Decoronation: how, why, and when?

Decoronation is a surgical method for treating ankylosed incisors in children and adolescents. The crown and root filling are removed, leaving the root in situ to be resorbed and covered with a mucoperiosteal flap. Early loss of a permanent tooth leads to loss of alveolar bone, especially in buccopalatal width. Decoronation preserves not only the width of the ridge but also the vertical height.     

Caries prevalence and distribution in 3-20-year-olds in Jönköping, Sweden, in 1973, 1978, 1983, and 1993

Abstract – Four cross‐sectional studies were carried out in 1973, 1978, 1983, and 1993 to collect clinical and radiographic epidemiological data on the dental health status of the inhabitants of Jönköping, Sweden. The aim of the present paper was to use these data to analyze trends in the development of caries among children and adolescents between 1973 and 1993. Approximately 500 randomly selected individuals evenly distributed among the age groups 3, 5, 10, 15, and 20 years participated in each study. The main results show that the numbers of caries‐free individuals increased in all age groups. In 1993, the mean number of decayed and filled tooth surfaces in the primary (dfs) and the permanent (DFS) dentition in all age groups was less than half of that found in 1973. Most of this decrease took place during the first 5 years, i.e., between 1973 and 1978. Between 1978 and 1983, only minor changes were observed. There was a further reduction of approximately 30%–50% in dfs/DFS between 1983 and 1993 in 3‐, 5‐, 10‐, and 20‐year‐olds. The frequency distributions of dfs/DFS for 5‐ and 15‐year‐olds revealed an increasing skewness over time: in 1993, a large majority of the children and adolescents had a low or moderate caries severity while only a small group had high scores of dfs/DFS.     

Interrelations between orthostatic postural deviations and subjects’ age,sex, malocclusion,and specific signs and symptoms of functional pathologies of the temporomandibular system: a preliminary correlation and regression study

Aims:

Studies on the relationships between postural deviations and the temporomandibular system (TS) functional health are controversial and inconclusive. This study stems from the hypothesis that such inconclusiveness is due to authors considering functional pathologies of the TS (FPTS) as a whole, without taking into account subjects’ specific FPTS signs and symptoms.

Methodology:

Based on the author and collaborators’ previous studies, the present study analyzed data on body posture from a sample of 50 subjects with (30) and without (20) FPTS. Correlation analyses were applied, taking as independent variables age, sex, Helkimo anamnestic, occlusal, and dysfunction indices, as well as FPTS specific signs and symptoms. Postural assessments of the head, cervical spine, shoulders, lumbar spine, and hips were the dependent variables. Linear regression equations were built that proved to partially predict the presence and magnitude of body posture deviations by drawing on subjects’ characteristics and specific FPTS symptoms.

Results:

Determination coefficients for these equations ranged from 0·082 to 0·199 in the univariate, and from 0·121 to 0·502 in the multivariate regression analyses.

Conclusions:

Results show that factors intrinsic to the subjects or the TS may potentially interfere in results of studies that analyze relationships between FPTS and body posture. Furthermore, a trend to specificity was found, e.g. the degree of cervical lordosis was found to correlate to age and FPTS degree of severity, suggesting that some TS pathological features, or malocclusion, age or sex, may be more strongly correlated than others with specific posture patterns.     

Caries prevalence and distribution in 20-80-year-olds in Jönköping, Sweden, in 1973, 1983, and 1993

Abstract – In 1973, a cross‐sectional study on oral health status was performed on 1000 individuals in the age groups 3–70 years in Jönköping, Sweden. In 1983 and 1993, new cross‐sectional studies were carried out in the age groups 3–80 years. The aim of the present study was to analyze caries prevalence and distribution in the three investigations 1973, 1983, and 1993 in the age groups 20–80 years. In the younger age groups (20–40 years), a larger proportion of individuals with good oral health was found in 1993 than in 1973 or 1983. A steady increase in the number of teeth in the age groups 40–80 years could be found, which was also reflected in the increasing number of decayed and filled tooth surfaces (DFS) in the same age groups. A marked decrease in proximal DFS in 20–50‐year‐olds in 1993 compared to 1973 and 1983 was found. However, a rather large and unchanging group of individuals suffering from severe caries was also observed. This situation demands an individualized caries treatment strategy based on risk assessment.     

Remote monitoring and “Tele-orthodontics”: Concept,scope and applications

Tele-orthodontics is a broad term that encompasses remote provision of orthodontic care, advice, or treatment via information technology. The Purposes of the article were two-fold: (1) to review the rather new concept, applications and scope of teleorthodontics, and (2) to present preliminary results of a study with and without Dental Monitoring™ (DM) usage on appointment efficiency, patient perspectives and patient demographics. The sample was comprised of 74 consecutively treated Invisalign® patients using DM™ and 85 consecutively completed Invisalign® patients. An online questionnaire was given to the DM™ group to assess the patients’ perspective on the ease of use and benefit to treatment experience using a 5-point Likert scale. Also requested was a list of 5 benefits and problems while using DM™. Independent t-tests were used to determine any inter-group differences in, number of appointments and age; a chi-square test was used for differences between genders. Significance was set at P ≤ 0.05. Mean number of appointments was significantly lower by 1.68 appointments for DM compared to control (P < 0.001). Age averaged 3.2 years younger for the DM group (P < 0.05). More males used DM than the control group (31.6% vs 16.7%, P < 0.05, respectively). The mean Likert scale rating for “ease of use” was 4.31 out of 5.0, while benefit to treatment experience rating was 4.4. The most oft-mentioned perceived benefits were “better communication” (47 times), “increased convenience” (44 times), “reduced number of appointments” (40 times), and “ease of use” (38 times). The most oft-mentioned problems were related to the “difficulty of taking scans” (27 times) and “reduced communication” (12 times). Preliminary study results suggest the number of appointments may be reduced with Dental Monitoring. In addition, there was a positive patient perception on the use of DM.     

A clinical, radiographic, and microbiologic comparison of Astra Tech and Brånemark single tooth implants

Background: The soft tissues around single tooth implants differ fundamentally from the gingiva around natural teeth. There are very limited data comparing soft tissues around different implant systems. Aim: To assess whether the design characteristics of dental implants, particularly the implant‐abutment junction, may affect the dimensions and health of the peri‐implant soft tissues and radiographic bone levels. Subjects and Method: Fifteen Astra Tech and 15 Brånemark single tooth implants that had been in function for a minimum of 2 years in 30 partially dentate subjects were examined for plaque accumulation, probing depth, and bleeding on probing and compared to contralateral healthy teeth. Standardized radiographs were taken to measure the most coronal bone to implant contact on the mesial and distal surfaces. In addition, samples of subgingival plaque were taken on paper points and examined by darkfield microscopy. Results: Significantly higher mean probing depths (p < .001) and higher mean percentage of spirochetes (p= .003) were found at implants compared to teeth. In this sample, the Brånemark implants had significantly higher probing depths than the Astra Tech implants (median and interquartile range: Astra Tech 2.7 mm [2–3], Brånemark 3.3 mm [3–3.7] p= .026) and the most coronal bone to implant contact was closer to the implant–abutment junction in the Astra Tech implants (Astra Tech 0.6 mm [0.2–0.9], Brånemark 1.6 mm [1.4–2.0]. p < .001). Conclusion: Although there were statistically significant differences between the two implant systems, the clinical differences were small and probably reflect differences in the biologic width in relation to the location and design of the implant‐abutment junction.     

Microvascular reconstructions in oral and maxillofacial surgery — Results of a survey among oral and maxillofacial surgeons in Germany,Austria, and Switzerland

This study aimed to evaluate the use of microvascular free flaps (MFF) in oral and maxillofacial surgery (OMFS) in Germany, Austria, and Switzerland.A dynamic online questionnaire, using 42–46 questions, was sent to OMF surgeons based in hospitals in Germany, Austria, and Switzerland. The questionnaire was evaluated internally and externally. Aside from general information, data were collected on organizational aspects, approaches, MFF types and frequency, presurgical planning, intraoperative procedures, perioperative medications, flap monitoring, and patient management.Participants mostly performed 30–40 MFF each year (11/53). Most stated that the COVID-19 pandemic did influence MFF frequency (25/53) to varying extents. Radial forearm flap was most frequently used (37/53), followed by ALT (5/53), and fibula flap (5/53). Primary reconstruction was performed by most participants (35/48). Irradiated bony transplants were mostly used for implant placement after 12 months (23/48). Most participants (38/48) used reconstruction plates, followed by miniplates (36/48), PSI reconstruction (31/48), and PSI miniplates (10/48). Regarding the postoperative use of anticoagulants, low-molecular-weight (37/48) and unfractioned heparins (15/48) were widely used, most often for 3–7 days (26/48). Clinical evaluation was mostly preferred for flap monitoring (47/48), usually every 2 h (34/48), for at least 48 h (19/48).Strong heterogeneity in MFF reconstructions in OMFS was found, especially regarding the timepoints of reconstruction, types of osteosynthesis, and postoperative MFF management. These findings provide the chance to further compare the different treatment algorithms regarding relevant MFF aspects, such as postoperative management. This could create evidence-based treatment algorithms that will further improve the clinical outcomes in MFF reconstructions.     

Occlusal splints and temporomandibular disorders: why, when, how?

Occlusal splints are one form of treatment in the management of patients with a temporomandibular disorder. Appliances are often used in conjunction with other forms of treatment such as physiotherapy or medication. A variety of splints is described in the literature and the dentist must ensure that the splint prescribed is of a design that has a proven success rate for the specific diagnosis. General principles that apply to the provision of all splints are outlined in this paper.     

Toothbrushing: why, when and how?

Toothbrushing is a widely practiced oral healthcare habit which, in conjunction with fluoride toothpaste, can help to prevent dental caries and periodontal disease. The effectiveness of toothbrushing is dependent on many different factors including frequency and duration of brushing, rinsing habits and brush type. Knowledge of how these factors influence effectiveness will allow the dental professional to give appropriate advice.     

Relationships among interleukin-6, tumor necrosis factor-α, adipokines, vitamin D, and chronic periodontitis

Background: The aim of this study is to explore relationships among serum adipokines, vitamin D, and clinical and microbial parameters of chronic periodontitis before and after treatment. Methods: Weight, height, and smoking status were recorded for 56 patients with chronic periodontitis. Plaque, gingivitis, bleeding on probing, suppuration, probing depth, and clinical attachment level were measured at all teeth present. Subgingival biofilm samples from each tooth were analyzed for levels of 40 bacterial species using checkerboard DNA–DNA hybridization. Serum levels of interleukin‐6 (IL‐6), tumor necrosis factor‐α, adiponectin, leptin, resistin, and vitamin D were measured at baseline. Sample collection was then performed in a subset of the population 6 months after therapy (n = 17). Serum samples were analyzed using enzyme‐linked immunosorbent assay and immunoassays. Differences in clinical, microbial, and serum factors among groups were sought using the Mann‐Whitney U test. Correlations among factors were evaluated using regression analysis. Effects of therapy were sought using the Wilcoxon signed rank test. Results: There were positive correlations between adiponectin/vitamin D and between IL‐6/leptin, negative correlations between IL‐6/vitamin D and leptin/vitamin D, but no associations between serum analytes and clinical or microbial parameters. Sex and body mass index were associated with levels of adipokines. Periodontal therapy improved clinical and microbiologic parameters but did not influence the levels of serum analytes. Conclusion: Adipokines and IL‐6 levels were affected by sex and body mass index. Serum analytes were not influenced by periodontal therapy.     

Changes in United Kingdom oral and maxillofacial surgical specialty trainees since 1995 – numbers,gender, first degrees,and nations of origin

Training in UK surgery has changed dramatically since 1995, from a relative lack of structure to time-limited and highly documented programmes. Training in oral and maxillofacial surgery (OMFS) has shared these changes and included some significant changes of its own. Minutes from the OMFS Specialty Advisory Committee (SAC) were reviewed over the last 25 years to record the number and location of newly approved posts. The General Medicine Council’s (GMC) OMFS specialist list in 2019 was combined with the records of OMFS specialists’ dental qualifications held by the General Dental Council (GDC) and augmented from a database of OMFS trainees and consultants in the UK. Data on demographics, location, and nature of the first medical or dental degree were noted for analysis.A total of 691 OMFS specialists and trainees were identified from GMC, OMFS SAC and consultant databases. Of these, 12 consultants held only dental qualification/registration. First degree data could not be obtained for 12 specialists (all male). A further 20 OMFS specialists, whose training was outside the UK, were also excluded from further analysis.In 1995 there were 95 national training posts, by 2013 there were 150. Over the last quarter of a century, there has been an increase in medicine first trainees, an increase in female trainees and specialists, and a relative decrease in OMFS trainees from the Indian subcontinent. The varied origins of the OMFS workforce has contributed to greater diversity and inclusion within the specialty. In the UK, OMFS appears to have produced the correct number of specialists whilst maintaining a high standard of training. The next change in OMFS training programmes is to deliver The Postgraduate Medical Education and Training Board’s (PMETB) recommendations. As we move to achieve this it is imperative that as new doors open, we do not close others.