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JADA Specialty Scan - Cosmetic/Esthetic
Cosmetic/Esthetic - A Quarterly Newsletter on Dental SpecialtiesJADA

Successful esthetic treatment of brown and white stains caused by enamel fluorosis

Photo of teeth whitening tray

Brown and white tooth stains caused by enamel fluorosis can be treated with at-home whitening with 10% carbamide peroxide in a custom-fitted tray to whiten the brown enamel areas, followed by resin infiltration to camouflage the white spots. Direct resin composite restorations also can create the illusion of alignment of slight tooth misalignments. Those findings are from a study published in the July/August issue of Journal of Operative Dentistry.

The treatment plan involved at-home whitening with 10% carbamide peroxide gel with potassium nitrate and sodium fluoride in a custom-fitted tray overnight for at least 5 to 10 weeks to mask the brown stains.

Researchers heated a 0.035–inch-thick ethylene vinyl acetate sheet before forming the tray around the stone model in a vacuum device. They then trimmed the tray in a horseshoe shape and following the scalloped contour of the free gingival margin. The tray was kept 0.5 to 1.0 millimeters short of the free gingival margin to prevent possible irritation caused by the contact of the gel with the soft tissues.

Researchers showed the patient how to insert the gel into the tray, prescribed syringes of 10% carbamide peroxide gel, and provided take-home written instructions.

After the at-home bleaching, teeth were cleaned with a suspension of pumice and water and isolated with a rubber dam. A 15% hydrochloric acid gel was applied directly to the white-spot areas for 2 minutes. The gel was thoroughly rinsed with water for 30 seconds, and the area was air dried for 15 seconds. The etched areas were treated by ethanol for 30 seconds and air-dried for 15 seconds before the application of a resin with a higher penetration coefficient. Excess material was removed by gently blowing on the area, followed by light curing for 40 seconds. Cotton pellets can be used instead of blowing air.

The treatment was finalized by replacing an existing resin composite restoration in the maxillary right central incisor. Direct resin composited was used to improve the symmetry and proportion of the remaining maxillary incisors, as the patient was unable to receive orthodontic therapy.

“Through the selective addition of resin composite,” the authors noted, “an illusion of alignment can be created, which, in many cases, provides a very satisfactory result to our patients.”

Read the original article here.


Consulting Editor: Luiz Meirelles, DDS, MS, PhD
Director, Professional Products and Standards
ADA Science Institute


Effect and parental acceptance of silver diamine fluoride treatment on dental caries in primary teeth

Photo of happy mother, daughter and dentist

Silver diamine fluoride (SDF) offers an easy, efficient, and well-accepted nonsurgical alternative treatment for early childhood caries. SDF is also less expensive than other treatments, which can aid the dental public health community in addressing dental caries in at-risk populations. These findings are from a study published online July 27 in American Journal of Public Health Dentistry.

Researchers designed the study to assess the effectiveness of 38% SDF in arresting active dental carious lesions and in reducing or preventing associated dental pain and infections in young, at-risk children. They also assessed parental acceptance of SDF treatment and evaluated the effectiveness of arrest associated with different durations of SDF application time.

The study enrolled 32 children aged 2 to 5 years, with 118 active caries lesions in the primary teeth. Children had to have at least 1 carious lesion as defined by the International Caries Detection and Assessment System (ICDAS). Using ICDAS, the researchers categorized the lesions as active (soft) cavitated carious lesions in the primary dentition, extending into the dentin (ICDAS 5 or 6), noncavitated lesions (ICDAS 3 or 4), or initial carious lesions (ICDAS 1 or 2).

After a baseline examination 38% SDF was applied to identify carious lesions on primary teeth. The SDF was applied directly to the lesion with a microbrush and allowed to absorb for up to 2 minutes depending on the child’s behavior. Children were re-evaluated at 3-week and 3-month recalls to assess color and consistency changes in lesions (soft or hard). Parents were interviewed regarding pain or infection symptoms and were surveyed regarding their subjective feelings about SDF.

The efficacy of SDF was evaluated based on clinical outcomes; dark, hard, and black lesions with no pain or infection were considered positive outcomes. Progression of the lesion; a yellow, soft lesion; pain; or infection were considered to indicate treatment failure.

Because 16 lesions were excluded after the baseline examination, only 102 lesions were assessed at first recall. One hundred of those lesions were black and hard and were considered arrested after 1 application (98.0% arrest rate).Two lesions were not fully black and still soft in some areas, and they were considered not arrested. These 2 lesions (ICDAS classification 5) were treated with a second application of SDF and were considered arrested at the second recall. No incidences of pain or infection of treated teeth were recorded.

Most parents agreed or strongly agreed about the ease of SDF application, their comfort with discoloration of teeth, the painlessness of the process, and the taste of SDF. Child behavior during SDF application was not correlated with subjective parent feelings about the discoloration of teeth, painlessness of the process, or taste. Parents’ feelings about ease of SDF application were strongly correlated with discoloration of teeth, absence of pain, and taste.

“Children in this age group may benefit from delayed dental treatment and overall caries arrest,” said the authors, “thus reducing potential pain and infection, expensive future emergency room visits, the need for general anesthesia, or traumatic dental experiences on uncooperative children.”

Read the original article here.

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A composite for every indication
Uniquely formulated to be used in any combination, the Tetric Evo Line of composites delivers efficiency, reliability and esthetics for a wide range of restorative needs. All four composites afford high esthetics, extended working time, a single 10-second curing cycle (curing light intensity ≥ 1000 mW/cm2) and high radiopacity for a highly predictable placement and esthetic result. Simply select and combine materials to create a superior restoration with confidence. Learn More.


Optimal ratio for maxillary anterior teeth: preferences among professionals and laypeople

Photo of woman's smiling mouth

Professionals and laypeople consider a width to length ratio of 85% for maxillary central incisors and 80% for lateral incisors and canines as the most esthetic for maxillary anterior teeth, according to a study published online May 17 in Journal of Prosthodontics.

Researchers designed the study to determine the esthetic preferences of a sample of dentists relative to the proposed dental proportions and compare them with those of a sample of laypeople.

Researchers used Photoshop CS to alter the length to width ratios of the 6 maxillary anterior teeth on 4 photographs showing the full face of a female subject. The 4 images showed different width to length ratios: original or control: 90% central incisors, 82% lateral incisors, and 80% canines; 80% for all maxillary anterior teeth; 85% for all maxillary anterior teeth; and 85% central incisors and 80% canines and lateral incisors. Three sequences of photograph pairs were created with different ratios and presented in PowerPoint to a sample of 100 general dentists and 100 laypeople.

Researchers paired the photographs until 7 pairs were formed (1 repeated to test the viability of the results). Each pair of photographs was randomly given a letter to avoid conditioning the observer (pairs O, F, H, B, S, L, and E). The O and E pairs were repeated to test the viability of the results. Three different sequences were created using PowerPoint 2013, with the pairs presented in different orders to avoid bias related to the order of appearance.

The sample of interviewed observers included 100 dentists—both dentistry graduates and doctors specializing in dentistry—who worked at or were associated with the School of Dentistry at the University of Seville in Seville, Spain and 100 patients who attended the same dental school for different reasons but had no professional link to dentistry. Participants had to choose the most attractive image out of the pair of photographs that they viewed in the sequence.

The dentists’ samples included 100 participants (48% men) with ages ranging from 23 to 64 years (average [standard deviation], 31.72 [9.610]). Twenty-three percent viewed sequence O, 33% viewed sequence L, and 44% viewed sequence H. The layperson sample also included 100 participants (43% men) between 15 and 76 years old. Thirty-seven percent viewed sequence O, 30% viewed sequence L, and 33% viewed sequence H.

The ratio considered as the most esthetic by most of the judges was 85% for central incisors and 80% for lateral incisors and canines, with a statistically significant difference (P < .01). There was no statistically significant difference in the esthetic preferences of the studied populations either due to sex or professional experience of the dentists (P > .01).

Read the original article here.


Color correction technique for Class IV restorations

Photo of 3 teeth showing color correction modification

A color correction technique was able to change the final color of Class IV restorations and can be used when there is no time for making a stratified restoration. The technique description was published online July 22 in the Journal of Esthetic Restorative Dentistry.

Researchers designed their study to measure the technique’s ability to produce restorations that exhibit mimesis with tooth structure and to define a restorative clinical protocol.

The authors conducted their study in a plastic typodont with A3 color teeth. Researchers created a restoration of a Class IV lesion in the maxillary right central incisor using a natural stratification technique, simulating the optical effects of a natural tooth. They called it the reference tooth (RT).

Researchers tested different protocols in the maxillary left central incisor for realization of the proposed technique. They used 6 teeth with Class IV lesions and called them test teeth (TT). The TT were restored with A3.5 dentin resin (moderate intensity discoloration) and A4 dentin resin (severe intensity discoloration) to create unsatisfactory restorations (monochrome restorations). The authors tested 3 depths of preparation (0.5 millimeters, 0.7 mm, and 1.0 mm) to modify the color and brightness of unsatisfactory restorations. This resulted in 6 groups, depending on the color of unsatisfactory restoration and preparation depth: GA3.5-0.5, GA3.5-0.7, GA3.5-1.0, GA4-0.5, GA4-0.7 and GA4-1.0

The preparation step provided sufficient roughness for micromechanical retention and space for the composite resin. The researchers conditioned the remaining composite resin with phosphoric acid, rinsed it with water spray, and air-dried it. They then applied silane for 60 seconds and air-dried it. After they applied and light cured the adhesive system, the composite insertion was initiated by opaque halo reproduction with DA3 composite resin. Researchers inserted esthetic translucent resin into the opalescent halo region to fill the space between the mamelons and opaque halo. Finally, they applied A3 enamel resin in a single increment and adapted it with the aid of brushes. They shaped the labial enamel and the performed the finishing and polishing procedures as described for the RT. The restored teeth were stored in distilled water without light at room temperature for 7 days.

Of the 720 evaluations conducted, 610 (84.72%) were classified as harmonic (H) in the perception of the evaluators and only 110 (15.28%) as nonharmonic (NH). For harmonic perception by evaluator class, statistical test showed no association between variables (P = .331). However, there were a higher number of H evaluations by laypeople (LP) (87.5%) compared with dental students (DS) (82.9%) and operative dentistry experts (ODE) (83.8%).

Most groups received more than 75% of H, except for the GA4-0.5 group, which received the following rates: LP, 72.5%; DS, 65%; and ODE, 62.5%. In A3.5 groups, all evaluator classes saw the highest rates of H to GA3.5-0.5 and GA3.5-0.7. Among A4 groups, researchers observed that GA4-1.0 was the largest group with H in LP (90%) and ODE (92.5%), while for DS, the group GA4-0.7 was classified as more H (87.5%).

The authors concluded that “The results demonstrated that the moderate intensity restorations (DA3.5) with depths of 0.5 and 0.7 had the highest prevalence of acceptance. For severe intensity restorations (DA4), the preparation depth of 1.0 mm obtained better acceptance.”

Read the original article here.


Cementation Navigation System

Tooth image of the cementation process

The high strength of IPS e.max lithium disilicate offers dentists a choice to use an adhesive cement, self-adhesive cement or a conventional cement to seat their restorations depending on the clinical situation. To help guide dentists through the cementation process, Ivoclar Vivadent has developed an online tutorial so that you can maximize the performance and esthetics of your IPS e.max restorations.
To help you determine what type of cementation system would work best in each case, Ivoclar Vivadent has developed an online cementation decision tree. This tool asks you a series of questions to determine which cement system would work and then provides an online tutorial for each system. This tool enables you to maximize the performance and esthetics of your IPS e.max restorations.

Find the best the cement option for your situation using the Ivoclar Vivadent Cementation Navigation System.

Working together to make cancer history

Oral and oropharyngeal cancer graphic

As a dentist, you know that oral health is an integral part of overall health. The American Cancer Society estimates that there will be nearly 50,000 new cases of oral and oropharyngeal cancer in the U.S. in 2017.

A first-time ever symposium at ADA 2017 - America’s Dental Meeting brings together experts from the University of Texas MD Anderson Cancer Center, University of Chicago, Centers for Disease Control and Prevention and the American Dental Association’s Science and Practice Institutes to address the relationship between HPV infection and oropharyngeal cancer, and how health professionals can work together to help reduce cases and provide better treatment results for patients.

Let’s work together to make cancer history.

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Curing with confidence
Research shows that inadequate curing of resin based materials may lead to post-operative sensitivity and other clinical failure. Bluephase Style LED curing light utilizes Polywave technology, allowing it to achieve a broad spectrum of 385-515 nm (similar to the spectrum of halogen lights). It polymerizes all photo initiators and materials currently on the market. Learn More.


JADA+ Specialty Scans and JADA+ Scans

JADA+ Specialty Scans and JADA+ Scans are quarterly newsletters updating dentists on the latest research in selected specialties and disciplines in dentistry. ADA Publishing and the consulting editors from the represented specialties and disciplines aggregate and summarize research from previously published materials, each item attributed to its publication of origin. JADA+ Scan specialties and disciplines include endodontics, oral pathology, orthodontics, pediatric dentistry, periodontics, prosthodontics, radiology, cosmetic/esthetic and osseointegration. The ADA has engaged the specialty organizations in these areas as well as its own Science Institute and Division of Legal Affairs to assist with these newsletters. View past issues here.

Editorial and Advertising Policies

Any statements of opinion or fact are those of the authors and do not necessarily reflect the views of the American Dental Association. Neither the ADA nor any of its subsidiaries have any financial interest in any products mentioned in this publication. Any reference to a product or service, whether in advertisements or otherwise, is not intended as an endorsement or as approval by the ADA or any of its affiliated organizations unless accompanied by an authorized statement that such approval or endorsement has been granted.

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