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Cementation failures
LETTERS
TO
THE
E D IT O R
penicillin. In this group, gastro intestinal symptom s occurred in 31% and clindam ycin-associated diarrhea in 21%. . . . In the patient described, vanco m ycin might have been m ore appro priate. V ancom ycin given orally is p oorly absorbed. . . . M u ch o f the previously reported toxicity was as sociated with parenteral administra tion before many of the impurities were rem oved. . . . V ER LE D U A N E BO H M A N , MD C. C H R IST O P H E R G U IR Y , DM D T A C O M A , W A SH 1 . N e u , H. C ., a n d o th ers. In c id e n c e o f d ia rrh e a a n d c o litis a sso cia te d w ith c lin d a m y c in th era p y . J In fect D is 1 3 5 ( s u p p l) :S l2 0 1 2 5 , 19 7 7 . 2. T e d e sc o , F. J.; B arton , R. W .; a n d A lp e rs , D. H. C lin d a m y c in -a s so c ia te d co litis. A n n In tern M ed 8 1 (4 ):4 29 -4 33 O ct 1 9 7 4 .
A uthor’s com m ent: The patient was given m ultiple antibiotics not be cause o f any resistance developed to any particular drug, but because she d eveloped m ultiple allergic re sponses to each o f the drugs pre scribed after tw o to seven days. Cul ture and sensitivity tests were not possible on tw o occasions because of contam ination with normal oral flora, and on a third occasion be cause o f the nonfluctuant nature o f the swelling. At the time o f treatment (a year be fore publication o f the report), lin com ycin was available; I have since replaced it with clindam ycin w hen indicated. A week before my examination o f the patient, I was in form ed that cholestyram ine cou ld be used for antibiotic-induced diarrhea. I do not feel that it was particularly helpful in this case, possibly be cause of the patient’s history of diarrhea during menses. Synthetic tetracyclines were not tried because of the patient’s allergy to tetracycline. Cephalosporins were originally not used because o f possi ble cross-allergenicity to the p en icil lins. On consultation with a physi cian, cephalexin was prescribed, with resultant allergic phenom ena. I w ou ld still be hesitant to use vancom ycin because o f its toxic side effects. At the time in question, vancom ycin was noted for its side 526 ■ JADA, V ol. 98, A p ril 1979
effect o f deafness. R O G E R J. H A R R IS , D DS M Y S T IC , C O N N
C e m e n t a tio n f a ilu r e s
□ In response to the letter from Dr. J. E. Reuter and associates (The Jour nal, February), data obtained from our recently com pleted study on the effect o f thermal fluctuation on the integrity o f the cement seal in full cast-gold crow ns support their clin i cal experience. Zin c phosphate and zinc polyac rylate cements were used in this in vitro experiment dealing with mar ginal leakage in full cast-gold resto rations subjected to thermal cycling. Manufacturers’ recom m endations for m ixing procedures and liquidpow der ratio were strictly follow ed. Results indicated an enormous de gree o f marginal leakage in all crowns, regardless o f the fit or ce ment thickness, particularly in the polyacrylate group. This evidence has also been sup ported by our scanning electron m i croscop ic study w hich clearly show ed lack o f any adhesion o f polyacrylate cement to enamel, co n trary to the com m on claim. The m i crographs demonstrated an interfa cial separation o f cem ent from tooth and metal ranging from 2/u.m to 5/xm. Presumably these spaces open a pathway for salivary and bacterial penetration, causing acceleration o f the disintegration o f cement and tooth substrate. This, in conjunction with functional stresses in du ced in the cement, contributes to premature loosening o f cemented restorations. Our report is being prepared for publication. A N T H O N Y H . L . T JA N , DDS G A R Y D. M IL L E R , DDS LO S A N G ELES
□ After 40 years o f seating gold castings, I, too, am still seeking a cement that is “ kin d” to the pulp. I have now recemented or replaced all the restorations that were cem ented with EBA-type cements. At present we are recementing the polycarboxylate-cem ented restorations. This may not be a com puterized
study, but w henever a patient calls to say a casting has com e out, there is a 90% chance that my records w ill show “ Cemented with polycarboxylate.” I find that zinc oxyphosphate ce ment, even with its irritating qual ities, is still the most reliable luting material. Used w ith sedative bases and varnishes, it works and lasts. I w ou ld be interested in the experi ences of other dentists. . . S.
FO G ELSO N , DDS
W H IT E F IS H B A Y , W IS
L a r g e c a s t o f s u p e r n u m e r a r ie s
□ If you look closely, you should see at least a dozen supernumerary teeth in this radiograph. What is the largest number reported? H A R O L D R. B. H U T C H IN SO N , D D S R O G E R L . G E R T E N R JC H , D D S SA LEM , O RE
Editor’s com m ent: An article by Shusterman and others in the Novem ber-Decem ber 1978 issue o f Journal of Dentistry for Children re fers to a report by Smith in 1969 of 19 supernumerary teeth in a 21year-old, and also to a report by Foley in 1970 o f 14 supernumerary teeth in a 22-year-old man w hose nephew reportedly had 12.
C h i ld r e n ’s D e n ta l H e a lt h W e e k
□ It was very gratifying to read the editorial regarding National Chil dren’s Dental Health W eek (The Journal, February). I was especially pleased to see the Akron Dental S o ciety get recognition because so
TO
THE
E D IT O R
penicillin. In this group, gastro intestinal symptom s occurred in 31% and clindam ycin-associated diarrhea in 21%. . . . In the patient described, vanco m ycin might have been m ore appro priate. V ancom ycin given orally is p oorly absorbed. . . . M u ch o f the previously reported toxicity was as sociated with parenteral administra tion before many of the impurities were rem oved. . . . V ER LE D U A N E BO H M A N , MD C. C H R IST O P H E R G U IR Y , DM D T A C O M A , W A SH 1 . N e u , H. C ., a n d o th ers. In c id e n c e o f d ia rrh e a a n d c o litis a sso cia te d w ith c lin d a m y c in th era p y . J In fect D is 1 3 5 ( s u p p l) :S l2 0 1 2 5 , 19 7 7 . 2. T e d e sc o , F. J.; B arton , R. W .; a n d A lp e rs , D. H. C lin d a m y c in -a s so c ia te d co litis. A n n In tern M ed 8 1 (4 ):4 29 -4 33 O ct 1 9 7 4 .
A uthor’s com m ent: The patient was given m ultiple antibiotics not be cause o f any resistance developed to any particular drug, but because she d eveloped m ultiple allergic re sponses to each o f the drugs pre scribed after tw o to seven days. Cul ture and sensitivity tests were not possible on tw o occasions because of contam ination with normal oral flora, and on a third occasion be cause o f the nonfluctuant nature o f the swelling. At the time o f treatment (a year be fore publication o f the report), lin com ycin was available; I have since replaced it with clindam ycin w hen indicated. A week before my examination o f the patient, I was in form ed that cholestyram ine cou ld be used for antibiotic-induced diarrhea. I do not feel that it was particularly helpful in this case, possibly be cause of the patient’s history of diarrhea during menses. Synthetic tetracyclines were not tried because of the patient’s allergy to tetracycline. Cephalosporins were originally not used because o f possi ble cross-allergenicity to the p en icil lins. On consultation with a physi cian, cephalexin was prescribed, with resultant allergic phenom ena. I w ou ld still be hesitant to use vancom ycin because o f its toxic side effects. At the time in question, vancom ycin was noted for its side 526 ■ JADA, V ol. 98, A p ril 1979
effect o f deafness. R O G E R J. H A R R IS , D DS M Y S T IC , C O N N
C e m e n t a tio n f a ilu r e s
□ In response to the letter from Dr. J. E. Reuter and associates (The Jour nal, February), data obtained from our recently com pleted study on the effect o f thermal fluctuation on the integrity o f the cement seal in full cast-gold crow ns support their clin i cal experience. Zin c phosphate and zinc polyac rylate cements were used in this in vitro experiment dealing with mar ginal leakage in full cast-gold resto rations subjected to thermal cycling. Manufacturers’ recom m endations for m ixing procedures and liquidpow der ratio were strictly follow ed. Results indicated an enormous de gree o f marginal leakage in all crowns, regardless o f the fit or ce ment thickness, particularly in the polyacrylate group. This evidence has also been sup ported by our scanning electron m i croscop ic study w hich clearly show ed lack o f any adhesion o f polyacrylate cement to enamel, co n trary to the com m on claim. The m i crographs demonstrated an interfa cial separation o f cem ent from tooth and metal ranging from 2/u.m to 5/xm. Presumably these spaces open a pathway for salivary and bacterial penetration, causing acceleration o f the disintegration o f cement and tooth substrate. This, in conjunction with functional stresses in du ced in the cement, contributes to premature loosening o f cemented restorations. Our report is being prepared for publication. A N T H O N Y H . L . T JA N , DDS G A R Y D. M IL L E R , DDS LO S A N G ELES
□ After 40 years o f seating gold castings, I, too, am still seeking a cement that is “ kin d” to the pulp. I have now recemented or replaced all the restorations that were cem ented with EBA-type cements. At present we are recementing the polycarboxylate-cem ented restorations. This may not be a com puterized
study, but w henever a patient calls to say a casting has com e out, there is a 90% chance that my records w ill show “ Cemented with polycarboxylate.” I find that zinc oxyphosphate ce ment, even with its irritating qual ities, is still the most reliable luting material. Used w ith sedative bases and varnishes, it works and lasts. I w ou ld be interested in the experi ences of other dentists. . . S.
FO G ELSO N , DDS
W H IT E F IS H B A Y , W IS
L a r g e c a s t o f s u p e r n u m e r a r ie s
□ If you look closely, you should see at least a dozen supernumerary teeth in this radiograph. What is the largest number reported? H A R O L D R. B. H U T C H IN SO N , D D S R O G E R L . G E R T E N R JC H , D D S SA LEM , O RE
Editor’s com m ent: An article by Shusterman and others in the Novem ber-Decem ber 1978 issue o f Journal of Dentistry for Children re fers to a report by Smith in 1969 of 19 supernumerary teeth in a 21year-old, and also to a report by Foley in 1970 o f 14 supernumerary teeth in a 22-year-old man w hose nephew reportedly had 12.
C h i ld r e n ’s D e n ta l H e a lt h W e e k
□ It was very gratifying to read the editorial regarding National Chil dren’s Dental Health W eek (The Journal, February). I was especially pleased to see the Akron Dental S o ciety get recognition because so