A Contemporary Evaluation on Posterior Direct Restoration Teaching among Undergraduates in Dental Schools in Malaysia

There is a current trend to restore posterior teeth with composite resin due to increasing demands on natural tooth colour restoration and increased concern about the safety of amalgam restorations. The objective was to evaluate the current teaching of posterior direct restoration among restorative dental lecturers in Malaysia compared to available international literature. An online questionnaire, which sought information on the teaching of posterior restoration was developed and distributed to 13 dental schools in Malaysia. The response rate for the questionnaire was 53.8%. The most popular posterior restoration teaching methods among the respondents were lecture (95.7%), demonstration (87.0%) and problem-based learning (PBL) (73.9%), while continuous assessment and a practical competency test (82.6%) were the most popular assessment methods. Placing a hard setting calcium hydroxide and GIC base for deep cavity restored by composite restoration was taught in 79.2% of cases. The standard protocols for posterior composite restoration were incremental filling in deep cavity (87.5%), using circumferential metal bands with wooden wedge (91.7%), with a total etch system (95.8%), using a light emitting diode (LED) light curing unit (91.7%), finishing using water cooling (80%) and finishing with a disc (87.5%). Graduates from dental schools in Malaysia received similar theoretical, preclinical and clinical teaching on posterior restoration techniques, although there were variations in the delivery methods, techniques and assessments, pointing to a need for uniformity and consensus.

In Vitro Fracture Resistance of Endodontically Treated Premolar Teeth Restored with Prefabricated and Custom-Made Fibre-Reinforced Composite Posts

(1) Background: The study aimed to compare and analyse the differences between the features of prefabricated fibre-reinforced composite (FRC) posts and custom-made FRC posts in the form of a tape and confirm the necessity of using FRC posts in teeth treated endodontically in comparison to direct reconstruction with a composite material. (2) Methods: Sixty premolars after endodontic treatment were used. The teeth were divided into four groups (n–15). Group 1: teeth with embedded prefabricated posts (Mirafit White); group 2: teeth with embedded prefabricated posts (Rebilda); group 3 teeth with embedded custom-made posts in the form of a tape (EverStick); group 4: teeth without a post restored with composite material. The compressive strength of the teeth was tested using the Instron-5944 testing machine until the sample broke. The crystal structure of the investigated posts was detected with the X-ray diffractometer (3) Results: During the experiment, the maximum values of forces at which the damage of the restored premolar teeth after endodontic treatment occurred were obtained. The best results were obtained for teeth rebuilt with Rebilda Posts (1119 N), while teeth with cemented Mirafit White posts were the weakest (968N). Teeth without an embedded FRC post, rebuilt only with light-cured composite material, obtained the lowest value—859 N. (4) Conclusions: The use of FRC posts increases the resistance to damage of an endodontically treated tooth when compared to direct restoration with light-cured composite material.

Deep margin elevation: a systematic review

Deep margin elevation (DME) is a nonsurgical, alternative technique of dental crown lengthening. Portion of direct restoration placed only at the deep apical part of the cavity to elevate the margin to a more coronal and more adequate position for final cementation of indirect restoration.Materials and methods. In this systematic review, we were looking for in vitro studies in which deep margin elevation (DME) technique were used. The electronic databases PubMed and EMBASE were used for the search. The search began on July 29, 2021 and ended on August 10, 2021. We have analyzed the materials and methods of each research and entered them in the appropriate tables to give a clearer assessment of the obtained results.Results. Analysis of marginal quality showed the best results when indirect restorations luted to dentin directly and with DME technique with three consecutive layers of resin composite. In groups without DME there were fewer microleakage. DME did not statistically significantly influence the fracture strength.Conclusions. We conducted a systematic review that included 12 in vitro studies. Even though samples without DME showed better results in in vitro studies, the difference between samples with and without DME was not statistically significant. However, in clinical practice, DME facilitates the insertion of indirect restorations. Therefore, further studies and clinical observations are necessary.

Comparative Effects of Dental Treatment and Two Different Physical Therapy Interventions in Individuals with Bruxism: A Randomized Clinical Trial

Objective: To compare the efficacy of dental treatment and two different physical therapy interventions in individuals with bruxism. Methods: A total of 72 individuals with bruxism were randomly allocated to the massage (massage with stretching exercises), relaxation (relaxation with imagination therapy) groups (n=24 each; biweekly 40-min sessions over 6 weeks) or the dental group (n=24; direct restoration; two 2-h sessions 1 week apart). Primary outcomes included muscle pain and symptoms, and mandibular opening. Secondary outcomes included anxiety, stress, depression, oral health and sleep quality. Outcomes were evaluated at baseline, 6 weeks and 2 months post-initial intervention by a blinded assessor. Physical therapy interventions included individual sessions that lasted 40 min biweekly for 6 weeks and dental treatment, two 2-h individual sessions conducted a week apart. The level of significance established was α=5%. RESULTS: After 6 weeks, the improvement with difference among massage and relaxation groups and dental group was observed in muscle pain, symptoms, anxiety, stress, depression and sleep quality (p<0.001). Relaxation group exhibited significantly greater improvement in oral health than dental group (p<0.001). These effects were sustained for up to 2 months. Conclusion: Therefore, two physical therapy interventions are superior to dental treatment in the improvement of muscle pain, symptoms, anxiety, stress, depression and sleep quality in individuals with bruxism. Oral health improves more with relaxation with imagination therapy than with dental treatment.

AGE RELATED PECULIARITY OF THE CONTACT POINTS OF THE POSTERIOR TEETH FROM THE POINT OF VIEW OF RESTORATIVE DENTISTRY

Reconstruction of the age-related anatomical and physiological features of the contact surfaces and contact points inherent in natural teeth in the treatment of caries of posterior teeth with a direct restoration with light-cured composite is one of the unsolved problems of practical dentistry. The study is devoted to the determination of age-related characteristics of the localization and shape of contact points of posterior teeth in permanent dentition. The assessment of localization and shape of 1224 contact points of posterior teeth in 236 patients aged 20 to 59 years was carried out. Comparison of data about the surface area, shape, vertical and horizontal positions of contact points related to teeth anatomic structures in the interdental space was performed. The analysis of interproximal intraoral radiography data, examination and measurement of the parameters of interdental contacts using dental floss, analysis of the display of contact points on dental impressions made according to a special technique were carried out. The localization of the contact areas of the posterior teeth with a displacement in the vestibular direction, the associated asymmetry of the buccal and lingual (palatal) interdental embrasures, as well as a gradual increase in the surface area of contact areas and a decrease in the depth of the occlusal interdental embrasures, correlated with the age of the patients, were recorded. The average numerical values of the listed parameters are derived, taking into account the age of the patients. Anatomical and topographic features of the interdental spaces of the posterior teeth in adult patients are characterized by the following features: the contact areas of the posterior teeth are displaced in the vestibular direction, the buccal and lingual (palatal) interdental embrasures are asymmetric; dynamics of the depth of occlusal interdental embrasures, linear dimensions and area of contact areas is expressed as average digital values for different age groups: 20-40 years: contact areas – 1×2 mm, S = 2 mm2, depth of occlusal interdental embrasure – 1.5 mm; over 40 years old: contact pads – 1.5 × 3 mm, S = 4.5 mm2, the depth of the occlusal interdental embrasure – 1.0 mm.

LABORATORY STUDY OF THE EFFICIENCY OF THE RECREATION OF THE AGE FEATURES OF THE CONTACT SURFACES OF THE POSTERIOR TEETH BY DIRECT COMPOSITE RESTORATION

The methods of aesthetic restoration of posterior teeth with composite materials currently used in practical dentistry make it possible to create only a point contact, which does not correspond to the age characteristics of the patients' teeth, therefore, it is important to develop methods for creation and positioning the contact areas, taking into account the age characteristics of structures of the teeth. A laboratory study of the effectiveness of the method of recreation of the age-related characteristics of the contact areas of the posterior teeth using the method of direct aesthetic restoration using light-cured composite materials with a specially developed tool – a contact-former was carried out. Phantom models were used to evaluate the significant characteristics of 40 restorations of posterior teeth with cavities of class 2 according to Black, performed in accordance with the traditional method, 80 restorations performed in accordance with the developed algorithm for restoring the contact points of posterior teeth by the method of direct composite restoration, taking into account age characteristics: 40 restorations with using a contact former with a working part of 1×2 mm (S = 2 mm2), 40 restorations - using a contact former with a working part of 1.5×3 mm (S = 4.5 mm2). It was found that the usage of the approved method of restoration of the contact points of posterior teeth using the method of direct composite restoration, taking into account age characteristics with the use of a contact-former in the process of tooth restoration, allows to obtain the required planar shape of the contact area (95.0±2.44%) to obtain its desired localization (90.0±3.35%), to form the functional configuration of interdental embrasures (86.7±3.79%) with a high degree of probability. There was a significant (p˂0.05) difference in indicators characterising the quality of positioning and restoration of the contact areas of the posterior teeth when using the tested technique in comparison with the traditional technique of restoration of teeth with carious defects of class 2 according to Black. The effectiveness of the tested method of direct restoration of the contact surfaces of the posterior teeth while taking into account age characteristics has been proved. The efficiency and ergonomics of the contact-former developed by us for this technique have been confirmed. It is concluded that it is advisable to study the effectiveness of the proposed technique in a clinical setting.

THERAPEUTIC METHODS FOR TREATMENT OF DENTAL DISCOLORITIS

The problem of discoloration of teeth, especially accompanied by increased sensitivity, does not lose its relevance in modern dentistry. Despite the presence in the arsenal of dentists of a significant number of means and methods for solving this problem, it does not go away, but, on the contrary, is overgrown with new complaints. In this work, we analyzed the frequency to analyze the frequency of choice of therapeutic methods for treating discoloration of teeth by patients of dental clinics. A questionnaire was developed for a dentist on the patient's choice of a therapeutic method for eliminating dental discoloration and a survey of 30 dentists (10 - therapists, 10 - orthopedists and 10 - general dentists) was conducted for 2019 and 6 months of 2020. It was found that during this period, 184 out of 331 patients who applied to dental clinics with this problem used therapeutic methods for eliminating tooth discoloration: tooth enamel coating with varnish ("Colordent" + adhesive "Single Bond") was carried out in 16.6% of patients, clinical bleaching of enamel in 32.6% of patients with tooth discoloration, intracoronal bleaching followed by direct restoration (replacement of existing fillings with new ones) in 53.8%. The analysis showed that therapeutic methods for eliminating discoloration of teeth predominate slightly, 55%. Of course, in choosing this direction, the doctor is guided by the clinical situation, IROPZ, taking into account the wishes of the patient and his capabilities. However, it seems necessary to develop and test new, gentle and resistant to mechanical stress methods for eliminating discoloration of economy-class teeth with the possibility of solving the problem of increased tooth sensitivity.

Reconstructing natural aesthetics of posterior teeth with direct composite restorations (a case report)

One of the most common methods of dental treatment in a minimally invasive concept is a direct restoration of carious damaged teeth or teeth with dental trauma. In this article represents a clinical case of old unsatisfactory restorations replacement in teeth 36, 37 followed by restoration of hard tissue class II defects using direct composite restoration taking into account aesthetic and biomechanical aspects.

Could different direct restoration techniques affect interfacial gap and fracture resistance of endodontically treated anterior teeth?

Objectives To evaluate different direct restoration techniques on various cavity designs in anterior endodontically treated teeth (ETT). Materials and methods Ninety upper central incisors (n = 90) were selected, endodontically treated, and divided into three groups (n = 30) accordingly to the cavity design: minimal endodontic cavity access (group A), endodontic access + mesial class III cavity (group B), and endodontic access + two class III cavities (group C). Three subgroups (n = 10) were then created accordingly to the restoration technique: nano hybrid composite restoration (subgroup a), glass fiber post + dual-cure luting cement (subgroup b), and bundled glass fiber + dual-cure luting cement (subgroup c). Samples underwent micro-CT scan, chewing simulation, and a second micro-CT scan. 3D quantification (mm3) of interfacial gap progression was performed; then, samples underwent fracture resistance test. Data were statistically analyzed setting significance at p < 0.05. Results Groups A and B showed significantly lower interfacial gap progression compared with group C. Subgroup b performed significantly better compared with subgroups a and c. Improved fracture strength was reported for group C compared with group A, while both subgroups b and c performed better than subgroup a. Conclusions Cavity design significantly influenced interfacial gap progression and fracture resistance. Fiber posts significantly lowered gap progression and improved fracture resistance while bundled fibers only increased fracture resistance. A significant reduction of non-repairable fractures was recorded when fibers were applied. Clinical relevance A minimally invasive approach, conserving marginal crests, should be applied whenever possible. Inserting a fiber post is indicated when restoring anterior ETT, in order to reduce gap progression, improve fracture resistance, and avoid catastrophic failures.

METHODS FOR ELIMINATION OF DENTAL DISCOLORITIS

Discoloration of teeth is an urgent problem of modern dentistry. This is a very common and multifactorial pathology in nature. With this problem, patients turn to dentists of various profiles. This work analyzes the frequency of using various methods for eliminating discoloration of teeth. A survey of 50 doctors of various specializations was conducted and it was found that for the period from September to November 2020, clinical enamel whitening was carried out in 22,5% of patients with tooth discoloration, intracoronal bleaching followed by direct restoration (replacement of existing fillings with new ones) in 30%, covering the vestibular surface of the teeth located in the smile line with ceramic veneers in 22,5% and total prosthetics in 25%. The analysis showed that at present the arsenal of a dentist is quite wide and, depending on the clinical situation taking into account the wishes of the patient and his capabilities, the doctor can choose a way to eliminate the discoloration of the teeth suitable for a particular patient. In addition, the use of this problem is higher among general dentists – 9,4%, in second place in terms of accessibility are dentists orthopedists - 8%, and in third place are dentists therapists – 6,5%. The problem of teeth discoloration, especially accompanied by increased sensitivity, does not lose its relevance in modern dentistry. It seems necessary to develop, test and implement means and methods for quickly and gently eliminating discoloration of teeth, which will not only correct, change the color of the tooth, but also solve the problem of increased sensitivity of teeth.