Extra-oral endosseous craniofacial implants: current status and future developments

The published experience of extra-oral endosseous craniofacial implants (EOECIs) is reviewed. The definition of osseointegration, concept of success, the relative merit of one- or two-stage implant placement, EOECI design and control of peri-abutment skin infection are discussed. A plea is made for more consistent and objective reading of clinical experience of this technique.     

Biomaterials and biomechanics of oral and maxillofacial implants: current status and future developments

Research in biomaterials and biomechanics has fueled a large part of the significant revolution associated with osseointegrated implants. Additional key areas that may become even more important--such as guided tissue regeneration, growth factors, and tissue engineering--could not be included in this review because of space limitations. All of this work will no doubt continue unabated; indeed, it is probably even accelerating as more clinical applications are found for implant technology and related therapies. An excellent overall summary of oral biology and dental implants recently appeared in a dedicated issue of Advances in Dental Research. Many advances have been made in the understanding of events at the interface between bone and implants and in developing methods for controlling these events. However, several important questions still remain. What is the relationship between tissue structure, matrix composition, and biomechanical properties of the interface? Do surface modifications alter the interfacial tissue structure and composition and the rate at which it forms? If surface modifications change the initial interface structure and composition, are these changes retained? Do surface modifications enhance biomechanical properties of the interface? As current understanding of the bone-implant interface progresses, so will development of proactive implants that can help promote desired outcomes. However, in the midst of the excitement born out of this activity, it is necessary to remember that the needs of the patient must remain paramount. It is also worth noting another as-yet unsatisfied need. With all of the new developments, continuing education of clinicians in the expert use of all of these research advances is needed. For example, in the area of biomechanical treatment planning, there are still no well-accepted biomaterials/biomechanics "building codes" that can be passed on to clinicians. Also, there are no readily available treatment-planning tools that clinicians can use to explore "what-if" scenarios and other design calculations of the sort done in modern engineering. No doubt such approaches could be developed based on materials already in the literature, but unfortunately much of what is done now by clinicians remains empirical. A worthwhile task for the future is to find ways to more effectively deliver products of research into the hands of clinicians.     

Omicron Kappa Upsilon: a historical and current perspective

Founded by G. V. Black at Northwestern Dental School in 1914, Omicron Kappa Upsilon is the "Phi Beta Kappa" of dentistry, honoring students, faculty members, and honorary members for academic excellence and professional character. In addition, the honor society has a history of granting recognition of schools and individuals who have distinguished themselves and show promise for advancing dental education.     

Community-based dental education: history, current status, and future

This article examines the history, current status, and future direction of community-based dental education (CBDE). The key issues addressed include the reasons that dentistry developed a different clinical education model than the other health professions; how government programs, private medical foundations, and early adopter schools influenced the development of CBDE; the societal and financial factors that are leading more schools to increase the time that senior dental students spend in community programs; the impact of CBDE on school finances and faculty and student perceptions; and the reasons that CBDE is likely to become a core part of the clinical education of all dental graduates.     

牙髓再生的临床应用与未来

旨在修复牙髓牙本质复合体的牙髓再生治疗是近年来的研究热点,目前仅有牙髓血运重建技术已实现临床初步应用,而干细胞移植和细胞归巢等技术尚处于临床前阶段。经过多年的基础研究和临床实践,牙髓再生特别是牙髓血运重建技术在取得进展的同时也暴露出不少问题,包括概念混淆、适应证选择不当、评价标准不完善等。为此,本综述从牙髓血运重建技术出发,对牙髓再生临床应用的现状、存在的问题和未来的临床实践路径等进行分析和探讨。     

Salivary enhancement: current status and future therapies.

Saliva provides the principal protective milieu for teeth by modulating oral microbial ecosystems and reversing the initial phases of caries development. Patients with inadequate salivary function are at increased risk for dental decay. Therefore, it is likely that therapies that increase overall fluid output of these individuals will reverse early carious lesions. The most common causes of salivary dysfunction are medication usage, Sj?gren's syndrome, and damage of salivary parenchyma during therapeutic irradiation. For patients with remaining functional acinar tissue, treatment with the parasypathomimetic secretogogues pilocarpine and Cevimeline may provide relief. However, these medications do not benefit all patients. The possibilities of using gene therapy and tissue engineering to develop treatments for those with severe salivary dysfunction are discussed.     

Oral cancer prevention: current status and future promise

Head and neck carcinogenesis is a multistep process requiring the accumulation of multiple genetic alterations in epithelial cells. These alterations allow growth advantages over other cells and the development of malignant phenotypes.     

Lactoferrin and oral diseases: current status and perspective in periodontitis

Lactoferrin (Lf), an iron-binding glycoprotein able to chelate two ferric ions per molecule, is a component of human secretions synthesized by exocrine glands and neutrophils in infection/inflammation sites. Lactoferrin in saliva represents an important defence factor against bacterial injuries including those related to Streptococcus mutans and periodontopathic bacteria through its ability to decrease bacterial growth, biofilm development, iron overload, reactive oxygen formation and inflammatory processes.A growing body of research suggests that inflammatory periodontal disease involves a failure of resolution pathways to restore tissue homeostasis. There is an important distinction between anti-inflammation and resolution; anti-inflammation is pharmacologic intervention in inflammatory pathways, whereas resolution involves biologic pathways restoring inflammatory homeostasis. An appropriate regulation of pro-inflammatory cytokine synthesis might be useful in reducing periodontal tissue destruction. Recently, the multi-functional IL-6 is emerging as an important factor able to modulate bone, iron and inflammatory homeostasis.Here, we report an overview of Lf functions as well as for the first time Lf anti-inflammatory ability against periodontitis in in vitro model and observational clinical study. In in vitro model, represented by gingival fibroblasts infected with Prevotella intermedia, Lf exerted a potent anti-inflammatory activity. In the observational clinical trial performed through bovine Lf (bLf) topically administered to volunteers suffering from periodontitis, bLf decreased cytokines, including IL-6 in crevicular fluid, edema, bleeding, pocket depth, gingival and plaque index, thus improving clinical attachment levels.Even if other clinical trials are required, these results provide strong evidence for a instead of an therapeutic potential of this multifunctional natural protein.     

The dental workforce in Kentucky: current status and future needs

Objectives: This study assessed the geographic distribution of dentists in Kentucky, determined socioeconomic correlates of practice location, estimated the future availability of dental providers, and made policy recommendations that could improve access to oral health care in Kentucky and other rural states. Methods: Dentists' addresses were mapped using a geographic information system. Poisson regression modeling and geospatial analyses were conducted using SAS v9.1 (SAS Institute, Cary, NC, USA) and ArcGIS v9.2 (Environmental Systems Research Institute Inc., Redlands, CA, USA), respectively. Data on the number of dentists (n = 2,391) per county (n = 120) were used for the regression models. Explanatory variables included: per capita income, 2006 intercensal population estimates, percent adults with six or more teeth removed, percent population uninsured, physician‐to‐population ratios, and region type. A simulation model was used to project dentist‐to‐population ratios to the year 2016. Results: The dental workforce analysis revealed disparities in the distribution of dentists between rural, urban, and Appalachian Kentucky counties. Dentists were more likely to be found practicing in areas with higher income and higher physician‐to‐population ratios. Compounding this geographic maldistribution, our projections suggest that the number of dentists per unit population will decrease over time in the near future, likely widening this disparity in rural and underserved areas. Conclusions: These results show present and widening workforce disparities in rural and socioeconomically depressed counties in Kentucky. Understanding the geographic distribution of dentists and the socioeconomic correlates of their practice locations may inform workforce development and reimbursement policies for the goal of improving access to oral health care in these areas.