Buonocore Memorial Lecture. Dentin caries: progression and clinical management

A fundamental issue of restorative treatment is assessing the different conditions of cases not only from tooth-to-tooth but also from the activity of each caries lesion and the size of the cavity. In addition, restorative treatment is sometimes carried out for prosthetic and cosmetic purposes and involves cutting sound, unaffected dentin. These aspects are outlined in classic textbooks and are based on the principles described by Black (1908). However, each factor and its relative importance has changed over the years. Significant time has been devoted to improving the important technical aspects of performing restorative treatment. Traditionally, these aspects have primarily been related to cavity design, choice of restorative material and the clinical procedures involved. In this context, Dr Michael Buonocore's contributions must be recognized because the adhesive technique he introduced has become an integral part of modern operative dentistry. Operative dentistry today also focuses on cavity design and selecting restorative materials. Less effort has been placed on incorporating what is known about the pattern of caries progression and how it relates to caries removal or excavation. Although the reaction pattern of the pulp-dentin organ is quite different in terms of the nature of active (rapid-progressing) and arrested (slow-progressing) lesions, no widespread major distinction has been made regarding the different restorative treatment approaches in these situations. This presentation updates the progression and clinical management of dentin caries and how it relates to treating deep caries lesions.     

Acceptance of psychology teaching in paediatric dentistry by undergraduate dental students

By means of a questionnaire, 4 cohorts of undergraduate students (n = 144) were asked before and after the clinical course in paediatric dentistry about their acceptance of the teaching of psychological aspects in dentistry. A generally very high interest was found for psychology as well as for child-related psychology. The teaching of this topic by means of lectures was thought to be useful, but other didactic means were demanded to supplement teaching. For many of the aspects taught, more information was requested. Moreover, teaching of aspects not taught in the lectures was also requested. The more obvious the practical relevance of each topic appeared, the greater was the students' interest. Psychology was thought to be useful as an aid to paediatric treatment. However, interest dropped after the completion of the paediatric dentistry course. It is concluded that undergraduate dental students have no particular inclination towards the treatment of children but rather a need for guidelines to avoid potential problems in dealing with this demanding group of patients.     

Oral diagnosis and treatment planning: part 1. Introduction

A good manageable treatment plan does not just happen, but comes about as the natural consequence of taking carefully considered steps. History taking and clinical examination are two of the most important aspects of the patient assessment process, and complement each other to such an extent that it is impossible to build a satisfactory treatment plan without combining and collating information from the two procedures.     

Space analysis: putting it all together

Space analysis is the foundation of all orthodontic treatment plans and is critical in deciding whether functional and cosmetic orthodontic goals can be achieved. An organized, comprehensive, integrated space analysis will help dentists to choose between a variety of treatment approaches and to determine if permanent teeth must be extracted. At present, most of the literature focuses on individual aspects of space analysis; a search of the literature revealed only three published articles that involved integrating treatment planning with comprehensive space analysis. The mandibular arch is the template for this space analysis because it is less malleable than the maxilla. Using four key arch measurements as variables with a curve of Spee correction creates custom starting and final arch forms for each patient. This three-dimensional total arch form approach is incorporated into a spreadsheet template that integrates the individual aspects of space analysis into one unified approach while performing most of the calculations. The spreadsheet is available for free download at www.agd.org or www.herseycentral.org/drsolomon.     

Conventional retreatment versus surgery in failed root canal treatment--the importance of canal anatomy

This case report highlights two important aspects of root canal treatment, knowledge of root canal anatomy and inappropriate use of surgery to correct failure of conventional treatment. Initially, two mandibular incisors were root treated conventionally but only one of the two canals present in both teeth was prepared and filled in each case. Symptoms persisted and a surgical approach was adopted but, again, only one of the root canals in each tooth was located and sealed with a root-end filling. Surgery was performed on a second occasion but again failed to resolve the patient's problems. On referral, the presence of the additional root canals was confirmed and further conventional non-surgical treatment resulted in the immediate cessation of symptoms. This case highlights the need for a thorough understanding of root canal morphology, and the need to expose an angled radiograph when performing root canal therapy on teeth with a high incidence of multiple canals. It emphasises that surgery should not be the first option when conventional treatment fails.     

Overview of ethical issues in clinical studies.

Research in human subjects should be conducted only if the rights and welfare of the participants are protected. Prospective study subjects must be given adequate information about all aspects of a study so that they can make a rationally exercised decision about participation; coercive techniques to solicit participants should not be used. Research in humans may be classified in one of three categories: A. Research on treatment of existing conditions; B. Research on preventive measures; and C. Research other than for treatment or prevention. Different concerns and aspects of informed consent assume particular importance in each category. In research on the treatment of existing conditions, untreated or placebo-treated control groups are rarely justified if the condition is irreversible. In research on preventive methods prospective subjects should be informed of the likelihood of receiving an ineffective treatment, if one or more placebo groups are included. A randomized clinical trial is usually the best design for studies of preventive methods. Nonrandomized designs, that are feasible and statistically valid, may be employed in order to avoid depriving some subjects from receiving effective preventive methods. In social or behavioral research, confidentiality of collected information and privacy of the subject are essential considerations.     

Overview of ethical aspects of clinical studies

Research in human subjects should be conducted only if the rights and welfare of the participants are protected. Prospective study subjects must be given adequate information about all aspects of a study so that they can make a rationally exercised decision about participation; coercive techniques to solicit participants should not be used. Research in humans may be classified in one of three categories: (1) research on treatment of existing conditions; (2) research on preventive measures; and (3) research other than for treatment or prevention. Different concerns and aspects of informed consent assume particular importance in each category. In research on the treatment of existing conditions, untreated or placebo-treated control groups are rarely justified if the condition is irreversible. In research on preventive methods prospective subjects should be informed of the likelihood of receiving an ineffective treatment, if one or more placebo groups are included. A randomized clinical trial is usually the best design for studies of preventive methods. Non-randomized designs, which are feasible and statistically valid, may be employed in order to avoid depriving some subjects from receiving effective preventive methods. In social or behavioral research, confidentiality of collected information and privacy of the subject are essential considerations.     

Registrations for relating the mandibular cast to the maxillary cast based on Kennedy's classification system.

Accurate registrations of centric relation are mandatory for many aspects of diagnosis and treatment. Registrations can be obtained with a variety of techniques. However, each technique must give consideration to such factors as: the character and location of tooth support, the quantity and quality of soft-tissue support, the location of dentulous and edentulous regions, the neuromuscular control of the patient, and the physical characteristics of the registering material. Kennedy's classification system provides a guide to the selection of the method of registration.     

Rehabilitation of the edentulous maxilla and mandible with fixed implant-supported restorations applying immediate functional loading: a treatment concept

The rehabilitation of the complete edentulous arch with fixed implant-supported bridges can be a particular challenge for the practitioner. In the treatment concept presented, each jaw is provided with sufficient implants to realize fixed restorations under immediate (2-3 days after surgery) functional loading. After a healing time of 40 to 60 days, the metal/resin transitionals are exchanged for definitive metal/porcelain bridgework under gnathological aspects. Fixed implant-supported bridges correspond to the arches of natural teeth and can reveal better results in function, phonation, and aesthetics than removable prostheses.     

Acrylic resin copings: An adjunct to fixed restorative dentistry

A simple technique for fabricating and several uses for acrylic resin copings have been presented. These techniques apply to many aspects of restorative dentistry and often are used in combination with each other. Master cast fabrication, interocclusal registrations, and verification of die accuracy can be done using the copings during a one-appointment sequence. The use of resin copings is especially helpful for the inexperienced dentist, permitting high quality dentistry with a minimum of mistakes and frustations. For the experienced fixed prosthodontist they provide another approach to treatment.     

Rehabilitation of maxillary edentulism with implant-supported milled-bar prostheses

Implantology has allowed more options for rehabilitation of complete and partially edentulous patients. The professional should describe all possible alternatives to the patient, addressing all the positive and negative aspects of each possibility, such as treatment time, complexity of surgical procedures, and the final cost. The patient should select the best cost-benefit relationship because fixed prostheses are often not the option of choice for the patient. The aim of this article is to present one possible treatment option for the completely edentulous patient by use of implants to support and retain a removable complete or partial prosthesis. The clinical situations were rehabilitated by the use of a milled bar screwed to the implants to support a removable prosthesis with attachments and a milled metallic groove, which provide many advantages to the patient.     

On the management of extraction sites

Extraction sites may be needed to achieve specific orthodontic goals of positioning the dentition within the craniofacial complex. The fundamental reality that determines the final position of the dentition, however, is the control exercised by the clinician in closure of the extraction sites. A specific treatment objective may require the posterior teeth to remain in a constant position anteroposteriorly as well as vertically, while the anterior teeth occupy the entire extraction site. Another treatment objective may require the reverse, or any number of purposeful alternatives of extraction site closure. An appliance system developed over time, which provides this control, is described. The system takes advantage of aspects of continuous arch therapy that provides constant, positive orientation of the anterior and posterior groups of teeth to each other in three-dimensional space across an extraction site, combined with aspects of the segmented arch technique that permit definable and predictable force systems to be applied to these teeth. Consequently, the clinician has the ability to forecast treatment outcomes with confidence.(Am J Orthod Dentofac Orthop 1997;112:645-55.)     

Why orthodontists get sued

The question, Why do orthodontists get sued?, is a vexing one for mostorthodontists. The circumstances that evolve to make one person challenge, verbally attack, or sue another is a very individual issue that involves multiple aspects of the interpersonal relationship. Doctor-patient relationships are not infallible. They involve the personalities of each of the participants, the activity on which the relationship is founded, the relative success or failure of the treatment, communication or the lack thereof, and possibly psychological issues. The bottom line is that orthodontic lawsuits can and do happen. This article describes a number of orthodontic lawsuits, the basis for each suit, and the risk management lessons that one should take home today and put into use tomorrow.     

糖尿病与牙周炎的相互关系

探讨牙周炎与糖尿病之间的双向关系。一些研究表明，糖尿病的表征可以表现为牙周炎，同时也可能成为糖尿病的危险因素，两者相互影响，互为因果。本文就两者相互作用的病理基础、临床表现及治疗特点进行综述，以期对今后的治疗有所裨益。     

A questionnaire survey of attitudes and concerns of three professional groups involved in the cleft palate team.

This study investigated the opinions of three of the professional groups who treat cleft lip and palate patients in the United Kingdom. Plastic surgeons, orthodontists, and speech therapists were asked to give their opinions regarding adolescents with a unilateral cleft of the lip and palate. A mail questionnaire investigating four main areas: treatment, facial appearance and speech, social and emotional aspects, and the perceived success of the specialists was sent to each subject. Nearly all the subjects reported that they worked as part of a cleft palate team and there was good agreement among the three groups. Although the professionals felt that they have been successful, they were not satisfied with the results of their treatment nor with the patients' overall facial appearance or speech. They also felt that the patients are emotionally and socially affected by their cleft and are teased. The subjects noted that they think patients feel similarly to themselves on all aspects. The significance of the results is discussed.     

Scanning electron microscopic study of air abrasion effects on human dentine.

AIM: Mechanical Surface Micro-Abrasion (MSM) is a technique of cavity preparation and surface treatment. By means of a precise air-powder jet it cleans and widens pits and fissures before sealing, in order to create micro-retention on tooth surface and to prepare small therapeutic cavities. It is particularly indicated in children's therapy. The aim of this study is to verify (by SEM) the existence of a relationship between working time and distance and both macroscopic and ultrastructural aspects of the treated surfaces following cavity preparation by MSM. MATERIALS AND METHODS: This experimental study was carried out in vitro using a Micro- Abrasion system on 60 human third mandibular molars. Before SEM observation the surfaces were divided in five groups, each with a different working time and distance. All specimens were observed by SEM at several magnifications. RESULTS: After a treatment of 5 sec at a distance of 2 mm a small preparation could be noticed with a circular section of 0.5 mm of diameter. With a working time of 15 sec, and a working distance of 2 mm, a cavity preparation on dentinal tissue was obtained. With a working distance of 15 mm, even for a relatively long time of treatment, such as 30 sec, no preparation was noticed but only a sandblasted surface of a circular section with a diameter of 3.5 mm. With different time of application the authors noticed different microscopic aspects. CONCLUSION: The authors realised that the macroscopic size and shape of cavities is connected to working distance, while working time is important to determine the depth of preparation and ultrastructural aspect. SEM analysis of dentin surface shows how different parameters determine macroscopic and ultrastructural aspects. It can help to standardise a protocol to follow according to the desired treatment.     

Organization and administration of the United States Air Force Dental Service.

The United States Air Force was established as an independent department in 1947 and in 1949 became responsible for its own medical support. In 1951 the dental division was renamed the USAF Dental Service and 432 dental officers were transferred to it from the Army. The dental service now provides a world-wide oral health service from 286 fixed dental centers having a total of over 2200 treatment rooms. The backbone of the service is the general dental practitioner and great stress is laid on the preventive aspects of the service. Eight specialty areas are recognized and in-service training, supplemented by specialist training in civilian institutions provide the trained professional resources required. The facilities for the provision of dental services comprise clinics with multiple treatment rooms for each dentist and adequate space for oral hygienists and support and administrative services. Equipment follows the modern trend towards 4-handed seated practice by the dental team.     

Primary human teeth and their root canal systems

A thorough knowledge of dental anatomy of both the permanent and primary dentition is essential for all treatment aspects of these teeth. All too often, the study of the anatomy of primary teeth is given secondary importance due to the fact that these teeth will exfoliate eventually. Rather than premature extraction, the retention of primary teeth through restorative or endodontic means is evolving amongst dental practitioners and endodontic and pediatric dental specialists. Thus, knowledge of the normal and abnormal anatomy of primary teeth is required in making diagnosis and treatment decisions in young patients. In rare incidences, as in cases of absent permanent premolars, primary teeth may be retained in the permanent arch and if the pulp becomes diseased, endodontic treatment may be among the treatment options. This article provides a comprehensive review of normal and abnormal morphology of the primary teeth with an emphasis on the roots and root canal systems of each of the teeth in the primary dentition.