Evaluation of the Parameters Underlying the Decision by Adult Patients to Opt for Lingual Therapy: an International Comparison

BACKGROUND: The present study is the first instance of patients having been questioned on the criteria applied in their decision for therapy with lingual brackets and on the sources of information available to them within the framework of an international comparison prior to the start of therapy by means of a standardized questionnaire. PATIENTS AND METHOD: 68 patients (19 male, 49 female; mean age 32.4 years, range 19.8 to 60.0 years, SD 9.7) were interviewed. RESULTS: Therapy with lingual brackets was more important to the patients in the present study for professional than for private reasons: The further the patients were from the typical "braces age", the more important was treatment with an invisible appliance from the professional standpoint. The patients' educational level had no influence on the decision for a fixed lingual appliance. There was no significant difference between the German and the French patients in the decision-making criteria of adult patients and the sources of information available to them in the context of the lingual technique. CONCLUSION: The information available through the media on the lingual technique is inadequate in both countries.     

In-vitro Investigation on Suitability of Light-cured Resins for Interocclusal Splints

OBJECTIVE: The aim of the present study was to determine the surface hardness of light- and auto-cured resins for the fabrication of occlusal splints employing Vickers hardness measurements. MATERIALS AND METHOD: In this study we used three auto-polymerized resins (Palapress, Orthocryl, Steady-Resin M) and four light-polymerized resins (Acrylight, Primosplint, Triad Tran- Sheet Colorless and Triad TranSheet Pink). The Vickers hardness measurement was carried out by means of a universal Durimet indenter applying a test load of 50 g for 30 seconds. The light-cured resins were polymerized in a Tagris Power light oven for 10 and 15 minutes each. Three separate test series were carried out (the hardness of plates under optimal conditions and of occlusal splints was measured, and the curing of light-polymerizing materials in layers of varying depth was evaluated). Data underwent statistical analysis via ANOVA and the Scheffé test. RESULTS: The microhardness determined in each case amounted to values between 10.4 HV 0.5 and 39.3 HV 0.5. The Vickers hardness determined for the plates that had been produced under optimal conditions demonstrated that their surface was significantly (p < 0.05) harder than that of cylinders and splints. The hardness values of the light-cured material Triad TranSheet Pink (39.3 HV 0.5) were significantly higher (p < 0.05) than those of all other resins. In all auto-polymerized resins, the surface hardness of the samples we examined (in the form of plates and splints) was significantly lower (p < 0.05) than that of the light-cured materials Triad TranSheet Pink and Colorless. CONCLUSION: The results we have obtained so far concerning surface hardness indicate that, in the fabrication of occlusal splints, light-cured resins may represent an alternative to auto-polymerizing materials.     

The reliability and validity of self-reported temporomandibular disorder pain in adolescents

AIMS: To evaluate the reliability and validity of self-reported pain associated with temporomandibular disorders (TMD) in adolescents and to determine how this validity may change over time. The authors' hypothesis was that self-reported pain can be used to reliably and accurately detect adolescents with TMD pain. METHODS: One hundred twenty adolescents, 60 with self-reported TMD pain and 60 age- and gender-matched controls without TMD pain, were examined twice. At the first examination at a Public Dental Service clinic, self-reported TMD pain was recorded for each patient. At the second examination, a clinical examination was completed, blind to the patients' self-report of pain symptoms, after which self-reported TMD pain was again recorded. The clinical examination was based upon the Research Diagnostic Criteria for TMD (RDC/TMD). Self-reported TMD pain in this investigation was based upon the subjects' responses to 2 questions: (1) Do you have pain in your temples, face, temporomandibular joint (TMJ), or jaws once a week or more? and (2) Do you have pain when you open your mouth wide or chew once a week or more? RESULTS: Test-retest reliability of .83 (kappa) was found for the 2 questions. The sensitivity was .98 (95% CI, .90 to 1.0) and specificity was .90 (95% CI, .81 to .95) for comparison of assessments made on the same day. Sensitivity was .96 (95% CI, .85 to .99) and specificity .83 (95% CI, .72 to .90) for assessments made 2 to 4 weeks apart. CONCLUSION: Very good reliability and high validity were found for the self-reported pain questions. A short time interval between the screening question and examination slightly increased the accuracy of the measure. In adolescent populations, the questions in this study can be used to screen for TMD pain.     

Recalibration improves inter-examiner reliability of TMD examination

OBJECTIVE: The purpose of this study was to assess whether recalibration of examiners would improve the reliability of gathering clinical findings and related diagnoses of temporomandibular disorders (TMD) in accordance with the Research Diagnostic Criteria for TMD (RDC/TMD). MATERIAL AND METHODS: Two clinicians independently examined a total of 48 symptomatic and asymptomatic subjects according to the RDC/TMD on two occasions: examination 1 (E1). Aarhus, Denmark (n=24; 18 female, ages 18-59 years); examination 2 (E2). Malm?, Sweden (n=24; 18 female, ages 18-86 years). The clinicians were calibrated in the use of the RDC/TMD Axis-I examination on the day before E1. Six months later, they were recalibrated on the day before E2. Intra-class correlation coefficients (ICCs) were used to examine the inter-examiner reliability of the two clinicians on the two occasions (E1, E2). RESULTS: The intra-class correlation coefficients of vertical range of jaw motion differed little between E1 and E2. At E2, all other examination components consistently improved in reliability relative to E1. Similar improvements were seen for the frequently occurring RDC/TMD clinical diagnoses: Ia. Myofascial pain [ICC = 0.83 (E1) and 1.00 (E2)], IIa. Disk displacement with reduction [ICC = 0.26 (E1) and 0.64 (E2)], and IIIa. Arthralgia [ICC = 0.16 (E1) and 0.73 (E2)]. CONCLUSION: Recalibration considerably improved inter-examiner reliability for assessing RDC/TMD clinical variables and diagnoses, which are critically dependent on reliable assessment of clinical signs; improvement was most marked when initial inter-examiner reliability was low. Final inter-examiner reliabilities after recalibration were all associated with acceptable to excellent levels.     

Relationships between clinical attachment level and spine and hip bone mineral density: data from healthy postmenopausal women

BACKGROUND: There are physiological reasons to expect an association between bone mineral density of the spine and hip and attachment loss. To this point, however, most studies have found no correlation. METHODS: The 135 patients in this report were part of a randomized controlled trial of estrogen replacement. All patients were in good oral health at entry and received annual oral prophylaxis as part of the study. Standard probing measurements were made with a pressure sensitive probe at 6 sites on each tooth. Bone mineral density was measured with dual-energy x-ray absorbtiometry at the lumbar spine (anterior-posterior and lateral) and proximal femur (neck, trochanter, intertrochanter, Ward's triangle, and total area). These procedures were performed at baseline and at annual intervals for 3 years. RESULTS: Correlations between cross-sectional measurements of clinical attachment level and bone mineral density were very weak, and did not approach statistical significance (-0.06 < or =r < or =0.10, 0.15 < or =P < or =0.75). A few somewhat stronger correlations were found between longitudinal changes in bone mineral density and attachment (-0.20 < or = r < or =-0.02, 0.02 < or = P < or =0.81). Although the correlations in the longitudinal changes were weak, they were consistently in the direction of greater bone mineral density being associated with less attachment loss. CONCLUSIONS: There is no clear association between clinical attachment level and bone mineral density of the lumbar spine and proximal femur, whether examined on a cross-sectional or longitudinal basis. Patterns in the data suggest there may be a weak association in the longitudinal changes.     

Subsurface microhardness of enamel and dentin after different external bleaching procedures

PURPOSE: To evaluate the influence of various bleaching systems on subsurface microhardness of enamel and dentin. METHODS: 60 bovine crowns were distributed among seven groups (A: Opalescence Xtra Boost, B: Opalescence Quick, C: Rapid White, D: Whitestrips, E: Opalescence 10%, F: Opalescence PF 15%). The crowns were sectioned and baseline hardness (Knoop) of enamel and dentin was assessed on the sectioned surface at various distances from the enamel surface. The sectioned surface was covered with wax and the enamel was treated for 10 days with the bleaching agents A-F according to manufacturers' instructions. Bleaching with C-F was conducted each day (C: twice per day for 10 minutes, D: twice per day for 30 minutes, E: 8 hours, F: 4 hours), systems A-B were applied on first and fifth days (A: twice for 10 minutes, B: 1 hour). Finally, hardness was re-assessed. Data were statistically analyzed to compare baseline hardness and final hardness in the respective groups (P< 0.05). RESULTS: Analysis showed that in Group C, hardness was significantly reduced in both enamel and dentin. In the remaining groups, significant reduction of hardness was observed up to the following depths [microm] in enamel; A: 250, B: 700, D: 300, E: 150, F: 150. In these groups no significant hardness changes were recorded in subsurface dentin.     

Platelet-derived growth factor stimulates bone fill and rate of attachment level gain: results of a large multicenter randomized controlled trial

BACKGROUND: Growth factors are generally accepted to be essential mediators of tissue repair via well-established mechanisms of action that include stimulatory effects on angiogenesis and cellular proliferation, ingrowth, differentiation, and matrix biosynthesis. The aim of this study was to evaluate in a large-scale, prospective, blinded, and randomized controlled clinical trial the safety and effectiveness of purified recombinant human platelet-derived growth factor (rhPDGF-BB) mixed with a synthetic beta-tricalcium phosphate (beta-TCP) matrix for the treatment of advanced periodontal osseous defects at 6 months of healing. METHODS: Eleven clinical centers enrolled 180 subjects, each requiring surgical treatment of a 4 mm or greater intrabony periodontal defect and meeting all inclusion and exclusion criteria. Subjects were randomized into one of three treatment groups: 1) beta-TCP + 0.3 mg/ml rhPDGF-BB in buffer; 2) beta-TCP + 1.0 mg/ml rhPDGF-BB in buffer; and 3) beta-TCP + buffer (active control). Safety data were assessed by the frequency and severity of adverse events. Effectiveness measurements included clinical attachment levels (CAL) and gingival recession (GR) measured clinically and linear bone growth (LBG) and percent bone fill (% BF) as assessed radiographically by an independent centralized radiology review center. The area under the curve (AUC), an assessment of the rate of healing, was also calculated for CAL measurements. The surgeons, clinical and radiographic evaluators, patients, and study sponsor were all masked with respect to treatment groups. RESULTS: CAL gain was significantly greater at 3 months for group 1 (rhPDGF 0.3 mg/ml) compared to group 3 (beta-TCP + buffer) (3.8 versus 3.3 mm; P = 0.032), although by 6 months, this finding was not statistically significant (P = 0.11). This early acceleration of CAL gain led to group 1 exhibiting a significantly greater rate of CAL gain between baseline and 6 months than group 3 as assessed by the AUC (68.4- versus 60.1-mm weeks; P = 0.033). rhPDGF (0.3 mg/ml)-treated sites also had significantly greater linear bone gain (2.6 versus 0.9 mm, respectively; P < 0.001) and percent defect fill (57% versus 18%, respectively; P < 0.001) than the sites receiving the bone substitute with buffer at 6 months. There was less GR at 3 months in group 1 compared to group 3 (P = 0.04); at 6 months, GR for group 1 remained unchanged, whereas there was a slight gain in gingival height for group 3 resulting in comparable GR. There were no serious adverse events attributable to any of the treatments. CONCLUSIONS: To our knowledge, this study is the largest prospective, randomized, triple-blinded, and controlled pivotal clinical trial reported to date assessing a putative periodontal regenerative and wound healing therapy. The study demonstrated that the use of rhPDGF-BB was safe and effective in the treatment of periodontal osseous defects. Treatment with rhPDGF-BB stimulated a significant increase in the rate of CAL gain, reduced gingival recession at 3 months post-surgery, and improved bone fill as compared to a beta-TCP bone substitute at 6 months.     

Fluoridation in Anglesey: a clinical study of dental caries in mothers at term.

A study of dental caries was carried out involving 1537 mothers who attended St David's Hospital, Gwynedd, between July 1986 and July 1987 for their confinement. The study was 'blind' in respect of residence. The mean DMFT value for mothers with continuous residence in the non-fluoridated Gwynedd mainland was 13.6 and the mean DMFT value for mothers living in the Anglesey Health Unit who had consumed fluoridated mains water from birth was 30% lower at 9.5 (P less than 0.0001). The confidence interval for the difference between means was 3.4-4.9. The samples from the two areas showed no significant differences in social class and age group structures. The percentage of Anglesey mothers with DMFT exceeding 15 was less than one-sixth of that for mainland mothers and the percentage of those with DMFT less than 6 was three times greater. The mean DMFS value for occlusal sites in premolars was 3.9 for mainland Gwynedd and for Anglesey 52% less at 1.9 (P less than 0.0001) with a confidence interval of 1.6-2.4. For smooth surface sites in posterior teeth, the difference was not as pronounced, with a mean DMFS value for mainland of 20.3 and for Anglesey 42% less at 11.8 (P less than 0.0001) with a confidence interval of 7.5-9.6. The results showed that child-bearing women continued to enjoy important benefits from water fluoridation into their early thirties.