Loss Of Tooth Structure Research Articles

Guided Endodontics: Three-dimensional Planning and Template-aided Preparation of Endodontic Access Cavities.

Pulp canal obliterations (PCO) are often a consequence of dental trauma, such as luxation injuries. Even though dentin apposition is a sign of vital pulp, pulpitis or apical periodontitis may develop in the long term. Root canal treatment of teeth with severe PCO and pulpal or periapical pathosis is challenging for general practitioners and even for well-equipped endodontic specialists. To ensure detection of the calcified root canal and avoid excessive loss of tooth structure or root perforation, static navigation using templates ("Guided Endodontics") was introduced a few years ago. The general workflow includes three-dimensional imaging using cone-beam computed tomography (CBCT), a digital surface scan, and superimposition of both in a planning software. This is followed by virtual planning of the access cavity and the design of a template that will guide the drill to the desired target point. To do this, a true-to-scale virtual image of the drill must be placed in a way that the tip of the drill reaches the orifice of the calcified root canal. Once the template has been fabricated using computer-aided design and computer-aided manufacturing (CAD/CAM) or a 3D printer, guided preparation of the access cavity can be performed clinically. For research purposes, a postoperative CBCT image can be used to quantify the accuracy of the access cavity performed. This work aims to present the technique of static guided endodontics from imaging to clinical implementation.

Accuracy of 3D dynamic navigation system for fiber post retrival from RC treated teeth

Introduction: Removing fiber posts from root canal–treated teeth is inherent to tooth loss and time consuming. Hence in our study we aim to investigate the accuracy and efficiency of the 3-dimensional dynamic navigation system (DNS) compared with the freehand technique (FH) when removing fiber posts from root canal–treated teeth. Material and Methods: We compared the extracted single rooted teeth prepared with post and build with core. We divided 40 teeth equally as DNS & FH. We compared Global coronal and apical deviations, angular deflection, operation time, and volumetric tooth loss, keeping the p<0.05 as significant. Results: The DNS group showed significantly lower global coronal and apical deviations and angular deflection than the FH group (P < .05). DNS required less operation time than FH. Moreover, the DNS technique had significantly less volumetric loss of tooth structure than the FH technique (P < .05).Conclusions: The DNS was more precise and effective in removing fiber posts from root canal–treated teeth than the FH technique.

Clinical direct posterior restoration in aesthetic and functional aspect

Direct restoration is one of the most common methods of rehabilitation of defects in teeth hard tissues. Composite nano-ceramic restorations are an alternative to traditional prosthetic treatment in view of the growing demand for minimally invasive technologies, since crowns or other prosthetic restorations imply a significant loss of tooth structure with macro-mechanical and more invasive preparation of the dental tissues. This article represents a clinical case of direct composite restoration in carious teeth 3.6,3.7 with aesthetic and functional rehabilitation of contact points.

Management of External Cervical Resorption in Mandibular Molar Furcation Area - A Case Series

<p>External cervical resorption (ECR) is an aggressive form of root resorption causing loss of tooth structure and sometimes leading to destruction of adjacent alveolar bone. In the advanced extent of ECR lesion, surgical intervention is inevitable. Several studies presented favorable treatment outcomes on advanced ECR lesions at single teeth. In the light of these studies, this article reports on surgical management of two ECR cases. Materials and Methods: Two cases had ECR combined with bony defect in left mandibular first molar. Case 1 had ECR lesion over buccal furcation area combined with buccal bone plate loss. Following root canal treatment, the resorptive defect was restored by mineral trioxide aggregate and the bony defect was treated with guided tissue regeneration (GTR). Case 2 had class II furcation defect with ECR over furcal surfaces of mesial and distal roots. The resorptive defect was restored with bioceramic putty and class II furcation bony defect was treated by GTR. Root canal treatment of tooth 36 was done later after case 2 suffered from symptomatic irreversible pulpitis of tooth 36. Result: At one-year follow-up of case 1, no inflammatory signs with probing pocket depth (PPD) less than 3mm clinically and regeneration of buccal bone plate radiographically were found of tooth 36. At half year follow-up of case 2, there was a healthy gingiva with PPD less than 3mm clinically and the furcation area has been partially filled with regenerated bone radiographically of tooth 36. Conclusion: These case series presented an interdisciplinary surgical management of two cases with external cervical resorption combined with bony defect over lower molar furcation area which were successfully treated with biocompatible restorative material in combination with GTR technique in short-term follow-up.</p> <p> </p>

Present status and future directions - Managing discoloured teeth.

Managing tooth discolouration involves a range of different protocols for clinicians and patients in order to achieve an aesthetic result. There is an increasing public awareness in the appearance of their teeth and management of tooth discolouration may be inter-disciplinary and involve both vital and nonvital teeth. Vital teeth can be easily treated with low concentration hydrogen peroxide products safely and effectively using an external approach and trays. For endodontically treated teeth, the walking bleach technique with hydrogen releasing peroxide products is popular. However, there is an association with external cervical root resorption with higher concentrations of hydrogen peroxide of 30%-35%. There are also regulatory considerations for the use of hydrogen peroxide in certain jurisdictions internationally. Prosthodontic treatments are more invasive and involve loss of tooth structure as well as a life cycle of further treatment in the future. This narrative review is based on searches on PubMed and the Cochrane library. Bleaching endodontically treated teeth can be considered a safe and effective protocol in the management of discoloured teeth. However, the association between bleaching and resorption remains unclear although there is likely to be a relation to prior trauma. It is prudent to avoid thermocatalytic approaches and to use a base/sealer to cover the root filling. An awareness expectations of patients and multidisciplinary treatment considerations is important in achieving the aesthetic result for the patient. It is likely that there will be an increasing demand for aesthetic whitening treatments. Bleaching of teeth has also become increasingly regulated although there are international differences in the use and concentration of bleaching agents.

Anti-erosive profile of an experimental 5% SnCl₂ varnish containing different concentrations of NaF.

This in vitro study evaluated the anti-erosive effect of an experimental varnish containing 5% stannous chloride (SnCl₂) associated with different concentrations of NaF (NaF-free, 2.5% NaF, or 5.2% NaF) on bovine enamel and root dentin. One hundred samples were pre-eroded (0.3% citric acid, pH 2.6, 10 min) and randomized into five groups (n=10 for each substrate): Negative control - milli-Q water; NaF-free - Experimental varnish SnCl₂-free and NaF-free; 2.5 NaF - Experimental varnish 5% SnCl₂ associated with 2.5% NaF; 5.2 NaF: Experimental varnish 5% SnCl₂ associated with 5.2% NaF and positive control - Commercial varnish containing 5% NaF (Duraphat). After the varnishes were applied, the erosive and abrasive challenges were carried out for five days. Loss of tooth structure (TSL) was determined by optical profilometry, and the loss of calcium (ΔCa2+) using atomic absorption spectroscopy. Dentin analysis was also performed by SEM. A one-way ANOVA/Bonferroni test was performed to analyze the data (α=0.05). The experimental 2.5 NaF and 5.2 NaF groups showed greater effectiveness in preventing TSL when compared to the other groups (p <0.05), regardless of the substrate. In addition, these groups showed lower loss in Ca2+ content when compared to the other groups (p <0.05), for enamel and dentin. Dentin showed greater TSL and ΔCa2+ loss when compared to enamel in all treatments (p <0.05). The 5.2% and 2.5% NaF-containing experimental varnishes showed promising results in both, the prevention of TSL and the loss of Ca2+, regardless of the substrate studied.

Survival of Prosthodontic Restorations Luted with Resin-Based versus Composite-Based Cements: Retrospective Cohort Study.

The purpose of this study was to evaluate clinical performance, survival, and complications of indirect composite inlays, onlays, and overlays on posterior teeth. Digital records of 282 patients treated between 2014 and 2018 were accessed and analyzed retrospectively. The included patients received 469 composite restorations luted with seven different resin-based types of cement, i.e., Filtek Ultimate Flow, Enamel Plus, Relyx Ultimate, Harvard Premium Flow, Relyx Unicem, Filtek Bulk Fill Flowable, and Filtek Ultimate. The restorations had been clinically and radiographically evaluated annually. The mechanical and clinical complications, e.g., debonding, fracture, and secondary caries, were evaluated and recorded. The examined restorations exhibited a high survival rate (84.9%), and failure was found in only 71 cases. Fracture was the most common cause (n = 36), followed by prosthetic work release (n = 19) and secondary caries (n = 16). There was a statistically significant difference between failure and cement material (Sig. < 0.001); the composite-based cements (87.2%) had a high survival rate compared to the resin-based cement (72.7%). Similarly, the cements with high viscosity (90.2%) had significantly higher survival rates than the low-viscosity cements (78.9%). Moreover, onlays showed higher longevity compared to overlays (Sig. = 0.007), and patients aged under 55 years showed less complications (Sig. = 0.036). Indirect composite restoration was a successful solution to tooth structure loss. The material of the cementation is an important part of the success. Higher survival rate was found in our study when the fixation materials with high viscosity were used, thus suggesting using these materials with indirect restorations. Composite-based cements had significantly higher survival rate than resin-based cements.

Use of dynamic navigation system in endodontics: A literature review

Over the years, traditional endodontic approaches performed have caused significant loss of healthy tooth structure. Clinical approach became relatively predictable following the introduction of cone-beam computed tomography, Digital Imaging and Communications files, and dental operating microscopes. Despite these advances, mishaps such as excessive dentin loss and/or perforations may still occur during freehand preparations affecting the tooth's prognosis. Following the developments in surface scanning and three-dimensional printing, static guidance systems were introduced. However, they too had multiple drawbacks. Dynamic navigation systems (DNSs) were introduced following to overcome them. DNS is based on computer-aided navigation technology analogous to the Global Positioning System (GPS) navigation. New minimally invasive preparations have been put forward claiming to be the future of endodontics which can be achieved with the help of DNS. The review thus aims at evaluating the possible use of DNS in planning and executing these minimally invasive preparations without unnecessary loss of healthy tooth structure.

Assessment of Oral Health and Treatment Needs in Population with Visual Impairment

Background: Visually impaired individuals when compared to healthy have poor oral health status as they cannot visualize the plaque deposits on the tooth surface, leading to poor understanding of the importance of oral hygiene which results in development of dental caries as well as inflammatory disease of the periodontium and loss of tooth structure. Aim: The study aims to assess the oral health and treatment needs of patients with visual impairment using WHO Oral Health Assessment form for adults 2013. Materials and Methods: A cross-sectional study was conducted on 207 visually impaired patients who visited the special care dentistry department, a unit of Oral Medicine and Radiology in a private dental college &amp; hospital and a private blind institute. WHO Oral Health Assessment form was filled after oral examination was done using Type III clinical examination. Statistical Analysis: Descriptive analysis was used to describe the frequencies and percentages. Chi-square test was used to determine statistical significance. Results and Conclusion: Dental caries were present in 129 (62.3%) study participants. Oral mucosal lesion was prevalent in 14% of the study population. 146 (71%) participants required prompt dental treatment such as scaling, restorations, extractions, 58 (28%) participants required immediate dental treatment due to presence of pain or infection of dental origin such as advanced dental caries, periapical abscess and OPMD. Only 3 (1%) participants out of 207 did not require any dental treatment. The findings of the study suggest that the dental treatment needs are high and unmet in the visually impaired population.

The effect of desensitizing agents on the bond strength of dentin bonding agents: A systematic review.

Dentinal hypersensitivity (DH) is a common dental problem and is treated non-invasively using topical application of various desensitizing agents. When there is loss of tooth structure or tooth preparation is to be followed by a bonded restoration, it requires application of dentin bonding agent. However, the effect of desensitizers on bond strength is still controversial. To evaluate the influence of different desensitizing agents on the bond strength of the dentin bonding agents. PICO strategy was used to formulate the research question. In-vitro studies conducted on human teeth to evaluate the bond strength of dentin bonding agent following the application of desensitizing agent were included. Electronic databases PubMed and Cochrane and google scholar were searched using search terms alone or in combination from the year 2010 till 2020. Search was conducted using the key words and MeSH terms (hypersensitivity, bond strength, dental adhesives, dentin bonding agents). The title and abstract were read to verify the inclusion and exclusion criteria and if further any details required, full article was accessed to check the criteria and then included or excluded. Data extraction was done using a customized data extraction form. The risk of bias was evaluated using modified Cochrane Collaboration Quality Assessment tool. Total no of studies identified in the search were 146, after scrutiny 23 articles were eligible to be included in this study. Out of 23 articles, 17 articles were of medium bias and 6 articles were of high risk after risk of bias assessment. According to the various articles included in this study, GLUMA and 8.0%Arginine and CaCO3 when used as desensitizing agents along with different bonding agents, were found to be highly compatible without interfering with the bond strength of the dentin adhesives.

Minimalistic Intervention of White Spot Lesions and Dental Fluorosis with Resin Infiltration Technique- A Report of Two Cases

The advances in scientific developments in dentistry have led to the emergence of innovative technologies for early diagnosis, prevention, interception, and therapeutic strategies for the preservation of tooth structure loss due to carious destruction or tooth decay arresting the carious lesions in order to preserve the tooth structure loss. Minimal intervention techniques to replace, repair, and remove as little tissue as possible is gaining significant importance over traditional techniques, as the emphasis is given on the preservation of the original tooth structure. White spot lesions are a form of enamel demineralisation which usually occurs due to dental fluorosis or postorthodontic treatment, compromising the aesthetics and self-esteem of the patient. The resin infiltration technique is a reliable treatment option advocated for the treatment of white spot lesions and non cavitated carious lesions. It is a microinvasive intervention performed without drilling or sacrificing the healthy tooth structure aiming at reinforcing the demineralised enamel by filling with visible light curing resin. The rationale for the use of resin infiltration is to allow the light-activated resin to permeate into the enamel porosities by virtue of capillary action, into the treated surface of the tooth. The infiltrated resin occludes the enamel microporosities and prevents the lesion progression further as it blocks the various pathways of ingress created by the acid penetration and dissolved materials in the enamel matrix. The first case presentation highlights the successful management of white spots visible in the maxillary anterior region of a female patient of age 25 years. The second case represents the use of the resin infiltration technique to treat and eliminate yellow-brownish stains in the maxillary anterior teeth of a female patient of age 23 years. Both the patients expressed concerns about the non uniform colour and appearance of their teeth and wanted solutions to rectify the same, without any drilling or removal of the tooth surface. This article highlights the concept of resin infiltration as a minimally invasive treatment option for the management of white spot lesions as a viable solution to suit patient specific needs.

Biological restoration – Nature's own alternative for primary care

In humans, especially in childhood, the more prevalent disease is dental caries. Dental caries can extensively destroy the tooth structure. Extensive loss of the tooth structure and premature loss of the primary tooth can lead to loss of vertical dimension, developing habits such as tongue thrusting and mouth breathing that may lead to malocclusion in future. The treatment of mutilated primary teeth should adequately reestablish the anatomy of the tooth, which helps to maintain the mastication, phonation, esthetics, and acts as a natural space maintainer. It is always challenging for the pediatric dentist to satisfactorily restore these teeth to maintain space, esthetics, and function. In recent years, both children and their parents have given priority to esthetics over primary dental care. This demands the innovation and the development of newer treatment options that should be biological and conservative. Hence, natural teeth are increasingly being used as a restorative material to treat damaged teeth with this desire for innovation. As a result, here we report a case of a severely mutilated primary tooth of a 2½-year-old child treated with the technique of biological restoration. This biological restoration procedure involves bonding a sterile dental structure to a tooth that needs treatment.

Reinforcing the cervical dentin with bonded materials to improve fracture resistance of endodontically treated roots.

Introduction:Endodontic procedure leads to the loss of tooth structure resulting in fractures. Intraorifice barriers of bonded restorative materials placed in the cervical third of tooth may help in increasing fracture resistance.Materials and Methods:Human mandibular premolars (n = 75) underwent decoronation to adjust working length at 14 mm and prepared up to F3. They were obturated using gutta-percha and resin sealer AH-Plus and randomly divided into five groups (n = 15), Group 1: Control obturated with gutta-percha only. Groups 2, 3, 4, and 5 had placement of intraorifice barriers after the removal of 3 mm coronal gutta-percha such that Group 2: RMGI, Group 3: Self-adhering flowable composite, Group 4: Bulkfill Flowable Composite, and Group 5: mineral trioxide aggregate (MTA). Mounting of specimens was done in acrylic resin to expose coronal 3 mm and tested using the universal testing machine.Results:Group 1 (control) showed least fracture strength among all groups. Among those with intraorifice barriers, Group 2 Resin-modified glass ionomer cement showed maximum fracture resistance followed by Group 4 (Bulkfill composite) and Group 5 (self-adhering flowable composite) and least by Group 5 (MTA).Conclusion:The type of intraorifice barrier had a significant impact on root fracture resistance.

Loss of dental tissue after restoration or sealing of occlusal carious lesions: 3-4-year results of randomized clinical trials.

Although preservation of the tooth structure is quoted as the main advantage of sealing of carious lesions, there are no long-term studies comparing the maintenance of dental tissue after restoration or after caries sealing. To measure the radiographically visible loss of dental tissue after conventional restoration and sealing of carious lesions. This study was a secondary analysis of two randomized controlled clinical trials, one conducted in Brazil and another in Belgium, which evaluated two different therapies for the treatment of occlusal carious lesions in permanent teeth: sealant (SE) without previous carious tissue removal or restoration (RE) with total removal of carious dentin. The greater depth and width of sealed carious lesions and restorations were compared. The independent t-test was used to compare therapies at different time points, while the paired t-test was used to compare the same therapy over time. Carious lesions in the RE and SE groups showed similar measurements at baseline (P > 0.05). Over time, significantly greater loss of tooth structure was observed in the RE group than in the SE group. No increase in lesion depth or width was observed in the SE group, suggesting no progression of sealed lesions. Sealing of carious lesions resulted in greater preservation of dental tissue.

Biological post: An Avant-Garde approach

It is not uncommon to see fracture or loss of tooth structure due to caries of the anterior teeth, be it primary or permanent dentition. Successful functional, structural and esthetic rehabilitation of anterior teeth has always been a challenge in restorative dentistry. Though there are various accepted treatment modalities, there is always continuous hope of developing newer techniques, in order to overcome the drawback of existing treatments. This paper discusses the use of a simple, yet successful, cost-effective treatment option of restoring anterior teeth with the use of biological posts through two case reports.

Hemisection- A Saviour for Periodontally &amp; Cariously Involved Permanent Mandibular Molar

Progressive carious and inflammatory involvement of teeth if left untreated will ultimately lead the loss of tooth structure in the oral cavity. Earlier clinician was left with no option but extraction of such hopeless teeth followed by replacement with fixed partial denture, removable partial denture or implants. Hemisection is a removal of compromised root and the associated crown portion. It is one of the treatment options for preserving remaining part of molar having sound periodontium. This case report presents a patient in which distal half of the teeth was carious but with sound periodontium and the periodontally compromised mesial root was resected, and after healing, fixed dental prosthesis was delivered to restore proper form and function

Contribution of dentistry in the diagnosis of systemic disorders related to erosive tooth wear

Erosive tooth wear (ETW) is the irreversible loss of dental hard tissue resulting from the chemical-mechanical process. The aim of the present case report was to present two clinical cases of patients affected by ETW arising from different etiological factors. The patients, of the male gender, 9 and 10 years of age presented to the pediatric dental clinic, for routine evaluation. On clinical exam, both patients had no caries lesions, but some lesions suggestive of ETW, which had aspects such as a translucent halo around the occlusal surface of teeth, in addition to "cupping” lesions - mainly in the cusp region, and loss of tooth enamel (by volume). The lesions were restricted to enamel, and the patients showed no dental hypersensitivity. From the dental clinical exam and anamnesis, the two patients were found to have similar tooth structure loss, with diagnosis of ETW. However, in one patient the etiology was extrinsic due to diet, and in the other, it was intrinsic due to gastroesophageal reflux disease (GERD). The latter patient was referred to a specialist for evaluation of the systemic condition, and GERD was diagnosed. It was concluded that dentists play an important role, as coadjuvant in the diagnosis of health problems related to ETW. Therefore, meticulous clinical exams must be performed to establish the correct diagnosis, because swift intervention in the clinical cases presented had a positive impact on halting the erosive process.

A retrospective comparison of the survival of vital teeth adjacent to single, bounded edentulous spaces rehabilitated using implant-supported, resin-bonded, and conventional fixed dental prostheses

ObjectivesIn this study, we aimed to compare the long-term survival of vital teeth adjacent to bounded edentulous spaces rehabilitated using an implant-supported prosthesis (ISP), a resin-bonded fixed partial denture (RBFPD), or a conventional fixed partial denture (CFPD). The risk factors for complications in teeth adjacent to the edentulous space (TAES) were also investigated. MethodsWe followed-up a consecutive series of 514 patients who underwent rehabilitation of a single bounded edentulous space with vital TAES (ISP: 103; RBFPD: 216; and CFPD: 195) from 2008 to 2017. Cumulative survival rates of prosthesis and TAES, and complication-free rates of TAES, were evaluated using the Kaplan−Meier analysis and log-rank test. Risk factors were evaluated using a Cox proportional hazards model. ResultsCumulative complication-free rates of TAES showed no significant differences among the three groups. The cumulative survival rate of TAES in CFPD was significantly lower than that of ISP (p = 0.037); no significant differences were observed between ISP and RBFPD (p = 0.513), and RBFPD and CFPD (p = 0.076). Older age (p = 0.027) was the only independent significant risk factor for complications in TAES. Installation of CFPD (p = 0.019), ceramic prosthesis in edentulous space (p = 0.026), and deeper periodontal probing depth (p = 0.018) of TAES were significant risk factors for non-surviving TAES. ConclusionsRehabilitating a single bounded edentulous space with CFPD could increase the risk for TAES loss compared with ISP. Risk of TAES loss remained similar between ISP and RBFPD, which can minimize the loss of coronal tooth structure during tooth preparation. Clinical SignificanceTeeth adjacent to edentulous space show equivalent longevity when rehabilitating a single bounded edentulous space with resin-bonded fixed partial dentures or single standing implant-supported prosthesis, at least 10 years post-installation.

A comparison of near-infrared imaging with other diagnostic tools for dental caries.

Dental caries is one of the most common diseases in the world, and global incidence rates are increasing. The early detection of dental lesions enables a conservative approach to be employed and represents a priority in modern dentistry. Recent studies have suggested that conventional diagnostic methods, such as visual tactile inspection and X-ray examination, exhibit low sensitivity and are not very effective in early diagnoses. Consequently, late detection of decay is associated with an increased loss of tooth structure. New diagnostic systems based on optical properties have been developed to facilitate early detection. Several studies have evaluated the performance of near-infrared imaging (NIRI) as an early diagnostic tool. NIRI using light ranging from 700 to 1700 nm has demonstrated better optical properties compared to conventional optical systems using light in the visible spectra. NIRI enables deeper penetration of the light in the tooth tissue, weak scattering with lower background noise and strong photon absorption with detailed images. Several in-vivo studies have demonstrated that NIRI technology has the potential to improve performance compared with current diagnostic methods. NIRI exhibits increased sensitivity compared to radiographs and is more suitable to identify approximal enamel lesions. This paper aimed to review these recent advances and their potential applications in daily clinical practice.

Internet of Dental Things (IoDT), Intraoral Wireless Sensors, and Teledentistry: A Novel Model for Prevention of Dental Caries

Dental caries is a complex, multifactorial, transmissible biofilm-initiated oral disease, which results in loss of tooth structure. Oral microbial flora, pH of biofilm, consumption of carbohydrates, and oral hygiene are few of those major factors, which cause dental caries. However, it is possible to monitor those cariogenic factors with the help of new technology, and that will result in the prevention and early detection of dental caries. Internet of Dental Things (IoDT) is an advanced cloud-based digital technology, which could be successfully used in this area. Our goal is to generate such a technology-based model. This paper proposes a novel innovative model, which is based on Internet of Dental Things, intraoral wireless sensors and tele dentistry, which will achieve prevention and detection of dental caries in its initial stages.