Discussion.—Use of an adhesive product with denturesproduced better retention, stability, maxillary bite force,and denture dislodgement results than not using theseproducts. Patients rated their confidence, comfort, and sat-isfactionmore highly when using the denture adhesive thanwhen it was not used.

Clinical Significance.—Although the assess-ment of these denture adhesives was limited toa 2-hour period after application, studies indicatethat it is likely that these positive results wouldcontinue for a longer duration. Dental profes-sionals can help to guide denture patients onthe proper use and application of denture adhe-sives. They should also educate their patients toexpect that their dentures will need to be refittedor relined with time. Patients should know that

adhesives are to be used sparingly and if their useincreases, it is likely an indication that the den-tures have become ill-fitting. Denture patientsshould also be advised about problems relatedto the use of zinc-containing adhesives. Despitethe lackof natural teeth, patients still need to visitthe dentist regularly to evaluate denture fit andcheck for cancer and other oral diseases.

Munoz CA, Gendreau L, Shanga G, et al: A clinical study to evaluatedenture adhesive use in well-fitting dentures. J Prosthodont 21:123-129, 2012

Reprints available from J Dorcher, GlaxoSmithKline ConsumerHealthcare, 1500 Littleton Rd., Parsippany, NJ 07054, USA; e-mail:JohnP.Durocher@gsk.com

Restorative DentistryTeaching repair rather than replacement

Background.—Because of developments in tooth-colored restorative systems and new approaches to cariesmanagement, the teaching of operative dentistry has beenchanging across the world. Minimally invasive dentistryhas become the guiding philosophy, and students are beingschooled in posterior composite resin placement at least asoften as in amalgam techniques. The result will be morecomposite resin restorations will be placed in general den-tal practices. The performance of posterior composites inclinical service will, as a result, need to be improved.Some restorations inevitably require replacement. How-ever, deteriorating but still serviceable restorations maybe repaired rather than done away with. This reflects a min-imally invasive approach and offers many advantages, suchas being more conservative of tooth tissue, reducing therisk of iatrogenic damage, reducing the need for local anes-thesia, giving an opportunity for better patient experiences,and saving both time and resources. Composite restorationrepair may also contain an element of refurbishment, in-cluding refinishing or resurfacing with or without recon-touring of the restoration. A review of the undergraduateteaching programs of Scandinavian dental schools done in2002–2003 revealed marked variations in the teaching of in-dications for and expected longevities of composite restora-tion repairs. The contemporary teaching of compositerepair techniques in Scandinavian dental schools wasassessed.

Methods.—A questionnaire was mailed to the 12 Scan-dinavian (four Swedish, three Norwegian, three Finnish,and two Danish) dental schools in late 2010/early 2011.Questions focused on the undergraduate teaching of com-posite repair techniques, indications for such techniques,and materials used. All 12 schools responded.

Results.—Eleven of the 12 schools indicated they cur-rently taught repair of defective direct composite restora-tions in the primary dental degree program, with thetwelfth school indicating it planned to include this withinthe next 5 years but currently had a lack of personalclinical experience for performing such repairs. The rea-sons for teaching these procedures cited were personalclinical experience, existing literature, and case reports.Teaching techniques were reported as both didactic andclinical for the 11 schools that included this topic. Six re-ported the relevant clinical teaching was primarily basedon clinical case scenarios in student clinics; one reportedthe teaching of composite repairs included no clinicalexperience.

Indications for repair rather than replacement thatwere being taught included tooth substance preservation,reduced harmful effects on the pulp, reduced costs to thepatient, and reduced treatment time. Ten schools agreedthat marginal defects were an indication for the repair of

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composite restorations, but the views on other indica-tions varied. The most common scenario the schoolsagreed constituted an indication for repair rather than re-placement was a cusp fracture of a posterior tooth re-stored with a direct composite restoration. The leastcommon scenario on which they agreed was a proximalfracture in an anterior tooth. The management ofa cracked tooth scenario yielded a lack of agreement be-tween the schools.

The surface technique taught by all 11 schools for re-pairing existing direct composite restorations was mechan-ical roughening of the existing composite restoration andremoval of the surface layer of material. Ten used acidetching of the existing composite surface using phosphoricacid, and one taught the use of hydrofluoric acid. All 11schools taught students to apply an adhesive bonding sys-tem to the prepared and etched composite surface. Ninetaught the use of a hybrid composite resin to complete re-pairs. One occasionally taught the use of surface silicatiza-tion using the CoJet system for challenging repairs onanterior teeth. All schools instructed students on the useof diamond finishing instruments and 9 taught the use offinishing disks.

Ten of the schools taught that patients were receptive torepair of a less than ideal composite restoration as an alter-native to its replacement. Six schools indicated an accept-able longevity of a repair to an existing compositerestoration, with one citing 3–5 years, three 6–10 years,and two over 10 years. Five of these schools estimatedthat repairs increased the lifespan of direct composite res-torations by 30%, whereas one gave an estimate of 50%.Monitoring the repaired composite restorations was

52 Dental Abstracts

considered part of the recall system taught by three of theseschools.

Discussion.—Teaching the repair of defective compos-ite restorations appears to be well established in the pri-mary dental degree programs of Scandinavian countries.The principles and techniques taught are in line with thebest available evidence in most cases and agree with theconcepts of minimally invasive dentistry.

Clinical Significance.—Repairing rather thanreplacing direct composite restorations whenpossible is in the best interest of the patientand can approach the goal of giving patients‘‘teeth for life.’’ Studies show that retaining teethinto patients’ later years is associated with bet-ter food quality choices, better nutritional sta-tus, and increased self-confidence. Teachers ofoperative dentistry must continue to developand refine their instruction on the techniquesof repairing direct composite restorations asmaterials and approaches change.

Blum IR, Lynch CD, Wilson NHF: Teaching of the repair of defectivecomposite restorations in Scandinavian dental schools. J Oral Reha-bil 39:210-216, 2012

Reprints available from IR Blum, Bristol Dental Hosp. & School, Univ.of Bristol, Lower Maudlin St., Bristol BS1 2LY, UK; e-mail:i.blum@bristol.ac.uk

Temporomandibular DisordersOcclusal support and degeneration of the temporomandibular joint

Background.—The temporomandibular joint (TMJ) isa load-bearing joint and, as with other such joints, can beloaded excessively. As the functional demands placed on itincrease, the TMJ attempts to remodel and adapt accord-ingly. However, when the physiologic limits of remodelingare surpassed, pathologic degenerative changes take place,often focused on the articular cartilage. The developmentof degenerative changes is a slow process but can cause se-vere damage to the hard and soft tissues of the joint. Agingis closely tied to the development of degenerative changesin the TMJ, possibly reflecting an intrinsic accumulation oftissue damage coupled with a time-related decline in theability of cellular processes to adapt. The body’s ability to

regenerate declines with age, and the condylar remodelingmay simply become insufficient to handle the increasedstress. Other possible contributing factors for degenerationinclude tooth attrition, occlusal support, food consistency,gender, and genetics. Contemporary human skull materialwas evaluated to determine whether there is a relationshipbetween degenerative form and TMJ surface changes linkedto occlusal support.

Method.—A total of 259 human skulls of 170 male and89 female subjects were studied. They ranged in age from18 to 100 years and mostly included subjects with a back-ground of poverty. This factor may reflect a worse dental