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1.
Luiz Fernando Noira Passos da Costa Cristine da Silva Furtado Amaral Davi da Silva Barbirato Anna Thereza Thomé Leão Mariana Fampa Fogacci 《Journal of the American Dental Association (1939)》2017,148(5):308-318
Background
Through a systematic literature review, the authors evaluated the use of chlorhexidine (CHX) mouthwash as an adjunct to mechanical periodontal therapy for chronic periodontitis.Types of Studies Reviewed
The authors performed a systematic search by using PubMed (MEDLINE), Scopus, Scientific Electronic Library Online, and Cochrane Central Register of Controlled Trials. The authors selected randomized controlled clinical trials in which the investigators evaluated the probing depth (PD) and clinical attachment level (CAL) in test groups by using CHX as an adjuvant and in control groups and subject to mechanical periodontal therapy (scaling and root planing [SRP] 4-6 visits or 24 hours).Results
The literature search resulted in 8 articles, which the authors then assessed for quality. After testing for heterogeneity, the authors performed a meta-analysis only in the SRP group with 4 to 6 visits. Results were positive for both PD and CAL with use of CHX. However, the summary measure was significant (P < .05) only for PD at 40 to 60 days (0.33 millimeters; 95% confidence interval, 0.08 to 0.58 mm) and 180 days (0.24 mm; 95% confidence interval, 0.02 to 0.47 mm) of follow-up, showing positive results for the use of CHX at those times. Although those differences were statistically significant, they could be interpreted as clinically slight.Conclusions and Practical Implications
Adjunctive use of CHX mouthrinse with mechanical SRP resulted in slightly greater PD reduction than did SRP alone. Clinicians must consider the small additional gain in PD reduction, negligible effect on CAL, and potential for tooth staining when using CHX as an adjunct to SRP in treating chronic periodontitis. 相似文献2.
Navid Khalighinejad Anita Aminoshariae James C. Kulild Jeannie Wang Andre Mickel 《Journal of endodontics》2017,43(11):1781-1785
Introduction
The aim of this study was to investigate the effect of periodontal status at the time of nonsurgical root canal treatment (NSRCT) on the survival rate of endodontically treated teeth (ETT).Methods
In this retrospective investigation, molars that received NSRCT in an advanced specialty education program in endodontics from 2009 through 2017 were initially recruited. After the application of inclusion and exclusion criteria, 315 teeth were included in the study. Inclusion criteria were ETT with an acceptable quality of NSRCT; ETT that received an adequate crown within 3 months after NSRCT; and ETT with complete periodontal charting before NSRCT including pocket depths, clinical attachment loss, and bone loss. The periodontal status of all included teeth was assessed based on American Academy of Periodontology guidelines. All included ETT were divided into 3 groups as follows: healthy group, mild periodontitis, and moderate periodontitis. The survival rate of ETT was analyzed using univariate Kaplan-Meier and log-rank tests for differences between groups (P < .05). A Cox regression model was used to assess the effect of independent variables on the survival rate.Results
Teeth that were diagnosed with mild periodontitis were almost 2 times more likely to be extracted compared with ETT diagnosed with normal periodontium at the time of NSRCT (odds ratio [OR] = 1.9, P < .05). This increased risk of tooth loss was 3.1 (OR = 3.1, P < .05) for ETT diagnosed with moderate periodontitis. Smokers were twice as likely to have tooth loss compared with nonsmokers (OR = 2.2, P < .05).Conclusions
Patients' periodontal health, being 1 of the prognostic determinants of the outcome of NSRCT, requires attention before and subsequent to NSRCT. This may improve the survival of ETT and help patients maintain their natural dentition. 相似文献3.
He Cai Shuying Yang Xibo Pei Hai Qing Jian Wang 《The Journal of prosthetic dentistry》2017,117(3):405-409
Statement of problem
Gingival displacement is recognized as a substantive and difficult procedure in fixed prosthodontics. However, a realistic simulation of gingival displacement is unavailable for preclinical dental students.Purpose
The purpose of this study was to evaluate whether practice-based preclinical instruction of gingival displacement with animal models could improve students’ skill in patient care.Material and methods
Isolated bovine mandibles (calves were younger than 6 months of age) and isolated porcine hemimandibles were prepared for this study. Twenty-two general dental practitioners with at least 5 years of experience were randomly selected and assigned to perform gingival displacement on both bovine and porcine jaws. Those practitioners were then asked to assess the clinical similarity of gingival displacement between human teeth and animal teeth. The data were analyzed with the paired t test (α=.05). Upon confirmation that the animal jaw provided a similar gingival displacement environment to that of human teeth, 80 predoctoral dental students were enrolled and randomized into 2 groups. Half of them underwent the new practice-based instruction, while the others underwent traditional preclinical teaching only (lectures, online video, or live demonstration). After preclinical learning, clinical performance in gingival displacement was evaluated for all students in terms of the effect of gingival displacement and quality of impression. The data were analyzed with the chi-square test (α=.05).Results
The dentogingival environments of porcine and bovine jaws were similar to those of human jaws, and no significant difference was detected between these 2 animal models (P=.178). A significant increase occurred in the acceptable rate of the effect of gingival displacement (P<.001) and the quality of impression (P<.001) among students who received the practice-based instruction compared with those who received traditional teaching.Conclusions
These findings suggest that this practice-based instruction of gingival displacement with animal models is an effective method of promoting dental students’ learning of gingival displacement. 相似文献4.
Introduction
Mandibular premolars that have rare and complex anatomies may have the highest failure rate in nonsurgical endodontic treatment. Awareness of rare and complex anatomies of mandibular second premolars would aid in better outcomes of the treatment. This study aimed to evaluate the success of nonsurgical root canal treatment of mandibular second premolar teeth with complex apical branching.Methods
Twenty-six mandibular second premolar teeth with complex apical branching treated with multiple-visit nonsurgical root canal treatment or nonsurgical retreatment were retrospectively evaluated.Results
For the clinical outcomes, 9 subjects had complete healing, 1 subject had functional healing, and no subject had no healing scores out of 10 root canal treatment subjects. Six subjects had complete healing, 8 subjects had functional healing, and 2 subjects had no healing scores out of 16 retreatment subjects. For the radiographic outcomes, 7 subjects had complete healing, 3 subjects had incomplete healing, and no subject had no healing scores out of 10 root canal treatment subjects. Six subjects had complete healing, 8 subjects had incomplete healing, and 2 subjects had no healing scores out of 16 retreatment subjects. The clinical outcome of root canal treatment subjects was significantly different than retreatment subjects (P < .05). Similarly, the radiographic outcome of root canal treatment subjects was also significantly different than retreatment cases (P < .05).Conclusions
The outcome of endodontic treatment of mandibular second premolars may be influenced by treatment type. 相似文献5.
Melissa Drum Al Reader John Nusstein Sara Fowler 《Journal of the American Dental Association (1939)》2017,148(4):267-271
Background and Overview
Profound pulpal anesthesia after a successful inferior alveolar nerve block can be difficult to achieve when the clinical condition is a pulpal diagnosis of symptomatic irreversible pulpitis. The authors reviewed the literature as it relates to the anesthesia necessary for endodontic therapy of patients with painful, vital, mandibular teeth diagnosed with symptomatic irreversible pulpitis.Conclusions
Supplemental anesthetic techniques and medications are available that can be used to improve pulpal anesthesia for patients with the clinical condition of symptomatic irreversible pulpitis.Practical Implications
The authors identified treatment recommendations for anesthesia in the case of symptomatic irreversible pulpitis based on a review of the available evidence. 相似文献6.
Ronald E. Goldstein Wendy Auclair Clark 《Journal of the American Dental Association (1939)》2017,148(6):387-391
Background
Awake bruxism is a common clinical condition that often goes undetected, often leading to pain or damaged teeth and restorations.Methods
The authors searched electronic databases regarding the treatment and effects of awake bruxism compared with those of sleep bruxism. The authors used the search terms diurnal bruxism and oral parafunction. The authors combined information from relevant literature with clinical experience to establish a recommended protocol for diagnosis and treatment.Results
The authors found articles regarding the diagnosis and treatment of bruxism. The authors combined information from the articles with a review of clinical cases to establish a treatment protocol for awake bruxism.Conclusions
Literature and clinical experience indicate a lack of patient awareness and, thus, underreporting of awake bruxism. As a result, myriad dental consequences can occur from bruxism. The authors propose a need for increased awareness, for both patients and professionals, particularly of the number of conditions related to awake bruxism.Practical Implications
Clinicians should look for clinical signs and symptoms of awake bruxism and use minimally invasive treatment modalities. 相似文献7.
8.
Belinda Hsu Stephanie Lee Donald Schwass Geoffrey Tompkins 《Journal of the American Dental Association (1939)》2017,148(7):493-499
Background
Application of astringent hemostatic agents is the most widely used technique for gingival retraction, and a variety of products are offered commercially. However, these products may have additional unintended yet clinically beneficial properties. The authors assessed the antimicrobial activities of marketed retraction products against plaque-associated bacteria in both planktonic and biofilm assays, in vitro.Methods
The authors assessed hemostatic solutions, gels, pellets, retraction cords, pastes, and their listed active agents against a collection of microorganisms by means of conventional agar diffusion and minimum bacteriostatic and bactericidal concentration determinations. The authors then tested the most active products against monospecies biofilms grown on hydroxyapatite disks.Results
All of the tested retraction products exhibited some antimicrobial activity. The results of the most active products were comparable with those of a marketed mouthwash. The listed retraction-active agents displayed relatively little activity when tested in pure form. At 10% dilution, some products evidenced inhibitory activity against most tested bacteria within 3 minutes of exposure, whereas others displayed variable effects after 10 minutes. The most active agents reduced, but did not completely prevent, the metabolic activity of a monospecies biofilm.Conclusions
Commercial gingival retraction products exhibit antimicrobial effects to various degrees in vitro. Some products display rapid bactericidal activity. The antimicrobial activity is not owing to the retraction-active agents. Biofilm bacteria are less sensitive to the antimicrobial effects of the agents.Practical Implications
The rapidity of killing by some hemostatic agents suggests an antimicrobial effect that may be efficacious during clinical placement. The results of this in vitro study suggest that clinicians should be aware of the potential antimicrobial effects of some hemostatic agents, but more research is needed to confirm these observations in clinical use. 相似文献9.
10.
Statement of problem
Reports on computer-engineered complete dentures (CECDs) continue to increase. Systematic reviews on clinical outcomes and applications associated with CECDs are lacking in the literature.Purpose
The purpose of this systematic review was to determine the clinical outcomes and applications of CECDs.Material and methods
Electronic searches of the English literature from January 1984 to May 2016 were performed in MEDLINE and Cochrane databases, with the results enriched by hand searches and citation mining to address 2 relevant population intervention comparison outcome (PICO) questions: What are the clinical outcomes associated with CECDs? Are there specific applications and significant advantages for CECDs?Results
A review of the selected articles on CECDs revealed significantly better retention and reduced clinical time for the milled CECDs compared with conventional complete dentures. An advantage associated with CECDs is the possibility of electronically archiving data using digital technology for rapid fabrication. Applications reported in the literature with CECDs were also identified.Conclusions
A positive trend was seen in the outcomes with CECDs, although patient selection might have also contributed to favorable outcomes. Significantly reduced clinical time, improved retention, and digital archiving were the main advantages associated with CECDs. 相似文献11.
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13.
Gary Goldstein Mark Andrawis Mijin Choi Jonathan Wiens Malvin N. Janal 《The Journal of prosthetic dentistry》2017,117(3):426-429
Statement of problem
The definition of centric relation (CR) has been both controversial and divisive, with little consensus.Purpose
The purpose of this study was to determine whether agreement can be reached on a definition for CR among the Fellows of the Academy of Prosthodontics, the organization that writes the Glossary of Prosthodontic Terms.Material and methods
A survey of the Fellows of the Academy of Prosthodontics was conducted at the organization’s annual business meeting.Results
Of the 83 eligible Fellows in attendance, 72 responded to the survey, a response rate of 86%. Of those, the 5 responders who did not indicate a preferred definition and the 2 that chose 2 definitions were censored, yielding an analyzable sample of 65 for the definitions. The most common definition received 19 votes, the next 16, and the third 13, with the other 6 definitions receiving from 2 to 5 votes. Some of the variability in definition depended on the era of training.Conclusions
Disagreement and confusion continues regarding the definition of centric relation. Some of this disagreement can be explained by training era. 相似文献14.
Martín Caserío Valea Victor Alonso de la Peña 《Journal of the American Dental Association (1939)》2017,148(2):75-80
Background
The authors conducted a retrospective study to evaluate the long-term (18-22 years) clinic results of titanium post and bonded amalgam core restorations with metal-ceramic crowns placed in patients.Methods
From 1992 through 1996, the authors placed 88 restorations in 66 patients. They measured the ferrule effect in the minor dentin collar area. In 2014, the authors analyzed the following variables: ferrule length, length and thickness of the post, and tooth position.Results
The overall survival of the restorations decreased over time with survival rates of 89.6% after 5 years of follow-up appointments and 64.2% after 18 years of follow-up appointments. There were 42 failures, and the maxillary premolars had the most failures. The teeth with 2 or more millimeters ferrule length had a higher survival rate than those with a 0 to less than 2 mm ferrule length; these results were not statistically significant.Conclusions
Statistically significant differences were detected according to the location of the tooth. The cores in the anterior teeth were 3.26 times more likely to fail than those in the molars, which presented higher survival rates; maxillary premolars had the most failures (28.5%). Both the metallic post length and its diameter did not influence restoration survival. The ferrule length was not statistically significant.Practical Implications
The clinical technique to restore endodontically treated teeth that includes a titanium post and bonded amalgam restorations results in greater coronal destruction but shows good long-term results, ease of fabrication, and modest cost in comparison with other techniques. 相似文献15.
Yunchun Kuang Bo Hu Jin Chen Ge Feng Jinlin Song 《Journal of the American Dental Association (1939)》2017,148(10):750-759
Background
For this systematic review, the authors evaluated and synthesized the available scientific evidence related to the effects of periodontal endoscopy on the treatment of periodontitis.Methods
The authors searched PubMed, Embase, Cochrane Library, Chinese Scientific Journals database, China National Knowledge Infrastructure, and Chinese Medicine Premier’s Wanfang database for articles about periodontal endoscopy that were published through January 2017. The authors considered the percentage of residual calculus, average treatment time, bleeding on probing (BOP), gingival inflammation (GI), and probing depth (PD) as outcome measures. The authors extracted data and performed meta-analyses for groups of articles for which it was appropriate.Results
The authors identified 8 articles as being suitable for this systematic review. The investigators of 3 studies reported results related to BOP and GI that revealed some advantages of periodontal endoscopy over traditional scaling and root planing (SRP). The investigators of 4 studies explored PD and found no difference between periodontal endoscopy and traditional SRP. The authors could not perform meta-analyses on the study results related to BOP, GI, or PD. The percentage of residual calculus after periodontal endoscope–aided debridement was significantly less than the percentage of residual calculus after traditional SRP (mean difference, ?3.18; 95% confidence interval, ?4.86 to ?1.49; P = .002; heterogeneity I2 = 74%). The authors found that periodontal endoscopy took significantly more time than traditional SRP (mean difference, 6.01 minutes; 95% confidence interval, 4.23 to 7.8; P < .00001; heterogeneity I2 = 0%).Conclusions and Practical Implications
Periodontal endoscopy may provide additional benefits for calculus removal compared with traditional SRP, although it could take more time to perform. With respect to BOP, GI, and PD, the authors found no sufficient evidence to support the difference between the use of periodontal endoscopy and traditional SRP. The authors concluded that additional scientific research is required to assess the effects of periodontal endoscopy on the treatment of periodontitis. 相似文献16.
Letícia M. Wambier Juliana L. de Geus Thaynara Faelly Boing Ana Claudia Rodrigues Chibinski Denise S. Wambier Rodrigo O. Rego Alessandro D. Loguercio Alessandra Reis 《Journal of the American Dental Association (1939)》2017,148(11):814-824.e2
Background
In this systematic review and meta-analysis, the authors evaluated the pain during scaling and root planing with use of topical anesthetic versus that with the use of injected anesthetic in adult patients.Types of Studies Reviewed
The authors searched 6 databases for randomized clinical trials in which the investigators compared the clinical effectiveness of intrapocket and injectable anesthetics. The primary outcome was the risk of developing pain or intensity of pain. Quality assessment followed the guidelines from the Cochrane Collaboration’s risk-of-bias tool. The authors performed meta-analyses on studies considered at low and unclear risk of bias.Results
From 976 articles identified, 6 remained in the qualitative synthesis (4 at low and 2 at unclear risk of bias). Injected anesthetic produced lower pain intensity than did anesthetic gel (P = .03) and required less rescue anesthetic than did topical anesthetic (P < .0001). There was no difference in patient preference (P = .09).Conclusions and Practical Implications
Injected anesthetic decreased the intensity of pain and the need for rescue anesthetic during scaling and root planing, but the risk of developing pain yielded similar results for injected and topical anesthetics. 相似文献17.
Marcelo Coelho Goiato Henrique Rinaldi Matheus Rodrigo Antonio de Medeiros Daniela Micheline dos Santos Sandro Basso Bitencourt Aldiéris Alves Pesqueira 《The Journal of prosthetic dentistry》2017,117(5):685-689
Statement of problem
The rehabilitation of patients after a maxillectomy involves the use of an obturator to seal oral-nasal-sinus communication and to facilitate mastication, swallowing, and speech.Purpose
The purpose of this in vitro study was to evaluate different attachment systems used for implant-retained obturators at dissipation loads and under shear forces.Material and methods
Photoelastic models were fabricated with 3 external hexagon implants at the incisor, canine, and first molar regions. Subsequently, overdentures were made, and metal hooks were placed at the incisor and first molar regions to displace the prostheses in the vertical, anterior, and posterior directions, with a constant speed of 50 mm/min. A photoelastic model with an O-ring or bar-clip system was placed in a circular polariscope, and tested with a universal testing machine. The images were recorded and high-intensity fringes were counted using software. For strain gauge analysis, each strain gauge was placed horizontally at the mesial and distal sides of the implants. The registered strains were submitted to 2-way ANOVA (α=.05).Results
The O-ring showed the lowest number of high-intensity fringes in photoelastic imaging, while the strain gauge analysis showed the lowest stress values in the bar-clip group (P=.007).Conclusions
The stress around titanium implant necks was more damaging to surrounding bone, while the bar-clip attachment system had a better biomechanical performance. The bar-clip presented the lowest strain values around the dental implants and few high-intensity fringes. 相似文献18.
Thanh An Nguyen Le Anthony T. Lo Sasso Marko Vujicic 《Journal of the American Dental Association (1939)》2017,148(4):257-262.e2
Background
The authors examined the factors associated with sex differences in earnings for 3 professional occupations.Methods
The authors used a multivariate Blinder-Oaxaca method to decompose the differences in mean earnings across sex.Results
Although mean differences in earnings between men and women narrowed over time, there remained large, unaccountable earnings differences between men and women among all professions after multivariate adjustments. For dentists, the unexplained difference in earnings for women was approximately constant at 62% to 66%. For physicians, the unexplained difference in earnings for women ranged from 52% to 57%. For lawyers, the unexplained difference in earnings for women was the smallest of the 3 professions but also exhibited the most growth, increasing from 34% in 1990 to 45% in 2010.Conclusions
The reduction in the earnings gap is driven largely by a general convergence between men and women in some, but not all, observable characteristics over time. Nevertheless, large unexplained gender gaps in earnings remain for all 3 professions.Practical Implications
Policy makers must use care in efforts to alleviate earnings differences for men and women because measures could make matters worse without a clear understanding of the nature of the factors driving the differences. 相似文献19.
Mathew T. Kattadiyil Abdulaziz AlHelal Brian J. Goodacre 《The Journal of prosthetic dentistry》2017,117(6):721-728
Statement of problem
Computer-engineered complete dentures (CECDs) have significant potential as shown by recent reports of outcomes and specific applications. An understanding of complications and quality assessment factors associated with CECDs from compiled data is lacking in published reports.Purpose
The purpose of this systematic review was to determine the clinical complications and quality assessments related to CECDs.Material and methods
Electronic searches of publications in English from January 1984 to September 2016 were performed in MEDLINE and Cochrane databases, with the results enriched by manual searches and citation mining to address 2 population intervention comparison outcome (PICO) questions: what are the clinical complications associated with CECDs, and what are the quality assessments with CECDs?Results
A review of 5 selected articles (limited data) on CECDs revealed patient dissatisfaction related to overall outcome (25.49%), inadequate retention (20.73%), and esthetic concerns (15.09%) as common complications. Quality assessment factors that were used to report complications were identified.Conclusions
Patient dissatisfaction, inadequate retention, and inadequate esthetics were the most common complications with CECDs. The addition of a trial placement option for CECDs could result in a better clinical outcome, reducing the incidence of other complications related to occlusal vertical dimension, centric relationship, tooth arrangement, and esthetics, improving patient satisfaction, and reducing remakes. The difficulty in reading the digital preview for an objective assessment before fabrication is a unique but not a common, complication for CECDs. 相似文献20.
Cherilyn G. Sheets Jean C. Wu Samer Rashad Michael Phelan James C. Earthman 《The Journal of prosthetic dentistry》2017,117(2):218-225