Placement of cast restorations over direct pulp capping procedures: a decision analytic approach

Article Abstract:

Teeth with small areas of pulp exposed during drilling in preparation for a filling are often treated with pulp caps, especially in children. Many clinicians regard the cap as a temporary measure until endodontic work (work on the tooth pulp itself) can be performed, and some even believe that the pulp cap can damage teeth and interfere with subsequent endodontic treatment. The dental literature, on the other hand, while reporting different rates of success for capping, yields an overall positive outcome rate that is quite high (81 percent averaged over several studies). This discrepancy between published reports and the prevalent clinical opinion needs to be understood. Decision analysis was used to evaluate pulp capping in a tooth with pulp that was accidentally exposed. This method specifies formal decision-making procedures and is suited to situations where information is contradictory or uncertain. Decision trees are constructed and consequences of decisions are outlined along with their probabilities of occurrence. A software package was used to construct this model. Proceeding down the main branches of 'pulp cap' vs 'endodontic therapy', outcomes were calculated based on the cost of each branch and the probabilities of success. Results ran counter to common clinical practice in that pulp capping had a lower cost to the patient regardless of its probability of success (the lowest probability of success for either procedure was 0.5). Even if the probability of retention of the cast placed over the pulp is 50 percent or less, the success of capping need only be greater than 0.37 for that to be the preferred option. As the cost of the restoration increased, the probability of capping success necessary to make it the preferred approach went down. Use of other outcome measures such as patient time or discomfort could have given different results. Patients, with their individual risk preferences, should be brought into this decision-making process. Pulp capping thus seems the optimal treatment for small exposures of pulp when no sign of pulp disease is present. (Consumer Summary produced by Reliance Medical Information, Inc.)

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Guided tissue regeneration in oral reconstruction: surgical and restorative applications

Article Abstract:

Different tissue regeneration techniques may be used to treat severe periodontal lesions, to provide ridge augmentation or to provide bone fill for cylindrical dental implants. One technique is use of a polytetrafluoroethylene membrane to exclude certain types of cells from the site of a periodontal lesion, or a break or tear occurring around a tooth. Another is the addition of demineralized freeze-dried human cortical bone to stimulate new bone formation. Non-resorbable hydroxylapatite can be used to create a space for new bone growth in patients undergoing ridge augmentation. Guided tissue regeneration techniques have also been used to facilitate new bone formation in patients receiving cylindrical dental implants. Membranes are placed in the extraction socket at the time of the tooth extraction. New bone growth occurs in the space between the membrane and the wall of the extraction socket.

Surgery

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Determining amalgam marginal quality: effect of occlusal surface condition

Article Abstract:

The carve-burnish procedure may be the most effective finishing technique for dental amalgam restorations. Dental amalgam restoration is the replacement of a missing, diseased or damaged filling. A study examined the use of four different techniques to finish dental amalgam restorations in the first and second molars of removable partial dentures. Deterioration of the margin of the dental restoration was less when the carve-only or the burnish-carve techniques were used. Use of the carve-burnish or the burnish-carve-burnish techniques increased the amount of marginal deterioration significantly.

Dental amalgams, Maintenance and repair

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