Taner Yucel

Clinical comparison of a flowable composite and fissure sealant: A 24-month split-mouth, randomized, and controlled study

OBJECTIVES The aim of this clinical study was to evaluate the retention rate and caries-prevention effect of a flowable composite compared to a conventional resin-based sealant in a young population over a 24-month period. METHODS Thirty-four patients, ranging in age from 16 to 22 years, diagnosed with at least 2 non-cavitated pit-and-fissure caries in the first and second molars were selected for this randomized split-mouth design trial. A total of 220 sealants, were placed in 117 upper molars and 103 lower molars. The teeth were sealed with a flowable resin composite (Tetric Evo Flow) or a sealant material (Helioseal F). Each restoration was independently evaluated in terms of retention and the presence of caries at baseline and at 1, 6, 12, and 24 months. Data were analyzed using non-parametric Mann-Whitney U and Friedman 1-way ANOVA tests at p<0.05. RESULTS Tetric Evo Flow showed complete retention with 100%, 95.5%, 93.8%, and 88.5% at 1, 6, 12, and 24-month evaluations, respectively, while Helioseal F retention rates were 98.1%, 95.5%, 94.8%, and 85.4%, respectively, for the same evaluation periods. At the 24-month recall, 4 (4.2%) total losses were observed in subjects treated with Tetric Evo Flow and 2 total losses (2.1%) for Helioseal F, respectively. No significant differences were observed between the materials in retention rates or caries incidence for each evaluation period (p>0.05). CONCLUSION Placement of flowable composite as fissure sealants in the younger population seems to be as effective as conventional fluoride containing fissure sealants for the prevention of fissure caries. CLINICAL RELEVANCE The use of a flowable composite as a fissure sealant material, in conjunction with a total-etch, single bottle adhesive, yielded better retention than did the conventional fluoride containing resin-based fissure sealant over a 24-month period in young patients.

Shear bond strength of a new self-adhering flowable composite resin for lithium disilicate- reinforced CAD/CAM ceramic material

PURPOSE The purpose of this study was to evaluate and compare the effects of different surface pretreatment techniques on the surface roughness and shear bond strength of a new self-adhering flowable composite resin for use with lithium disilicate-reinforced CAD/CAM ceramic material. MATERIALS AND METHODS A total of one hundred thirty lithium disilicate CAD/CAM ceramic plates with dimensions of 6 mm × 4 mm and 3 mm thick were prepared. Specimens were then assigned into five groups (n=26) as follows: untreated control, coating with 30 µm silica oxide particles (Cojet™ Sand), 9.6% hydrofluoric acid etching, Er:YAG laser irradiation, and grinding with a high-speed fine diamond bur. A self-adhering flowable composite resin (Vertise Flow) was applied onto the pre-treated ceramic plates using the Ultradent shear bond Teflon mold system. Surface roughness was measured by atomic force microscopy. Shear bond strength test were performed using a universal testing machine at a crosshead speed of 1 mm/min. Surface roughness data were analyzed by one-way ANOVA and the Tukey HSD tests. Shear bond strength test values were analyzed by Kruskal-Wallis and Mann-Whitney U tests at α=.05. RESULTS Hydrofluoric acid etching and grinding with high-speed fine diamond bur produced significantly higher surface roughness than the other pretreatment groups (P<.05). Hydrofluoric acid etching and silica coating yielded the highest shear bond strength values (P<.001). CONCLUSION Self-adhering flowable composite resin used as repair composite resin exhibited very low bond strength irrespective of the surface pretreatments used.

Overfilling of the root A case report

In this report, attempts have been made to present as an interesting case report overfilling of the root canal, which is one of the most important errors caused by a dentist. The iodoform paste that was applied as a result of canal treatment, which was performed on the left mandibular second premolar, did not only overfill the apical lesion of that tooth but also extended as far as the apical region of the left mandibular second molar. In the periapical and panoramic radiographs, it is seen that the overfilled canal filling material extended as far as the angulus region of the mandible. It is also observed that the canalis mandibularis was not affected by this process and that the overfilled canal paste extended through the trabeculae of the mandibular bone. The fact that the paste disappeared after a short period of time supports the view that the canal filling material was the iodoform paste, which was resorbed.

Initial Consultation and/or Clinical Considerations (Patient History)

Initial consultation is important for both patient and clinician for a joint evaluation of an esthetic treatment plan. Multiple appointments are necessary to create optimal results and satisfactory outcomes for both patient and clinician; hence, a comprehensive evaluation of the patient before initiation of any therapy is mandatory. Sufficient time should be allotted for initial consultation to gather necessary information and response the specific questions related to the case. Thereafter, a detailed medical history of the patient should be gathered to identify the conditions that could contraindicate, complicate, or alter the treatment procedure. In addition, extraoral, muscle, intraoral, periodontal, radiographic, and occlusion examinations should be performed meticulously, with attention also devoted to esthetic considerations.

EFFECT OF SURFACE SEALING ON STAIN RESISTANCE OF A NANO-HYBRID RESIN COMPOSITE

Purpose: This study investigated the influence of sealant application on stain resistance of a nanohybrid resin composite compared to the efficacy of a bonding agent used as a surface sealant on prolonging color stability of the resin composite. Materials and Methods: 28 disc-shaped materials were prepared from a nano-hybrid resin composite Filtek Z550 and assigned to four groups: G1K: nonsealed; G2:Adper Single Bond; G3: Fortify ; G4: Biscover LV. After 24 h storage in distilled water at 37˚C, all specimens were subjected to thermocycling and immersed into coffee solution. Color measurements were performed using spectrophotometer (VITA Easyshade; Vident) according to CIEL*a*b* system. Results: Color change values were significantly different among the groups in each evaluation period except for after thermocycling (p<0.05). For 7 days evaluation period, the difference between G3 and G4 group was statistically significant while G4 exhibited statistically significant differences (p<0.05 and p<0.0001 respectively) compared to control (G1) in 14 day whereas no significant difference was found between GI and GII in 28-day evaluation period. However, ΔE values of sealed specimens (GIII, GIV) differed significantly from non-sealed (GI) specimens after 28 days of immersion in coffee solution (p<0.05 and p<0.0001 respectively). Conclusion: It may be concluded that using a bonding agent as a surface sealant does not increase stain resistance of resin composites of the sealants evaluated. Biscover LV showed the highest efficacy to prolong color stability of the resin composite.

Prevalence of dental injuries and awareness regarding mouthguards among basketball players and coaches

BACKGROUND Dental injuries are frequently occurred by an impact to facial area among basketball players. In fact, mouthguards are able to absorb the power of impacts and protect teeth from excessive forces, it is crucial for players even at training to wear mouthguards. To determine the prevalence of dental injuries and investigate the awareness about the use of mouthguards among basketball players and coaches. METHODS A 14-item questionnaire was designed and tested among licensed basketball players and coaches, all of whom were continuously exposed to the risk of dental injuries. The questions focused on the prevalence of dental injuries and attitudes and knowledge regarding the use of mouthguards among the players and coaches. Data were calculated using descriptive statistics and χ2 tests. RESULTS A total of 53 coaches (18-69 years) and 351 players (12-38 years) participated. Of these, 124 players (35% of the total sample) had experienced oral injuries, including soft tissue lacerations (80.6%), fractures (17.7%) and avulsions (1.6%). Although the players had sustained dental injuries, 95% of them found mouthguards to be protective, and only 6.3% (N.=22) actually used a mouthguard. The rate of mouthguard use among players who had experienced an oral injury was significantly higher than that among players without any history of injury (P<0.05). Although 98% of the coaches believed that mouthguards could prevent dental injuries, only 47% of them suggested their use to their players. The most common reasons for not using a mouthguard were discomfort (37.7%) and difficulty in breathing (7.3%) or talking (6.4%). CONCLUSIONS This study showed that the use of mouthguards among basketball players is very rare, with inadequate knowledge among the coaches. Consequently, more information is required through sports associations and dentists.

Material Selection: Restorative Materials

Recent development and improvements in dental technology have made it possible to restore teeth as same as natural, biomimetic, and functional by creating a strong bond between tooth structures with minimal invasive or no tooth preparation by preserving the healthy tooth. Innovations in the resin composites’ material formulation have led to the use of new monomers and fine inorganic fillers in the material composition, and these improvements have allowed reduced polymerization shrinkage, high mechanical and physical properties, and high polishability and also mimic nearly as the same natural tooth structures. Moreover, advances in ceramic technology have also led to major development in these systems typically reinforced materials that withstand occlusal forces and translucency that mimic natural tooth structures in the esthetic zone.

Esthetic Parameters/Smile Design

Increasing number of patients are demanding mechanically functional, physiologically sound, and esthetically pleasant restorations in recent years. Achieving esthetically and functionally pleasant restorations in harmony with the patient’s teeth, gingiva, lips, face, as well as occlusion is the most important aspect in esthetic dentistry. In esthetic dentistry, several combinations of measurable dimension, formulae, and geometric proportions have been proposed. Applying these specific rules, tools, and principles to patient’s face as well as mouth for smile design creates a pleasant, esthetic, and natural final appearance.

Facial-Dentofacial Analysis

In creating a naturally pleasing esthetic smile in smile design procedure, the clinician should use horizontal and vertical lines between anatomical landmarks of the face to produce harmonious form and balance between teeth, gingiva, lips, and face. A variety of essential facial landmarks are used for smile analysis, and these should be examined using guidelines for facial symmetry and proportions. In general, the concept of facial analysis comprises dividing the face horizontally into three equal thirds for optimal balance and pleasing proportions for achievement of a more attractive and harmonious face. In addition to facial evaluation through smile analysis, the clinician should also evaluate the lateral facial profile in collaboration with the orthodontist using cephalometric radiographs for appropriate diagnosis and treatment plan of a case.

Definition and Causes of Diastema

Diastema has a multifactorial etiology. Some of the etiological factors are clear-cut, whereas others are controversial and not completely elucidated. It is very important to define the possible causes because the treatment of diastema depends on the correct diagnosis of the etiology and elimination of the causes. This chapter will describe diastema and related etiological factors.