Friday, March 16, 2018

Glass ionomer cements in pediatric dentistry: review of literature

Resident’s Name:        Carol Caudill                                                                           Date: 3/21/2018
Article Title: Glass ionomer cements in pediatric dentistry: review of literature
Author(s): Croll, TP and Nicholson, JW
Journal: Pediatric Dentistry
Date: 2002
Major Topic: Glass ionomer cements
Type of Article: background information
Main Purpose: To review the development and history of glass ionomer cements and their current role in pediatric dentistry
Key Points: (2 lines Max): Newer glass ionomer products have been modified to fix old disadvantages and take advantage of glass ionomer fluoride release, biocompatibility, and chemical bonding
·      Glass ionomer cements were invented in 1969. They are made out of calcium or strontium aluminofluorosilicate glass powder base and a water-soluble polymer acid. They set via acid-base reaction

Original self-hardening glass ionomer cements
·      Advantages
·               Fluoride ion release
·               Coefficient of thermal expansion similar to teeth
·               Biocompatibility
·               Chemical bonding to enamel and dentin
·      Disadvantages
·               Extended setting time
·               Poor wear resistance
·               Poor fracture strengths

Resin-modified glass ionomer restorative cements
·      Includes Vitrebond, Fuji II GC
·      Hardens initially by free radical photopolymerization of the resin component and then the glass ionomer setting reaction happens
·      These cements have all of the advantages of traditional glass ionomers.
·      Additional advantages compared to traditional glass ionomers:
·               Decrease in initial hardening time and handling difficulties
·               Increase in wear resistance and physical strength

Fluoride ion release and uptake
·      Glass ionomers can release fluoride for up to 5 years
·      This fluoride can be taken up by dentin and enamel, making the tooth less soluble. It also has an antimicrobial effect.

Glass ionomer luting cements
·      Glass ionomer luting cements can be used for cementing stainless steel crowns, space maintainers, and stainless steel orthodontic bands
·      Resin-modified glass ionomer luting cements can also be used for orthodontic bands and SSCs. The added strength makes band loosening uncommon

Glass ionomer/resin-based composite stratification
·      AKA the “sandwich technique”
·      Using a glass ionomer in conjunction with composite can significantly decrease post-op sensitivity and better mimic the original tooth structure

Bioactivity of glass ionomers
·      Glass ionomers can release ions besides fluoride like calcium and aluminum. These ions have the ability to promote remineralization of the tooth.
Assessment of Article:  Level of Evidence/Comments: III-background information

Wednesday, March 14, 2018

Clinical applicability of resin infiltration for proximal caries

Resident’s Name: Michael Hatton                                                                              Date: 3/14/2018
Article Title: Clinical applicability of resin infiltration for proximal caries
Author(s): Altarabulsi MB, Alkilzy M, Splieth CH
Journal: Quintessence International
Date: Feb 2013
Major Topic: Restorative dentistry
Type of Article: Clinical trial
Main Purpose: Evaluate clinical applicability and patient satisfaction of resin infiltration of proximal caries in children and adolescents.
Key Points: (2 lines Max): Resin infiltration is a feasible ultraconservative approach to treat initial non-cavitated proximal lesions without prior tooth separation with high patient acceptance

A sample of 50 patients (30 male/20 female), age 5-30 years, with proximal lesions in enamel or outer third of dentin in primary or permanent teeth which were assessed by radiographic evaluation as non-cavitated.  A total of 10 providers with no previous experience using Icon resin infiltration technique were recruited, Icon is a light curable low-viscosity resin that has a high refractive index so has a chameleon affect requiring no shade matching.

The Icon Technique is as follows:
1.       Clean proximal surfaces of surface debris with dental floss
2.       Place rubber dam
3.       Place icon wedge to gain access to proximal surface
4.       Etch 15% Hydrochloric acid 120 sec
5.       Rinse 30 sec
6.       Dry surface by dehydrating applied 95% ethanol and air dry for 30 sec
7.       Infiltrant applied for 180 sec
8.       Remove excess with dental floss
9.       Light cured from 3 sides for 40 sec
10.     Infiltrant applied again for 60 sec and light cured
11.     Finishing and polishing with disks and strips

It provides a single visit treatment, without the need to remove tooth structure, by occluding micropores of the non-cavitated lesion with low-viscosity resin and reducing the progression of noncavitated proximal caries lesions.

Patients and providers were questioned by survey.

Results showed:
- Satisfaction with the infiltration procedure and length of time of procedure by both patients and providers
- 93.6% of patients would opt for infiltration again
- 78.8% would be willing to pay for this treatment privately
- The providers reported that the dental dam procedure was the longest and most difficult aspect of treatment, as these providers rarely used dental dams in regular treatment. Rubber dam critical to isolation in order to optimize resin penetration, however rubber dam placement was also the primary cause of problems due to time and difficulty of placing, as well as interference of the clamp with the special wedge.
- There exists a high correlation between experience (number of procedures) and reduction in treatment time

Variables Affecting General Anesthesia Time for Pediatric Dental Cases

Variables Affecting General Anesthesia Time for Pediatric Dental Cases
Resident’s Name: Wayne Dobbins                                                                                 Date: 03-14-2018
Article Title: Variables Affecting General Anesthesia Time for Pediatric Dental Cases
Author(s): Yi Y, Lee J, Yi H, Asher S, Feldman L, Rivas-Morello C, Haque M, Ross E
Journal: Pediatric Dentistry
Date: 2015
Major Topic: Anesthesia
Type of Article:  Restrospective Chart Review
Main Purpose: Identification of variables that predict procedural times for dental treatments
Key Points: Provider inexperience, need for radiographs, older age, medical complications, and oral intubation all significantly increase procedural time.
All pediatric dental OR cases at Boston Children’s Hospital looked at from April 2009 to December 2013, excluding cleft lip and palate cases, intradisciplinary cases, and cases with incomplete data – 2266 cases used for study in total. Statistical analysis was conduted to determine significant predictors of early or late finish times as compared to the booked time; for the cases of this study a 15 minute difference qualified as early or late.

Provider inexperience, need for radiographs, older age, medical complications, and oral intubation all significantly increased the chances for late finishes. Early and late finishes did not vary significantly by academic quarter, by referrer type (resident vs attending), by gender of patient, or by time elapsed between date of referral and date of treatment.

Overestimation of pediatric dental operating room cases exists, and identification of variables associated with these inaccuracies can aid providers in recapturing underutilized operative room times.

Much of the findings of this study are most relevant to Boston Children's, as it specifically relates to the manner in which they book patients. At St. Joseph, with 2 hour blocks, the specific refinements provided by the data are not as relevant, but the notion that a formula could be created to estimate procedure length could increase efficiency.  Of course, this is just a theory and if you have spent a day in the OR at Lady of Fatima Hospital efficiency is not in their vocabulary! 

The continuum of restorative materials in pediatric dentistry – a review for the clinician

NYU Langone Dental Medicine
Resident: Albert Yamoah, DDS                                                                                                                                                          Date: 03/14/2018
Article Title: The continuum of restorative materials in pediatric dentistry – a review for the clinician
Author(s): Joel Berg, DDS, MS
Journal: Pediatric Dentistry
Date: 1998
Major TopicDental materials
Type of Article: Literature Review
Main Purpose: To provide a review of the intracoronal restorative materials used in modern pediatric dental practice
Key Points:
·  Many choices for restorative materials are available to the practitioner of restorative dentistry for children
·  Confusion has been created about what these materials are, making it difficult to identify their appropriate clinical use
·  This paper reviews glass-ionomer materials, resin-modified (reinforced) glass ionomers, compomers and, composite resins
o   Definitions of these materials, a general description of their contents, and usage-selection criteria are provided
Glass Ionomer
·   A salt formed by the reaction between polyalkenoic acid and aluminum containing glass
·   Fluoride in glass material is released over time with a very high fluoride release occurring for a period of several weeks
o   Dissipates to around 10% of original level in 3-4 weeks and then remains at this level for 1 year
·   Has a true chemical bond to tooth structure
·   Coefficient of thermal expansion (COTE) of glass-ionomer is the most similar to tooth structure (mostly dentin)
·   Large difference in the COTE of material and tooth structure leads to failure of the restoration
o   Due to temperature-related expansion/contraction
·   Physical properties of glass ionomers have improved dramatically
o   Due to introduction of high powder-to-liquid ratio glass ionomer materials
o   Denser versions provide a "condensable” feel, facilitating use in posterior teeth

Resin-Modified Glass Ionomers
·   Contain the same components as traditional GICs PLUS resin materials
o   Resin added to provide strength and also the capability to light cure-hydrophilic resin
o   More resistant to fracture
·   Relative amount of resin to glass ionomer in the mixture of RMGI determines physical and clinical behavior of material
o   Being more glass ionomer-like or more resin-like

·   Resin composites with acidic functional groups
o   participate in an acid/base glass-ionomer reaction after the polymerization of the resin molecule has taken place
·   COMPosite + Glass IonOMER = COMPOMER
o   BUT they are not glass ionomer materials
o   A true GI material must be a two-component system, otherwise acid/base reaction occurs immediately
·   With compomers, a resin polymerization takes place, then the material is completely set
·   There must be no water or moisture to prevent a premature GIC reaction
·   The amount of total fluoride released is significantly lower than that of traditional GIC and RMGI
·   Essentially resin composite material
·   Require use of primer before placing

Composite Resin
·   Contains a monomeric or prepolymeric resin that is filled to various levels with glass or quartz
·   Filler particles are silanized (or silanated) to allow the hydrophilic filler to bond to the hydrophobic resin matrix
o   Good silanation is essential for a stable material that is resistant to wear and homogenous in its composition
·   Undergoes polymerization shrinkage.
o   This shrinkage ranges from 2 to 3.5%
o   Causes the composite to pull towards the center of its mass
·   Come in many shades
·   Be aware of both the filler content and size-different clinical indications
o   Filler content is a description of the amount of filler in a composite
o   Filler size is particle size
·   Filler content is merely a description of the quantity of filler in a composite
·   It is generally measured as the weight:weight quantity of filler placed into the resin matrix
o   Expressed as a percent
o   If there is no filler in the resin matrix, the material may be called an "unfilled" resin
§  These materials are used as unfilled sealants, and sometimes as components of bonding agents
o   If the resin matrix is filled approximately 30% by weight, the material may be designated as a "filled" sealant
§  Many sealants are filled to this extent today
§  Some bonding agents are also filled as much or even slightly more (called “filled” bonding agents)

·   Flowable composites are composite-resin materials that are 50- to 70%-filled by weight
·   Highly filled, modern, composite-resin materials are 75- to 85%-filled by weight
o   At this level of filler content, a stiff, easily packable material is achieved
o   Can be used for both anterior and posterior placements
·   Mathematics of adding more filler to resin and measuring the weight:weight filler content percentage:
o   The more filler added, the less the filler content percentage number will rise
o   If a composite is 50% filled, then the filler-to-resin weight ratio is 1:1.
o   If twice the amount of filler exists in a different composite resin, then the filler-to-resin weight ratio is 2:1
·   Filler size is generally expressed as median size (usually the mode as well) of the filler particles within the resin matrix
o   Fillers ground to 5-50 um are referred to as "macrofillers"
o   Fillers that aren’t ground but produced by other procedures and range from 0.01 to 0.1 um are called "microfillers
o   When various mixes of macro and microfillers are created, resultant particle size ranges from 0.5 to 5.0 um
§  Referred to as a hybrid
o   Hybrid materials offer advantage of being suitable for anterior and posterior indications
§  Anterior – polishablity due to microfill
§  Posterior – durability as a result of larger particle size
o   Many clinicians choose to purchase only one material, commonly a hybrid that can be universally used
o   However, to achieve the best esthetic results for anterior restorations, microfilled materials are sometimes preferred

Assessment of Article
·   Level of Evidence/Comments: Level II
·   A good resource to reference contemporary restorative materials