D I
C L IN IC A L R E P O R T S
Importance of combined periodontal and acid-etch composite treatment in restoration of anterior teeth and periodontal health B la s c o C. G o m e s , B D S, L D S , M D S , P h D S te v e B . G o ld , D D S P a u l N . B a er, DDS S t e p h e n F e s ta , D D S
C o m p o site re sin w a s u s e d to re sto re s e v e r e ca rio u s d e fe c ts in te e th o f a 1 7 -ye a r-o ld p a tie n t.
Report of case
T
J L h e e f f e c t iv e n e s s o f a c id - e t c h
c o m p o s ite r e s in p ro c e d u r e s h a s b e e n s u b s ta n tia te d b y m a n y c lin ic a l re p o r t s . 1' 3 T h e u s e o f a c id - e t c h c o m p o s ite r e s in te c h n iq u e s h a s in c lu d e d s p lin t in g , 45 te m p o r a r y p a r t ia l d e n tu r e s ,6
A 1 7 -ye a r-o ld g ir l w it h m in im a l b ra in damage came fo r d e n ta l trea tm e nt to the School o f D e ntal M e d ic in e at the State U n iv e rs ity o f N e w Y o rk at S tony Brook. R o u tin e m e d ic a l a nd socia l e va lu a tion d isclo se d th a t the p a tie n t was w e ll d e ve l o p e d a n d w e l l n o u r is h e d a n d w a s cooperative, frie n d ly , and w e ll groom ed. She had delayed le a rn in g s k ills and s lig h t d if f ic u lt y in c o o rd in a tin g m o to r fu n c tio n s. A t a p p ro x im a te ly 3 years o f age, the pa tie n t had been h o s p ita liz e d fo r a severe case o f rubeola. A c c o rd in g to the parents, she h ad n o rm a l in te llig e n c e before th is illn e ss. T he re m a in d e r o f her m e d ica l h is to ry was n o n c o n trib u to ry .
d ir e c t b o n d in g o f o r th o d o n t ic b ra c k e ts ,7' 8 r e s t o r a t io n s o f fr a c t u r e d i n c is o r s , 1' 3,9,10 a n d h y p o p l a s t ic
de
f e c ts .1,2,1° T h e a c id - e tc h te c h n iq u e s a re safe, s im p le , q u ic k , c o n s e rv a tiv e , e c o n o m ic a l, a n d c a n b e u s e d w i t h th e p h y s ic a lly
o r e m o t io n a lly h a n d i
c a p p e d p a t ie n t i n w h o m c o o p e r a tio n m a y b e a p r o b le m . A lth o u g h
a c id - e t c h
t e c h n iq u e s
h a v e r e v o lu t io n iz e d th e tr e a tm e n t o f h y p o p la s t ic a n d c a rio u s d e fe c ts o f th e a n t e r io r te e th o f y o u n g i n d i v i d u a ls , t e c h n iq u e s c a n be p e r fo r m e d c o r r e c t ly o n ly i n
h e a lt h y p e r io d o n t a l
tis s u e s . 8 3 4 ■ J A D A , V o l. 9 9 , N o v e m b e r 1 9 7 9
D e n ta l h is to r y R o u tin e d e n ta l tre a tm e n t w as b e g u n w h e n th e p a tie n t was 5 years old. Records in d ic a te d a n o rm a l p rim a ry d e n titio n and c o rre c t se q u en ce o f p e rm a n e n t to o th e ru p tio n . A p la s ia o f th e m a x illa ry le ft p e rm a n e n t c a n in e w as e v id e n t. T h e m a x illa r y in c is o r s h a d m ild areas o f h y p o c a lc ific a tio n . A t the tim e o f e ru p tio n , h y p o p la s tic and h y p o c a lc ific defects w ere seen on the m a n d ib u la r incisors. W h e n th e p a t ie n t w a s 9 y e a rs o ld , co m p o site re sto ra tio n s w ere in se rte d in the m a n d ib u la r incisors. O rth o d o n tic care was begun at age 11.
C lin ic a l and c e p h a lo m e tric analysis d is closed a Class II, d iv is io n I m a lo cclu sio n . C ro w d in g o f th e m a n d ib u la r inciso rs was n o tic e d . In a d d itio n , th e p a tie n t h a d th u m b - s u c k in g a n d to n g u e - th ru s tin g habits. T he ra p y to co rre ct these habits was ac co m p lish e d in p a rt b y use o f a H a w le y p a la ta l c r ib a p p lia n c e . A fte r th is use, co m p le te o rth o d o n tic trea tm e nt was be g u n . T h e o r t h o d o n tis t, a t th a t tim e , th o u g h t th a t th e trea tm e nt was in pa rt co m p ro m ise d b y the p a tie n t’s b ra in d a m age and in a b ility to cooperate fu lly . The trea tm e nt spanned th re e years. To p re ve n t relapse and m a n d ib u la r c ro w d in g , a m a n d ib u la r f ix e d lin g u a l a rc h w a s cem ented to th e canines after treatm ent was c o m p le te d . A fte r th e o rth o d o n tic care, the p a tie n t had received o n ly a m in im a l a m o u n t o f d e n ta l supervision.
T r e a tm e n t E v a lu a tio n d isclo se d severe d e te rio ra tio n in th e re g io n o f th e m a n d ib u la r in ciso rs (F ig 1). Caries, pla q u e a ccu m u la tio n s, and g in g iv itis w ere e vid e n t. In itia l th e ra p y consisted o f rem o va l o f the m a n d ib u la r fix e d lin g u a l arch, in s tru c tio n in the im p o rta n ce a n d te c h n iq u e o f re m o v a l o f plaque, scaling, ro o t p la n in g , and cu re t tage. T h is re su lte d in some im p ro v e m e n t in g in g iv a l h e a lth . H o w e ve r, th e teeth w ere in such d isre p a ir th a t th is th e ra p e u tic reg im e n alo n e was n o t adequate to m a in ta in a le v e l o f c o n tro l o f plaque re q u ire d fo r re tu rn o f g in g iv a l he a lth. A g in g iv e c to m y was necessary to e lim in a te the re m a in in g h yp e rp la s tic g in g iv a l tis sue and to expose a h e a lth y area o f to o th stru ctu re in th e c e rvica l reg io n . T h is p e r m itte d use o f resto ra tive d e n tis try and c o n tro l o f plaque. T w o weeks after the g in g iv e c to m y was p e rfo rm e d (Fig 2), the g in g iv a was healed s u ffic ie n tly to p e rm it resto ra tio n o f the m a n d ib u la r a n te rio r teeth w ith use o f a standard a cid -e tch com posite technique. A rub b e r dam was a p p lie d w ith a no. 212 cla m p to re fle c t th e free g in g iv a and h o ld th e rub b e r dam . T he teeth were th e n ex cavated, a base (D ycal) was placed over the d e n tin , a nd th e enam el was etched w ith acid. A n a c ry lic resin p o ly m e riz e d
Fig 1 ■ Initial app ear a n ce o f patient. Inflam m atory gin gival hyp erp lasia, cariou s le sio n s, and defective resto rations are seen in m an dib ular arch. O rthodontic retainer w a s present, Left, lab ial view ; right, lin gu al view .
Fig 2 ■ T w o w eek s after in itia l p eriodontal ther a p y that con sisted o f sc a l in g, curettage, and control o f plaque. T here w a s lim ited resp on se o f gin gival tissu e s to procedures. Or th od on tic a p p lia n ce has been rem oved. Left, labial view ; right, lin g u a l view .
Fig 3 ■ A ppearance after periodontal th erapy and placem en t o f acid-etch com p osite restorations. C om parison w ith Figures 1 and 2 sh o w s im proved app earance. Left, labial view ; right, lin g u a l view .
w ith u ltra v io le t lig h t was a p p lie d , and the teeth w ere restored w ith co m p o site resin and p o lis h e d . T he fin a l resu lts w ere ex c e lle n t (F ig 3). W h e n w e co nsidered the c o n d itio n o f th e teeth and th e age o f the p a tie n t, w e th o u g h t th a t th e a cid -e tch te ch niqu e was less lik e ly to cause in ju r y to the p u lp s o f th e m a n d ib u la r in c is o r teeth th a n w ere f u ll crow ns.
The patient has been seen during three-month recall visits for the past year and both the periodontal and dental status has been maintained.
S u m m a ry S e v e re ly fr a c tu r e d , h y p o p la s tic , a n d c a rio u s m a n d ib u la r a n t e r io r te e th in a 1 7 - y e a r -o ld p a t ie n t p r e c lu d e d th e a b ili t y to u s e a d e q u a te m e th o d s o f c o n t r o l o f p la q u e . W i t h s im p le , in e x p e n s iv e t e c h n i q u e s , p e r i o d o n t a l h e a lth w a s r e s to r e d a n d a f u n c t io n a l a n d e s th e tic o c c lu s io n w a s p r o v id e d .
T h is tr e a tm e n t p la n w a s a c c o m p lish ed w ith m in im al risk of in ju rin g th e p u lp s of th e teeth. Dr. Gomes is assistant professor, periodon tics; Dr. Gold is assistant professor, department of children’s dentistry; Dr. Baer is professor and chairman, department of periodontics; and Dr. Festa was a senior student at the time the study was done, School of Dental Medicine, State University of New York at Stony Brook, Health Sciences Center, Stony Brook, NY 11790. A d dress request for reprints to Dr. Gomes. 1. Buonocore, M.G., and Davilla, J. Restora tion of fractured anterior teeth w ith ultravioletlight-polymerized bonding materials: a new technique. JADA 86(6):1349-1354, 1973. 2. Jordan, R.E., and others. Restoration of fractured and hypoplastic incisors by the acid etch resin technique: a three-year report. JADA 95(4):795-803, 1977. 3. Roberts, M.W., and Moffa, J.P. Repair of fractured incisal angles w ith an ultravioletlight-activated fissure sealant and a composite resin: two-year rep o rt o f 60 cases. JADA
87(4):888-891, 1973. 4. Iacono, J.V., and Ceen, R. An acid etch splint for periodontally involved teeth. NY State Dent J 48(5):142-145, 1978. 5. Poison, A.M., and Billen, J.R. Temporary splinting of teeth using ultraviolet lig h t poly merized bonding materials. JADA 89(5):11371141,1974. 6. Lambert, P.M.; Moore, D.L.; and Elletson, H.H. In vitro retentive strength of fixed bridges constructed w ith acrylic pontics and an u l tra v io le t lig h t p o lym e rize d resin. JADA 92(4):740-743, 1976. 7. Brandt, S.; Servoss, J.M.; and Wolfson, J. Practical methods of bonding, direct and in d i rect. J Clin Orthod 9(10):610-635,1975. 8. Cohl, M .L.; Green, L.J.; and Eick, J.D. Bonding of clear plastic orthodontic brackets using an ultraviolet-sensitive adhesion. Am J Orthod 62(4):400-411,1972. 9. Laswell, H.R.; Welk, D.A.; and Regenos, J.W. Attachment of resin restorations to acid pretreated enamel. JADA 82(3):558-563, 1971. 10. Ward, G.T.; Buonocore, M.G.; and Woolridge, E.D. Preliminary report of a technique using Nuva-Seal in the treatment and repair of anterior fractures without pins. NY State Dent J 38(5):269-274, 1972.
G o m e s -o th e rs : C O M B IN E D P E R IO D O N T A L A N D A C ID - E T C H C O M P O S IT E T R E A T M E N T ■ 8 3 5
C L IN IC A L R E P O R T S
Importance of combined periodontal and acid-etch composite treatment in restoration of anterior teeth and periodontal health B la s c o C. G o m e s , B D S, L D S , M D S , P h D S te v e B . G o ld , D D S P a u l N . B a er, DDS S t e p h e n F e s ta , D D S
C o m p o site re sin w a s u s e d to re sto re s e v e r e ca rio u s d e fe c ts in te e th o f a 1 7 -ye a r-o ld p a tie n t.
Report of case
T
J L h e e f f e c t iv e n e s s o f a c id - e t c h
c o m p o s ite r e s in p ro c e d u r e s h a s b e e n s u b s ta n tia te d b y m a n y c lin ic a l re p o r t s . 1' 3 T h e u s e o f a c id - e t c h c o m p o s ite r e s in te c h n iq u e s h a s in c lu d e d s p lin t in g , 45 te m p o r a r y p a r t ia l d e n tu r e s ,6
A 1 7 -ye a r-o ld g ir l w it h m in im a l b ra in damage came fo r d e n ta l trea tm e nt to the School o f D e ntal M e d ic in e at the State U n iv e rs ity o f N e w Y o rk at S tony Brook. R o u tin e m e d ic a l a nd socia l e va lu a tion d isclo se d th a t the p a tie n t was w e ll d e ve l o p e d a n d w e l l n o u r is h e d a n d w a s cooperative, frie n d ly , and w e ll groom ed. She had delayed le a rn in g s k ills and s lig h t d if f ic u lt y in c o o rd in a tin g m o to r fu n c tio n s. A t a p p ro x im a te ly 3 years o f age, the pa tie n t had been h o s p ita liz e d fo r a severe case o f rubeola. A c c o rd in g to the parents, she h ad n o rm a l in te llig e n c e before th is illn e ss. T he re m a in d e r o f her m e d ica l h is to ry was n o n c o n trib u to ry .
d ir e c t b o n d in g o f o r th o d o n t ic b ra c k e ts ,7' 8 r e s t o r a t io n s o f fr a c t u r e d i n c is o r s , 1' 3,9,10 a n d h y p o p l a s t ic
de
f e c ts .1,2,1° T h e a c id - e tc h te c h n iq u e s a re safe, s im p le , q u ic k , c o n s e rv a tiv e , e c o n o m ic a l, a n d c a n b e u s e d w i t h th e p h y s ic a lly
o r e m o t io n a lly h a n d i
c a p p e d p a t ie n t i n w h o m c o o p e r a tio n m a y b e a p r o b le m . A lth o u g h
a c id - e t c h
t e c h n iq u e s
h a v e r e v o lu t io n iz e d th e tr e a tm e n t o f h y p o p la s t ic a n d c a rio u s d e fe c ts o f th e a n t e r io r te e th o f y o u n g i n d i v i d u a ls , t e c h n iq u e s c a n be p e r fo r m e d c o r r e c t ly o n ly i n
h e a lt h y p e r io d o n t a l
tis s u e s . 8 3 4 ■ J A D A , V o l. 9 9 , N o v e m b e r 1 9 7 9
D e n ta l h is to r y R o u tin e d e n ta l tre a tm e n t w as b e g u n w h e n th e p a tie n t was 5 years old. Records in d ic a te d a n o rm a l p rim a ry d e n titio n and c o rre c t se q u en ce o f p e rm a n e n t to o th e ru p tio n . A p la s ia o f th e m a x illa ry le ft p e rm a n e n t c a n in e w as e v id e n t. T h e m a x illa r y in c is o r s h a d m ild areas o f h y p o c a lc ific a tio n . A t the tim e o f e ru p tio n , h y p o p la s tic and h y p o c a lc ific defects w ere seen on the m a n d ib u la r incisors. W h e n th e p a t ie n t w a s 9 y e a rs o ld , co m p o site re sto ra tio n s w ere in se rte d in the m a n d ib u la r incisors. O rth o d o n tic care was begun at age 11.
C lin ic a l and c e p h a lo m e tric analysis d is closed a Class II, d iv is io n I m a lo cclu sio n . C ro w d in g o f th e m a n d ib u la r inciso rs was n o tic e d . In a d d itio n , th e p a tie n t h a d th u m b - s u c k in g a n d to n g u e - th ru s tin g habits. T he ra p y to co rre ct these habits was ac co m p lish e d in p a rt b y use o f a H a w le y p a la ta l c r ib a p p lia n c e . A fte r th is use, co m p le te o rth o d o n tic trea tm e nt was be g u n . T h e o r t h o d o n tis t, a t th a t tim e , th o u g h t th a t th e trea tm e nt was in pa rt co m p ro m ise d b y the p a tie n t’s b ra in d a m age and in a b ility to cooperate fu lly . The trea tm e nt spanned th re e years. To p re ve n t relapse and m a n d ib u la r c ro w d in g , a m a n d ib u la r f ix e d lin g u a l a rc h w a s cem ented to th e canines after treatm ent was c o m p le te d . A fte r th e o rth o d o n tic care, the p a tie n t had received o n ly a m in im a l a m o u n t o f d e n ta l supervision.
T r e a tm e n t E v a lu a tio n d isclo se d severe d e te rio ra tio n in th e re g io n o f th e m a n d ib u la r in ciso rs (F ig 1). Caries, pla q u e a ccu m u la tio n s, and g in g iv itis w ere e vid e n t. In itia l th e ra p y consisted o f rem o va l o f the m a n d ib u la r fix e d lin g u a l arch, in s tru c tio n in the im p o rta n ce a n d te c h n iq u e o f re m o v a l o f plaque, scaling, ro o t p la n in g , and cu re t tage. T h is re su lte d in some im p ro v e m e n t in g in g iv a l h e a lth . H o w e ve r, th e teeth w ere in such d isre p a ir th a t th is th e ra p e u tic reg im e n alo n e was n o t adequate to m a in ta in a le v e l o f c o n tro l o f plaque re q u ire d fo r re tu rn o f g in g iv a l he a lth. A g in g iv e c to m y was necessary to e lim in a te the re m a in in g h yp e rp la s tic g in g iv a l tis sue and to expose a h e a lth y area o f to o th stru ctu re in th e c e rvica l reg io n . T h is p e r m itte d use o f resto ra tive d e n tis try and c o n tro l o f plaque. T w o weeks after the g in g iv e c to m y was p e rfo rm e d (Fig 2), the g in g iv a was healed s u ffic ie n tly to p e rm it resto ra tio n o f the m a n d ib u la r a n te rio r teeth w ith use o f a standard a cid -e tch com posite technique. A rub b e r dam was a p p lie d w ith a no. 212 cla m p to re fle c t th e free g in g iv a and h o ld th e rub b e r dam . T he teeth were th e n ex cavated, a base (D ycal) was placed over the d e n tin , a nd th e enam el was etched w ith acid. A n a c ry lic resin p o ly m e riz e d
Fig 1 ■ Initial app ear a n ce o f patient. Inflam m atory gin gival hyp erp lasia, cariou s le sio n s, and defective resto rations are seen in m an dib ular arch. O rthodontic retainer w a s present, Left, lab ial view ; right, lin gu al view .
Fig 2 ■ T w o w eek s after in itia l p eriodontal ther a p y that con sisted o f sc a l in g, curettage, and control o f plaque. T here w a s lim ited resp on se o f gin gival tissu e s to procedures. Or th od on tic a p p lia n ce has been rem oved. Left, labial view ; right, lin g u a l view .
Fig 3 ■ A ppearance after periodontal th erapy and placem en t o f acid-etch com p osite restorations. C om parison w ith Figures 1 and 2 sh o w s im proved app earance. Left, labial view ; right, lin g u a l view .
w ith u ltra v io le t lig h t was a p p lie d , and the teeth w ere restored w ith co m p o site resin and p o lis h e d . T he fin a l resu lts w ere ex c e lle n t (F ig 3). W h e n w e co nsidered the c o n d itio n o f th e teeth and th e age o f the p a tie n t, w e th o u g h t th a t th e a cid -e tch te ch niqu e was less lik e ly to cause in ju r y to the p u lp s o f th e m a n d ib u la r in c is o r teeth th a n w ere f u ll crow ns.
The patient has been seen during three-month recall visits for the past year and both the periodontal and dental status has been maintained.
S u m m a ry S e v e re ly fr a c tu r e d , h y p o p la s tic , a n d c a rio u s m a n d ib u la r a n t e r io r te e th in a 1 7 - y e a r -o ld p a t ie n t p r e c lu d e d th e a b ili t y to u s e a d e q u a te m e th o d s o f c o n t r o l o f p la q u e . W i t h s im p le , in e x p e n s iv e t e c h n i q u e s , p e r i o d o n t a l h e a lth w a s r e s to r e d a n d a f u n c t io n a l a n d e s th e tic o c c lu s io n w a s p r o v id e d .
T h is tr e a tm e n t p la n w a s a c c o m p lish ed w ith m in im al risk of in ju rin g th e p u lp s of th e teeth. Dr. Gomes is assistant professor, periodon tics; Dr. Gold is assistant professor, department of children’s dentistry; Dr. Baer is professor and chairman, department of periodontics; and Dr. Festa was a senior student at the time the study was done, School of Dental Medicine, State University of New York at Stony Brook, Health Sciences Center, Stony Brook, NY 11790. A d dress request for reprints to Dr. Gomes. 1. Buonocore, M.G., and Davilla, J. Restora tion of fractured anterior teeth w ith ultravioletlight-polymerized bonding materials: a new technique. JADA 86(6):1349-1354, 1973. 2. Jordan, R.E., and others. Restoration of fractured and hypoplastic incisors by the acid etch resin technique: a three-year report. JADA 95(4):795-803, 1977. 3. Roberts, M.W., and Moffa, J.P. Repair of fractured incisal angles w ith an ultravioletlight-activated fissure sealant and a composite resin: two-year rep o rt o f 60 cases. JADA
87(4):888-891, 1973. 4. Iacono, J.V., and Ceen, R. An acid etch splint for periodontally involved teeth. NY State Dent J 48(5):142-145, 1978. 5. Poison, A.M., and Billen, J.R. Temporary splinting of teeth using ultraviolet lig h t poly merized bonding materials. JADA 89(5):11371141,1974. 6. Lambert, P.M.; Moore, D.L.; and Elletson, H.H. In vitro retentive strength of fixed bridges constructed w ith acrylic pontics and an u l tra v io le t lig h t p o lym e rize d resin. JADA 92(4):740-743, 1976. 7. Brandt, S.; Servoss, J.M.; and Wolfson, J. Practical methods of bonding, direct and in d i rect. J Clin Orthod 9(10):610-635,1975. 8. Cohl, M .L.; Green, L.J.; and Eick, J.D. Bonding of clear plastic orthodontic brackets using an ultraviolet-sensitive adhesion. Am J Orthod 62(4):400-411,1972. 9. Laswell, H.R.; Welk, D.A.; and Regenos, J.W. Attachment of resin restorations to acid pretreated enamel. JADA 82(3):558-563, 1971. 10. Ward, G.T.; Buonocore, M.G.; and Woolridge, E.D. Preliminary report of a technique using Nuva-Seal in the treatment and repair of anterior fractures without pins. NY State Dent J 38(5):269-274, 1972.
G o m e s -o th e rs : C O M B IN E D P E R IO D O N T A L A N D A C ID - E T C H C O M P O S IT E T R E A T M E N T ■ 8 3 5
