- Email: [email protected]
Repair or replacement?
Overall, the CAD-CAM’s technique demonstrated the best combination of accuracy and reproducibility. Discussion.—Dentures deform during processing, which can affect the retention, stability, and support provided by the final denture. Limiting any deformation to the minimum is the goal of refinements in the processing techniques. CAD-CAM appears to be a more accurate and reproducible technique than any of the others currently used.
Patients will also appreciate the shorter time to receive their new dentures and the ability to obtain a replacement quickly if something happens to their initial denture.
Goodacre BJ, Goodacre CJ, Baba NZ, et al: Comparison of denture base adaptation between CAD-CAM and conventional fabrication techniques. J Prosthet Dent 116:249-256, 2016
Clinical Significance.—Dentists can feel comfortable trusting the fabrication of dentures for their patients to the CAD-CAM technique.
Reprints available from BJ Goodacre, Loma Linda School of Dentistry, Graduate Prosthodontic Clinic, 11092 Anderson St, Loma Linda, CA 92350; e-mail: [email protected]
Restorative Dentistry Repair or replacement? Background.—Minimally invasive or minimal intervention dentistry (MID) is shaping the practice of dentistry today, with repair often chosen over replacement of defective restorations. Resin-based composite (RC) is usually the restorative material of choice for posterior restorations because it can be repaired, which increases restorations’ lifetime significantly. In addition, additives to bonding systems, such as silanizing agents and phosphates, can improve bond strength, also extending the functional life of restorations. How much time clinicians spend on operative treatment in dental practices, specifically the treatment of caries or replacement of restorations, has not been evaluated in light of these MID practices. The effect of MID principles on dentists’ treatment choices concerning repair or replacement of defective RC restorations also requires updating. Methods.—The 1313 dentists in the Public Dental Service (PDS) of Norway were sent a pre-coded questionnaire electronically to gather information regarding (1) the time spent on direct restorative therapy and fillings due to primary caries; (2) the repair or replacement of restorations; and (3) the bonding agent used and any pretreatment of the residual restoration. They were also asked to consider what they believed the best treatment would be for three patient cases with tooth and/or restoration fractures (Figs 1 to 3). The respondents were also asked about age and gender, then the results of the complete questionnaire were analyzed. Results.—Seven hundred forty-eight dentists (55.8%) responded. They ranged in age from 25 to 77 years
(mean 41.8 years), and 69.6% were women. Comparison with the data for all PDS-employed dentists in Norway indicated that those responding to the survey were not significantly different in age or gender from the overall group. The time spent each day on placing restorations ranged from 10% to 100%, with an average of 57.5%. The mean number of restorations placed was 7.7, with a range of 1 to 30. The reasons for placing restorations were as follows (in descending order): primary caries (55.7%), repair of old restorations (26.7%), and total replacement of restorations (18.2%). Pretreatment data were as follows: 2% used none, 82.3% used acid etching, 83.3% used a bonding agent, 7.4% used a silanizing agent, 79.8% prepared for extra retention in adjacent restorations, 0.3% did not repair composite restorations, and 3.9% used some other treatment. The bonding systems used most often were 2-step etch-and-rinse agents (48.7%), followed by 3-step etch-and-rinse agents (24.6%). Repair with RC was the treatment suggestion for 89.6% of dentists for case one and 86.9% for case two. For case three, treatment decisions could be grouped by amount of tooth substance removal as minimally invasive treatment—repair with RC (54.1%), medium invasive treatment—replacement of the entire restoration with a filling or inlay/onlay (24.0%), or invasive treatment—restoration of the tooth with a crown (21.8%). The oldest dentists preferred minimally invasive treatment significantly more
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Fig 1.—Case one. What treatment would you suggest for this upper right second premolar? The tooth has a mesial-occlusal-distal (MOD) composite restoration where some of the mesiobuccal part of the filling has fractured off. There is enamel around the entire restoration and the damaged part. The X-ray shows no caries and the distance to the pulp is at least 1 mm. No other pathology or discomfort/sensitivity is observed. The patient is a woman in her mid-fifties with low caries activity and normal occlusion. There are no financial limitations concerning dental treatment and the patient has no desire to improve the esthetical appearance of the restoration. (Courtesy of Staxrud F, Tveit AB, Rukke HV, et al: Repair of defective composite restorations. A questionnaire study among dentists in the Public Dental Service in Norway. J Dent 52:50-54, 2016.)
often than the younger dentists (those age 38 years or younger). Discussion.—Over half of the dentists’ working day was devoted to operative dentistry, generally the treatment of primary caries, but also the repair of old restorations. Dentists tended to prefer the repair of RC restorations over replacement.
Fig 2.—Case two. What treatment would you suggest for this lower right second molar? The distobuccal cusp has fractured off adjacent to a composite restoration. There is enamel around the entire filling and the damaged part. The X-ray shows no caries and the distance to the pulp is at least 1 mm. No other pathology or discomfort/sensitivity is observed. The patient is a woman in her mid-fifties with low caries activity and normal occlusion. There are no financial limitations concerning the dental treatment. (Courtesy of Staxrud F, Tveit AB, Rukke HV, et al: Repair of defective composite restorations. A questionnaire study among dentists in the Public Dental Service in Norway. J Dent 52:50-54, 2016.)
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Dental Abstracts
Fig 3.—Case three. What treatment would you suggest for this upper left first premolar? The palatal cusp is lost. There is a remaining composite MOD restoration. There is enamel surrounding the entire filling and fracture. The X-ray shows no caries. The distance to the pulp is good and there is no other pathology. The patient is a woman in her mid-fifties with low caries activity and normal occlusion. There are no financial limitations concerning the dental treatment. (Courtesy of Staxrud F, Tveit AB, Rukke HV, et al: Repair of defective composite restorations. A questionnaire study among dentists in the Public Dental Service in Norway. J Dent 52:50-54, 2016.)
Clinical Significance.—The dentists surveyed appear to have firmly grasped the principles of MID and put them into practice, choosing to repair rather than replace in the majority of cases. The pretreatment options selected are well-documented for their efficacy in repairing RC. Older dentists chose more conservative options than younger dentists, but no difference related to gender was identified.
Staxrud F, Tveit AB, Rukke HV, et al: Repair of defective composite restorations. A questionnaire study among dentists in the Public Dental Service in Norway. J Dent 52:50-54, 2016 Reprints available from F Staxrud, PO Box 1109 Blindern, NO-0318 Oslo, Norway; e-mail: [email protected]
Patients will also appreciate the shorter time to receive their new dentures and the ability to obtain a replacement quickly if something happens to their initial denture.
Goodacre BJ, Goodacre CJ, Baba NZ, et al: Comparison of denture base adaptation between CAD-CAM and conventional fabrication techniques. J Prosthet Dent 116:249-256, 2016
Clinical Significance.—Dentists can feel comfortable trusting the fabrication of dentures for their patients to the CAD-CAM technique.
Reprints available from BJ Goodacre, Loma Linda School of Dentistry, Graduate Prosthodontic Clinic, 11092 Anderson St, Loma Linda, CA 92350; e-mail: [email protected]
Restorative Dentistry Repair or replacement? Background.—Minimally invasive or minimal intervention dentistry (MID) is shaping the practice of dentistry today, with repair often chosen over replacement of defective restorations. Resin-based composite (RC) is usually the restorative material of choice for posterior restorations because it can be repaired, which increases restorations’ lifetime significantly. In addition, additives to bonding systems, such as silanizing agents and phosphates, can improve bond strength, also extending the functional life of restorations. How much time clinicians spend on operative treatment in dental practices, specifically the treatment of caries or replacement of restorations, has not been evaluated in light of these MID practices. The effect of MID principles on dentists’ treatment choices concerning repair or replacement of defective RC restorations also requires updating. Methods.—The 1313 dentists in the Public Dental Service (PDS) of Norway were sent a pre-coded questionnaire electronically to gather information regarding (1) the time spent on direct restorative therapy and fillings due to primary caries; (2) the repair or replacement of restorations; and (3) the bonding agent used and any pretreatment of the residual restoration. They were also asked to consider what they believed the best treatment would be for three patient cases with tooth and/or restoration fractures (Figs 1 to 3). The respondents were also asked about age and gender, then the results of the complete questionnaire were analyzed. Results.—Seven hundred forty-eight dentists (55.8%) responded. They ranged in age from 25 to 77 years
(mean 41.8 years), and 69.6% were women. Comparison with the data for all PDS-employed dentists in Norway indicated that those responding to the survey were not significantly different in age or gender from the overall group. The time spent each day on placing restorations ranged from 10% to 100%, with an average of 57.5%. The mean number of restorations placed was 7.7, with a range of 1 to 30. The reasons for placing restorations were as follows (in descending order): primary caries (55.7%), repair of old restorations (26.7%), and total replacement of restorations (18.2%). Pretreatment data were as follows: 2% used none, 82.3% used acid etching, 83.3% used a bonding agent, 7.4% used a silanizing agent, 79.8% prepared for extra retention in adjacent restorations, 0.3% did not repair composite restorations, and 3.9% used some other treatment. The bonding systems used most often were 2-step etch-and-rinse agents (48.7%), followed by 3-step etch-and-rinse agents (24.6%). Repair with RC was the treatment suggestion for 89.6% of dentists for case one and 86.9% for case two. For case three, treatment decisions could be grouped by amount of tooth substance removal as minimally invasive treatment—repair with RC (54.1%), medium invasive treatment—replacement of the entire restoration with a filling or inlay/onlay (24.0%), or invasive treatment—restoration of the tooth with a crown (21.8%). The oldest dentists preferred minimally invasive treatment significantly more
Volume 62
Issue 4
2017
219
Fig 1.—Case one. What treatment would you suggest for this upper right second premolar? The tooth has a mesial-occlusal-distal (MOD) composite restoration where some of the mesiobuccal part of the filling has fractured off. There is enamel around the entire restoration and the damaged part. The X-ray shows no caries and the distance to the pulp is at least 1 mm. No other pathology or discomfort/sensitivity is observed. The patient is a woman in her mid-fifties with low caries activity and normal occlusion. There are no financial limitations concerning dental treatment and the patient has no desire to improve the esthetical appearance of the restoration. (Courtesy of Staxrud F, Tveit AB, Rukke HV, et al: Repair of defective composite restorations. A questionnaire study among dentists in the Public Dental Service in Norway. J Dent 52:50-54, 2016.)
often than the younger dentists (those age 38 years or younger). Discussion.—Over half of the dentists’ working day was devoted to operative dentistry, generally the treatment of primary caries, but also the repair of old restorations. Dentists tended to prefer the repair of RC restorations over replacement.
Fig 2.—Case two. What treatment would you suggest for this lower right second molar? The distobuccal cusp has fractured off adjacent to a composite restoration. There is enamel around the entire filling and the damaged part. The X-ray shows no caries and the distance to the pulp is at least 1 mm. No other pathology or discomfort/sensitivity is observed. The patient is a woman in her mid-fifties with low caries activity and normal occlusion. There are no financial limitations concerning the dental treatment. (Courtesy of Staxrud F, Tveit AB, Rukke HV, et al: Repair of defective composite restorations. A questionnaire study among dentists in the Public Dental Service in Norway. J Dent 52:50-54, 2016.)
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Dental Abstracts
Fig 3.—Case three. What treatment would you suggest for this upper left first premolar? The palatal cusp is lost. There is a remaining composite MOD restoration. There is enamel surrounding the entire filling and fracture. The X-ray shows no caries. The distance to the pulp is good and there is no other pathology. The patient is a woman in her mid-fifties with low caries activity and normal occlusion. There are no financial limitations concerning the dental treatment. (Courtesy of Staxrud F, Tveit AB, Rukke HV, et al: Repair of defective composite restorations. A questionnaire study among dentists in the Public Dental Service in Norway. J Dent 52:50-54, 2016.)
Clinical Significance.—The dentists surveyed appear to have firmly grasped the principles of MID and put them into practice, choosing to repair rather than replace in the majority of cases. The pretreatment options selected are well-documented for their efficacy in repairing RC. Older dentists chose more conservative options than younger dentists, but no difference related to gender was identified.
Staxrud F, Tveit AB, Rukke HV, et al: Repair of defective composite restorations. A questionnaire study among dentists in the Public Dental Service in Norway. J Dent 52:50-54, 2016 Reprints available from F Staxrud, PO Box 1109 Blindern, NO-0318 Oslo, Norway; e-mail: [email protected]