Using a Delphi panel to survey criteria for successful periodontal therapy in posterior teeth

BACKGROUND: Health care providers have focused on outcome measures to determine the success or failure of treatment. In periodontics, there is no consistent view regarding what outcome measure(s) is(are) important for successful treatment. This study used a Delphi surveying technique to determine which outcome measures were clinically relevant to an expert panel of periodontists. METHODS: The Delphi surveyed 35 periodontists from the United States to determine the level of importance of attachment level, probing depth, furcation involvement, mobility, plaque, inflammation, esthetics, pain, and patient satisfaction following periodontal treatment of posterior teeth in a patient with severe chronic periodontitis. The Delphi panelists were questioned concerning the relative importance of each outcome measure, a minimally acceptable level considered necessary for success for each outcome measure, and the length of time required for these outcome measures to remain stable. RESULTS: Following two rounds of Delphi surveys, the panelists considered the control of pain to be an "extremely important" outcome measure for successful periodontal treatment. Attachment levels, probing depths, plaque levels, degree of inflammation, function, furcation involvement, and patient satisfaction were considered to be "very important" outcomes for successful periodontal treatment. The minimally acceptable reduction in probing depths following 1 year of treatment was 2 mm; whereas up to 1 mm of attachment loss was considered acceptable. The panel found that Glickman grade 2 furcation involvement or Miller degree II mobility would be considered an acceptable outcome for clinical success. Finally, the panel agreed that the 1-year results of treatment should remain stable for a minimum of 5 years. CONCLUSIONS: The Delphi surveying technique proved useful in developing a hierarchy for the relevance of periodontal outcome measures. Absence of pain was the only outcome measure considered to be "extremely important" for successful therapy. Although panelists considered attachment loss, furcation invasions, and mobility as "very important" outcomes, they were willing to accept loss of attachment of up to 1 mm, grade 2 furcation involvement, and degree II mobility following treatment as long as outcomes remained stable for 5 years. These data suggest that minimal standards for success of posterior teeth can be established among periodontal practitioners.     

Using a Delphi panel to survey criteria for successful periodontal therapy in anterior teeth

BACKGROUND: Valuable decision making for periodontal treatment success in situations where there is ambiguous or conflicting information was previously reported using a consensus building method, the Delphi survey, for posterior teeth with chronic periodontitis. This study focuses on outcome measures relevant in assessing therapy of anterior teeth with chronic periodontitis. METHODS: The Delphi panelists were the same American periodontists who participated in the previous Delphi survey evaluating successful therapy in posterior teeth. In this study, panelists determined the level of importance of attachment level, probing depth, mobility, plaque, inflammation, esthetics, pain, and patient satisfaction following periodontal treatment of a single tooth or multiple anterior teeth in a patient with severe chronic periodontitis. The panelists were questioned concerning the relative importance of each outcome measure, a minimally acceptable level considered necessary for success for each outcome measure, and the length of time required for these outcome measures to remain stable. RESULTS: The 35 panelists considered the control of pain, esthetics, and patient satisfaction to be "extremely important" outcome measures for successful periodontal treatment of single or multiple teeth. Attachment levels, probing depths, plaque levels, degree of inflammation, and mobility (for multiple teeth) were considered to be "very important" outcomes. The minimally acceptable reduction in probing depths following 1 year of treatment was 2 mm; whereas 2 mm of attachment gain was considered necessary for successful treatment. The panel also found a Miller degree I mobility as an acceptable outcome for clinical success. Finally, the panel agreed that the 1-year results of treatment should remain stable for a minimum of 5 years. CONCLUSIONS: The Delphi technique proved a practical instrument to transform expert opinion into a group consensus for relevant periodontal outcome measures. Absence of pain, esthetics, and patient satisfaction were outcome measures considered "extremely important" for successful therapy. Although panelists considered attachment loss, probing depths, and mobility somewhat less important outcomes, they wanted an attachment gain of 2 mm and would accept a degree I mobility as long as outcomes remained stable for 5 years. These data suggest that minimal standards for successful therapy of anterior teeth can be established among periodontal practitioners.     

Die kondyläre Metastasierung

Background

Metastases in the mandibular condyle are rare. A survey of the literature showed that only 23 of 69 selected cases qualified under the criteria of Meyer and Shklar.

Report of a case

A 48-year-old white male suffering from a previously operated lung carcinoma was referred due to pain and discomfort in the left TMJ. A solitary condylar metastasis of the mandible was revealed. Because of diffuse tumorous infiltration into periarticular tissue, irradiation treatment was performed. During the long-term follow-up growth of additional skeletal metastases occurred.

Discussion

The course of condylar metastases in general is similar to other metastases involving the jaw. Breast cancer as the primary tumor is most frequent, followed by lung cancer. There are no specific clinical or radiological parameters leading to diagnosis. The clinician should take a potential metastasis into account when dealing with TMJ complaints, radiological oddities, and medical history of malignant tumors. For proper treatment planning, diagnosis should be based on histology. Since the diagnosis of metastasis is usually made at an advanced stage of disease, therapy will be mainly intended as palliative.     

Induced mandibular condylar growth in a sheep model after functional appliance treatment

This paper reports on changes in mandibular condylar growth in sheep fitted with experimental functional appliances. The paper also addresses the similarities of mandibular condylar growth in sheep and humans. Experimental functional appliances were developed, constructed and applied to four, four-month old, male sheep. Another four sheep served as matched controls. All animals received fluorochrome bone labels during the study and their weight gain also was recorded. Fifteen weeks later, all animals were sacrificed and each temporo-mandibular joint and left metacarpus were removed. Undecalcified mid-sagittal sections of the joint and metacarpus were prepared for fluorescence microscopy. The mandibular condylar growth vector in sheep was found to be in a postero-superior direction. Condylar growth in the control sheep during the experimental period varied from 8.8 to 11.9 mm, with the mean being 10.6 mm, which is quantitatively similar to two years of condylar growth in human adolescents. In the experimental sheep, the condylar growth varied from 8.5 to 13.3 mm, with the mean being 11.4 mm. When metacarpal growth and weight gain were taken into consideration using multivariant analysis, the coefficients for growth in the postero-superior and posterior direction were found to be high, with adjusted r2 as 0.84 and 0.82 respectively. The induced condylar growth was estimated to be largest in the posterior direction (2.30 mm), which is also similar to previous reports in humans. These findings suggest the appropriateness of using sheep as a model for quantitative histological analysis when investigating the mechanisms of functional appliance treatment.     

Salivary and serum antibody response to Streptococcus mutans antigens in humans

Humoral immunity against Streptococcus mutans infection was analyzed in caries-active and caries-free young adults by immunoblotting. All volunteers from both groups had detectable salivary immunoglobulin A (IgA) and serum IgG antibodies, with similar profiles. They could be classified on the basis of relative intensity of the immunoblot bands into categories of high or low responders. Common protein antigens with molecular weight ranging from approximately 45 to 190 kDa could be found either extracellularly or associated with the cell wall of S. mutans cultured in vitro. The predominant reactive antigens recognized by both IgA and IgG were of proteins around 63 and 60 kDa. Detection of IgA antibodies to the various antigens of S. mutans in individual saliva samples did not always correlate with serum IgG antibody profiles. In addition, distinct bands, which reacted preferentially with either IgA or IgG, could be detected by antibodies from specific subjects. Differential reactivities of salivary IgA and serum IgG antibodies to two, cell-wall associated protein antigens around 33 and 36 kDa were found in caries-active and caries-free young adults; 30.8% of caries-free subjects and 12% of caries-active subjects (P < 0.01) exhibited detectable antibody response to these antigens. This difference was not attributable to variations in antibody levels, since antibody response to these proteins were still detectable in some caries-free but not caries-active individuals whose levels of antibodies to other antigens were low. Thus, a new antibody profile which correlates with dental caries disease activity has been identified in a selected population. Differences in mucosal and systemic immune responses to S. mutans seem to be both antigen and host dependent.     

Leached components from dental composites in oral simulating fluids and the resultant composite strengths

The aim of this study was to analyse the leached moieties of dental composites after storage in ethanol and organic acids of plaque and further evaluate the resultant effect on the diametral tensile strength (DTS) of the composites. Three commercial composites were used: Bis-GMA-based Z100, Bis-GMA/UDMA-based Heliomolar, and Bis-MPEPP-based Marathon One. The solutions used were: 99·9% acetic acid, 99% propionic acid and 75% ethanol. Specimens (4 mm diam. × 2 mm thick) were stored at 37°C in 3 mL of solution for up to 30 days. Gas chromatography/mass spectrometry was used to characterize the leached moieties and DTS of the specimens after immersion was evaluated. Data were analysed using ANOVA and Tukey LSD test. The eluted substances were not all the same in different solutions and composites but mostly increased with immersion time, and included diluents (TEGDMA and decamethacrylate) and some additives, such as an ultra-violet stabilizer (TINUVINP), plasticizers (dicyclohexyl phthalate and bis(2-ethylhexyl) phthalate), initiator (triphenyl stibine), coupling agent (γ-methacryloxypropyl trimethoxysilane), and phenyl benzoate. The chief polymerizing monomers were not found. More kinds of components were found in the acetic acid and ethanol groups studied. The fewest kinds and quantities of leached moieties were found for Bis-GMA specimens and then Bis-GMA/UDMA ones, most of which are diluent agents. Bis-MPEPP specimens leached the most substances, which were composed mostly of a short phenyl group chain structure. The BisGMA composite showed the highest DTS (54·8 ± 5·7 MPa), which was not greatly affected by the length of storage. Bis-GMA/UDMA (36·2 ± 6·8 MPa) and Bis-MPEPP (26·1 ± 4·5 MPa) composites were significantly reduced (P < 0·05) after 30 days storage in the ethanol (35–50%), in the propionic acid (25–30%), and in the acetic acid (40–60%). Irreversible processes such as the leaching of components occur in fluids simulating an oral environment, which may contribute to irreversible material degradation, especially for non-Bis-GMA-based composites.     

Safeguarding the health of dental professionals

BACKGROUND: A healthy dentist is one of the most important ingredients in a successful dental practice, an ingredient not to be taken for granted. Professionals, dentists included, can and do experience illnesses and problems that can disrupt or impair a practice. CONCLUSIONS: In addition to the vulnerabilities of the human condition--addictive disorders, psychiatric illnesses, infectious disease, family and relationship problems, or the many varieties of human misery--dentists have undergone a powerful process of socialization into their professional role that makes it difficult to seek help for themselves. Stigma about addictive and psychiatric illnesses continues to be a problem despite significant advances in scientific understanding of these disorders. Many people, especially those in positions of community visibility as dentists are, still struggle with shame when they associate problems with personal failure. Dental societies are in an ideal position to provide resources and support, should they choose to take this opportunity, and the ADA has the information and expertise to help them do this. PRACTICE IMPLICATIONS: Dentists can become more aware of their own vulnerabilities and enhance their personal and professional effectiveness, as well as evaluate ways they may support their staff and colleagues.     

Dimensions of oral-health-related quality of life

Oral-health-related quality of life (OHRQoL) is expected to have multiple dimensions. It was the aim of this study to investigate the dimensional structure of OHRQoL measured by the Oral Health Impact Profile (German version) (OHIP-G) and to derive a summary score for the instrument. Subjects (N = 2050; age, 16-79 yrs) came from a national survey. We used rotated principal-components analysis to derive a summary score and to explore the dimensional structure of OHIP-G. The first principal component explained 50% of the variance in the data. The sum of OHIP-G item responses was highly associated with the first principal component (r = 0.99). This simple but informative OHIP-G summary score may indicate that simple sums are also potentially useful scores for other OHRQoL instruments. Four dimensions (psychosocial impact, orofacial pain, oral functions, appearance) were found. These OHIP-G dimensions may serve as a parsimonious set of OHRQoL dimensions in general.     

Rationale for dental implants

The clinical replacement of lost natural teeth by osseointegrated implants has represented one of the most significant advances in restorative dentistry. Two decades ago, a majority of dentists were sceptical about implants and rejected them entirely. Today it is rare to find a practitioner who does not work with dental implants or who is not actively participating in one of the many seminars or courses offered by universities, professional societies and implant manufacturers.