Restorative Techniques Research Articles

Fracture Resistance of Endodontically Treated Maxillary Premolar Teeth Restored with Wallpapering Technique: A Comparative In Vitro Study.

This in vitro study aimed to evaluate and compare the fracture resistance and mode of failure of endodontically treated maxillary premolar teeth restored with different direct composite restorative techniques. Forty freshly extracted maxillary premolar teeth with comparable sizes were used in this in vitro study. Each tooth received mesio-occluso-distal cavity preparation (3 mm width and 6 mm depth) followed by endodontic treatment. Canals were instrumented with RACE EVO rotary files (FKG, Dentaire, Switzerland) up to MAF 25/.06. Canals were obturated using a single cone technique, then the teeth were divided arbitrarily into five groups (n = 8): Group A: direct composite resin only using a centripetal technique, Group B: direct composite resin with glass fiber post, Group C: direct composite resin with short fiber-reinforced composite (everX Flow), Group D: direct composite resin with leno wave ultra high molecular weight polyethylene (LWUHMWPE) fibers placed on cavity floor, and Group E: direct composite resin with LWUHMWPE fibers placed circumferentially around the cavity walls (wallpapering technique). The teeth were then stored in distilled water at 37°C for 24 hr. The fracture resistance of each sample was measured using a universal testing machine in Newton (N). The data were analyzed using one-way analysis of variance (ANOVA) and the Bonferroni test with a significance level of 0.05. Group E recorded the maximum mean of fracture load (2,139.375 N), while Group A recorded the minimum mean of fracture load (689.6250 N). The one-way ANOVA test revealed a significant difference between the groups. The Bonferroni test showed a significant difference between each two groups, with the exception of those between Groups B and C and between Groups D and E, where there were no statistically significant differences (p > 0.05). Restoration of endodontically treated teeth using the wallpapering technique recorded the highest mean of fracture resistance with a repairable mode of fracture.

Adaptation of Relined Fiber Post Using Discontinuous Short Fiber-Reinforced Resin Composite to Restore Weakened Endodontically-Treated Premolars

Abstract Objective This study aimed to investigate the effect of relining prefabricated fiber-reinforced composite (FRC) posts using bulk-fill, flowable, discontinuous short fiber-reinforced composite (SFRC) on intracanal adaptation in weakened endodontically-treated premolar teeth. Materials and Methods Forty extracted human premolar teeth were selected and randomly allocated to five groups (n = 8) according to the canal preparation method and restorative technique after endodontic treatment: Group 1 (control): nonflared, closed apex root canals; group 2, 4: flared, open-apex root canals; group 3, 5: flared, closed apex root canals. Groups 1 to 3 were restored with standard RelyX fiber post size #1, while groups 4 and 5 were restored with customized RelyX fiber post size #1 and relined with bulk-fill flowable SFRC (everX Flow, GC, Tokyo, Japan). To evaluate intracanal adaptation, the empty root of each sample with the corresponding fiber post (standard or customized) inserted was measured twice using a micro-digital scale and the average value was calculated. The post was then removed, followed by the insertion of a light body polyvinyl siloxane (PVS) impression material into the canal, followed by reinsertion of the post and removal of excess material once the PVS was set. Finally, the sample weight was recorded, and the data were analyzed using one-way analysis of variance and the Bonferroni post hoc test (p-value = 0.05). Results A statistically significant difference (p < 0.05) in PVS material weight was identified between the groups. Group 1 (control) had the lightest weight of PVS material, followed by groups restored with customized fiber posts (groups 4 and 5) and standard fiber posts (groups 2 and 3). Conclusion Anatomically-customized fiber posts with bulk-fill flowable SFRC provided better intracanal adaptation compared with standard fiber posts in teeth with compromised root canals.

Monitoring ecological restoration of riparian forest: Is the applied nucleation effective ten years after implementation in the Pampa?

Ecological restoration is a process that helps restore a degraded, damaged, or destroyed ecosystem. Applied nucleation is considered a strategy that facilitates the development of vegetation, attracts dispersers, and, over time, tends to expand, coalescing into continuous forests. However, simply implementing restorative techniques is not enough, it is also necessary to monitor the process. Monitoring requires good ecological indicators, which is a challenge for ecological restoration. The present study aims to evaluate, through ecological indicators, the effectiveness of the applied nucleation for restoration of riparian forest. The study was carried out in the Serra do Sudeste, Pampa region, southern Brazil. Ecological indicators were analyzed in two areas of restoration: passive and active restoration. In the area under active restoration, paired plots were evaluated: intra-nuclei (inside the nuclei) and inter-nuclei (outside the nuclei). To assess natural regeneration, all regenerant shrubby and arboreal individuals taller than 30 cm were counted and taxonomically identified. The species were classified according to the dispersal syndrome. Shannon diversity indices and Pielou evenness were calculated. The canopy cover of nuclei and trees planted crown cover were evaluated. Ecological indicators were compared using Tukey’s test (p < 0.05). The results showed a significant difference between passive, intra-nuclei, and inter-nuclei restorations for the evaluated indicators, with higher averages for intra-nuclei, followed by inter-nuclei and passive restorations. It is concluded that the intra-nuclei plots showed an increase in richness, abundance, biotic dispersal syndrome, canopy cover, and soil cover by plant litter and arboreal species. The applied nucleation is an effective strategy for ecological restoration in the study region.

RESTORATIVE JUSTICE IN THE CUSTOMARY JURISDICTION OF THE DAYAK TRIBE COMMUNITIES OF WEST KALIMANTAN

This study aims to investigate the application of restorative justice within the customary legal systems of communities belonging to the Dayak tribe in the Indonesian province of West Kalimantan. The villages that are part of the Dayak tribe have a long-standing tradition of settling disagreements via various sacraments and rituals, including restorative justice. On the other hand, customary practices are increasingly disappearing due to the growing impact of recent legislation and the government's legal system. This investigation is carried out with Socio-Legal Research, with data being gathered through semi-structured interviews and various observational techniques. Traditional community leaders, community members, and persons previously participating in restorative justice are among the participants. Despite the growing influence of modern law, the findings of this research demonstrate that groups within the Dayak tribe continue to use restorative justice techniques. Many people believe that using restorative justice to resolve conflicts and preserve communal harmony is a beneficial strategy. The community members value the participation of traditional leaders in the process of restorative justice since these leaders are regarded as being objective and competent. The research also emphasizes specific problems experienced by the communities that are a part of the Dayak tribe in implementing restorative justice. These challenges include limited resources and the growing influence of modern law. Despite this, the people who live in the village continue to acknowledge the significance of the traditional rituals and have expressed a commitment to maintaining them.

Mechanical Properties of Poly(Alkenoate) Cement Modified with Propolis as an Antiseptic.

We assessed the effect of propolis on the antibacterial, mechanical, and adhesive properties of a commercial poly(alkenoate) cement. The cement was modified with various concentrations of propolis, and antibacterial assays were performed against S. mutans by both MTT assays and agar diffusion tests. The compressive, flexural, and adhesive properties were also evaluated. the modified cement showed activity against S. mutans in both assays, although reductions in compressive (from 211.21 to 59.3 MPa) and flexural strength (from 11.1 to 6.2 MPa) were noted with the addition of propolis, while adhesive strength (shear bond strength and a novel pull-out method) showed a statistical difference (p < 0.05). the antiseptic potential of modified material against S. mutans will allow this material to be used in cases in which low mechanical resistance is required (in addition to its anti-inflammatory properties) when using atraumatic restorative techniques, especially in deep cavities.

Aesthetic Surgical Pathway in Permanent Facial Filler Removal.

Although permanent fillers have been introduced in order to get long-lasting results, many studies have shown numerous severe and disfiguring complications. Nonsurgical procedures may mitigate those adverse events but the only way to remove the filler previously injected is represented by surgical excision. We present a pathway of facial surgical accesses to be performed achieving two goals: permanent filler removal and restore facial aesthetic balance. The proposed surgical accesses are already standardized in aesthetic surgical practice in order to avoid direct excision and unpleasant facial scar. A total of 231 patients underwent surgery for permanent filler removal and aesthetic restoration of the involved facial area, represented by forehead, glabella, nose, cheeks, eyelids, chin, jawline, and lips. Magnetic resonance evaluation was performed with the exception of lip patients who were evaluated with ultrasound. Postoperative follow-up was 12 months to 6 years. Subjective and objective methods were used for outcome evaluation according to the FACE-Q questionnaire. Functional and aesthetic correction was scored using the patient-graded Global Aesthetic Improvement Scale (GAIS), overall patient satisfaction was assessed by a five-point scale questionnaire. Functional and aesthetic restoration was globally recognized as improved according to the GAIS. Patients reported high levels of satisfaction assessed by a five-point scale questionnaire. A very good satisfaction level was registered in both subjective and objective judgment scores. To the best of our knowledge, we present the largest case series regarding surgical removal of permanent facial fillers. A proper preoperative evaluation, filler removal followed by restorative facial aesthetic surgery technique is paramount to approach challenging cases.

Sentencing: New trajectories in law By E.A.O.Freer, Abingdon: Routledge. 2021. pp. 131. £44.99 (hbk); pp. 146. £16.99 (pbk). ISBN: 9780067862619; 9781032063027

Sentencing: New trajectories in law By E.A.O.Freer, Abingdon: Routledge. 2021. pp. 131. £44.99 (hbk); pp. 146. £16.99 (pbk). ISBN: 9780067862619; 9781032063027

Portal Vein Interventions for Portal Hypertension: Complications and Management

AbstractPercutaneous management of complications of portal hypertension entails reducing portal pressures, controlling varices, and redirecting collateral flow using embolization, obliterative, restorative, recanalization, and shunt creation techniques. Management is based on the clinical status and symptoms and the physiologic and anatomic abnormalities causing portal hypertension. This article briefly describes percutaneous management strategies, their results, and related iatrogenic and physiologic complications.

Curing profile and marginal gap formation using a liner containing long-wavelength-absorbing photoinitiator: an in vitro study.

The aim was to evaluate the marginal-gap formation and curing profile of a new restorative technique using a liner with long-wavelength-absorbing photoinitiator (LWAP). Box-shaped preparations (6mm × 4mm × 4mm) were made in third molars. All samples were treated with Clearfill SE Bond and divided into 4 groups (n = 5), according to restorative technique used: (1) incremental technique (INC-Technique); (2) camphorquinone-based liner (CQ-Liner) + bulk-fill resin composite; (3) LWAP-based liner (LWAP-Liner) + bulk-fill resin composite; and (4) bulk-fill technique without liner (BF-Technique). The marginal gaps (%) for all the samples were measured using micro-computed tomography. The restorations were cross-sectioned, and the degree of conversion (DC) and Knoop microhardness were evaluated at different depths (0.3, 1, 2, 3, and 4mm). INC-Technique, CQ-Liner, and LWAP-Liner groups showed significantly fewer marginal gaps than those from the BF-Technique group. The BF-Technique specimens had the lowest DC and microhardness in depth. All the other techniques presented similar degree of conversion and microhardness at all the depths. The use of liners, regardless of the photoinitiator system, decreased the marginal-gap formation and improved the curing profile of bulk-filling restoration technique.

Insertion methods and gap/void formation in atraumatic restorative technique: A micro-CT analysis.

Wetting the dentin is critical to atraumatic restorative treatment. The conventional insertion can be challenging when using high-viscosity glass-ionomer cement. This study evaluated the formation of gaps and voids after three insertion methods using micro-CT. Teeth underwent removal of occlusal and proximal caries through the atraumatic restorative treatment technique. Then, they were fixed in an artificial dental arch to simulate the clinical condition and were restored using three insertion methods: conventional, Centrix injection, and double-filling. Previous dentin conditioning procedures, steel matrix and wooden wedge application, and post-insertion procedures (digital compression and surface protection) were the same. The material was inserted using a manual instrument in the conventional technique and was inserted with a syringe in the Centrix injection group. In the double-filling technique, the tooth received a first layer of a flowable ionomer (through modifying the powder/liquid ratio), and a second layer (with standard ratio) was applied before the final set of the first one. A micro-CT unit scanned each tooth before and after restoration. Each cavity was defined as the volume of interest, and the volumes of gaps and voids were calculated. Data were analyzed using one-way ANOVA and Tukey posthoc test (p < .05). Double-filling had improved filling volume with lower values for gap volume, followed by Centrix injection. The conventional technique had the highest gap volume. No statistically significant difference was observed for void volume. Double-filling demonstrated fewer gaps, followed by Centrix injection, which is critical to obtain better adhesive, remineralizing, and antibacterial activities.

Oral health for baby boomers: Past, present, and future.

This paper reviews the oral health services which were available for early (1945-1955) and late (1956-1964) baby boomers, as well as predicts their future oral healthcare needs. The knowledge, beliefs, and attitudes of the parents of the baby boomers toward dental hygiene and oral healthcare, are reviewed. The introduction of dental health screenings occurred from 1910 to early 1970s, the creation of the first dental hygiene school and the introduction of water fluoridation influenced oral healthcare. Technology introduced in the dental offices in the 1960s included the high-speed handpiece, followed by intraoral suction in 1979. Baby boomers are keeping their teeth at higher rates than preceding generations due to improved prevention and advances in the treatment of periodontal disease, and overall lower rates of smoking in older adults, when compared to younger adults. However, access to dental care remains an issue for many. Advances in prevention and treatment of periodontal disease, early detection of root caries, new restorative techniques, and improved technologies to replace teeth are also discussed. Early detection of periodontal disease, oral, and oropharyngeal cancer, risk factors for tooth loss and untreated caries are needed to improve the oral health for baby boomers. Access to oral healthcare is still an issue due to socio-economic disparities in America.

Successional Change and Fire History in Montane Longleaf Pine-Dominated Ecosystems of Northwestern Georgia, USA

In the absence of fire, Pinus palustris (Longleaf Pine) ecosystems in the southeastern United States are vulnerable to successional change including mesophication, a process where increases in the importance of mesic and fire-intolerant species reduce biodiversity and thwart efforts to restore these systems. To determine the degree and nature of this successional trajectory at a local scale, we examined changes in species composition of a montane Longleaf Pine ecosystem in northwest Georgia using modern vegetation surveys and historical “witness tree” data. We also determined historical fire frequency using fire scars within Longleaf Pine stumps cross-dated to extant Longleaf Pine trees. Modern forest composition contained significantly more fire-intolerant taxa than the historical forest due to increased abundance of mesophytic species, especially Acer rubrum (Red Maple) and decline of Pinus spp. (pines) and some pyrophytic Quercus spp. (oaks). Counter to expectation, there were few differences in species composition between northeastern- and southwestern-facing slopes in modern or historical data. Fire scars indicated a historical mean fire-return interval of 5.5 years and suggest that without the reintroduction of more frequent prescribed fire, regeneration of montane Longleaf Pine is unlikely. Additional restorative techniques may also help these stands support greater biodiversity over time. For instance, co-dominance of pines and oaks in the historical forest suggests that fire-tolerant oaks should be retained in montane restoration efforts.

Dental Caries and Its Management.

In recent years, the management of dental caries has evolved significantly. Caries prevention, early detection, and a diagnosis based on risk indicators and risk factor assessments are the most current practical approaches. Furthermore, as proposed in minimally invasive dentistry, the new management approaches preserve healthy tissue and maintain pulp vitality. This article overviews the latest minimally invasive dental caries management and treatment options. The information will assist the reader in the early detection, diagnosis, and treatment of dental caries. The PubMed (MEDLINE) search engine was used to gather the most relevant information on dental caries. The search was restricted to five years (May 30, 2018-May 29, 2022), and only English-language studies were accessed. A Boolean search of the PubMed data set was implemented to combine a range of keywords. The following filters were applied: abstract, free full text, full text, clinical trial, randomised control trial, systematic review, meta-analysis, and review. More studies were also obtained by manual searches from Google Scholar and textbooks on dental caries. By using this process, 683 articles and studies were obtained. The most relevant published studies were chosen and used in the current review. The selected articles are included in the references list. However, the search extended to cover the last five years as our understanding and management of dental caries have changed significantly. Early detection and diagnosis of caries based on risk indicators and risk factor assessments are effective. Furthermore, minimally invasive restorative techniques are beneficial in managing dental caries and preserving healthy tissue and should be used whenever possible. This new information, knowledge, and materials should encourage professionals to implement this method. Having a strategy and system based on patient-centred care is critical, and our dental responsibilities must prioritise patient-centred care.

Class II composite restoration technique teaching: A randomised controlled crossover laboratory-based trial involving a novel ringless sectional matrix technique.

Objectives were to assess how different techniques (including a novel ringless sectional matrix approach) affect students' restorative outcomes, and their preferences for and preparedness to clinically implement new techniques with the aim of introducing appropriate techniques to the undergraduate curriculum. Students performed two class II composite restorations in plastic teeth using two sectional matrix techniques (separating ring vs. without [ringless]), and two composite restorative techniques (incremental vs. injection-moulded bulk-fill). Restorations were assessed on multiple parameters which were combined to rate them as "good" or not. Online surveys assessed students' preferences for and preparedness to clinically implement new techniques. Contact area concavity (OR=106, p< .001) and cervical marginal overhang (OR=7.4, p< .001) were much more likely with the separating ring compared to the ringless sectional matrix technique. "Good" restorations were 29.5 times more likely when using ringless compared to separating ring techniques and 3.3 times more likely when using the injection-moulding bulk-fill compared to layered composite technique. A majority of students preferred the ringless to separating ring sectional matrix technique and the injection-moulding bulk-fill to layered composite technique. Large majorities felt prepared to implement the new techniques clinically with no or minimal guidance. A classic sectional matrix technique with separating ring resulted in a much greater occurrence of contact area concavity and cervical marginal overhang than a novel ringless approach. When allied with student preferences and clinical preparedness, inclusion of the novel ringless approach in the undergraduate curriculum can be supported alongside bulk-fill injection-moulding techniques.

Evaluation of shade matching of monochromatic versus polychromatic layering techniques in restoration of fractured incisal angle of maxillary incisors: A randomized controlled trial

Aim: To evaluate shade matching potential of monochromatic layering technique (Filtek Universal) compared to polychromatic layering technique (Filtek Z350XT) in restoration of fractured incisal angle. Materials and Methods: A total of 26 patients received 26 class IV restorations divided randomly between groups (n = 13) using either; monochromatic layering technique (Filtek Universal) or polychromatic layering technique (Filtek Z350XT) in a parallel study design with superiority framework. After preparation, class IV resin composite restorations were performed according to manufacturers’ instructions. Shade matching of class IV restorations was evaluated by two blinded and calibrated assessors using the modified USPHS criteria and digital photography at baseline and after three-days. Association between the layering technique for restoration of fractured incisal angle and shade matching potential was done using the chi square test; statistical significance was set at P ≤ 0.05. Results: Inter-group comparison between layering techniques for shade matching using the modified USPHS criteria have shown statistically significant difference at baseline (P = 0.0001), while there was no statistically significant difference after 3 days (P = 0.2864). Intra-group comparison between follow-up periods within monochromatic layering technique have revealed statistically significant difference (P = 0.0001), while within polychromatic layering technique there was no statistically significant difference (P = 0.2864). Inter-group comparison between both layering techniques using digital photography have shown no statistically significant difference at baseline (P = 0.3592), while after 3 days there was statistically significant difference (P = 0.0071). Intra-group comparison between follow-up periods within monochromatic layering technique have shown statistically significant difference (P = 0.0002), while within polychromatic layering techniquethere was no statistically significant difference (P = 0.3592). Conclusions:Monochromatic resin composite restorations showed satisfactory shade matching potential when compared to polychromatic resin composite restorations.

The effect of the die material used in the indirect technique on the fracture resistance of a restored molar.

The aim of this study was to evaluate the effect of different die materials used in the indirect resin composite restorative technique on the fracture resistance and failure mode of restored molars and compare it with the direct resin composite restorative technique. Two flexible die silicone materials for dental models (Die Silicone - Voco and Scan die - Yller) and a type IV dental stone material (Fujirock EP - GC) were evaluated. Sixty third molars were selected and divided into four groups: indirect resin composite restoration - Die silicone (IRCR-DS); indirect resin composite restoration - Scan die (IRCR-SD); indirect resin composite restoration - Fujirock EP (IRCR-FR), and direct resin composite restoration (DRCR). Class II MOD cavities were prepared with 5 mm of buccolingual width and depth. The specimens were restored and subjected to an axial compression load until fracture, and the data were analyzed by one-way ANOVA and Tukey's HSD test (α=.05). The fracture mode was classified into restorable and unrestorable fractures. Fracture resistance values were influenced by the die material used for the IRCR fabrication and by the restorative technique (p<.001). Fracture resistance mean values and standard deviation were: IRCR-DS: 1835.5 ± 324.0 A; IRCR-SD: 1732.5 ± 384.1 AB; IRCR-FR: 1419.3 ± 318.8 BC; and DRCR: 1100.6 ± 224.9 C. Restorable fracture was more prevalent. IRCR with flexible die casts promoted higher fracture resistance and lower prevalence of unrestorable fractures.

Maxillary Ridge Split with Simultaneous Implant Placement – A Case Report

Inadequate alveolar ridge width often poses difficulty in implant placement. Such ridges require a combination of techniques in placing implants. One such technique is the ridge split technique which helps the expansion of the ridge with or without greenstick fracture of cortical plates. Before placing implants the width of the alveolar ridge can be effectively restored utilising the modified ridge splitting approach employing autologous bone grafts. This case report describes the ridge splitting and placement of a dental implant in the left maxillary central region followed by guided bone regeneration. Ridge expansion was done in relation to 21 and osteotomy was prepared to the desired depth. After proper treatment planning implant measuring 3.5 mm in diameter and 11.5 mm in length was placed. Four months later final cementation was done with PFM crown. The ridge split technique with the immediate implant placement resulted in minimal resorption of alveolar bone along with maximum expansion of the bone. The sequential surgical and restorative techniques were combined into one successful protocol whose steps are well elaborated in this case report.

Microleakage Assessment of Composite Restorations in Class V Cavities by Using Different Techniques – An In Vitro Study

Background Till date no restorative material has the capability to completely bond to the tooth structure without forming marginal gaps. This article describes about different restorative techniques in placing composite to reduce polymerization shrinkage.Aims and objectives The purpose of this study was to compare and evaluate microleakage of Class V cavities restored with two different techniques using dye penetration method and to determine better technique for placing composites which can increase the longevity of restoration by minimizing polymerization shrinkage.Methods Thirty extracted human premolar teeth were selected and Class V cavities were prepared. They were then randomly divided into two groups Group A- Snow plow technique and Group B- Control group. Composite restorations were done using two different techniques. All the samples were thermocycled and subjected to cyclic loading. Nail polish varnish was applied were immersed in dye for 24 hours and were sectioned buccolingually into two halves. The sectioned samples were subjected to stereomicroscopic investigation and depth of dye penetration was analysed according to scoring system. Statistical analysis using Statistical Package for Social Science SPSS software was done.Results No statistical variance was found in the microleakage scores between Group A and Group B and between the two techniques followed for restoration. Conclusion Placement of thin film of flowable composite under main bulk fill composite in Class V cavities did not decrease the microleakage rates resulting in decreased longevity of restorations

Rehabilitation with Table-Top Restoration Post Bicuspidisation: An Interdisicplinary Case Report

The first teeth to erupt in the oral cavity are the mandibular molars which are more prone to endodontic and periodontal involvement. This may lead to significant issues like an increase in pocket depth, furcation involvement, loss of clinical attachment and mobility of teeth ultimately resulting in tooth loss. Thus, it necessitates cautious oral hygiene measures. Advances in dentistry have led to treatment modalities for preserving teeth which were earlier indicated for extraction. Hence, periodontally compromised tooth with severe furcation involvement, which may not be amenable for regeneration, may be retained by bicuspidisation. Bicuspidisation is a surgical technique which involves separation of mesial and distal roots of mandibular molars along with its crown portion, where both segments are then retained individually, followed by rehabilitation with fixed prosthesis of the individual segments. This not only eliminates furcation involvement but also facilitates effective oral hygiene maintenance. In the present case report, a 50-yearold male patient reported with the chief complaint of pain, sensitivity and food lodgement in left mandibular first molar. Clinical and radiographic examination revealed grade III furcation involvement, significant pocket depths, delayed electric pulp test response and bone loss in furcation area. Bicuspidisation was opted as the suitable treatment modality. Root canal treatment was done, followed by bicuspidisation and subsequent rehabilitation with novel prosthetic technique. The bicuspids were restored using combination of deep margin elevation, and non splinted Lithium Disilicate table-top restorations. Six month follow-up showed good healing of hard and soft tissues around the bicuspidized sections, which was indicative of a successful treatment outcome, and can be attributed to a careful case selection, choice of restorative materials and techniques as well as good oral hygiene compliance.

Silver-modified atraumatic restorative technique (SMART) in early childhood caries

Silver-modified atraumatic restorative technique (SMART) in early childhood caries