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The core build-up procedure is utilized to restore teeth with limited remaining coronal tooth structure. However, voids have been observed radiographically within composite resin- and glass ionomer-based core build-ups, potentially compromising the mechanical strength of a fully restored tooth and requiring build-up replacement before a final restoration can be delivered. The purpose of this in vitro study was to determine whether applying ultrasonic vibration during core build-up placement reduces the presence of radiographically detectable voids. A total of 120 acrylic resin mandibular premolar analogs were fabricated using a 3-dimensional printer and randomly allocated into 4 groups (n = 30). Dual-cured composite resin or glass ionomer core build-ups were placed with or without vibration. The final build-ups were assessed radiographically and rated by 3 independent calibrated clinicians based on a 4-category scale for the severity of voids. In an ordinal logistic regression model with the void severity rating as the outcome, a significant interaction was found for glass ionomer, composite resin, and the use of ultrasonic vibration (P = 0.03). Vibration was associated with worse void severity ratings in glass ionomer specimens (P < 0.01). No effect of vibration was found in the composite resin specimens. The Fleiss kappa score (κ = 0.36) indicated fair agreement in all severity ratings among the 3 raters. These results suggest that the application of ultrasonic vibration during core build-up placement may not be clinically advantageous for improving restorative outcomes., Competing Interests: No conflicts of interest reported.

Competing Interests: Disclaimer: The author reports no conflicts of interest pertaining to any of the products or companies discussed in this column.

A new fluoride-releasing sealant system is claimed to allow easier and faster placement while providing high bond strengths without the need for phosphoric acid etching. A study was designed to compare the microleakage and shear bond strength of a self-etching, Giomer-based sealant system with those of a traditional resin sealant. Group 1 received traditional sealant applied after use of a 35% phosphoric acid etchant; group 2 received Giomer sealant after use of a self-etching primer; and group 3 received Giomer sealant after the addition of an initial phosphoric acid etching step and placement of the primer. The sealants were placed in the occlusal pits and fissures of extracted human third molars, thermocycled, placed in dye, and sectioned. The extent of microleakage (dye penetration) was expressed as a percentage of the cross-sectional length of the sealed interface. The sealants were also bonded to the facial enamel of bovine incisors. Specimens were thermocycled and tested in shear mode in a universal testing machine. The new self-etching sealant demonstrated significantly greater microleakage (P < 0.017) and lower bond strength (P < 0.05) than both the traditional sealant system and the new system when placed with phosphoric acid etchant. Phosphoric acid etching significantly improved the shear bond strength and reduced the microleakage of the new sealant., Competing Interests: Disclaimer: The views expressed in this article are those of the authors and do not reflect the official policy of the US Air Force, the Department of Defense, the Uniformed Services University of the Health Sciences, or the US government. The authors do not have any financial interest in the companies whose materials are discussed in this article.

A 12-year-old boy presented for dental care 35 days after he fell from his bicycle. Clinical and radiographic examinations revealed a longitudinal crown-root fracture with pulp exposure in the maxillary left central incisor. The radiograph also suggested necrosis of the maxillary right central incisor. Urgent treatment of the left central incisor involved gingivectomy followed by autogenous bonding of the tooth fragment with self-curing composite resin. Immediately after bonding, coronal access was prepared, chemical and mechanical preparation was completed, and a calcium hydroxide intracanal dressing was placed. One week after the initial appointment, endodontic treatment was initiated in the right central incisor. The root canal of the maxillary left central incisor was maintained with calcium hydroxide paste (replaced at 45-day intervals) for 1 year and then definitively obturated. At the 16-year follow-up, satisfactory periodontal, esthetic, and clinical conditions were observed, and a radiograph revealed no resorption or periapical changes.

This case report describes preventive and restorative treatment planning for a 56-year-old female patient with severe, chronic, poorly controlled gastroesophageal reflux disease and resulting loss of vertical dimension of occlusion. First, the demineralization process was controlled through collaboration with the patient's physician, and measures were taken to restore adequate stimulated salivary flow. Then, for financial reasons, indirect laboratory-fabricated composite resin restorations were adhesively bonded to replace lost tooth structure and reestablish the patient's collapsed vertical dimension. Indirect-laboratory fabricated restorations can be a cost-effective alternative to direct composite resin or all-ceramic restorations for the treatment of chronic severe erosion, but there are no long-term clinical reports in the current literature to support or contraindicate the use of indirect composites for this type of clinical application. Therefore, careful, long-term follow-up evaluations are planned for this patient.

The purpose of this in vitro study was to compare the penetration of 2 resin-based and 2 glass ionomer sealants into fissures after either conventional or mechanical preparation. All the materials placed in the conventionally prepared and mechanically prepared fissures penetrated the fissures beyond the standard (0.5-mm) reference line used in this study. For 1 glass ionomer sealant, the number of specimens showing complete penetration of sealant was significantly greater (P < 0.05) in mechanically prepared fissures than in conventionally prepared ones. No significant differences were found between mechanically and conventionally prepared fissures for the other sealants.

This study was conducted to report the clinical outcomes and the parental and child satisfaction of onlays for restoring mutilated primary molars. Twenty subjects, ages 3-8 years, with the presence of at least 1 mutilated primary molar (≥3 carious surfaces and a carious surface area ≥3/4 of the occlusal surface) were recruited. This study assessed the clinical success, gingival health, and parent/child satisfaction of 28 indirect composite onlays. The onlays showed a 100% retention rate at 12 months follow-up and a marginal integrity of 96.43%. High rates of satisfactory Alpha ratings for color stability (92.86%), surface texture (92.86%), and anatomic form (100%), coupled with significant improvements in gingival health of the restored teeth (P < 0.05), were reported. Indirect composite onlays successfully restored anatomic form and function of the grossly decayed primary molars--with shorter chairside times--while satisfying the esthetic demands of the young pediatric patients.

Invasive cervical resorption (ICR) occurs in the cervical area of the teeth due to the formation of a soft tissue that progressively resorbs dentin. The disease is asymptomatic unless the pulp is exposed. This article presents a case involving a mandibular canine that was treated with a calcium-enriched mixture (CEM) cement. After a full mucoperiosteal flap was performed, the soft tissue was curetted away and the cavity filled with CEM biomaterial. One week later, the supragingival surface of the CEM was polished and covered with composite resin. At a 1-year follow-up visit, the pulp was healthy and the gingival probing depth decreased from >3 mm to 1 mm, showing attachment gain. As a biocompatible material, CEM has proven its ability in dentinogenesis, cementogenesis, and osteogenesis; it may prove to be a suitable biomaterial for treating ICR cases.

This study compared the accuracy of impressions using 3 types of splinting materials: a pattern acrylic resin (Group 1), an acrylic resin (Group 2), and a dual-cured composite resin (Group 3). A total of 60 impressions (n = 20) were made. Implant positions were compared against the master model using a coordinate measuring machine with ANOVA comparison (P = 0.05). The minimum and maximum differences in the x axis were found in Groups 2 and 3, respectively. For the y axis, Groups 2 and 1 showed the minimum and maximum differences, respectively. The minimum and maximum differences in the z axis were found in Groups 3 and 1, respectively. All differences in the axes were statistically significant (P < 0.05). These findings indicated that the composite resin demonstrated better accuracy than the other tested splinting materials.

This study sought to compare and rank the in vitro microleakage behavior of four self-etching adhesive systems to determine any differences in their marginal sealing ability. Using a coarse rounded diamond wheel, Class V cavities were prepared at the facial or lingual cementoenamel junction (CEJ) of 40 recently extracted human third molars. All preparations had incisal margins in enamel and gingival margins in dentin. Ten randomly selected teeth were restored with one of four different adhesive systems; all teeth received the same composite material. The teeth were stored in distilled water (37 degrees C) for four weeks, thermocycled between 4 degrees C and 58 degrees C for 100 cycles, treated with 45Ca radioisotope, sectioned, and placed on radiographic film to produce autoradiographs. The degree of microleakage was scored separately at the enamel (incisal) and dentin (gingival) margins, and the results were compared using nonparametric statistical methods. The analysis found statistically significant differences in the degree of microleakage between the materials used at both the dentin and enamel margins.

This study sought to use scanning electronic microscopy (SEM) to evaluate the dentinal tubule occlusion potential of different desensitizing agents. Ten slices of bovine dentin were divided into six fragments, cleaned (using ultrasound), and etched for 15 seconds with a 35% phosphoric acid solution. All but one of the groups received a different desensitizing agent; the sixth group served as a control and received no additional treatment. After the agents were applied, the dentin specimens were analyzed by SEM and scores were assigned based on the extent of tubular obliteration. Only three agents demonstrated tubular sealing that was significantly different from that of the control group.