John S. Blalock

A Comparison of Human Raters and an Intra-oral Spectrophotometer

Consistently choosing an accurate shade match is far more difficult than it appears. Recently, several electronic shade-matching devices have been marketed. One device is an intraoral spectrophotometer, Easyshade. The current study compared the accuracy and consistency of the Easyshade (ES) device to three clinicians experienced in tooth whitening trials and trained in the use of the Vitapan 3D Master shade. The maxillary anteriors of 16 participants were matched on three separate occasions one month apart. At each appointment, the three clinicians (R1, R2 & R3) and ES independently chose a single 3D Master tab. A trained research assistant used the Easyshade device to record CIE L*, C* and H* and a shade tab. In addition, color differences between shade tabs were calculated using the Delta E 2000 (delta e 00) formula. The CIE L*C*H* data were also used to establish standards for the five lightness groups of the 3D Master. An intrarater agreement was evaluated using an intraclass correlation statistic, and an inter-rater agreement was evaluated using a weighted Kappa statistic. The percentages of exact matches were: ES = 41%; R1 = 27%; R2 = 22% and R3 = 17%. Matches within a half-shade were also calculated. This represents a mismatch that is perceptible but acceptable. The percentages of matches within a half-tab were: ES = 91%; R1 = 69%; R2 = 85% and R3 = 79%. In terms of lightness, the intra-rater agreement was considered to be very good for ES and R2 and good for R1 and R3. For chroma, agreement for ES was considered good, and for the three clinicians, it was considered moderate. The mean color difference for the L*, C*, H* data recorded at each evaluation was 1.5, or only slightly greater than the color difference between the same tab on different guides (1.2). The delta e 00 data were the most accurate data collected, and they were used to establish a standard to which the tab choices of the four raters were compared. A weighted Kappa statistic was performed and, in terms of lightness, agreement was found to be good for all raters. For chroma, agreement was very good for ES and it was good for the clinicians. In terms of the number of exact matches and matches within a half-shade, the performance of ES was at least comparable to, if not better than, the dentists. Statistically, the same was true in terms of consistency and accuracy when making repeated matches of lightness and chroma using the 3D Master shade guide.

Effect of restoration size on the clinical performance of posterior "packable" resin composites over 18 months.

Fifty predominantly moderate or large Class II or multiple-surface Class I resin composite restorations were placed in molars under rubber dam isolation. The restorative systems used were: Alert Condensable (Jeneric/Pentron) and SureFil (Dentsply/Caulk). The restorations were classified according to size, with 7 small, 25 moderate and 18 large, of which 8 were cusp replacement restorations. Baseline, 6, 12 and 18-month double-blinded clinical evaluations were carried out using modified USPHS criteria. The independent variables: restorative material, restoration size and three other clinical factors, were tested using a Multiple Logistic Regression procedure to determine if any were predictive of failure. Of the 50 restorations, four failed by the 18-month recall, three failed due to fracture of the restoration and one due to secondary caries. Both restorative systems demonstrated a 92% success rate. No association between restoration size (p = 0.99) or restorative material (p = 0.65) and failure was found. Similarly, the additional variables, occlusal contact type, presence of occlusal wear facets and first or second molar, were not predictive of failure.

A technique to determine a desired preparation axial inclination

The guidelines recommended in the literature for the convergence angle of a crown preparation vary from 3 to 24 degrees. There is a lack of guidelines on techniques to achieve a specific axial inclination. The purpose of this article was to present a practical technique, with a diamond rotary cutting instrument of known axial inclination, to determine the diamond rotary cutting instrument angulations required to achieve the desired axial inclination of a preparation.

Postoperative Sensitivity: A Comparison of Two Bonding Agents

Historically, postoperative pain associated with temperature was considered a thermal conduction problem. More recently, pulpal hydrodynamics has been used to explain this sensitivity. Relative to restorations placed with dentin bonding agents that require a separate etching step, agents that include an acidic primer are believed to result in a better seal of the dentinal tubules. This study compared pain associated with a standardized cold stimulus in two groups of restorations. One group was placed with a self-priming resin that required a separate etch step, the other with a self-etching, self-priming dentin bonding agent. This was a community-based, randomized, double-blind clinical trial. Two hundred and nine restorations were placed for 76 participants. All teeth were asymptomatic at the start of the trial. Immediately following application of a standardized cold stimulus, participants rated the pain for each restored tooth using a Visual Analog Scale (VAS). For each group of restorations, VAS scores at 13 weeks were compared to preoperative scores. In addition, the preoperative score was subtracted from the 13-week score, and the two groups of restorations were compared. For both groups of restorations, the median scores were significantly reduced at 13 weeks. This decrease in the VAS score reflects a reduction in sensitivity below that which existed preoperatively. There was no significant difference between the two groups of restorations in terms of change in sensitivity at 13 weeks.

The effect of chlorine-based disinfectant on wettability of a vinyl polysiloxane impression material.

STATEMENT OF PROBLEM Extended contact of impression materials with chemical disinfectant could remove surfactant, significantly altering the contact angle and wettability characteristics of an impression material. PURPOSE The purpose of this study was to determine the effect of contact time of chemical disinfectant solution on the dynamic contact angle of a commercial vinyl polysiloxsane impression material. MATERIAL AND METHODS Discs (3.5 × 25 mm) of heavy-body and wash consistencies of material (n=5) were fabricated and either left untreated, or subjected to spray treatment with a commercial disinfectant for various lengths of time (1, 20, or 60 minutes, or 24 hours). Treated specimens were washed and dried, after which dynamic contact angle measurements of a water droplet were determined at various points in time after deposition: 0, 2, 5, 10, 15, and 20 seconds. The same wash product was used without added surfactant (control). For a given type of impression material, contact angles were subjected to 1-way ANOVA within each droplet deposition time for all periods of disinfectant contact (α=.05). The Tukey-Kramer post hoc test was applied for pairwise means comparisons. RESULTS For each impression material type, significant increases in contact angles were found as the duration of disinfectant contact increased, at each measured droplet deposition time point. For both materials containing surfactant, extended contact with chemical disinfectant resulted in increased contact angles that were not significantly different from those of the nonsurfactant-containing control product. CONCLUSIONS Increasing the contact time between a surfactant-containing impression material and a disinfecting solution can significantly alter the resulting contact angle of the impression material and render it similar to a material depleted of surfactant. Following manufacturer-recommended chemical disinfection times reduces surfactant loss and only minimally affects surface wettability.

A Suggested Solution for Endodontic Provisional Challenges

The provisional restoration must provide a seal that prevents the exchange of fluids from the oral cavity to the canal space, while maintaining any medications within that space. Anderson and others have shown that IRM coronal restorations had significant leakage after seven days. This leakage was determined to be extensive under thermal stress. Galvin and others conducted a study wherein the resins tested “all produced coronal seals superior to those produced by IRM.” Efficient replacement and removal of the provisional restoration is essential. The restorative material must be prevented from entering the canal space. By using materials common to the dental office, cost is reduced.