This study evaluated the influence of finishing and polishing procedures on the decision to replace existing amalgam restorations. Twenty amalgam restorations from 6 patients were photographed before and after being polished. 27 clinicians and students reviewed the before and after photos and indicated whether replacement was needed. Before polishing, 44% of restorations were deemed replaceable, but after polishing this decreased significantly to 21%, with secondary caries being the main reason for replacement. The study concluded that finishing and polishing reversed the decision to replace many old amalgam restorations.
An Assessment on the Clinical Performance of Non-carious Cervical Restorationsasclepiuspdfs
Cervical restorations were known as the least durable type of restoration. Therefore, it is important for clinician to identify the contributing factors that may lead to failure of the restorations. Objective: The purpose of this study was to compare the clinical performance in terms of type of restorative materials and the influence of clinical handling technique of non-carious cervical restorations. Materials and Methods: This cross-sectional study was carried out to patients with restorations on non-carious cervical lesions (NCCLs) at Universiti Sains Islam Malaysia dental clinic. The clinical performance of the restorations was evaluated using the ratings of the United States Public Health Service criteria and analyzed using the Pearson Chi-square.
Preference of materials for posterior restorations: A cross-sectional study a...Premier Publishers
The aim of the study is to evaluate the preferences of materials for posterior restorations among Palestinian dentists and to assess whether postgraduate training or clinical experience had an influence on their material preferences. A cross-sectional study was carried out among 216 dentists in Palestine using an online survey, which consisted of closed questions asking about socio demographic variables, the level of specialization and time since graduation. It further probed into the preferences for posterior restorations through questions about the first choice of material, type of composite resin (if used), use of rubber dam and preferences for curing. It was observed that 66.2% of the dentists preferred using composite and 72.9% preferred nano-hybrid composite restorations over other types of composite material. However, the majority (88.4%) did not prefer using a rubber dam. There was no significant association between the time of clinical training or post-graduate training and their choices for the materials. The study reports that composite was the preferred material for posterior restoration among the Palestinian dentists, and nano-hybrid their preferred type of composite. However, these dentists seldom used rubber dam and their postgraduate training or time of training did not influence their choice of material
An Assessment on the Clinical Performance of Non-carious Cervical Restorationsasclepiuspdfs
Cervical restorations were known as the least durable type of restoration. Therefore, it is important for clinician to identify the contributing factors that may lead to failure of the restorations. Objective: The purpose of this study was to compare the clinical performance in terms of type of restorative materials and the influence of clinical handling technique of non-carious cervical restorations. Materials and Methods: This cross-sectional study was carried out to patients with restorations on non-carious cervical lesions (NCCLs) at Universiti Sains Islam Malaysia dental clinic. The clinical performance of the restorations was evaluated using the ratings of the United States Public Health Service criteria and analyzed using the Pearson Chi-square.
Preference of materials for posterior restorations: A cross-sectional study a...Premier Publishers
The aim of the study is to evaluate the preferences of materials for posterior restorations among Palestinian dentists and to assess whether postgraduate training or clinical experience had an influence on their material preferences. A cross-sectional study was carried out among 216 dentists in Palestine using an online survey, which consisted of closed questions asking about socio demographic variables, the level of specialization and time since graduation. It further probed into the preferences for posterior restorations through questions about the first choice of material, type of composite resin (if used), use of rubber dam and preferences for curing. It was observed that 66.2% of the dentists preferred using composite and 72.9% preferred nano-hybrid composite restorations over other types of composite material. However, the majority (88.4%) did not prefer using a rubber dam. There was no significant association between the time of clinical training or post-graduate training and their choices for the materials. The study reports that composite was the preferred material for posterior restoration among the Palestinian dentists, and nano-hybrid their preferred type of composite. However, these dentists seldom used rubber dam and their postgraduate training or time of training did not influence their choice of material
JOURNAL CLUB: Terminology of Dental Caries and Dental Caries Management: Cons...Urvashi Sodvadiya
Vita Machiulskienea, Guglielmo Campusb, c Joana Christina, Carvalhod Irene, Digee Kim, Rud Ekstrandf, Anahita Jablonski-Momenig, Marisa Maltzh, David J. ,Mantoni Stefania, Martignonj, k E. Angeles, Martinez-Mierl, Nigel B., Pittsj Andreas G., Schultem Christian, H. Spliethn, Livia Maria, Andaló Tenutao, Andrea Ferreira Zandonap, Bente Nyvade
CARIES RESEARCH; OCT 2019
Fabrication of Complete Dentures for A Patient with Resorbed Mandibular Anter...QUESTJOURNAL
ABSTRACT: The loose and unstable lower complete denture is one of the most common problems faced by denture patients with highly resorbed ridge. The management of such highly resorbed ridges has always posed a difficulty to the prosthodontist.Obtaining consistent mandibular denture stability has longbeen a challenge for dental profession. The simplest approach often is to extend the denture base adequately for proper use of all available tisues.To achieve this goal impression of the resorbed mandibular ridge is very important. The objective is to develop a physiologic impression with maximum support of both hard and soft tissues.In such cases, an innovative technique of impressionmaking by using a close fitting tray and anelastomeric impression material tomake a proper impression to achieve maximum retentionand stability.This article describes an impression technique used for highly resorbed mandibular ridge using an all green impression technique, to gain maximum retention andstability
Short term and long-term stability of surgically assisted rapid palatal expan...Dr Sylvain Chamberland
Introduction: The purpose of this article is to present further longitudinal data for short-term and long-term
stability, following up our previous article in the surgery literature with a larger sample and 2 years of stability
data. Methods: Data from 38 patients enrolled in this prospective study were collected before treatment, at maximum
expansion, at removal of the expander 6 months later, before any second surgical phase, at the end of
orthodontic treatment, and at the 2-year follow-up, by using posteroanterior cephalograms and dental casts.
Results: With surgically assisted rapid palatal expansion (SARPE), the mean maximum expansion at the first
molar was 7.60 6 1.57 mm, and the mean relapse was 1.83 6 1.83 mm (24%). Modest relapse after completion
of treatment was not statistically significant for all teeth except for the maxillary first molar (0.99 6 1.1 mm). A
significant relationship (P-.0001) was observed between the amount of relapse after SARPE and the posttreatment
observation. At maximum, a skeletal expansion of 3.58 6 1.63 mm was obtained, and this was stable.
Conclusions: Skeletal changes with SARPE were modest but stable. Relapse in dental expansion was almost
totally attributed to lingual movement of the posterior teeth; 64% of the patients had more than 2 mm of dental
changes. Phase 2 surgery did not affect dental relapse.
#News43: Young Clinicians Clinical Case Competition at the 3rd MIS Global Con...José Luis Pimentel
During the first day of the 3rd MIS Global Conference,
more than 300 people attended the young clinicians'
case competition session where 5 doctors were invited to
present their cases.
Chairing the event was Professor Gabi Chaushu, head of
the Department of Oral & Maxillofacial Surgery at the Rabin
Medical Center in Israel.
Out of the 49 cases submitted for review, the scientific
committee, which included Professor Stefen Koubi, Professor
Nitzan Bichacho, Dr. Eric Van Dooren and Professor Moshe
Goldstein, chose the finalists out of which these 3 winners
were ultimately chosen.
JOURNAL CLUB: Terminology of Dental Caries and Dental Caries Management: Cons...Urvashi Sodvadiya
Vita Machiulskienea, Guglielmo Campusb, c Joana Christina, Carvalhod Irene, Digee Kim, Rud Ekstrandf, Anahita Jablonski-Momenig, Marisa Maltzh, David J. ,Mantoni Stefania, Martignonj, k E. Angeles, Martinez-Mierl, Nigel B., Pittsj Andreas G., Schultem Christian, H. Spliethn, Livia Maria, Andaló Tenutao, Andrea Ferreira Zandonap, Bente Nyvade
CARIES RESEARCH; OCT 2019
Fabrication of Complete Dentures for A Patient with Resorbed Mandibular Anter...QUESTJOURNAL
ABSTRACT: The loose and unstable lower complete denture is one of the most common problems faced by denture patients with highly resorbed ridge. The management of such highly resorbed ridges has always posed a difficulty to the prosthodontist.Obtaining consistent mandibular denture stability has longbeen a challenge for dental profession. The simplest approach often is to extend the denture base adequately for proper use of all available tisues.To achieve this goal impression of the resorbed mandibular ridge is very important. The objective is to develop a physiologic impression with maximum support of both hard and soft tissues.In such cases, an innovative technique of impressionmaking by using a close fitting tray and anelastomeric impression material tomake a proper impression to achieve maximum retentionand stability.This article describes an impression technique used for highly resorbed mandibular ridge using an all green impression technique, to gain maximum retention andstability
Short term and long-term stability of surgically assisted rapid palatal expan...Dr Sylvain Chamberland
Introduction: The purpose of this article is to present further longitudinal data for short-term and long-term
stability, following up our previous article in the surgery literature with a larger sample and 2 years of stability
data. Methods: Data from 38 patients enrolled in this prospective study were collected before treatment, at maximum
expansion, at removal of the expander 6 months later, before any second surgical phase, at the end of
orthodontic treatment, and at the 2-year follow-up, by using posteroanterior cephalograms and dental casts.
Results: With surgically assisted rapid palatal expansion (SARPE), the mean maximum expansion at the first
molar was 7.60 6 1.57 mm, and the mean relapse was 1.83 6 1.83 mm (24%). Modest relapse after completion
of treatment was not statistically significant for all teeth except for the maxillary first molar (0.99 6 1.1 mm). A
significant relationship (P-.0001) was observed between the amount of relapse after SARPE and the posttreatment
observation. At maximum, a skeletal expansion of 3.58 6 1.63 mm was obtained, and this was stable.
Conclusions: Skeletal changes with SARPE were modest but stable. Relapse in dental expansion was almost
totally attributed to lingual movement of the posterior teeth; 64% of the patients had more than 2 mm of dental
changes. Phase 2 surgery did not affect dental relapse.
#News43: Young Clinicians Clinical Case Competition at the 3rd MIS Global Con...José Luis Pimentel
During the first day of the 3rd MIS Global Conference,
more than 300 people attended the young clinicians'
case competition session where 5 doctors were invited to
present their cases.
Chairing the event was Professor Gabi Chaushu, head of
the Department of Oral & Maxillofacial Surgery at the Rabin
Medical Center in Israel.
Out of the 49 cases submitted for review, the scientific
committee, which included Professor Stefen Koubi, Professor
Nitzan Bichacho, Dr. Eric Van Dooren and Professor Moshe
Goldstein, chose the finalists out of which these 3 winners
were ultimately chosen.
treatment outcome of early childhood caries treated under general anesthesiaZalan Khan
short attention span and multiple appointments makes it necessary to treat young child under general anesthesia. pediatric dentist would find it very helpful
Effect of Calcium Hydroxide on Deep Caries Dentin: A Clinical Studyasclepiuspdfs
Objective: The aim of this study was to evaluate the clinical efficacy of calcium hydroxide on arresting deep carious lesions in permanent teeth. Methods: A total of 190 patients aged between 15 and 55 years old were selected for this clinical study. Calcium hydroxide was applied to fully matured permanent anterior or posterior teeth clinically and radiographically after 2 weeks, 3–4 weeks, 3 months, 6 months, and 1-year follow-up. Results: The overall survival rate was 89.4%. The findings of this study showed that calcium hydroxide is effective in arresting deep carious lesions and formation tertiary dentine as well as preservation teeth vitality. Conclusion: Calcium hydroxide is effective in reducing the risk of pulp exposure in deep carious lesion.
Comparative study of DFDBA and FDBA block grafts.pptxDr. B.V.Parvathy
To evaluate and compare the effectiveness of demineralized freeze dried block graft and freeze dried block graft with chorion membrane as barrier membrane clinically and radiographically for the treatment of residual deep intra bony defects.
Aims: This study evaluated the subjective experience of masticatory performance and masticatory efficiency in partially edentulous patients rehabilitated with three different types of removable partial dentures (RPDs). Materials and methods: This was a crossover randomized study, which was carried out at the prosthodontics clinic of the University of Ghana Dental School clinic. Sixteen patients requiring RPDs but had never worn one before were consecutively recruited for the study. Three different RPDs [i.e., cobalt chromium, acrylic, and thermoplastic resin (iFlex)] were fabricated for each patient. Masticatory efficiency was assessed using a singlesieve method after chewing raw carrots. The subjective experience of masticatory performance was also assessed using a questionnaire after 1 week of using each denture. Results: The cobalt-chromium denture recorded the highest masticatory efficiency (31.4%), and the iFlex denture recorded the lowest (27.9%).
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
Normal Labour/ Stages of Labour/ Mechanism of LabourWasim Ak
Normal labor is also termed spontaneous labor, defined as the natural physiological process through which the fetus, placenta, and membranes are expelled from the uterus through the birth canal at term (37 to 42 weeks
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Executive Directors Chat Leveraging AI for Diversity, Equity, and InclusionTechSoup
Let’s explore the intersection of technology and equity in the final session of our DEI series. Discover how AI tools, like ChatGPT, can be used to support and enhance your nonprofit's DEI initiatives. Participants will gain insights into practical AI applications and get tips for leveraging technology to advance their DEI goals.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
Unit 8 - Information and Communication Technology (Paper I).pdfThiyagu K
This slides describes the basic concepts of ICT, basics of Email, Emerging Technology and Digital Initiatives in Education. This presentations aligns with the UGC Paper I syllabus.
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
Safalta Digital marketing institute in Noida, provide complete applications that encompass a huge range of virtual advertising and marketing additives, which includes search engine optimization, virtual communication advertising, pay-per-click on marketing, content material advertising, internet analytics, and greater. These university courses are designed for students who possess a comprehensive understanding of virtual marketing strategies and attributes.Safalta Digital Marketing Institute in Noida is a first choice for young individuals or students who are looking to start their careers in the field of digital advertising. The institute gives specialized courses designed and certification.
for beginners, providing thorough training in areas such as SEO, digital communication marketing, and PPC training in Noida. After finishing the program, students receive the certifications recognised by top different universitie, setting a strong foundation for a successful career in digital marketing.
Exploiting Artificial Intelligence for Empowering Researchers and Faculty, In...Dr. Vinod Kumar Kanvaria
Exploiting Artificial Intelligence for Empowering Researchers and Faculty,
International FDP on Fundamentals of Research in Social Sciences
at Integral University, Lucknow, 06.06.2024
By Dr. Vinod Kumar Kanvaria
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
The effect of finishing and polishing on the decision to replace existing amalgam restorations.
1. Restorative Dentistry
The effect of finishing and poiishing on the decision
to repiace existing amaigam restorations
Mariane Cardoso, DDSVLuiz N, Baratieri, DDS, MS, PhD*VAndré V, Ritter, DDS""
Objective: The purpose of this investigation ivas to evaluate the influence of finishing and polishing proce-
dures on the decision to replace existing amalgam restorations. Method and materials: Twenty Ciass I
and Class il amalgam restorations, free from obvious defects, were selected in 6 patients The restorations
were photographed before and after being submitted to a standard finishing and poiishing procedure, in
the first phase, the preoperative siides were examined by 27 dinicians and senior dentai students, who
were instructed to inspect each restoration and answer a questionnaire indicating if and why the restoration
needed to be repiaced. Two weeks iater. the postoperative slides were presented to the same examiners,
who were asked to answer the same questionnaire as before. Results: At the first phase, there were 236
decisions (44%) to repiace existing amaigam restorations. Foiiowing the finishing and poiishing procedures,
114 decisions (21%) were made to repiace existing amalgam restorations. This difference was statisticaiiy
significant. Secondary caries was the most common reason for repiacement. Conclusion: The finishing
and poiishing procedure reversed the decision to repiace old amalgam restorations. (Quintessence Int
1999:30:413-418)
Key words: amalgam, clinical criteria, decision-making process
Amalgam restorations may fail and require replace-
CLINICAL RELEVANCE: A simple finishing and polish-
ment because of secondary or recurrent caries, body
ing procedure may inffuenoe the decision to replace a
fracture, marginal fractures, poor anatomic form, and,
questionable amalgam restoration.
to a lesser degree, overhangs,^'-'' However, tbe deci-
sion to maintain, repair, or replace an existing amal-
gam restoration is far from a logical process."'" Tbe
D ental amalgam bas been used as a direct restora-
tive material since tbe end of tbe last century.'
Regardless of tbe increasing use of resin composite
criteria used to make this decision are generally per-
sonal and empirical." Significant variations in treat-
ment decisions are observed not only among different
restorative materials, dental amalgam is still the most clinicians but also from tbe same person at different
widely used dental material for tbe restoration of pos-
terior teetb,^ In general, diagnosis of caries on restored teeth is
Tbe longevity of amalgam restorations varies, de- tnore complex than on unrestored teetb."'^ Despite
pending on the size of tbe cavity preparation (widtb of this complexity, a dentist spends a considerable
isthmus), tbe alloy used, and tbe tootb in question, amount of his or ber clinical time replacing restora-
among otber factors. On average, amalgam restora- tions tbat be or she judges to be unacceptable,'^-'*
tions last 6 to 11 years,''-'' Also, it bas been sbown tbat, many times, tbe new
restoration presents tbe same problems as the old
one.'"'^ In a recent in vitro study, Oleinisky et al'^
• Private Practice, Florianópoiís, Santa Catalina, Biazil, sbowed tbat the criteria used by students and clini-
"Professor and Chair, Department of Operatiue Dentislrv, Federal Uni- cians to make a treatment decision regarding old
versity af Santa Catarina, Florianópoiís, Santa Catarina, Brazil amalgam restorations are imprecise, Tbese authors
'"Alixrliaiy Professor, Department ot Operative Derlistry, Federal Univer- showed tbat tbe restoration's appearance, wbicb can
sily of Santa Catarina, Florianópolis, Santa Catarina, Brazil; Resident,
Department of Operative Dentistry and Denial Researcti Center, Uni-
be improved witb refinishing and repolisbing proce-
versity ol North Carolina at Chapel Hill, School of Dentistry, Chapel Hill, dures, significantly affected tbat decision, Tbis conclu-
North Carolina. sion was reacbed witb tbe observation tbat most deci-
fleprint requests: Dr André V, Ritter, Department of Operative Dentistry, sions to replace amalgam restorations were reversed
Uniuersity ol North Carolina at Chapel Hill, School of Dentistry, CB# 7450, after tbese restorations had been submitted to a stan-
Chapel Hill, North Carolina 27599-7450. E-mail: iHÏPERLINK maitto;
cientist@ccs, Jfsc.br Andre_Rifteredentistryunc,eöu
dard finisbing and polishing procedure.
Quintessence Internalional 413
2. • Cardoso et ai
Fig l a Occlusal view ol an amaigam restoration before bei,ng Fig 1b Occlusal view of the same tooth shown in Fig la, after
submitted to a standard finisining and polistiing procedure. the finishing and polishing procedure.
Ciinical slides corresponding to this image, as well as all the
others, were examined with x20 magnification in the reviews.
Fig 2a Occlusal view of an amalgam restoration belore being Fig 2b Occiusal view ot the same tooth shown in Fig 2a, after
submitted to a standard finishing and polishing procedure the finishing and poiishing procedure.
Fig 3a Ocolusal view of amalgam restorations before being sub- Fig 3b Occiusai view of the same tooth shown in Fig 3a. after
mitted to a standard finishing and poiishing procedure. the finishing and polishing procedure
414 Voiume 30, Number 6, IE
3. Cardoso el al
The purpose of this study was to investigate tbe
TABLE 1 Distribution of the examiners' groups
effect of refinishing and repolishing procedures on the
decision to replace existing amalgam restorations. Group Category Years ot practice n
Also, tbe reasons for the replacement decisions were 1 Senior students 0 9
assessed. The null hypothesis tested in this study was 2 Clinicians 5-10 9
that the finishing and polishing procedure does not in- 3 Clinicians 15-30 9
fluence the decision to maintain, repair, or replace old
amalgam restorations.
TABLE 2 Distribution of the examiners' answers
for the first question (decision to replace) before
METHOD AND MATERIALS
and after the finishing and polishing procedure
Twenty amalgam restorations present in 6 patients reg- Gro j p 1 • Group 2- Group 3'
ularly attending the Operative Dentistry Clinics at the Before After Before After Before After
Federal University of Santa Catarina (Fiorianópolis,
Yes 27% 9% 47% 28% 57% 43%
Santa Catarina, Brazil) were selected for the study. The No 73% 91% 72%
53% 43% 57%
University Ethics Committee approved the study, and
•Significance levels'group 1:x== 1B.99, P< 0.001; gioup 2i ;(= = 13.74,
the patients were informed about its objectives, meth- P = 0.002;grOLp3ï' = 7 51, P= 0.006.
ods, benefits, and risks. Only patients with good orai
care and general health were included in the study.
The restorations selected exhibited no evident fail-
ure. Also, only restorations with established inter-
proximal contacts were selected. Tbe type of alloy 1. Question 1 (decision to repiaee): In your opinion,
employed and the age of tbe restorations were un- docs this restoration call for repiacement?
iinown factors. Yes
Bitewing radiographs were obtained for each No
restoration before tbe initiation of the study, and infor- 2. Question 2 (reason for replacement): If your
mation regarding the patient's diet, bygiene, and use of answer for question 1 was "yes," for which reason?
fluoridated toothpaste was recorded in a patient cbart. A. Seeondary caries
This information provided some insight regarding tbe B. Body fracture
caries risk of the patient, which may influence tbe C. Deficient anatomic form (sculpture/contour)
treatment decision. D. Ditched margin
High-quality slides (occiusai view at 2:1 magnifica- E. Marginal overhangs
tion) of each restoration were obtained before (Figs F Otber
la, 2a, and 3a) and after (Figs lb, 2b, and 3b) a stan-
dardized finisbing and polisbing procedure. The fin- The same questionnaire was used before and after
ishing and polishing procedure was performed using tbe finishing and polisbing procedure. The patient's
rotary instruments at slow speed and polishing pastes anamneses information and the radiographs were
under rubber dam isoiation. avaiiable, if requested.
The preoperative and postoperative sets of slides Results were tabulated and submitted to statistical
were inspected by 3 groups of examiners (Table 1), witb analysis. Cbi-square {-/_-) and kappa tests were per-
a 2-week interval between tbe reviews. Group 1 con- formed, because tbese are measurement units on a
sisted of senior dental students from tbe Federal nominal level.
University of Santa Catarina, Schooi of Dentistry.
Groups 2 and 3 consisted of ciinicians with 5 to 10
years of practice, and 15 to 20 years of practice, respec- RESULTS
tively. At tbe first review, tbe examiners inspected only
the preoperative slides; they were not aware of the sec- Table 2 shows the distribution for tbe answers of tbe
ond stage of the study or of its objectives and method- different groups to the first question (decision to
ology. At tbe second review, tbe examiners inspected replace) before and after tbe finishing and pohsbing
the postoperative slides. Tbe slides were mounted in a procedure (first and second reviews). Ali groups ex-
magnification device (Ampligrapb, Fiorianópoiis, SC, hibited a statisticaily significant reduction in the deci-
Brazil) that provided x20 magnification. sion to replace after the experimental procedure.
The examiners completed tbe following question- Table 3 sbows tbe distribution for tbe answers to the
naire: second question (reason to replace). Secondary caries
Quimessence international 415
4. • Cardoso et ai
TABLE 3 Distribution of the examiners' answers TABLE 4 Use Of radiographs and anamneses
for the second question (reason to replace) before information (n = 27 examiners)
and after the finishing and polishing procedure
Preoperative radiographs Anamneses information
Group 1 Group 2 Group 3 Group Before After
Before After
Betöre Atter Before After Betöre After 1 4% 4%
15% 22%
49 83 52 2 11% 11% 0% 0%
Secondary 3 1% 4% 4% 4%
caries 51% 57% 48% Total 27% 37% 8% 8%
Body
fracture 15% 0% 6% 8%
Ditohed
margin 12% 16% 13% 17% 4%
Poor
anatomy 10% 16% 31% 24% 55%
Overhangs 14% 0% 2% 0% 9% •%
Other 0% 0% 1% 0% 1% 0%
"Total number oí answers lor thai particular variable.
was the most common answer to the seeond ques- for replacement in all groups (P = 0.0504), These re-
tion, both before and after the finishing and polishing sults are in accordance with the in vitro resuits re-
procedure. ported by Oleinisky et al."
Table 4 shows the frequency of requests for addi- The main reason for amalgam replacement was
tional information, ie, the anamneses chart and/or secondary caries, which is in accordance with the
radiographs. Fewer than 40% of the examiners asked findings reported by Mjör,' All 3 groups of examiners
for the radiographs, and 8% asked for the anamneses decided to replace fewer restorations because of sec-
charts. ondary caries after the finishing and polishing proce-
dure. In group 1, this reduction was 44^/0, in group 2
it was 47%, and in group 3 it was 34%. One factor
DISCUSSION that may have contributed to the change in the treat-
ment decision is the difficulty in diagnosing sec-
It is well known that the restorative dentist spends ondary caries.'-'"-'-^' This factor is responsible for
most of his or her clinical time replacing old, "failed" many false-positive diagnoses, and preventive actions
restorations.'^-" However, it has also been shown that should be implemented to minimize the subjective
the decision-making process regarding restoration nature of situations in which secondary caries is an
replacement is subjective and not based on clear issue.
criteria.'" Secondary caries should be approached the same
There is no clear protocol that defines precisely way as primary caries; ie, it is not the restoration ot
when a restoration should he replaced. However, this the defect that will cure the disease. Basic preventive
decision is made several times every day by clinicians methods, such as diet control, fluoride use, and oral
all over the world, in many cases with no scientific hygiene by the patient, should be considered in the
evidence.''-^^ This investigation showed that the crite- treatment plan to achieve low levels of primary and
ria used to decide the appropriateness of replacing secondary caries.^"^
amalgam restorations are poorly defined among the Regarding ditched margins, all 3 groups changed
groups of examiners participating in tiiis study. This their decisions after the finishing and polishing proce-
tendency is probably not confined to the loeation dure. The larger variation was observed in group 3,
examined (Florianópolis, Santa Catarina, Brazil), with a reduction of 82%. However, this result does not
because many other authors have presented similar indicate that the other groups did not notice the
results at other sites using different methods.'^•'^•^^•'•' ditched margins but rather that they did not consider
In this study, the influence of the finishing and pol- them a reason to replace the restorations.
ishing procedure on the decision to replace amalgam Poor marginal integrity seems to be a frequent
restorations is clearly demonstrated, because this pro- reason to replace restorations, although Barbakow el
cedure significantly reduced the numher of decisions aP' have shown that 100% of amalgam restoration
416 Volume 30, Number 6, 1999
5. Cardoso et al •
margins are defective 6 months after they are placed. tion will be needed in the future." This approach
Poor marginal integrity, therefore, should not justify tends to diminish the prognosis of the tooth, as a con-
the replaeement of a restoration. Either periodic recall sequence of the repetitive restorative cycle," It has
to monitor the restoration and the patient's caries risk been shown repeatedly that restorations do not cure
or the repair of the margin is preferable to total dental caries.''^^^ Also, a large number of the prob-
replaeement.-* lems in old amalgams are not solved by restoration re-
The marginal defects that appear in the tooth- placement, Ciinieians tend to believe that, "when in
restoration interface are simiiar to pit and fissure doubt, restore," which shows good faith in their own
defects hecause they act as plaque accumulation treatments. The fact that they spend more than S " of
O™
sites,'-^ Therefore, if it is possible to maintain occiusai their clinieal time replacing their own restorations and
pits and fissures free of caries, it should also be those of their colleagues demonstrates clearly that this
possible to do the same with the marginai defects in is not a good practice.'^-'« The appropriate ciinicai
old restorations. Plaque control is as caries preventive conduct should be "when in doubt, wait, obser'e, con-
in occlusal pits as it is in ditched margins, provided troi, and, if necessary, repair or repiace." The dentist
that these margins are accessible for cieaning. should always take into consideration and respect the
Many of the marginal defects diagnosed as sec- patient's needs and move toward a more health-
ondary caries could be treated conservatively with a oriented approach.
simple finishing and polishing procedure because real There is an additional point that should be
secondary caries is rare on occlusal areas.^^ improve- addressed regarding the results presented in this inves-
ments in plaque control, diet, and the correct use of tigation. The fact that finishing and polishing proce-
fluoride are additional preventive actions that should dures were able to reduce the number of decisions to
be implemented to avoid the unnecessary replacement repiace some restorations, ie, some restorations con-
of restorations.^^ sidered compromised at the first examination were
In this study, the examiners mentioned that the fact considered not compromised in the second review,
that they could not use an explorer for the reviews can be interpreted in 2 different ways. First, it can
was a problem because the observations were only be theorized that the first decision was wrong (false-
visual. However, the use of an explorer to diagnose positive), and the finishing and polishing procedure
caries is a controversial issue.'•'•'='^' Probing has shown prevented an unnecessary replacement. However, it
to be unreliable for diagnosis of caries in fissures and can also be inferred that the first decision was correct,
ditched margins.'^"" a situation in which the finishing and polishing proce-
Another frequently cited reason for replacing the dure couid have masked an existing problem, leading
restorations in this study was poor anatomic contour. to a false-negative decision; this would mcrciy have
Poorly contotired restorations can lead to periodontal. postponed necessary repair or replacement of the
occlusal, and restorative probletns.-' However, to solve existing restoration.
these problems, restorations do not aiways need to be The finishing and polishing approach proposed in
replaced," unless they are badly compromised by their this study is best suited when the clinician has control
contour, which was not the case in this study. of the patient records, mainiy radiographs and assess-
The use of bitewing radiographs is important in the ment of caries risk. Also, appropriate recalls should be
diagnosis of primary and secondary caries," especially scheduled to control for any false-negative decisions.
in Class II restorations because the cervical area is fre- All the restorations examined in the present study are
quently affected by recurrent caries.'' Espelid artd in a recali program; the long-term effects of the pro-
Tveit'-» have shown that clinical examinations, supple- posed approach will he presented in the future.
tnented by radiographie images, lead to increased sen-
sitivity in the diagnosis of secondary caries, Jokstad et
al" showed that the patient's age and caries risk are CONCLUSION
important factors among the restoration replaeement
criteria, Kidd^' also reported that information on diet, 1. The finishing and polishing procedure strongly in-
hygiene, and fluoride use are important to plan the fluenced the decision to replace or maintain existing
preventive and restorative treatment. However, very amalgam restorations {significance level: y^ — 7.51;
few examiners requested such information in the pre- P = 0.0504).
sent study- 2. Radiographs are not used routinely to make the
When an old restoration is removed, additional decision whether or not to replace an old amalgam
tooth structure is removed as well because of the restoration. Also, information about diet, oraL,
action of the bur.^ This weakens the tooth structure, hygiene, and fluoride use is seldom used as a diag-
and, therefore, it is likely that a more eomplex restora- nostic adjunct.
OL in less e nee International 417
6. • Caldoso et al
ACKNOWLEDGMENTS 16. Boyd MA, Richardson AS, Frequency of amalgam replace-
ment in general dental practice. J Can Dent Assoc 1985;51:
The authors would like lo express their gratitude to Sergio Freitas, 763-766,
DDS, Assistant Professor, Fédérai University of Santa Caiarina, 17 Elderton RJ, Assessment of the quality of restorations, A
Brazii, for his help with lhe slatisticai analysis and to Sandra L, literature review, J Oral Rebabil 1977;4:217-266,
Myers, DDS, Assistant Professor, University of Minnesota, for her 18. Elderton RJ Tbe quality of amalgam restorations. In: Allred
help in editing this manuscript. H (ed). Assessment of the Quality of Dental Care. London:
London Hospital Medical College, 1977:45-81,
19. Oleinisky JC, Baratieri LN, Ritter AV, Freitas SFT, Influence
of finishing and polishing procedures in the decision to
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