Factors Affecting Survival and Usefulness of Implants Placed in Vascularized Free Composite Grafts Used in Post–Head and Neck Cancer Reconstruction

Background: Bone‐containing vascularized grafts have been used successfully to reconstruct post‐cancer surgical defects. Dental implants can be placed in these bone‐containing grafts to allow implant‐supported prosthodontic reconstruction of these patients. Purpose: The aim of this study was to evaluate the survival of dental implants used in the rehabilitation of subjects treated with bone‐containing vascularized grafts to compare usability of implants placed at the time of reconstruction and after healing. Materials and Methods: A cross‐sectional study was undertaken to examine survival rates of implants placed in vascularized bone‐containing grafts either immediately at the time of surgical reconstruction or after 3 months healing. Other factors such as graft type, whether radiation therapy was given, and implant type were recorded. Results: A total of 41 patients had 145 implants placed in 47 vascularized bone‐containing flaps. Increased failure rate of implants was seen in immediately placed implants. There was also a significant increase in the number of osseointegrated implants that were prosthodontically unusable or sub‐optimally placed in the immediate placement group. Radiation therapy was associated with a significant increase in failure rate. Modern implant surfaces appeared to perform better than machined/turned surfaces. Graft donor site did not influence implant survival. Conclusion: This study demonstrated the difficulties encountered with immediate placement of dental implants at the time of post‐cancer reconstructive surgery.     

Knowledge and practice of behavioral management principles among dentists treating adults with learning disabilities

This study investigated U.K. dentists’ knowledge and practice of behavioral management principles (BMPs) as applied to adults with learning disabilities (AWLD). A postal questionnaire enquired into the dentists’ experience in managing AWLD, utilization of behavioral management techniques, and knowledge of BMPs. The response rate was 41% (N = 53). Two groups were investigated: specialists (dentists registered on the Special Care Dentistry specialists’ list, n = 37) and nonspecialists (dentists not on the list, n = 16). Although specialists treated more AWLD than nonspecialists, both groups of dentists reported they felt highly confident in managing AWLD. However, all dentists’ knowledge of the principles of nonpharmacological BMPs was low. Specialists had a tendency to use a greater range of nonpharmacological behavioral management techniques compared to non‐specialists. These results suggest that dental team members need more training in the theory and practice of BMPs, which might lead to less reliance on costly pharmacological interventions and a clinical experience that is more respectful of the dignity and independence of AWLD.     

The oral health of children with Down syndrome in Ireland

The authors investigated the oral health of a convenience sample of 71 children with Down syndrome. The study group had a lower caries prevalence but similar levels of unmet treatment needs as children at special and mainstream schools. Treatment experience varied with age: 5-year-olds had more extractions and fewer restorations, and 15-year olds had fewer extractions and more restorations. The number of teeth with fissure sealants was comparable to that of other children in Special Needs Schools. Although the study group had poor oral hygiene, a need for advanced periodontal treatment was not evident. Few had evidence of dental trauma. Malocclusion was prevalent. Through a government-funded program, most of the sample had seen a dentist within the previous year, and few parents reported problems accessing dental care.
This study suggests that services targeted toward groups with special needs could generate outcomes comparable to those seen in other service users. A finding that also may hold true for other underserved populations.     

Effect of Dynamic Loading Methods on Cement Film Thickness In Vitro

Purpose Reduced cement film thicknesses can improve crown seating and decrease marginal discrepancies. Improved marginal adaptation has the potential to reduce plaque accumulation, periodontal disease, and cement dissolution. Studies have indicated that dynamic seating methods can reduce seating discrepancies associated with zinc phosphate and resin cements. However, other types of cements and other dynamic techniques have not yet been studied or compared, nor has the mechanism for improved seating been fully explained. Therefore, the purpose of this study was to investigate the effect of a variety of loading methods on the film thicknesses of current types of crown and fixed partial denture cements compressed between glass plates. Materials and Methods This study investigated the effect of three dynamic loading methods on film thickness of six representative fixed prosthodontic cements. These included zinc phosphate, resin-modified glass ionomer, encapsulated glass ionomer, adhesive composite resin, composite resin, and polycarboxylate. The method was derived from American Dental Association specifications for cement film thickness. In control groups, the cements were placed between two glass plates and statically loaded with a 15-kg weight. The test groups were initially similarly loaded, and then for 30 seconds further subjected to simulated repeated patient opening and closing, vibrations from an electromallet, or an ultrasonic device. Results Mean film thicknesses ranged from 7.4 μm for polycarboxylate/ultrasound up to 40.3 μm for composite resin/static. Two-way analysis of variance revealed that the effects of material type and cementation method and their interaction all significantly affected film thickness (P < .0001). Multiple range analysis showed that dynamic methods were generally superior to static loading and that the ultrasonic method was the best overall. Conclusions The different dynamic loading methods all significantly decreased cement film thicknesses between glass plates. The ultrasonic method was the most effective. The type of cement used also influenced film thickness. Composite resins were more affected than other materials.     

The self-reported oral health status and behaviors of adults who are deaf and blind

This qualitative study explored perceived oral health, felt need, oral health knowledge and behaviors, and utilization of dental services among a community of deaf and blind adults in Toronto, Canada. Seven adults participated in in depth interviews facilitated by intervenors skilled in communication with people who are deaf and blind. Subjects reported that their oral health was good, however oral health knowledge was poor and daily oral hygiene practices were minimal. Few subjects had ever received dental health education and were largely unaware of how to prevent dental disease. A subsidized dental program enabled subjects to have regular dental visits, though they were concerned about the costs of more complex dental treatment not covered by the program. They also worried about finding an alternative source of care once their eligibility for the program ceased at the age of 65. The presence of the subsidized sympathetic dental program and the facilitative role of intervenors promoted utilization of dental care for many of the subjects who participated in this study. There is a clear need to develop appropriate dental health education programs for this group of people, which would harness the support of the community of deaf and blind people and their intervenors. The interventions need to be sensitive and appropriate for the individual's level of impairment.