25 years of veneering: what have we learned?

This is a review of the research completed over the 25 years in which dentists have been veneering teeth. Recommendations are made relative to the tooth preparation design for composite resin veneers and porcelain veneers. Material differences in a variety of applications are discussed together with recommended applications, indications and contraindications. From the research that has been reviewed, a series of best practices in the application of veneering materials and techniques is listed.     

Sixty-eight years of experimental occlusal interference studies: what have we learned?

STATEMENT OF PROBLEM: Understanding is needed regarding the effect that occlusal interferences have on the teeth, periodontium, and especially on jaw function. PURPOSE: This article summarizes research in which experimental occlusal interferences have been placed on the teeth of animals and human volunteers. MATERIAL AND METHODS: Data from 18 human and 10 animals studies were reviewed. Experimental occlusal interferences were grouped into those that alter intercuspal position and those contacting on lateral jaw movement only. The outcome of these interferences were analyzed according to their local pulpal-periodontal, jaw function, or bruxism effects. RESULTS: Experimental occlusal interferences in maximum intercuspation had a deleterious effect on periodontal and pulpal tissues of the affected tooth; sometimes this produces a disruption of smooth jaw function and occasionally jaw muscle pain and clicking. Experimental occlusal interferences that contact only in a lateral jaw movement are infrequently harmful to jaw function. Furthermore, no reliable evidence demonstrates that occlusal interferences can cause nocturnal bruxism, or stop it. CONCLUSION: Transient local tooth pain, loosening of the tooth, a slight change in postural muscle tension levels, chewing stroke patterns, and sometimes a clicking joint can be induced by an experimental occlusal interference. Because such findings are present in relatively asymptomatic patients, these data do not prove that occlusal interferences are causally related to a chronic jaw muscle pain or temporomandibular joint dysfunction problems.     

Do we need practitioner training schemes in orthodontics?

Orthodontic treatment appears to be in ever-increasing demand, but the number of specialists is insufficient to meet the current need. This article considers the role of the extended practitioner training scheme in the present climate of uncertainty surrounding orthodontics in the general dental services in the UK, particularly for the general dental practitioner.     

Impact of the COVID-19 pandemic on orthognathic patients: What have we learned?

Due to the COVID-19 pandemic orthognathic surgery was suspended in the UK. The effect this had on patients, to date, is unknown. A multi-centre, cross-sectional survey was conducted in the UK to investigate the health-related impact on patients on the orthognathic surgery pathway, including those on the waiting list for surgery. A structured questionnaire was designed to explore the impact of the pandemic on patients whose orthognathic treatment was temporarily cancelled. Ninety-five questionnaires were returned giving a response rate of 65%. When asked if the delay due to the pandemic had caused emotional distress, 63% (51/81) agreed. During the pandemic respondents experienced more distress in relation to dental appearance (60%, 51/83), self-confidence (52% 50/83), facial appearance (53%, 44/83), and ability to eat and chew (59%, 50/83). One hundred percent of patients would have appliances fitted or their appliances adjusted during the pandemic, and 93% stated that they would attend for surgery if they were offered this during the pandemic. In conclusion, patients appear to have experienced emotional distress in relation to the delay with their orthognathic treatment. They should be given greater priority during the remobilisation of elective surgery and should have access to ongoing psychological support when delays affect their treatment. The ‘surgery-first’ approach may be considered for suitable patients to minimise the duration of the treatment journey.     

Professionalism: what is it,why should we have it and how can we achieve it?

In this paper we argue that the terms 'profession', 'professional' and 'professionalism' provide us with important insights into the practice of dentistry and the priorities for the continuing development of dentistry as a profession. More significantly, we suggest that this understanding can assist us in designing continuing professional development (CPD) programmes aimed at maintaining the professionalism of dentists throughout their working lives. A CPD framework is required to support both the new graduate to develop from novice to expert as well as support experienced practitioners to maintain their expertise within a rapidly changing environment. Rather than an onerous task, CPD should be a positive and enjoyable experience, self-motivated to improve job satisfaction and self-confidence. Research is currently being undertaken to determine what is good CPD for the practising dentist with a view to recommending strategies based on sound educational theory.     

Diagnostic pulp testing in dentistry: how far have we come?

Techniques of pulp testing to determine vitality or sensibility have been in use for decades. While very little has changed in our methodologies, our understanding of the biology of the health and disease of the dental pulp has been enhanced. However, without thorough data collection using appropriate tests, and an integrated synthesis and analysis of this data, there is little chance of arriving at a diagnosis that will determine the proper course of treatment. While this need was clearly identified by Dr. Truman W Brophy over 130 years ago, we are still faced with these challenges today.     

Tooth decay in our poorest children: what can we do?

Dental programs for the poor have failed to deliver improved oral health for children to the same degree as their more well-off counterparts. Community health workers continue to identify dental problems as the greatest unmet need in their communities. Yet, many do not see this as a problem. Practitioners need to act in concert through their dental societies to establish and efficiently manage community-based outreach programs. Child dental health can also be improved by increasing access through public and non-profit community clinics and integrating child dental services with medical care.     

Alveolar socket healing: what can we learn?

Tooth extraction induces a series of complex and integrated local changes within the investing hard and soft tissues. These local alterations arise in order to close the socket wound and to restore tissue homeostasis, and are referred to as ‘“socket healing”. The aims of the present report were twofold: first, to describe the socket‐healing process; and, second, to discuss what can be learned from the temporal sequence of healing events, in order to improve treatment outcomes. The socket‐healing process may be divided into three sequential, and frequently overlapping, phases: inflammatory; proliferative; and modeling/remodeling. Several clinical and experimental studies have demonstrated that the socket‐healing process promotes up to 50% reduction of the original ridge width, greater bone resorption at the buccal aspect than at the lingual/palatal counterpart and a larger amount of alveolar bone reduction in the molar region. In conclusion, tooth extraction, once a simple and straightforward surgical procedure, should be performed in the knowledge that ridge reduction will follow and that further clinical steps should be considered to compensate for this, when considering future options for tooth replacement.     

Using Little's Irregularity Index in orthodontics: Outdated and inaccurate?

Objectives

Little's Irregularity Index (LII) was devised to objectively score mandibular incisor alignment for epidemiological studies but has been extended to assess the relative performance of orthodontic brackets, retainer or treatment modalities. Our aim was to examine the repeatability and precision of LII measurements of four independent examiners on the maxillary arch of orthodontic patients. The hypothesis was that the reproducibility of individual contact point displacement measurements, used to calculate the LII score, are inappropriate.

Methods

The displacement of the anterior contact points, of the six upper labial segment teeth of the maxillary arch on each of ten casts, were randomly assessed by four examiners at three time-points using LII.

Results

Significant correlations were evident between the six examiner-pairs (r > 0.413; p < 0.001) for contact point displacements of >0.5 mm. The coefficients of variation showed that 516 of the 600 individual contact point displacement measurements differed by >20% of the mean. Analyses of variance revealed significant differences (p < 0.047) between examiners for 46% of the contact point displacement measurements.

Conclusion

The reproducibility of individual contact point displacement measurements, used to calculate the LII score, is poor such that using LII to assess the performance of orthodontic brackets, retainers or treatment modalities must emphatically be discouraged.

Clinical significance

The use of LII by the orthodontic community to predictably determine the outcome of orthodontic treatment modalities in clinical practice cannot be advocated due to the limited accuracy and precision of the technique.