A finish equal or superior in smoothness to glazed porcelain was achieved through the use of a series of finishing grit diamonds (Micron Finishing System) followed by a 30-fluted carbide bur and diamond polishing paste. Other finishing combinations produced surface textures which were not as smooth as glazed porcelain, but which were better than that attained by the diamond polishing paste alone.

Effects of saliva contamination on resin-resin bond strength

OBJECTIVE The purpose of this study is to evaluate the effects of saliva contamination on microtensile bond strength (microTBS) between resin interfaces and to determine which decontamination methods best re-established the original resin-resin bond strength. MATERIALS AND METHODS Ninety-six light-cured resin composite cylinders of Z-250, Renew, Clearfil APX, and Pertac II were randomly divided into six groups. For each material, one group of specimens was not contaminated, serving as the control. For the other specimens, the top surface of each block was treated with saliva that was slowly dried (Treatment 1); dried forcefully (Treatment 2); slowly dried, rinsed, and dried (Treatment 3); slowly dried, rinsed, dried, and bonded with Single Bond, One-Step, Clearfil SE Bond, or Prompt L-Pop (Treatment 4); or slowly dried, but not rinsed, and bonded using the same adhesives (Treatment 5). Two 2-mm increments of resin composite were applied and light-cured. After 24 h, the assemblies were trimmed for microtensile bond testing and were loaded to failure at 1 mm/min. Data were analyzed using two-way and one-way ANOVA and Fishers PLSD (p<0.05). RESULTS Control values ranged from 45.1 MPa for Pertac II to 71.5 MPa for APX. Treatment 1 caused significant reduction in resin-resin bond strength for all materials tested but for two of the materials in treatment 2. Pertac II was the only material that did not show a statistical difference from control group for treatment 3. Treatment 4 re-established the control values for Z-250 and Renew and treatment 5 was the only one to show no statistical difference for all materials tested. SEM observation revealed a smooth surface in treatment 1, but treatment 3 showed a few craters. Treatment 4 and 5 showed a mixture of cohesive failure in the composite and adhesive. SIGNIFICANCE The most reliable method for decontaminating saliva from resin surfaces involves the application of adhesives.

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.

Mechanical properties of a new mica-based machinable glass ceramic for CAD/CAM restorations.

Machinable ceramics (Vita Mark II and Dicor MGC) exhibit good short-term clinical performance, but long-term in vivo fracture resistance is still being monitored. The relatively low fracture toughness of currently available machinable ceramics restricts their use to conservative inlays and onlays. A new machinable glass ceramic (MGC-F) has been developed (Corning Inc.) with enhanced fluorescence and machinability. The purpose of this study was to characterize and compare key mechanical properties of MGC-F to Dicor MGC-Light, Dicor MGC-Dark, and Vita Mark II glass ceramics. The mean fracture toughness and indented biaxial flexure strength of MGC-F were each significantly greater (p < or = 0.01) than that of Dicor MGC-Light, Dicor MGC-Dark, and Vita Mark II ceramic materials. The results of this study indicate the potential for better in vivo fracture resistance of MGC-F compared with existing machinable ceramic materials for CAD/CAM restorations.

Effects of water, speed, and experimental instrumentation on finishing and polishing porcelain intra-orally

Previous studies indicated that porcelain can be polished smoother than glazed porcelain with instruments suitable for intra-oral use. This study evaluated several experimental instruments and materials to determine if polishing could be done more efficiently. Scanning electron microscopy was used to evaluate the surface texture produced by different combinations of experimental instruments applied with high and moderate speed, wet and dry, to porcelain disks. No sequence matched the polished standard. However, the optimum surface texture was obtained with diamond instruments (with progressively smaller particle sizes) used at a moderate speed with water, followed by a 30-fluted carbide bur at high speed and dry, then diamond polishing paste on a webbed rubber cup. In all polishing sequences tested, the best results were obtained with each individual instrument when diamond instruments were used at moderate speed wet, and when carbide instruments were used at high speed dry.

Five-year clinical investigation of one conventional composite and three microfilled resins in anterior teeth

Abstract The objective of this clinical study was to compare the esthetic qualities of surface smoothness, color stability, and marginal discoloration in microfilled resins versus conventional composites. The study evaluated the long-term clinical performance of 3 microfilled resins (Finesse, Silar, Superfil) and one conventional composite (Concise) placed in conventional Class III cavity preparations. A total of 110 restorations were evaluated using USPHS criteria for color match, marginal discoloration, secondary caries, anatomic form, and marginal adaptation. Surface texture was also evaluated for each restoration. The recall level at 5 years was 57%, or 63 of the original 110 restorations. Despite exhibiting a smoother surface texture, the microfills displayed poorer color match than the conventional composite, Concise. The ideal color matching level at 5 years was 53% for Finesse, 27% for Silar, and 13% for Superfil as compare to 71% for the control, Concise. The microfills also exhibited a higher incidence of marginal discoloration, although not statistically significant from the control, Concise. All materials performed equally well regarding the parameters of secondary caries, anatomic form, and marginal adaptation. The results from this study are also compared to 2 similar 5-year studies regarding color match, marginal discoloration, and surface texture.

Confirmation of Leinfelder clinical wear standards

OBJECTIVES Accuracy of composite wear studies based on Leinfelder standards has been disputed. There are differences with other well-calibrated systems such as the M-L and Vivadent wear standards. The objective of this study was to reevaluate the margin height at key regions along the restoration margins for each of the 6 Leinfelder standards using laser profiling techniques. METHODS The Leinfelder standards were profiled in parallel paths 100 microns apart and measured in x-y-z position every 20 microns along those paths using a laser profilometer. RESULTS Rounding of cavosurface enamel margins from intraoral wear greatly increased the uncertainty of the true enamel margin location and step height measurements, precluding unequivocal measurements for standards #2 and #3. Values for other standards for the original report, newly measured means and standard errors, and measured ranges were: #4 (322 microns, 333 +/- 34 microns, 171-507 microns), #5 (382 microns, 459 +/- 44 microns, 202-649 microns), and #6 (493 microns, 584 +/- 91 microns, 315-1022 microns). There were no statistically significant differences (p < or = 0.10) between these and original values. Large standard errors may have obscured small differences that may exist. The Leinfelder cast conversion scale seems to be the correct relative magnitude. SIGNIFICANCE Differences between Leinfelder casts and other standards may be due to differences in shadow production. Clinical wear may be systematically underestimated by other cast evaluation methods that have well-defined margins. This emphasizes the need for standard casts with margin morphology similar to the clinical casts being evaluated for wear.