John O. Burgess

The advantages of coated titanium implants prepared by radiofrequency sputtering from hydroxyapatite

The method used to apply hydroxyapatite to implant surfaces may affect the thickness and ultimately the physical properties of the coating. This study investigated and compared the healing rates of bone around commercially pure titanium implants and titanium implants sputter-coated from a hydroxyapatite target. Forty-five sputter-coated implants and an equal number of noncoated titanium implants were placed into 15 partially edentulated dog mandibles. The implants were removed at three time periods and were evaluated mechanically and histologically. A multiple analysis of variance indicated that the interface bond strength was statistically greater (p less than 0.01) for the sputter-coated implants. Histologic analysis of the bone-implant interface demonstrated that coated implants had nearly twice the percentage of direct bone contact compared with noncoated implants. The results indicate that implants sputter-coated from a hydroxyapatite target will accelerate the healing of bone at the implant interface.

The resistance to tensile, compression, and torsional forces provided by four post systems.

This study measured the force required to displace four different endodontic posts (an experimental, Para-Post, Flexi-Post, and V Lock) when tensile, torsion, or compressive forces were applied. Extracted mandibular premolars were decoronated at the cementoenamel junction, the roots were divided into groups of similar size, and the pulpal tissue was removed. The canals were enlarged, cleaned, and filled with gutta percha. Post preparations were made, and the posts were cut and cemented into the post spaces with resin cement. The roots were notched with a separating disc and lowered into a metal tube filled with acrylic resin. Two Minim pins were placed into the coronal dentin paralleling the post. Composite resin cores were made around the coronal 4 mm of the posts and the two pins for 10 specimens from each group. The specimens were placed into a standardized fixture and a load applied until failure. The tensile load required to pull the experimental post and resin was significantly less than the load required to remove the threaded posts. Flexi-Posts provided the greatest resistance to torsion and tensile loading. The compressive load required to fracture the core over the V-Lock post was significantly greater than the other post systems.

Fracture resistance of amalgam coronal-radicular restorations

The effect of pulp chamber depth and extension into the root canal space on fracture resistance was examined on endodontically treated teeth with coronal-radicular amalgam restorations. Six groups of 10 mandibular molars were mounted in acrylic resin, and crowns were ground apically until the wall height of the pulp chamber was 2, 4, or 6 mm. Three millimeters of gutta-percha was removed from the three canals of one-half the teeth and amalgam was condensed into the canal space to a height 7.5 mm above the cementoenamel junction (CEJ). The remaining teeth had amalgam condensed from the floor of the chamber to 7.5 mm above the CEJ. The amalgam restorations were loaded with an Instron instrument (Instron Corp., Canton, Mass.) until failure. Amalgam extension into the root canal space contributed minimally to the fracture resistance of the amalgam coronal-radicular restoration with four or more millimeters of chamber wall. If less than 4 mm of chamber wall height remained, however, the fracture load was substantially increased. Amalgam extension into the root canal space should be confined to teeth with limited remaining pulp chambers.

Cutting effectiveness of diamond instruments subjected to cyclic sterilization methods

The effect of repeated sterilization on the cutting effectiveness of one brand of rotary dental diamond cutting instruments was measured. Four groups of five diamond burs were sterilized by four methods: (1) sterilization with a chemical agent (Sporicidin); (2) steam under pressure (autoclave); (3) dry heat (Dri-Clave); or (4) chemical vapor (Chemiclave). Each group of diamond instruments made a timed cut in a ceramic block. This cut and all subsequent cuts were measured and were used to determine a baseline cutting effectiveness. Each group of diamond burs was then ultrasonically cleaned, sterilized, and another cut was made. At the end of 10 cycles there was no difference in cutting efficiency of the dental diamond instruments. However, there are differences in the cutting efficiency of individual diamond instruments. The SEM evaluation made prior to cutting and at the end of the 10 cycles of sterilization demonstrated that diamond wear was similar in all groups and that little diamond particle loss occurred in any group.

Treating root-surface caries

This article summarizes the effectiveness of restorative materials used to restore root surfaces, the mechanisms by which these materials reduce caries, and placement techniques for restoring root-surface lesions. Patients may be classified into low, medium, and high caries risk groups for root caries, and specific dental restorative material recommendations are made for each category. Effective plaque control, xylitol-containing chewing gums, antimicrobial agents, fluoride-releasing restorative materials, topically applied fluoride, and fluoride-containing toothpastes provide maximum protection for the high caries risk patient.

Modification of the resistance form of amalgam coronal-radicular restorations

Three groups of 10 extracted endodontically treated mandibular molars were mounted in acrylic resin. The occlusal surface was reduced until a 4 mm pulp chamber height remained. A peripheral shelf 2 mm deep and 1.4 mm wide was placed on one group, while four TMS Minim pins were placed 45 degrees to the long axis of the tooth into the facial and lingual walls of the second group. The final group served as the control and had no further treatment. All teeth were then restored with amalgam. An Instron testing machine was used to apply a controlled force to the beveled amalgam at a crosshead speed of 2 mm/min until fracture occurred. A peripheral shelf did not improve the fracture resistance of the coronal-radicular restorations tested. The specimens with semihorizontal pins were significantly stronger than specimens from the other groups. Placement of pins into the pulp chamber is recommended when adequate dentin remains.

Factors influencing the progression of noncarious cervical lesions: A 5-year prospective clinical evaluation

STATEMENT OF PROBLEM The etiology (chemical, friction, abfraction) of noncarious cervical lesion (NCCL) progression is poorly understood. PURPOSE The purpose of this 5-year prospective clinical trial was to measure the relationship between NCCLs and various etiologic factors. MATERIAL AND METHODS After review board approval, 29 participants with NCCLs were enrolled. Polyvinyl siloxane impressions were made of each NCCL, and casts were poured at baseline, 1, 2, and 5 years. The casts were scanned with a noncontact profilometer, and 1-, 2-, and 5-year scans were superimposed over baseline scans to measure volumetric change in NCCLs. T-scan and Fujifilm Prescale films were used to record relative and absolute occlusal forces on teeth with NCCLs at the 5-year recall. Participant diet, medical condition, toothbrushing, and adverse oral habit questionnaires were given at the 5-year recall. Occlusal analysis was completed on mounted casts to determine the presence of wear facets and group function. Volumetric lesion progression from 1 to 5 years was correlated to absolute and relative occlusal force using mixed model analysis. The Kruskall-Wallis and Mann-Whitney analyses compared lesion progression with diet, medical condition, toothbrushing, adverse oral habits, wear facets, and group function. RESULTS The NCCL progression rate over 5 years was 1.50 ±0.92 mm(3)/yr. The rate of progression of NCCLs was related to mean occlusal stress (P=.011) and relative occlusal force (P=.032) in maximum intercuspation position. No difference was seen in NCCL progression between participants with any other factors. CONCLUSION Heavy occlusal forces play a significant role in the progression of NCCLs.

Complex single-tooth restorations

There are many options for restoring the decimated dentition. [43] Excellent results can be obtained with many of the materials currently available. The restorative option will depend on the size and location of the lesion, adequate isolation for adhesive restorations, caries rate, the patients age, the aesthetic needs of the patient, occlusal habits, maintenance of maximum tooth structure, the skill of the dentist, and the longevity desired for the restoration. Amalgam is a cost-effective material, and when used properly, it can provide many years of service. Aesthetic demands, the desire to strengthen teeth, [44] and concern about the safety of mercury in amalgam have increased the use of direct composites, ceramic material, and indirect composites. The main drawback with these materials, however, is their increased technique sensitivity and concerns about their longevity. Gold continues to be a cost-effective and predictable material if placed properly. Full-coverage gold or porcelain fused to metal provides long-term predictability but is more destructive and not as aesthetically appealing. The wide varieties of materials available provide both a challenge and an opportunity to place the most effective material for a particular patient. A thorough understanding of the available materials and their appropriate use is needed to achieve a long-lasting restoration that serves the patients needs.

Gloss and Stain Resistance of Ceramic-Polymer CAD/CAM Restorative Blocks: Gloss and Stain Resistance

OBJECTIVE To evaluate the gloss and stain resistance of several new ceramic-polymer CAD/CAM blocks MATERIALS AND METHODS Specimens (4 mm) were sectioned from: Enamic (polymer-infused ceramic), LAVA Ultimate (nano-ceramic reinforced polymer), e.max (lithium disilicate), Paradigm C (porcelain), and Paradigm MZ100 (composite). Specimens were wet polished on a polishing wheel to either 320 grit silicon paper (un-polished, N = 8) or 2000 grit silicon carbide papers followed by a 0.05 μm alumina slurry (polished, N = 8). Initial gloss and color (L*a*b*) values were measured. Specimens were stored in a staining solution at 37°C in darkness for 12 days (simulating 1 year). After storage, L*a*b* values re-measured. Change in color was reported as ΔE00 based on the CIEDE2000 formula. Gloss and ΔE00 were analyzed by two-way analysis of variance (ANOVA) (alpha = .05). Separate one-way ANOVA and Tukey post-hoc analyses were performed for both polish conditions and all materials. RESULTS Two-way ANOVA showed that factors material, polish and their interaction were significant for both gloss and ΔE00 (p < .01). Post-hoc analysis reveals that polished specimens had significantly less color change than un-polished specimens for Paradigm C and LAVA Ultimate. E.max had significantly higher gloss and less color change than all other materials. CONCLUSION The composition and polish of CAD/CAM materials affects gloss and stain resistance. CLINICAL SIGNIFICANCE Ceramic-polymer hybrid materials can achieve the high gloss required for esthetic restorations. These materials should be polished in order to minimize staining. If polished, all of the tested materials exhibited clinically acceptable color changes at 1 year of simulated staining. (J Esthet Restor Dent 28:S40-S45, 2016).