Placement and replacement of restorations in general dental practice in Iceland

Ninety-one Icelandic practicing dentists (51% response rate) provided information related to the reasons for placement and replacement of 8,395 restorations and 741 sealants in 5,997 patients. Information included the patient's gender and age, the clinician's gender and experience in years since graduation, the defined criteria for replacement of restorations, the estimated past use of material in five-year increments and the records of 100 consecutively placed restorations. The materials used include composite (52.7%), amalgam (29.2%), glass ionomer (9.5%), resin-modified glass ionomer (7.1%) and other materials (1.4%). Although material selection was independent of the clinician's gender, female patients received more composite and fewer amalgam restorations than their male counterparts. Reasons for placing restorations comprised replacement of failed restorations (47.2%), primary caries (45.3%) and non-carious defects (7.5%). Secondary caries was the main reason for replacement for all types of restorations. Chi square analysis related to the dependence between the reasons for replacement and clinician's experience showed that more experienced clinicians recorded a lower frequency of secondary caries than less experienced ones (p<0.0001), while the diagnoses of discoloration and fracture of restorations increased with the clinicians' experience (p<0.0001).     

Temporalis myofascial flap in maxillofacial reconstruction: clinical and histological studies of the oral healing process

Objectives—To report our experience with temporalis myofascial flaps (TMF), describe the healing process of uncovered flaps in the mouth, and the histology of the repaired mucosa in the long term. Design—Prospective clinical and histological study. Subjects—36 patients who received a TMF over a 6.5 year period for serial assessment of the oral healing, 24 patients whose scars over the reconstructed area were assessed clinically, and 11 whose repaired mucosa was assessed histologically. Main outcome measures—To follow the clinical process of oral healing of the TMF and describe the repaired mucosa healed over the flap. Results—The uncovered TMF in the mouth healed gradually starting with an acute inflammatory phase, going through chronic inflammatory and proliferative phases with eventual epithelialisation of the oral mucosa. There were no major complications. The healed mucosa showed mild scarring in 70% of cases and the repaired mucosa had characteristic histological features that were distinct from the normal mucosa. Conclusion—The TMF is an extremely reliable and versatile flap for maxillofacial reconstruction which heals gradually with eventual coverage by mildly scarred repaired mucosa.     

RESIN BOND TO DENTAL CERAMICS,PART I: REVIEW AND SILICA‐BASED CERAMICS

Silica‐based ceramics (eg, feldspathic, glass, and leucite‐reinforced feldspathic ceramics) are preferred materials for conservative, highly esthetic indirect restorations such as laminate veneers, ceramic inlays and onlays, and full‐coverage crowns because of their optical properties, biocompatibility, and longevity. Adhesive cementation of ceramics to the supporting tooth using resin cements has been identified as the main determinant for the excellent clinical success of bonded silica‐based ceramic restorations. The first article discussed in this Critical Appraisal reviews the current evidence for the need of adhesive technologies to support ceramics. Even though review articles typically are not addressed in this section, its thoroughness and clear conclusions make this article an important contribution to the field of esthetic and restorative dentistry. Controlled clinical trials are ideal to evaluate the success of certain materials or therapeutic interventions. However, laboratory studies are necessary to compare large varieties of materials and influencing parameters and to identify superior materials and bonding techniques prior to their clinical application. Numerous in vitro studies have evaluated the ceramic‐composite resin interface. The in vitro studies reviewed in this section indicate that acid‐etching and silane application are ideal methods to achieve strong and durable resin bonds to silica‐based ceramics. The selected articles indicate interesting trends in testing methods and interpretation of results. Earlier studies favor shear bond strength testing methods and emphasize the importance of surface microstructure and mechanical interlocking. However, some recent studies prefer modified tensile bond strength methods, and find silane application, and therefore chemical interaction, to be the main contributor to reliable resin‐ceramic bonds. Unfortunately, direct comparisons between different studies are difficult owing to the variations in methods and materials and the lack of standard protocols.     

Anticipating the Future and Change

As in all of medicine, there are basic assumptions underlying the present system of dental education and delivery. These basic assumptions are facing challenges due in part to the marked reduction in the incidence of caries and the development of more effective therapies. This current period of time is described as an era of true change, rather than the mere modification of existing technology. Changes are going to occur in a number of areas. The move will be from government to private, from small to large, from generalist to specialist. Since change is inevitable, one can learn about and prepare for the stress of change, the changes happening now, and how to adapt to change. Although many changes are beyond the individual's control, their occurrence may be beneficial.     

Radionuclide skeletal imaging and single photon emission computed tomography in suspected internal derangements of the temporomandibular joint

Fifty one subjects who had pain involving the temporomandibular joint were evaluated using multidirectional tomography, arthrography, conventional nuclear scanning, and single photon emission computed tomography (SPECT) to assess the association of arthritis of the temporomandibular joint with internal derangements related to meniscal dysfunction. Five (56%) of the nine subjects who had normal arthrograms and normal multidirectional tomograms had SPECT scans that were positive for osseous changes. Twenty-two subjects (27 temporomandibular joints) were diagnosed by arthrography to have meniscal displacement with reduction. Multidirectional tomograms of the 27 joints were positive for osseous changes in five (18%) joints, whereas SPECT scans were positive in nine (70%) joints. Twenty subjects (20 temporomandibular joints) had an arthrographic diagnosis of meniscal displacement without reduction. Multidirectional tomograms of the 20 joints were positive for osseous changes in 14 (70%) joints, and SPECT scans were positive in 16 (80%) joints (P less than 0.001 vs control group). Initial observations with SPECT indicate it is a promising imaging method for detecting and staging osseous disease of the TMJ related to meniscal dysfunction.     

Primary Hodgkin''s disease of the mandible: A case report and review of the literature

Extranodal presentation in Hodgkin's disease is uncommon and bone involvement is rare at diagnosis. However, late in the course of this disease, bone involvement may occur in 9% to 35% of the cases. The mandible is very rarely involved even in advanced stages with only seven such cases reported in the literature. Of these only one had primary Hodgkin's disease of the mandible. A second case is described in this report.     

Clinical evaluation of the anti-plaque effect of a commercial chewing gum

OBJECTIVE: The objective of this research was to evaluate the dental plaque control effect of a chewing gum versus brushing with a dentifrice via four clinical studies. METHODOLOGY: Study 1 compared a commercial chewing gum (Colgate Dental Gum, CDG) with a water control after 24 hours post-brushing; Studies 2 and 3 compared CDG to two different brands of commercially available fluoride dentifrices after 24 hours post-brushing; Study 4 examined the anti-plaque effect of CDG plus a regular fluoride dentifrice (Colgate Winterfresh Gel, CWG) versus brushing with CWG alone for five days. The 24-hour clinical tests employed the Modified Gingival Margin Plaque Index (MGMPI), while the Quigley-Hein Plaque Index (QHPI) was used for the five-day study. All studies utilized a randomized, crossover design with a one-week washout period, and were single-blinded to the clinical evaluator. RESULTS: In Study 1, the mean MGMPI score for CDG was significantly lower (p < 0.05) compared to the water control. In Studies 2 and 3, while brushing with regular fluoride dentifrices provided improved plaque control compared to CDG, the chewing gum alone with no tooth brushing delivered a plaque reduction 60% as effective as brushing with a fluoride dentifrice. In Study 4, the group using the combination of chewing with CDG and brushing with CWG provided a significantly lower (p < 0.05) mean QHPI score compared to the group using the dentifrice only, particularly on the hard-to-brush lingual surfaces. CONCLUSIONS: Four clinical studies demonstrated that CDG provides a plaque control benefit. The results suggest that chewing gum may serve as an effective oral hygiene device when brushing may not be possible and, additionally, that chewing gum may serve as an effective adjunct to brushing for enhanced oral health.     

Evaluation of condylar translation by sonography versus axiography in orthognathic surgery patients

PURPOSE: This study compares measurement of the condylar translation by sonography or axiography in preoperative assessment and follow-up of orthognathic surgery patients. PATIENTS AND METHODS: Forty-seven moderately dysgnathic patients had consecutive examinations by axiography and sonography in a blind fashion at a single time point by 2 observers. Thirty-nine different dysgnathic patients, scheduled for isolated Le Fort I osteotomy, had preoperative condylar translation and 24-month follow-up measured randomized by either axiography (25 patients as control group) or sonography (14 patients as study group). RESULTS: The examination time for axiography was 20 minutes average versus 2 minutes for sonography. The mean differences were 1.7 mm in opening, 2.1 mm in protrusion, and 3.3 mm for mediotrusion. Pearson's proportionality quotient was r = 0.75, analysis of variance (P <.95, F = 3.9, alpha =.05 significance level) was not significant. The 24-month longitudinal follow-up showed a Pearson's proportionality quotient of r = 0.7 between study and control group, and no significant difference in analysis of variance (P <.075, F = 2.81, alpha =.05 significance level). CONCLUSION: Sonography proved adequate for assessment and follow-up of condylar translation compared with axiography in orthognathic surgery patients. Temporomandibular joint sonography was faster and more comfortable, allowed 1-week postoperative examination and reexaminations, and was equally exact. Anatomic details like joint degeneration and disc displacement could be assessed. However, sonography did not measure the inclination of the condylar track.     

Conventional radiographic and computed tomographic findings in cases of fracture of the mandibular condylar process

A total of 40 patients with 46 fractures of the mandibular condylar process were examined an average of 47 months after the injury. The conventional radiologic examination consisted of panoramic radiography and lateral transcranial view of the fracture in the mouth-open and mouth-closed positions. Sixteen patients with 21 fractures of the condylar process were examined additionally by computed tomography (CT) because of temporomandibular joint problems in the sagittal and coronal projection. Computed tomography revealed bony changes in the fractured mandibular condyle and its position in the mandibular fossa more exactly than conventional radiographic examinations. Furthermore, the results showed that disturbances in the position and function of the articular disc may be more common than was earlier anticipated, suggesting the more frequent use of CT examinations to evaluate temporomandibular joint changes after condylar process fractures.