American Journal of Dentistry
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Abstracts of the August 2006 Issue


Comparative plaque removal efficacy of a dual-action power toothbrush and a manual tooth: Effects by tooth type.


Svetlana Farrell, dds, phd, Geza T. Terézhalmy, dds, ma, Robert D. Bartizek, ms &

Aaron R. Biesbrock, dmd, phd, ms

Abstract: Purpose: To evaluate the plaque removal efficacy of a dual action power toothbrush (Crest SpinBrush Pro Clean) relative to an ADA reference manual toothbrush. In addition to overall plaque removal, emphasis was put on plaque reduction around the gingival margin, interproximal areas of the tooth and in the posterior segment of the dentition. Methods: The study was a randomized, examiner-blind, two-treatment, four-period, crossover design. After an informed consent, 50 healthy volunteers were randomized to four treatment sequences and used each toothbrush twice according to their assigned treatment sequence. At every visit, plaque removal was assessed at baseline and after a single brushing using the Rustogi-modified Navy Plaque Index that allows estimation of interproximal plaque and plaque at the gingival margin. Self-reported and examiner-observed adverse events were collected at every visit. Mean Plaque Index (MPI) scores were calculated for the whole mouth, gingival region, interproximal region and different areas of the dentition using an analysis of covariance for crossover design with baseline plaque score as the covariate. Results: 49 subjects provided complete data and were included in the analysis. Baseline MPI scores were not significantly different between the groups for any investigated tooth region or dentition area. Following a single brushing, the power toothbrush provided a reduction of 43% (P< 0.001) for the whole mouth MPI, 43% (P< 0.001) for the gingival margin MPI and 65% (P< 0.001) for the interproximal MPI relative to a manual brush. Use of the power toothbrush resulted in a significant reduction of whole-mouth and gingival margin MPI across all areas of the dentition compared to a manual toothbrush (P< 0.001). The power toothbrush also had superior interproximal plaque removal efficacy compared to the manual toothbrush for molars (P< 0.001, with 118% greater removal score). Both brushes were well tolerated. (Am J Dent 2006;19: 195-200).

Clinical significance: The dual action power toothbrush, Crest SpinBrush Pro Clean, was found to deliver significantly superior plaque removal benefit compared to an ADA reference manual toothbrush in a single-use model, especially in areas of limited access such as the gingival margin, interproximal region and posterior area of the dentition.

Address: Dr. Aaron Biesbrock, The Procter & Gamble Company, 8700 Mason-Montgomery Road, Mason, OH 45040-9462, USA. E-mail:


The bonding area of intra- and extra-coronal tooth preparations

Werner H. Mörmann, prof, dr med dent  & Andreas Bindl,dr med dent

Abstract: Purpose: To assess the accuracy of preparation surface area measurements (mm2) using the Cerec digital mouth camera in vitro and to analyze a collection of 514 Cerec camera in vivo optical impressions of preparations from 274 patients according to the size of preparation/bonding area (mm2) Methods: The surface area (mm2) of model preparations with known dimensions namely of one occlusal (1) and one mesio-occluso-distal (2) cavity as well as of one central incisor (3) and one molar (4) crown preparation was calculated from linear (a) design dimensions, (b) slide-gauge and (c) coordinate-measuring-machine data as benchmark measurements and from repeated (n=10) (d) laser-scan (control), (e) Cerec-camera mounted on a support, (f) handheld Cerec-camera measurements. Data of (d), (e) and (f) was statistically analyzed. From a collection of data sets clinically recorded with the Cerec camera, the surface areas of 514 preparations from 274 patients were analyzed according to the type of tooth and type of preparation. Results: Occlusal cavity mm2 data 1(d) 48±0.4, 1(e) 48±0.2, 1(f) 48±0.6 and mod cavity mm2 data 2(d) 137±2, 2(e) 138±1, 2(f) 138±4 did not differ between (d), (e) and (f) (P> 0.05) confirming the hypothesis for inlay cavities. Incisor crown preparation mm2 data 3(d) 82±0.4 differed (P< 0.001) from 3(e) 85±0.2 and 3(f) 85±0.6 as well as molar crown preparation mm2 data 4(d) 133±0.6 differed by 3.5% (P< 0.001) from 4(e) 137±0.4 and 4f) 138±1. Clinical cavity and crown preparation area data obtained from in vivo Cerec camera recordings differentiated between type of tooth and type of cavity. 2D data of "classic", "reduced" and "endo" type crown preparations did not differentiate clearly. (Am J Dent 2006;19:201-205).

Clinical significance: The Cerec camera showed minimal 2D measuring incertitude for cavities and a low calculable incertitude of 3.5% for crown preparations providing quantitative preparation area data with adequate accuracy.

Address: Prof. Werner H. Mörmann, Department of Preventive Dentistry, Periodontology and Cariology, Center for Dental and Oral Medicine, University of Zurich, Plattenstrasse 11, Zurich, CH-8032, Switzerland.



Clinical evaluation of an all-ceramic restorative system: 24-month report

Douglas Barnes, dds, ms, James C. Gingell, DDS, MS, David George, dds, mba, Erika Adachi, dds, Steven Jefferies, dds, ms & Veeraraghavan Sundar, phd, mba

Abstract: Purpose: To clinically evaluate an all-ceramic restorative system (Finesse All-Ceramic) when used in conjunction with an ultra-low fusing porcelain (Finesse) using bonded esthetic resin cements (Enforce & Calibra). Methods: 40 posterior and anterior crowns, 20 all-ceramic inlays and onlays, and 26 veneers were placed in 43 patients. Standard ceramic preparations were performed followed by conventional polyvinylsiloxane (Aquasil) impression techniques using cord retraction. The bonded resin cement was used to place the restorations following manufacturer’s instructions. A majority of restorations (95-100%) were evaluated to be optimal at baseline (B), 6, 12, and 24 months using a modified Ryge criteria for the following categories: color match, marginal adaptation, porcelain staining, secondary caries, postoperative sensitivity, and retention. Results: There were sufficient shades available to obtain desired esthetic result with 98% of all restorations being rated Alfa for shade match to Vita Lumin shade guide. The overall 2-year success rate (inlay/onlays, crowns, and veneers) was 98.75%. (Am J Dent 2006;19: 206-210).

Clinical significance: Clinical performance of Finesse All-Ceramic low-fusing, pressable all-ceramic system was acceptable at the 2-year recall. The clinical performance was consistent with other pressable, all-ceramic systems commercially available today.

Address: Dr. Douglas M. Barnes, Advanced Education in General Dentistry, Baltimore College of Dental Surgery, Dental School, University of Maryland, 666 West Baltimore Street, Baltimore, Maryland, 21201-1586 USA. E-mail:



Influence of the length of instrumentation and canal obturation on the success of endodontic therapy. A 10-year clinical follow-up

Tomislav Tamarut, dds, phd, Maja Kovacevic, dds, phd & Sneježana Glavičič, dds, ms

Abstract: Purpose: To clinically test the periapical healing of the method of recurrent electronic root canal measurement and the method of root canal obturation by the guttapercha-eucapercha method. Methods: During 10 years of endodontic practice of the first author, endodontic interventions were performed on approximately 4500 patients, aged 12-75 years. The success of therapy was followed-up in 257 teeth with diagnosis K04.0 to K04.5 (according to the X international classification of diseases) for whom a preoperative and control radiograph during the investigation period existed. Root canal preparation started with the “crown-down pressureless technique” and proceeded with the method of recurrent electronic root canal measurement. Obturation was done by the guttapercha-eucapercha method up to the apical constriction. Results: The result of therapy success was approximately 95% overall (t-test, ANOVA); for the diagnosis: necrosis and pulp gangrene (K04.1): 64%; for the acute apical periodontitis (K04.4): 88%; for the inflamed pulp (K04.0) and pulp degeneration (K04.2) 95%; chronic apical periodontitis (K04.5): 98%, and abnormally formed hard tissue in the pulp (K04.3):100%. (Am J Dent 2006;19: 211-216).

Clinical significance: The results confirmed that every endodontic diagnosis needs a specific therapeutic approach that depends on the spread of tissue inflammation which influences the length of instrumentation. The length could be determined by the method of recurrent electronic root canal measurement.

Address: Dr. Maja Kovacevic, 51000 Rijeka, Mihanoviceva 13, Croatia.



Effect of Er:YAG laser irradiation distance on superficial dentin morphology

Aline Evangelista de Souza-Gabriel, dds, ms, Michelle Alexandra Chinelatti, dds, ms, Maria Cristina Borsatto, dds, phd, Jesus Djalma Pecora, dds, phd, Regina Guenka Palma-Dibb, dds, phd & Silmara Aparecida Milori Corona, dds, phd

Abstract: Purpose: To assess in vitro the effect of Er:YAG laser irradiation distance on dentin surface morphology, by SEM. Methods: 60 sound human third molars were employed to obtain discs ( 1mm thick), that were polished to standardize the smear layer. Discs were randomly assigned to six groups (n=10) and sequentially bisected. Five groups (including both disc halves of each sample) received Er:YAG laser irradiation (80mJ/2Hz) for 20s, according to the irradiation distance (11, 12, 14, 16 or 17mm) and one was the control group. In the lased-groups, one disc half was separated for superficial analysis without subsequent acid-etching and the other half received phosphoric acid for 15 seconds. In the control group, one disc half was treated with phosphoric acid and no superficial treatment was done in the other half. Specimens were prepared for SEM. Results: Er:YAG laser-irradiated specimens, regardless of the irradiation distance, showed an irregular and scaly surface, with intense ablation of the intertubular dentin, mainly when the irradiation was performed in the focused mode (12 mm). The smear layer was removed and dentin tubules were opened, however, no tubule enlargement was found, unlike the group that only received acid application. The irradiation with 17 mm resulted in a surface appearance more homogeneous than those presented with other distances closer to the focus. The subsequent acid-etching on the lased surfaces decreased the superficial irregularities with partial exposure and enlargement of dentin tubules, in all the tested irradiation distances. (Am J Dent 2006;19: 217-221).

Clinical significance: The typical topographical features of dentin surface after Er:YAG laser irradiation, such as irregularities, intertubular dentin removal and dentin tubule exposure were intensified when laser was performed in the focused mode (12 mm).

Address: Dr. Aline Evangelista de Souza-Gabriel, Department of Restorative Dentistry, University of São Paulo (USP), Ribeirão Preto School of Dentistry, Av. do Café, S/N, Monte Alegre, CEP: 14040-904 Ribeirão Preto, SP, Brazil. E-mail:



Effect of low O2-gas transmission rate barrier films on Knoop hardness and toothbrush abrasion of resin cements

Youkei Asaka, dds, Masashi Miyazaki, dds, phd, Hiroyasu Kurokawa, dds, phd, Toshiki Takamizawa, dds, phd & B. Keith Moore, phd

Abstract: Purpose: To investigate the influence of utilizing films with different oxygen transmission rates (O2-GTR) on Knoop hardness and toothbrush abrasion of resin cements for luting. Methods: Four dual-activated, composite-type resin cements, and a chemically activated PMMA-type resin cement, were used. Three different types of barrier films (Techbarrier HI, Harden Film N130, and Lix-2) were used. Resin cement was mixed and inserted into a cylindrical mold (4 mm in diameter, 3 mm in height), then chemically activated. The specimens were stored in the dark at 37±1°C, 90±5%RH conditions for 1 hour. Knoop hardness on the top surface of the resin cement was measured with a micro- hardness tester. The top surface of specimens (8 mm in diameter, 3 mm in height) polymerized under the same conditions were used for toothbrush abrasion testing. One-way ANOVA followed by Tukey HSD test (P< 0.05) were done. Results: When the cement surface was covered by low O2-GTR film, a significant increase in Knoop hardness and resistance to toothbrush abrasion was observed for the dual activated, composite-type resin cements, but not for the chemically activated PMMA type resin cement. From the results of this study, the use of low O2-GTR matrix barrier films for the dual activated, composite-type resin cements could be effective in eliminating the oxygen inhibited layer on the cement surface. (Am J Dent 2006;19: 222-226).

Clinical significance: The use of a low O2-GTR barrier film has the potential to eliminate the oxygen inhibited layer from dual activated, resin cement surface exposed to the oral environment resulting in increased surface hardness and resistance to toothbrush abrasion.

Address: Dr. Masashi Miyazaki, Department of Operative Dentistry, Nihon University School of Dentistry, 1-8-13, Kanda Surugadai, Chiyoda-Ku, Tokyo 101-8310, Japan. E-mail:


Prevention of demineralization by CO2 and Er,Cr:YSGG laser irradiation of overdenture abutments

Luke A. Darling, ba, Ronald L. Ettinger, bds, mds, ddsc, James S. Wefel, phd, Steven H. Cooper, dds, ms & Fang Qian, phd

Abstract: Purpose: To assess the effects of Er,Cr:YSGG and CO2 laser irradiation on the prevention of demineralization of overdenture abutments. Methods: 32 human canines, premolars, and molars were acquired, cleaned, and scaled. They were randomly divided into two groups. Each tooth had two windows on the occlusal cut dentin. One window on each tooth was irradiated by either Er,Cr:YSGG or CO2 laser, while the other window served as a control. After pH cycling at pH 5.5 for 18 days and pH 4.7 for 16 days, the teeth were sectioned and analyzed using polarized light microscopy with water as the imbibing medium. Results: The Er,Cr:YSGG irradiated dentin had a mean lesion depth of 207 ± 27 µm while its control had a mean lesion depth of 209 ± 34 µm. The CO2 laser irradiated dentin had a mean lesion depth of 185 ± 24 µm while its control had a mean lesion depth of 205 ± 22 µm. Based on paired t-tests Er,Cr:YSGG laser irradiation of dentin did not reduce demineralization when compared to the controls (P= 0.81), while CO2 laser irradiation of dentin showed that it helped reduce demineralization when compared to the controls (P= 0.025). (Am J Dent 2006;19: 227-230).

Clinical significance: The results suggest that CO2 laser irradiation may be a way to help reduce dentin demineralization on cut overdenture abutment teeth. This methodology does not rely on patient compliance.

Address: Dr. Ronald Ettinger, Department of Prosthodontics and Dows Institute for Dental Research, College of Dentistry, University of Iowa, Iowa City, IA 52242 USA. E-mail:


HEMA diffusion from dentin bonding agents through various dentin thicknesses in primary molars

Ayşegül Çetingüç, phd, Seval Ölmez, prof & Nilüfer Vural, phd

Abstract: Purpose: To evaluate in vitro HEMA diffusion amounts from three dentin-bonding systems in primary molars with various remaining dentin thicknesses. Methods: Occlusal cavities were prepared with remaining dentin thickness of 0.5, 1 and 2 mm respectively. Chambers that contain 1 ml of distilled water were attached to each tooth. The groups were treated with Total Etch + Syntac Single Component, Syntac Single Component and Clearfil SE Bond. Water eluates were removed after 72 hours for analyses by HPLC. Results: The cumulative HEMA release amounts were significantly different between all groups (P< 0.05). Decreasing dentin thickness and acid-etching significantly increased pulpward diffusion of HEMA. (Am J Dent 2006;19: 231-235).

Clinical significance: Acid-etching significantly increases pulpward release of HEMA from dentin bonding systems in primary molar teeth. However, the dentin bonding systems can be considered safe for clinical use in primary teeth even in deep cavities since the released HEMA amounts are below the level of cytotoxicity.

Address: Dr. Aysegül Çetingüç, Department of Pediatric Dentistry, Faculty of Dentistry, Hacettepe University, Sihhiye, Ankara 06100, Turkey. E-mail:


Clinical evaluation of an ormocer, a nanofill composite and a hybrid composite at 2 years

Begüm Güray Efes, dds, phd, Can Dörter, dds, phd & Yavuz Gömeç, dds, phd

Abstract: Purpose: To evaluate the 2-year clinical performance of an ormocer, a new nanofill composite and as a control a conventional hybrid composite restorations in small Class I cavities of permanent molars. Methods: 90 Class I maxillary cavities were prepared in 90 patients. Cavities were restored incrementally in oblique layers with ormocer (Admira), nanofill (Filtek Supreme), or hybrid (Renew) composite material. Restorations were examined using the United States Public Health Service modified Ryge criteria at baseline, after 6 months, 1 year and 2 years. The changes in the parameters during the 2-year period were assessed with Friedman test analysis. Comparison of the baseline scores with those at the recall periods was evaluated by Wilcoxon signed rank test; the level of significance was set at P< 0.05. Results: None of the restorative materials exhibited secondary caries or postoperative sensitivity at the 6-month, 1-year or 2-year recall (P> 0.05). After 2 years, except the one failed Admira restoration, no other criteria was clinically unacceptable. (Am J Dent 2006;19: 236-240).

Clinical significance: In small Class I cavities, when minimally invasive preparation techniques were applied, despite the high configuration factor of the cavity, packable ormocer, nanofill and hybrid composite resulted in high clinical performance at the end of 2 years.

Address: Dr. Begüm Güray Efes, Istanbul University, Faculty of Dentistry, Dept. of Operative Dentistry, 34390, Capa, Istanbul, Turkey. E-mail:


Direct bonding with precoated brackets and self-etching primers

Ascensión Vicente, dds, phd & Luis A. Bravo, md, dds, ms, phd

Abstract: Purpose: To evaluate the shear bond strength and the adhesive remnant on the tooth after the debonding of APC Plus precoated brackets, when conditioning the enamel with phosphoric acid and Transbond Plus Self Etching Primer (TSEP), in comparison with uncoated brackets bonded with Transbond XT. Methods: The brackets were bonded to extracted premolars, which were divided into three groups: (1) Acid/Transbond XT, (2) Acid/ APC Plus and (3) TSEP/APC Plus. Shear bond strength was measured using a universal test machine. The crosshead speed was 1 mm/minute. The adhesive remnant on the tooth was quantified using an image analysis equipment. Results: No significant differences were found in the bond strengths of the three groups evaluated (P> 0.05). The two groups in which APC Plus system was used left significantly less adhesive on the tooth than Transbond XT. TSEP/APC Plus left significantly less adhesive than Acid/APC Plus (P< 0.017). (Am J Dent 2006;19: 241-244).

Clinical significance: APC Plus system is a good alternative to traditional bonding. The use of this system together with TSEP reduces the number of steps during bonding without compromising the bond strength.

Address: Dr. Ascensión Vicente, Docent Unit of Orthodontics, Dental Clinic, University of Murcia, Hospital Morales Meseguer, 2ª planta, Calle Marqués de los Vélez, s/n, 30008 Murcia, Spain. E-mail:


Post-operative pain and use of analgesic agents following various dental procedures

Liran Levin, dmd, Alon Amit, dmd & Malka Ashkenazi, dmd

Abstract: Purpose: To evaluate the incidence and duration of post-operative pain and the use of analgesic agents in adults with regard to gender, type of injection, dental procedure performed, and tooth history. Methods: Frequency and duration of post-operative pain and use of analgesic agents were examined in 255 patients, aged 18-42 years, who received routine dental treatment, including amalgam and composite restorations, root canal treatment (instrumentation), root canal filling (obturation), posts, and extractions. Teeth were anesthetized by either local infiltration (for maxillary teeth) or inferior alveolar nerve block (for mandibular teeth). Information regarding post-operative pain and use of analgesic agents was obtained though a phone call, 24 hours after treatment. Results: The overall incidence of post-operative pain was 40.4% (103 patients) of whom 36.9% (38 patients) reported a low level of pain. Pain-relieving medication was used by 32% of the patients who reported post-operative pain (12.9% of the population). Incidence and severity of post-operative pain were significantly correlated with specific dental treatment: the highest after root canal filling (52.8%, 21% reported a low level of pain) and lowest after restorations (36.1%, 42.4% reported a low level of pain). Post-operative pain was reported more often by females (52.2%) than males (33.7%) (P= 0.012). Incidence of post-operative pain was not correlated with depth and extension of the restoration performed. However, the severity of post-operative pain as indicated by analgesic usage was more frequent following deep restorations (over 3 mm). (Am J Dent 2006;19: 245-247).

Clinical significance: Prediction of post-operative dental pain following a specific dental procedure and the need for post-operative analgesics should be an integral part of clinical practice for every dental professional. The possibility that more than 40% of patients who have dental treatment experience post-operative pain suggests that clinicians should be more aware of the problem and be prepared to prevent and manage the pain.

Address: Dr. Liran Levin, Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel-Aviv University, Tel-Aviv, Israel. E-mail:


Effect of ammonium hexafluorosilicate on dentin tubule occlusion for the treatment of dentin hypersensitivity

Toshiyuki Suge, dds, phd, Akiko Kawasaki, dds, phd, Kunio Ishikawa, phd, Takashi Matsuo, dds, phd & Shigeyuki Ebisu, dds, phd

Abstract: Purpose: To evaluate the occluding ability of ammonium hexafluorosilicate (SiF). Methods: Dentin disks prepared from human extracted teeth were grouped as follows to prepare different situations of dentin hypersensitivity: (1) those sonicated for 20 minutes; (2) those treated with 0.5 mol/L EDTA for 2 minutes; (3) those treated with 6% citric acid for 2 minutes; (4) those treated with 50% citric acid for 2 minutes. Then, SiF or diamine silver fluoride (AgF) was applied to the dentin disks and the dentin tubule occlusion was observed with scanning electron microscopy (SEM). The percent of open tubules before and after SiF or AgF treatment were measured by NIH image using SEM photographs. Also, the dentin permeability was measured. Results: SEM micrographs demonstrated that the dentin tubules were completely occluded by the precipitate after SiF treatment. Also, the dentin permeability was reduced to 10.3%. In contrast, most of the dentin tubules remained open after AgF treatment. EDXA analysis showed that the precipitate in the dentin tubules that forms after SiF treatment contains Si, Ca and P, indicating a silica-calcium phosphate complex. (Am J Dent 2006;19: 248-252).

Clinical significance: Ammonium hexafluorosilicate occluded dentin tubules completely with a silica-calcium phosphate mineral without changing the color of the teeth, and may be useful for the treatment of dentin hypersensitivity.

Address: Dr. Toshiyuki Suge, Department of Conservative Dentistry, Institute of Health Biosciences, the University of Tokushima Graduate School, 3-18-15 Kuramoto, Tokushima, 770-8504 Japan.

E-mail: suge@dent. tokushima-u.

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