# Long-Lasting Restorations for Buccal and Cervical Caries: Expert Insights**
Buccal and cervical caries, especially when wide and deep, present a significant challenge in restorative dentistry. A common concern among dental practitioners is finding a restoration material that ensures longevity and reliability in these difficult-to-reach areas.
## Key Factors and Solutions for Durable Restorations
1. **Rubber Dam Isolation:** Using a rubber dam during restorative procedures is crucial to prevent contamination from crevicular fluid. Contamination can significantly compromise the bonding process, leading to restoration failure. Studies have shown that the use of a rubber dam enhances the longevity of restorations by reducing contamination and providing a dry field, which is critical for bonding success .
2. **Material Compression and Failure:** Compression factors can also contribute to the failure of restorations. High flow composites are suggested as an alternative to GIC in such cases. High flow composites have better adaptability to the cavity walls and can withstand occlusal forces better, reducing the likelihood of failure .
3. **Moisture Control:** When a rubber dam is not used, ensuring that the cavity is dry using cotton rolls is essential. Excess moisture can interfere with the bonding process, leading to premature failure. The bonding agent should be carefully applied, with sufficient rubbing to form proper resin tags, ensuring better adhesion .
4. **Proper Etching and Dentin Management:** Over-drying after etching can cause the dentin tubules to collapse, leading to inadequate bonding. Maintaining slight moisture after etching is recommended to preserve the collagen network in the dentin, allowing better bonding .
5. **Optimizing GIC Use:** For those preferring GIC, using a medium consistency, which is neither too fluid nor too stiff, can provide better results. Additionally, applying a thin layer of GIC liquid on the tooth surface before placing the cement can improve adhesion. This technique, as endorsed by industry experts, has been observed to significantly enhance the performance of GIC in clinical practice .
In conclusion, the success of restorative procedures in cases of buccal and cervical caries depends on meticulous attention to isolation, moisture control, and the correct use of materials. Following these guidelines, supported by clinical experience and expert advice, can lead to more durable and reliable restorations.
---
### References:
1. **Rubber Dam Use in Dentistry**: "Effect of Rubber Dam on the Success of Direct Restorations: A Systematic Review," Journal of the American Dental Association, [link](https://jada.ada.org/).
2. **High Flow Composites**: "The Clinical Effectiveness of Resin Composites in Direct Restorations: A Systematic Review," International Journal of Dentistry, [link](https://www.hindawi.com/journals/ijd/).
3. **Moisture Control in Bonding**: "The Role of Moisture Control in Adhesive Dentistry," Journal of Dental Research, [link](https://journals.sagepub.com/home/jdr).
4. **Dentin Management**: "Etching in Adhesive Dentistry: Principles and Techniques," Operative Dentistry, [link](https://meridian.allenpress.com/operative-dentistry).
These references provide additional context and evidence-based support for the techniques discussed.
** **Disclaimer:**
This article was generated with the assistance of AI and should be used as a supplementary resource. While efforts have been made to ensure accuracy, it's essential to conduct your own research and consult authoritative sources before applying any of the information provided. This content is intended for informational purposes only and does not replace professional advice.
Here's another interesting fact about anesthesia in dentistry:
Did you know that the first local anesthetic used in dentistry was cocaine? In the late 19th century, cocaine was used as a topical anesthetic to numb the mucous membranes in the mouth. However, due to its high potential for addiction and abuse, it was eventually replaced by other safer alternatives like procaine (Novocain) and lidocaine.
But here's the fascinating part: the discovery of cocaine's anesthetic properties was accidental! In 1865, German chemist Albert Niemann isolated cocaine from coca leaves and experimented with it on his own tongue, discovering its numbing effects!
Today, modern dentistry uses a variety of safer, more effective local anesthetics, but it's interesting to note the origins of anesthesia in dentistry and how it has evolved over time!
# Job Title: GP Dentist, Female, South Indian ## Location: Al Ain, UAE *Description: Required Female Dentist with/without UAE experience to a reputed clinic in Al Ain* **Comment below if interested**
_(Visit the Group and Join the Group to be able to COMMENT)_
Latest Members
Significance of Implants in General Dentistry Practice!
A general dentist is mostly concerned with the study, diagnosis, prevention and treatment of the most common oral diseases which are dental caries and periodontal disease. Various treatment modalities involve the restoration of teeth, extraction or surgical removal of teeth, scaling and root planing,root canal treatment and replacement of missing tooth/teeth. However, a few challenging cases are reported leading to dilemma in diagnosis, treatment choice and the ultimate outcome.
The epidemic of caries and untreated periodontal diseases led to a concomitant increase in the extraction of teeth by dentists.A general dentist comes across cases of replacement of missing teeth on a regular basis.It can be challenging to decide the treatment plan in such a scenario due to the several options available (Figure 1). Replacement of the teeth in edentulous arches is recommended because when tooth loss occurs, masticatory function is diminished; when the underlying bone of the jaws is not under normal function it can slowly lose its mass and density, which can lead to fractures of mandible and reduction of the vertical dimension of the face. The physical appearance of the person is also noticeably affected.
Using
conventional method, the missing teeth can be replaced by using tooth or tissue
supported prostheses. These include complete dentures for replacement of fully
edentulous arches and conventional bridges or removable or fixed partial
dentures for replacement of partially edentulous arches. An alternative method
of replacement is the bone supported prostheses – dental implants (Figure 2).
Dental implant or fixture is defined by the Oxford Dental
Dictionary as “a device specifically designed to be placed surgically within or
on the mandibular or maxillary bone as a means of providing retention for a
prosthetic replacement of one or more teeth”. Over the last several years, many
different types of implants have been invented, improving the quality and lives
of many people suffering from dentition loss.
An implant can be used to support a single crown or a bridge or even to retain complete dentures.An endodontic implant can be used to provide increased retention and decrease tooth mobility.Many of the patients that a dentist encounters have insufficient dental support suitable for orthodontic anchorage or are not compliant with wearing extra-oral devices. Orthodontic implants have become broadly accepted as alternatives to extra-oral devices in such patients. Mini implants (orthodontic implants) are used in orthodontics as temporary anchorage devices.The many advantages of using mini-implants include ease of insertion, increased patient comfort, immediate loading and low price.
Implants are becoming the treatment of choice for a number of reasons. Most significant among these is the expected longevity, strength and stability offered by current implant treatment, as well as the predictability of implant treatment with current technologies. Today’s dental implants are strong, durable, and virtually indistinguishable from natural teeth and are typically placed in a single sitting. They offer long-term solution to tooth loss. In the presence of healthy tissues, a well-integrated implant with appropriate biochemical loads can have long term success rates of 93% to 98% for the fixture and 10 to 15 years life span for the prosthetic tooth. Implants are less dependent than tooth or tissue supported prostheses on the configuration of remaining natural teeth in the arch. They can be used to support prostheses for a completely edentulous arch, for an arch devoid of posterior tooth support and for almost any configuration of partial edentulism with tooth support on both sides of the edentulous space (Figure 3). The patient’s function when wearing a denture may be reduced to one sixth of that level formerly experienced with natural dentition; however an implant prostheses may return the function to near-normal limits. As implants are more successful and result in fewer complications, they develop a competitive advantage among the technical alternatives. In traditional dentistry the restoration reflects the existing condition of the patient. The dentist evaluates existing natural abutments first and fabricates a removable or fixed restoration accordingly. Treatment using implants is unique because additional foundation units may be created for a desired prosthodontic result.
General
dentists around the world certainly have proven that it is well within the
capability of every general practitioner to be able to surgically place dental
implants. However, a large group of general dentists hesitate in doing this
surgical procedure for various reasons. These include:-
The surgical procedure is technique sensitive
Need to undergo special training for performing the
procedure
Expensive
equipments
Confusion
due to the various different types of implant systems available
Experience
plays a vital role in the success of implant treatment
There
may be a need to do bone grafting at the time of implant placement or before
implant placement which is again technique sensitive
Risks
associated with dental implants are higher compared to the alternative
treatment options
It
is harder to manage the complications associated with dental implants.
However, because of the awareness of implant treatment and patient needs, a majority of dental professionals have equipped themselves with the requirements of implant procedures and have gained knowledge about failures and associated complications.
Factors that affect the need and demand for dental implants can be described under macro-factors and individual factors.
Macro-factors include:-
Overall population growth
Growth in disposable per capita income
Improvement in education levels
Extent and severity of oral disease that can result in loss of teeth
Tooth loss itself
Individual factors include:-
General health of the patient and any contraindications for the surgical implant procedure
Configuration of the remaining teeth in the arch as well as the opposing arch
Number of tooth spaces that need replacement by prostheses
The preference of the patient and his or her willingness to undergo a more invasive surgical procedure required by the dental implant option
Relative cost of the implant option compared to the alternative
Although they demonstrate a very high success rate, oral implants may fail for a number of reasons, often related to a failure in the osseointegration process. If the implant is placed in a poor position, osseointegration may not take place. Like natural teeth, dental implants may break or become infected and crowns may become loose. Dental implants are not susceptible to caries attack, but poor oral hygiene can lead to development of Peri-implantitis around the dental implant. Peri-implantitisis one of the common complications and leads to bone loss and implant failure (Figure 4).
A general practitioner should be able to manage a case of implant failure. Implants undergoing early or late failure show progressive bone loss and can be readily diagnosed on radiographs. Clinically, signs of infection such as the presence of fistula in the soft tissue covering the implants, purulent discharge on exploration, bleeding, discoloration of marginal gingival tissue, and discomfort to probing at the implant site may also be present. If left untreated, bone loss typically continues and, with time, complete loss of osseointegration will occur. The approach to treatment of ailing implants is often empirical and is an extension of modalities of treatment of periodontitis that occurs around the natural dentition. The goal is therefore to stop further bone loss and establish a healthy peri-implant soft tissue interface.Peri-implantitis can sometimes be treated, but in most cases the implant must be removed.In the case of a loose dental implant, the only treatment is to immediately remove all components of the implant to avoid the progressive destruction of the surrounding tissues.After a careful investigation of the clinical situation, the general practitioner must decide whether to carry out the implant removal or refer the patient to a specialist.All is not lost if a dental implant fails. It is sometimes possible to save an implant by building up the bone &gingival tissue surrounding it. However, in most cases the implant must often be removed and the area left to heal. Re-implantation procedure can be attempted once the area has recovered, which can take up to a year or until the dentist determines that the site is suitable. Depending on how well the area heals, a bone graft might be required to provide a better foundation for the implant and improve the chance of success.Scaling of dental implants is done using special instruments like plastic hand scalers, graphite and titanium hand scalers, ultrasonic scalers with titanium coated tips.
A
general dentist considering the use of implants should be well versed with its
contraindications as well. These include,
Systemic
contraindications:-
Severe
blood diseases
Within
six months of an attack of myocardial infarction
Cerebral
infarction and cerebral apoplexy
Severe
immunodeficiency
Chemotherapy
patients
Neuropsychiatric
patients
Youth
under the age of 15
Severe
osteoporosis
Local
contraindications:-
Insufficient
bone quantity, but where bone augmentation procedures with bone graft is not
possible.
Severe
periodontal diseases
Intractable
periodontitis
High
exposure to radiation
Chronic
osteomyelitis
Bruxism
Mouth
closing disorders
Heavy
smokers
Sjögren’s syndrome
Poor oral hygiene
It can be an easy or difficult decision to remove a tooth and place an
implant. Patients should also be involved in making that decision. Thorough
informed consent should be provided, and a detailed discussion of the potential
for success or failure should be made. The joint patient-dentist decision
should be based on the amount of tooth structure remaining, occlusion,
financial considerations, patient desire to keep the natural tooth, and patient
acceptance of other needed procedures to retain the tooth. Clinical procedure
can be successful if all factors are considered and treatment is accomplished
properly (Figure 5).
During the past several years, great strides have been made
in dental practices. With the advent of newer materials, newer techniques and a
better understanding of the dental anatomy, dentistry has achieved newer
levels. Dentistry has evolved over the years to bring to its patient’s better
treatment options and restorative and prosthetic solutions which have higher
success ratio and survival rates.
As new implant surface technologies develop and prosthetic options increase, the field of dental implantology continues to change. Implants are the nearest equivalent replacement to the natural tooth, and are therefore a useful addition in the management of patients who have missing teeth because of caries, periodontal diseases, trauma or developmental anomalies. General dentists considering the use of this treatment modality should be aware of the importance of treatment planning, assessment and teamwork in achieving successful outcomes and should gain the skills, education, and technology to add implants to their practice.
Want to publish your article or other content on D1 Magazine ?
Get a FREE Membership on Sign Up and Go to Articles in your Profile Page. Become an Author Dentista.
Share your thoughts, Get involved!
Comments