Multidisciplinary Approach to Complicated Crown-root Fracture Treatment: A Case Report

SUMMARY Treatment of complicated crown-root fractures is one of the most challenging within the various types of dental trauma and requires a multidisciplinary approach. This paper reports the complicated crown-root fracture of a maxillary right central incisor, in which there was esthetic, functional, and biologic (endodontic and biologic width invasion) involvement. A 15-year-old male patient presented to the dental clinic one month after suffering trauma with a complicated crown-root fracture on tooth 8. The patient had previously undergone endodontic treatment and was sent to have periodontal surgery to reestablish the biological width on the palatal surface. Following the surgery, a fiberglass post was cemented, and the fragment was reattached. This approach allows the exposure of the cervical margin, adequate isolation, and subsequent fragment reattachment in the same clinical appointment. Fragment reattachment is a viable approach as it is a simple and conservative procedure that restores the natural esthetic of the tooth and has superior resistance compared to a composite restoration. The patient’s cooperation in understanding the limitations of the treatment and maintaining adequate oral hygiene are very important to achieving a good prognosis of the case. After a 2-year clinical and radiographic follow-up period, the clinical protocol was found to be successful, and the tooth remained functional, esthetically favorable and asymptomatic.

Esthetic-functional reconstruction of posterior teeth with direct restorations (a case report)

Teeth restoration in respect with anatomy and function with direct composite restoration does not lose its relevance for many years. The driving factor for the widespread use of direct restorations is satisfactory aesthetic results, simplicity and high speed of their implementation, and relatively low cost. Moreover, dental restorations in direct technique are constantly being improved due to the unprecedented growth of technologies in the production of dental materials and equipment, which are now living their golden age. This article presents a clinical case of replacing old incompetent fillings with impaired marginal fit of the posterior teeth with highly aesthetic and functional composite restorations.

Ten tips for avoiding post-operative sensitivity with posterior composite restorations

Patients increasingly seek tooth-coloured restorations in their posterior dentition, and with the anticipated decline in the use of amalgam as a result of the Minamata Agreement, this will increase. However, the incidence of post-operative sensitivity has been variously assessed as being between 0% and 51%, therefore information on its avoidance is essential. This article reviews the reasons for such sensitivity by examining the potential materials' factors, plus clinical aspects, such as the configuration factor and bonding to tooth substance. CPD/Clinical Relevance: There is a significant incidence of post-operative sensitivity after placement of a posterior composite restoration, so information on how to avoid this may be of value.

Effect of Stress Generated by Occlusal Cyclic Force on Class I Bulk-Fill Composite Restoration Microleakage

Objective This study aimed to evaluate the effects of different types and restorative techniques of Class I composite restorations with a single loading force on stress distribution and cyclic loading force on microleakage formation. Materials and Methods Class I cavities were prepared in premolars with 4 mm depth and divided into six groups of different restorations with: (1) Filtek Z250; (2) a 3-mm-thick layer of Filtek Bulk Fill Flowable Restoration and covered with Z250; (3) a 1.5-mm-thick layer of flowable composite and covered with Z250; (4) lining all cavity with flowable composite and restored with Z250; (5) Filtek Bulk Fill Posterior Restoration; and (6) lining all cavity with flowable composite and restored with bulk-fill composite. The specimens with and without cyclic occlusal loading were subjected to microleakage observation. In addition, six different models of Class I restorations corresponding to the microleakage study were generated. Finite element analysis (FEA) was used to identify the stress distribution under a single loading force. Statistical Analysis Data were statistically analyzed by two-way analysis of variance and multiple comparison. The significance level set at 0.05. Results Cavity lining or restoration with flowable composite underneath conventional composite reduced stress on composite resin based on FEA (groups 2 and 3). The cyclic stress on composite increased microleakage. Restoration with flowable composite underneath conventional composite reduced the microleakage in Class I restoration (groups 2, 3, and 4). Conclusion The most effective cavity lining with a flowable composite underneath conventional composite restoration was stress reduction under loading force resulting in microleakage reduction.

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.

Aesthetic rehabilitation of posterior teeth with direct composite restorations (a case report)

Aesthetic composite restoration is the most common method for dental hard tissue defects reconstruction. Despite the active development and use of ceramic restorations for dental rehabilitation, the introduction of new nanotechnological filling materials has opened up fundamentally new possibilities in restorative dentistry. This article represents a clinical case of direct composite restoration in teeth 25, 26 and 27 using new nanoceramic materials.

Bonding States of In Vitro Class 2 Direct Resin Composite Restoration Applied by Various Incremental Techniques

Incremental techniques are always required for clinical cases of deep and/or large cavities restored with resin composite materials. The purpose of this study was to examine the bonding states of class 2 direct resin composite restoration applied by various incremental techniques after cyclic loading to simulate the intra-oral environment to define the appropriate technique. Three types of resin composites, namely, bulk-fill (B), flowable (F), and conventional resin composite (C), were applied to standardized class 2 cavities by incremental techniques with single- or bi-resin restoratives. After cyclic loading, the micro-tensile bond strength (μ-TBS) of the dentin cavity floor was measured. The Weibull modulus and Weibull stress values at 10%/90% probability of failure were analyzed. Single-resin incremental restorations with B or F and bi-resin incremental restorations with F + B and F + C demonstrated superior μ-TBS (quantitative ability), bonding reliability, and durability (qualitative ability) compared with the single-resin restoration with C (as control). Furthermore, F + B and F + C restoration yielded an excellent performance compared with the single-resin restorations with B, F, and C. In particular, the F + C restoration, which indicates not only the maximum mean µ-TBS, but also the highest values of the Weibull parameters, may be the optimal restoration method, including the esthetic benefits.

Temperature Rise at the Pulp-Dentin Junction for a Multi-Layered Composite Restoration using the Finite Element Method

Objectives: During the light-curing process of composite restoration, excessive heat can be produced, which can potentially lead to pulp necrosis (death). In this study, we aimed, based on the Finite Element Method (FEM), to assess the risk of pulp damage during the light-curing process by investigating the influence of light-curing devices, under various irradiation regimes, on the temperature increase at the pulp-dentin junction, during a one-layer or multi-layered deep composite restoration. Methods: A Three-dimensional finite element method model of typical geometry and material properties, as commonly reported in the literature, was employed in COMSOL Multiphysics simulations in order to determine the temperature increase in the pulp. Various combinations of light intensities, durations, and irradiation regimes were investigated for the two cases, of shallow and deep multi-layered composite restoration. Results: Results of light-curing composite resins within enamel; indicate that the temperature rise during the curing process was within the safety margins. Results of light-curing composite resin restorations closer to the pulp with thin remaining dentin, indicate a temperature increase that could be sufficient to cause thermal injury in the pulp. Modulating the light output marginally, reduced the temperature rise while reducing the intensity and increasing the curing duration which was consistently more effective in this respect. Conclusion: The results clearly demonstrate that with currently adopted standard procedures, there exists a risk of thermal injury during multi-layered composite restorations with thin remaining dentin; it is thus important to establish appropriate curing regimes that would lead to minimal temperature increase during deep composite restorations and hence reduce the risk of thermal injury to the pulp.