Louis Mackenzie

Guidelines for the selection, use, and maintenance of LED light-curing units - Part 1.

Light curing is a critical step in the restorative process when using light-activated resin-based composites, but it is frequently not given the attention it deserves. The selection of a reliable light curing unit (LCU) that meets the practitioners needs is an important equipment purchase. Using an inappropriate LCU may seriously compromise the quality of care without the practitioner realising their mistake until years later. The importance of the subject is reflected by the rapidly increasing use of light-cured composites and the decline in the use of amalgam. Many changes have occurred in the equipment and materials available for making light-cured restorations in the last twenty years. This article is part of a two-part series that will describe those changes and recommend guidelines for the selection, use, and maintenance of light emitting diode light-curing units (LED LCUs). This paper (Part 1) discusses terminology, clinical studies, the development of LCUs in dentistry, the aims of light-curing, and the need to deliver an adequate amount of energy. The interaction between light source and material is briefly described to demonstrate the complex nature of the resin photopolymerisation process.

The minimally invasive management of early occlusal caries: a practical guide.

Pits and fissures on the occlusal surfaces of posterior teeth are sites affected commonly by demineralisation caused by the caries process. Clinicians face daily challenges in detecting these lesions, accurately diagnosing their activity and choosing from a range of management options. Traditionally, the detection of an active (or potentially active) occlusal lesion invariably resulted in the preparation of a standardised occlusal cavity, often extending beyond the confines of diseased tissue, followed by the insertion of a direct restorative material, most commonly dental amalgam. The overwhelming weight of contemporary evidence now favours minimally invasive (MI) operative management when required (usually after non-operative prevention has failed), and a wide range of equipment, materials and operative techniques is available to help operators to preserve the maximum amount of healthy/repairable tooth tissue and to allow restoration with more biologically respectful, tooth-preserving materials. This paper aims to provide clinicians with practical guidance in the prevention, early detection, predictable diagnosis and minimally invasive management of early occlusal carious lesions.

An audit of cavity and crown preparations and two direct restorations carried out by foundation dentists in the Oxford and Wessex Deaneries

It is likely that many foundation dentists (FDs) will have completed only minimal amounts of restorative dentistry for a number of months immediately prior to commencing work as FDs. Thus this audit aimed to assess the performance of the FDs when they carried out a number of simulated clinical exercises: amalgam cavities and restoration; Class IV resin composite restorations; and full crown preparations for metal-ceramic restorations. A total of 67 FDs completed the assessments and some results did indicate a high level of concern and need for further evaluation of restorative practice.

Minimally invasive direct restorations: a practical guide

The primary objectives of minimum intervention dentistry (MID) are to prevent or arrest active disease using non-operative management techniques. However, patients commonly present with cavitated caries lesions or failed restorations that are in need of operative intervention. Although much of clinical practice is devoted to preventing and managing the effects of caries and subsequent failure of the tooth-restoration complex, the clinical survival of restorations is often poor and becomes significantly worse as they increase in size and complexity. Minimally invasive (MI) restorative techniques present a range of well-documented advantages over more tissue-destructive traditional restorations by minimising unnecessary tooth tissue loss, insult to the dentine-pulp complex and reducing the risk of iatrogenic damage to adjacent hard and soft tissues. They also maximise the strength of the residual tooth structure by use of optimal adhesive restorative materials designed to restore function and aesthetics with durable, long-lasting restorations that are easy for the patient to maintain. In contemporary oral healthcare practice, if patients are to give valid consent for operative interventions, minimally invasive options must be offered, and may be expected to be the first choice of fully informed patients. This paper describes concepts of MID and provides an update of the latest materials, equipment and clinical techniques that are available for the minimally invasive restoration of anterior and posterior teeth with direct restorations.