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Predictors of root caries in older adults in US. J [Meeting Abstract]

Pimenta, LA; Ritter, Andre V; Beck, J
ISSN: 0022-0345
CID: 4155152

Composite veneers: The direct-indirect technique revisited

Fahl, Newton; Ritter, André V
OBJECTIVE:This article provides an update on the direct-indirect composite veneer technique. CLINICAL CONSIDERATIONS/UNASSIGNED:Composite veneers have long been used as a conservative and esthetic treatment option for anterior teeth. While they are generally performed using a direct technique, there has been renewed interest in the direct-indirect composite veneer technique because of its advantages and broad indications for restoration of tooth color and morphology. In the direct-indirect composite veneer technique, the selected composites are initially applied on the tooth using a layering approach, without any bonding agent, sculpted to a primary anatomic form with slight excess, and light-cured. The partially polymerized veneer is then removed from the tooth, heat-tempered, and finished to final anatomy and processed extra-orally before being luted. Advantages of this technique include enhanced physical and mechanical properties afforded by the tempering process, unrivaled marginal adaptation, enhanced finishing and polishing, and the ability to try-in the veneer before luting, enabling a shade verification and modulation process that is not possible with the direct technique. The direct-indirect approach also affords enhanced gingival health and patient comfort. CONCLUSION/CONCLUSIONS:This article reviews the direct-indirect composite veneer technique, and outlines critical steps and tips for clinical success. CLINICAL SIGNIFICANCE/CONCLUSIONS:The direct-indirect technique for composite veneers combines advantages of the direct composite placement technique with those of the indirect veneer technique, including operator control, single-visit fabrication and delivery, increased material properties, and excellent esthetics.
PMID: 33336852
ISSN: 1708-8240
CID: 4722502

The inconspicuous nature of COVID-19 and its impact to dentistry

Brandolin, Bruce A; Watson, Colleen A; Resnick, Steven J; Allen, Kenneth L; Ritter, André V
To state that the new coronavirus SARS-CoV-2 has broadly and deeply impacted our lives is an understatement. Since it first showed up on our radar in December 2019, the new coronavirus has wreaked havoc on virtually all businesses and industries across the globe. The impact is equally felt in developing, developed, industrialized, rural, rich, and poor countries and communities, irrespective of how well-prepared those countries and communities felt they were 9 months ago. To this day we are still learning to prepare for, respond to, and adapt to the broad and deep impact of this virus. This essay presents different perspectives on the impact of the novel coronavirus to dentistry, through the lenses of a private practice-based general dentist, a nursing home-based public health dentist, and a school of dentistry clinical director. The goal of the essay is to share our experiences and challenges, as well as highlight our capacity to respond to a crisis with resilience, determination, creativity, inventivity, and, most importantly, humility and altruism.
PMID: 33223797
ISSN: 1073-8746
CID: 4680212

Effect of Tribochemical Coating on Composite Repair Strength

Ritter, A V; Sulaiman, T; Altitinchi, A; Baratto-Filho, F; Gonzaga, C C; Correr, G M
CLINICAL RELEVANCE/UNASSIGNED:Tribochemical treatment of existing composite surfaces is highly effective for composite repair. When repairing an old composite restoration, the clinician should try to use the same composite originally used for the restoration. If the information about the original restoration is not known, a composite with strong mechanical properties should be used for the repair restoration. SUMMARY/CONCLUSIONS:This study evaluated the effect of tribochemical coating on composite-to-composite repair interfacial fracture toughness (iFT). Sixty beam-shaped specimens (21×4×3 ± 0.2 mm) were prepared with a nanofill composite (Filtek Supreme Ultra [FSU]) and a nanohybrid composite (Clearfil Majesty ES-2 [CME]) and aged for 50,000 thermocycles (5°C-55°C, 20-second dwell time) and then sectioned in half. The resulting 120 hemispecimens (60 for each composite) were randomly assigned to different repair methods (n=10): universal adhesive (Clearfil Universal Bond Quick [CUB]), sand-blasting followed by CUB, or tribochemical coating (CoJet, CoJet sand, Espe-Sil, and Visio-Bond). The repair surface was prepared with a diamond bur (Midwest #471271), rinsed, and dried. Each aged composite brand (FSU, CME) was repaired with either the same composite or the opposite composite. All adhesives and composites were light cured with a high-irradiance LED curing light (Elipar DeepCure-S). After postrepair storage in 100% humidity and at 37°C for 24 hours, iFT was measured as KIc (MPa m½). Data were analyzed for statistical significance using two-way analysis of variance (ANOVA) and the Tukey honest significant difference post hoc test (α=0.05). Regardless of the substrate composite, ANOVA showed significant differences for surface treatment (p<0.0001) and repair composite (p<0.0001). Mean iFT values (SD) ranged from 0.91 (0.10) MPa·m½ to 2.68 (0.12) MPa·m½. Repairs made with FSU after CoJet resulted in significantly higher iFT (FSU: 2.68 MPa·m½; CME: 2.21 MPa·m½) when compared to the other experimental groups. The repair iFT was higher with CoJet treatment and when the nanofill composite FSU was used as the repair composite.
PMID: 32818966
ISSN: 1559-2863
CID: 5018192

Fracture load of two thicknesses of different zirconia types after fatiguing and thermocycling

Alraheam, Islam Abd; Donovan, Terry; Boushell, Lee; Cook, Ryan; Ritter, André V; Sulaiman, Taiseer A
STATEMENT OF PROBLEM/BACKGROUND:A direct relationship has been reported between yttria concentration and translucency in zirconia restorations. However, increased yttria concentration also increases the cubic phase of the zirconia, which reduces its strength. The effect of increased yttria content on the fracture resistance of zirconia as a function of material thickness after fatigue testing requires evaluation. PURPOSE/OBJECTIVE:The purpose of this in vitro study was to use the biaxial flexural test to evaluate the effect of yttria concentration on the mean fracture load (N) before and after fatiguing and thermocycling as a function of zirconia thickness. MATERIAL AND METHODS/METHODS:Disk-shaped specimens of 5 mol% yttria partially stabilized zirconia (5Y-PSZ, BruxZir Anterior Solid Zirconia) and 3 mol% yttria partially stabilized zirconia (3Y-PSZ, BruxZir Shaded Zirconia) were prepared to thicknesses of 1.2 and 0.7 mm. For each thickness, the biaxial flexural test was used to measure the fracture load (N) before and after fatigue testing, with 1.2 million cycles at a 110-N load and simultaneous thermocycling at 5 °C to 55 °C (n=20). The data were analyzed by repeated-measures ANOVA (α=.05). RESULTS:Yttria concentration, thickness, and exposure to fatiguing had a statistically significant effect on the mean biaxial flexural load (yttria concentration: P<.001; thickness: P<.001; fatiguing: P=.004 for the 3Y-PSZ). One of the major findings in this study was that 30% of the 1.2-mm-thick 5Y-PSZ specimens and 80% of the 0.7-mm-thick 5Y-PSZ specimens fractured during fatiguing. All specimens of the 3Y-PSZ groups survived the fatiguing protocol. The 3Y-PSZ groups had statistically significant higher flexural loads than the 5Y-PSZ groups. The 1.2-mm thickness groups had statistically significant higher flexural loads than the 0.7-mm thickness groups. CONCLUSIONS:Yttria concentration had a significant effect on the strength of zirconia. 5Y-PSZ was considerably less resistant to fracture before and after fatigue testing than 3Y-PSZ. Decreasing the thickness of zirconia reduces its fracture resistance, regardless of the zirconia type.
PMID: 31383533
ISSN: 1097-6841
CID: 4144112

Composite veneers : the direct-indirect technique

Fahl, Newton Jr.; Ritter, Andre V
Batavia, IL : Quintessence Publishing Co, Inc, [2020]
Extent: 1 v.
ISBN: 0867159596
CID: 4150142

Effect of surface treatment and cement type on dentin bonding of processed resin composite

Ritter, André V; Sulaiman, Taiseer A; Rodgers, Brandon M; Baratto-Filho, Flares; Cunha, Leonardo; Gonzaga, Carla C; Correr, Gisele M
PURPOSE/OBJECTIVE:To examine the effect of surface treatment and cement type on dentin bonding of processed resin composite restorations. METHODS:Bovine incisors were sectioned to expose mid-dentin, and randomly assigned to four different groups: Group ULT, Lava Ultimate composite blocks were bonded to dentin with RelyX Ultimate; Group ULT-CJ was treated as in Group ULT but CoJet was used to treat the intaglio surface prior to bonding; Group UNC was bonded with RelyX Unicem 2; and Group UNC-CJ was treated as in Group UNC but CoJet was used to treat the intaglio surface. RelyX Unicem 2 was used as a self-adhesive resin cement, while RelyX Ultimate was used as an adhesive resin cement with Scotchbond Universal. All adhesives and resin composites were polymerized with a high-irradiance LED polymerizing light (Elipar DeepCure-S). After bonding, all specimens were kept in 100% humidity and 37°C for 7 days and then processed for microtensile bond strength (µTBS) testing (n=15). The failure mode was analyzed under SEM as cohesive, adhesive, or mixed. Data were analyzed for statistical significance using two-way ANOVA and Tukey's HSD post-hoc test (α=0.05). RESULTS:Mean µTBS values ranged from 8.83 MPa (±3.13 MPa) for UNC to 25.63 MPa (±5.94 MPa) for ULT-CJ. Means were statistically significantly higher for the adhesive cement when compared with the self-adhesive cement (P< 0.05), and, for the adhesive cement, CoJet resulted in statistically significantly higher means (P< 0.05). The number of pre-test failures was uniform across groups (n=2-4). Failures were predominantly adhesive and mixed. The adhesive resin cement RelyX Ultimate performed significantly better than the self-adhesive resin cement RelyX Unicem 2, and surface treatment with CoJet improved bond strengths of Lava Ultimate to dentin. CLINICAL SIGNIFICANCE/CONCLUSIONS:CoJet treatment and adhesive resin cements should be used when bonding laboratory/CAD-CAM processed resin composite restorations to dentin.
PMID: 31920051
ISSN: 0894-8275
CID: 4270762

Composite-composite Adhesion as a Function of Adhesive-composite Material and Surface Treatment

Ritter, A V; Sulaiman, T A; Altitinchi, A; Bair, E; Baratto-Filho, F; Gonzaga, C C; Correr, G M
OBJECTIVE/UNASSIGNED:To evaluate the composite-to-composite repair interfacial fracture toughness (iFT) as a function of adhesive and composite repair material. METHODS AND MATERIALS/UNASSIGNED:tests (α=0.05). RESULTS/UNASSIGNED:>0.05). CONCLUSIONS/UNASSIGNED:Composite repair strength is adhesive and composite dependent. Repair strength appears to be higher when FSU is the repair composite regardless of the adhesive used.
PMID: 30444693
ISSN: 1559-2863
CID: 4144102

Sturdevant's art and science of operative dentistry

Ritter, Andre V; Boushell, Lee W; Walter, Ricardo; Sturdevant, Clifford M
St. Louis : Elsevier, 2019
Extent: xii, 530 p. ; 29 cm
ISBN: 9780323478335
CID: 4149712

Esthetic and functional management of an ankylosed central incisor with a conservative restorative approach

Ritter, Andre V; Cunha, Leonardo Fernandes; Correr, Gisele M
In this case report, we share a conservative and simple restorative management approach for a relatively complex esthetic situation on an adult patient with an ankylosed maxillary central incisor in infra-occlusion. A 37-year-old healthy female patient presented for a consultation with a chief complaint of an unappealing smile. The intraoral exam revealed tooth #8 (FDI 11) was in obvious and significant infra-occlusion due to altered eruption. Periapical radiographs of this area were non-contributory and all teeth responded within normal limits to pulp vitality tests. After review of several treatment options, the patient opted for a conservative restorative approach in which a partial ceramic veneer was planned for the ankylosed tooth, while composite resin was used on the contralateral central incisor to achieve a symmetric and pleasant result. CLINICAL SIGNIFICANCE: A relatively complex clinical problem was satisfactorily resolved with a very conservative option in which composite resin and a ceramic veneer were used to restore an asymmetric smile.
PMID: 29399941
ISSN: 1708-8240
CID: 4144082