Diagnosis and treatment planning for implant dentistry

Dental implants are well-established in dentistry and allow the restorative dentist to offer patients the best that dentistry has to offer. Through examination, radiographs, and study models, the restorative dentist and implant surgeon can develop a treatment plan. Comprehensive diagnosis and treatment planning involve much more than a clinical exam--they require an investigation involving past, present and future dental therapy.     

Epinephrine in digital blocks: revisited

STATEMENT OF PROBLEM: Implant treatment in the United Kingdom has been provided mainly in specialist, regional dental hospitals. However, increasingly, general dentists are providing implant-supported prostheses in a private office setting. PURPOSE: This study investigated the nature, timing, and frequency of complications associated with single tooth implant therapy in a dental hospital and two dental offices. METHODS: The dental records of 58 patients provided with 76 implants during the period of 1989-95 were reviewed retrospectively. Fifty-three single tooth crowns on implants were placed by general dentists and 23 by specialists in the dental hospital. RESULTS: Implant survival rate was 96%. Twenty-eight guided bone regeneration procedures were required, including 13 unplanned ones. Prosthodontic complications included the need for recontouring of three crowns and the recementation of three crowns. Only two abutment screws required retightening. Peri-implant soft tissue inflammation occurred around six crowns and recession around two. CONCLUSION: The single tooth implant-supported crown appears to be an effective and durable restorative treatment with a relatively low prevalence of postoperative complications.     

Treating restorative dentistry to health

The concepts that underpin much of dental practice need refocusing so as to accommodate the many scientific advances that have been made in recent years in understanding oral disease processes and their management. "Treatment' should come to mean what it says, namely the curing of diseases- and much of this can only be accomplished by non-invasive means. Restorative procedures should be seen simply as prosthetic, making up for lost tissues. The sequence of events with respect to caries should usually be diagnosis followed by treatment, and then the option of restoration if appropriate. In order to achieve this state of affairs for the whole population, I believe it will be necessary to stream dental undergraduates so that, while a portion learn restorative techniques and become licensed to practise them, the remainder concentrate on the non-restorative aspects of dentistry, having a special emphasis on the prevention and non-invasive "treatment' of oral and dental diseases, including caries, on a community scale. This latter group of dentists would not be licensed to undertake restorative procedures.     

Functional endoscopic sinus surgery: preoperative assessment and postoperative evaluation

Long-term success of dental implants depends largely on the continued health of peri-implant hard and soft tissues and an appropriate force distribution on the implants. Since dental implants are accepted as viable and, in some cases, ideal restorative options, all members of the dental team are faced with the task of maintaining implant health. This review outlines the current understanding of implant health and disease and presents recommendations for the treatment and management of diseased implants.     

Educating a patient with dental implants

A functional dentition can be restored for edentulous and partially edentulous patients through the placement of dental implants. Dental assistants have a significant role in the education of implant patients so that meticulous oral self-care can be accomplished. Only through the combined team efforts of the dental office staff and patients themselves will the continued success of dental implantology be insured.     

A case of systemic arterial supply to the normal left basal segments with no symptoms

STATEMENT OF PROBLEM: The surgical and restorative procedures at the posterior region of the maxilla and the mandible present a complex task in the treatment of partially edentulous patients. PURPOSE: The purpose of this study was to investigate the applicability of short hydroxylapatite-coated dental implants to the posterior mandible of partially edentulous patients. MATERIAL AND METHODS: Eight and 11 mm implants were evaluated as to their cumulative survival rate, clinical status (plaque index, gingival index, probing depth), and marginal bone loss over a 5-year period. RESULTS AND CONCLUSIONS: The verified overall cumulative survival rate was 94% for implants and 91% for prostheses. These results suggest predictable success for the application of short implants to the posterior mandible.     

Second primary cancers after cancers of the colon and rectum in New South Wales, Australia, 1972-1991

In this article, we present a survey on dental care and oral implantology in Beijing, China. The Chinese population comprises 1.2 billion or about 20% of the world's population. This survey shows: (i) there is a well-developed dental system in China, mostly operated by the Chinese government; (ii) in Beijing, there are 1328 dentists and oral surgeons and 515 special dental nurses working in dental departments of hospitals; (iii) about 2 million new patients visit the dentist every year; (iv) oral implantology is a new technology for the Chinese dentist and oral surgeon, as shown by the finding that in 1992, only 384 persons were treated with oral implants in a few hospitals in Beijing; however, most hospitals are interested in performing oral implantology in the near future; (v) imported implants are too expensive for Chinese patients, and therefore good qualified domestic implants and cheaper imported implants have a great market potential.     

Dentists' variability in restorative decisions, microscopic and radiographic caries depth

Restorative and dental caries depth decisions were recorded for 5168 un restored approximal tooth surfaces by 17 dentists who worked in the school dental clinics of the North York (Ontario) Public Health Department. Each dentist examined 15 pairs of experimental bitewing radiographs for which true caries depth had previously been determined by microscopy of the sectioned teeth following production of the radiographs. The dentists independently recorded their restorative decisions and radiographic caries depth perceptions. The relationship between the variation in the dentists' restorative decisions and their perceptions of caries depth based on a re-reading of the bitewings on the one hand, and true caries depth on the other was also examined. The percentages of total variability in each dentist's restorative decisions attributable to radiographic and to microscopic caries depth were estimated using regression analyses. Large variations were found among the 17 dentists' distributions of overall restorative and depth decisions. The relationship between microscopic caries depth and the dentists' restorative decisions was, understandably, less strong than that of the dentists radiographic perceptions of caries depth and restorative decisions. Relative to true caries depth, high numbers of false positive and false negative restorative decisions were made. Overall, 50% of the variability in the dentists' restorative decisions was explained by the perceptions of radiographic caries depth; however, among individual dentists, the range was from 29% for one dentist to 69% for another. A much lower percentage of the overall restorative variation was explained by microscopic depth, 18%. Like the finding of the only two previous European studies that quantified the role of radiographs on clinical decisions, this study demonstrated that dentists' perceptions of dental caries depth using bitewing radiographs play a major but variable role in their restorative decisions for approximal tooth surfaces.     

Incisal edge reattachment: literature review and treatment perspectives

Anterior crown fractures in children and adolescents are a common form of injury, affecting approximately 25% of that population. Common restorative treatments such as composite bonding, laminate veneers, or full-coverage restorations tend to sacrifice healthy tooth structure and challenge dentists to match the adjacent unrestored dentition. Incisal edge fragment reattachment, including the use of current bonding techniques, is a restorative treatment option that offers the advantages of simplicity, immediate esthetics, and conservatism in cases of dental trauma. This article presents a comprehensive literature review on this restorative technique. It also provides diagnostic and treatment algorithms to simplify and clarify the recommended diagnostic and clinical regimens.     

Pediatric dentists' attitudes regarding parental presence during dental procedures

A controversial aspect of pediatric dentistry today is parental presence. A number of authors report an increase in the number of parents who wish to accompany their children throughout the dental appointment. Dentists historically have excluded parents from the treatment area, while pediatricians routinely keep the parent and child together. The purpose of this survey was to determine the frequency that Florida pediatric dentists permit parental presence during children's dental visits and to relate the influence of patient age, dentist's years in practice, procedure type, and practitioner attitudes on parental presence. A high return rate (98.9%) was obtained, and results indicated a significant increase in parental presence in the dental operatory and that further increases in parental presence are expected. Younger children were more likely to be accompanied by a parent for each procedure. Parental presence for examination was more likely than for restorative or extraction. Analysis of variance (ANOVA) indicated that the most frequent attitudes influencing the pediatric dentist's choice to exclude parents were that their presence: wastes time (P < 0.001); disrupts the child (P < 0.05); and makes the dentist uncomfortable (P < 0.05).     

Dementia's impact on pain sensation: a serious clinical dilemma for dental geriatric care givers

Dementia's impact on pain sensation is not well understood. Very little research has been done in this area, our clinical knowledge is poor, and there is no published information available to practitioners. This article reviews the current literature and discusses the need for further research. The number of patients with dementia is growing. This patient group will require dental diagnosis and treatment, and cannot be ignored by dentists. A humane approach to treatment must be adopted.     

Impact of HIV on the practice of dentistry in Houston, Texas

Texas ranks fourth in the nation in the number of documented HIV-infected and AIDS cases. The city of Houston has the highest prevalence of HIV-infected and AIDS cases in Texas. Dental health personnel have an ethical and legal obligation to provide dental services for HIV-infected persons. The purpose of this study was to assess the impact of HIV on the practice of dentistry in Houston. The study population was all dentists with a current Houston practice address registered with the Texas State Dental Board. A 41-item questionnaire was mailed to a stratified random sample of 500 dentists in Houston. The questionnaire covered four main areas: demographics, knowledge, attitudes, and behavior. About three-quarters of the dentists said they had treated an AIDS or HIV+ patient. Sixty percent of the dentists were not aware that breastmilk is a mode of transmission of HIV. There was a significant correlation between "ever treated" an HIV+ patients and "willingness to treat" an AIDS or HIV+ patient (p < 0.01). The experience of treating HIV-infected patients has a greater impact than knowledge alone in influencing dentists' behavior towards AIDS/HIV+ patients.     

Gustatory and olfactory considerations: examination and treatment in general practice

Gustatory and olfactory problems have deleterious consequences to systemic health, nutritional status and quality of life. Since patients with these problems are initially seen by dentists, they should be identified, treated and referred to other health care providers when appropriate. Care of these patients should be included in the general dental practice.     

Developmental eye disease--a genome era paradigm

Usually, the French dental insurance system covers the cost of restorative treatment but does not reimburse the cost of preventive therapies. A French sick-fund covering self-employed persons tested a new dental benefit plan for children intended to provide an incentive to develop office-based preventive activities. The programme, which started in 1992, concerns all 4-year-old children of self-employed workers in a single French region (Auvergne). Participants undergo an annual examination by the dentist of their choice until their 15th birthday. If the child is seen every year, all services related to dental caries (preventive and restorative) are provided free of charge. An ongoing evaluation of the programme was necessary to determine its influence on the development of office-based preventive activities and the dental health of the participants. A cohort of children enrolled in the programme in 1992 was followed over 4 years to examine the patterns of service use. In addition, a cross-sectional study comparing the caries experience of all 8-year-old children participating continuously in the programme (test sample) with that of a sample of control children (n=90) was conducted in 1996. Data from the longitudinal follow-up indicate that 43.37% of the 551 children to whom the programme was offered in 1992 underwent an annual examination in the first year. Of the children enrolled in 1992, 55.2% were still participating in the programme in 1996. Results showed that independent practitioners continued to focus on restorative treatment rather than preventive therapy. Results from the cross-sectional study are in accordance with this trend. The number of caries-free children was identical in test and control samples and the mean dft, DMFT, DT and dt did not vary between the two groups (Student's t-test, P>0.05). However the mean number of filled teeth was significantly higher in the test children than in the controls (P<0.01). For children with caries, the mean dft was 23.5% greater in the test group than in the control group (P<0.05). In Auvergne, a large number of families were not ready to participate in a plan that required them to take their child to the dentist every year. There was not a perceived need for regular preventive dental care, an attitude probably reinforced by the interventionist approach undertaken by the dentists over the survey period. Moreover, the plan did not provide an incentive for dentists to develop office-based preventive activities.     

Anxious children: coping in dental practice

Treating anxious children is a challenge that many dentists face. Not only do anxious children find it difficult to cope with dental treatment but dentists also find it difficult to cope with anxious children. This article is intended to simplify the management of anxious children in general dental practice. Behavioural management, the coordination of the whole dental team, treatment planning and the use of inhalation sedation will be discussed.     

A phase II trial of CPT-11 in recurrent squamous carcinoma of the cervix: a gynecologic oncology group study

The purpose of this paper is to present an outline of student's practice of interviewing simulated patients at behavioral science in dentistry. This practice was initiated as part of a newly introduced behavioral science course at our school of dentistry, to enable students to acquire communication skills, comprehensive understanding, and a proper attitude vis-à-vis patients. Students as well as instructors involved in the practice evaluated it as highly relevant for clinical education. It is concluded that the development of such practices in dental education is a prerequisite for training students to dentists oriented toward patient-centered dental practice.     

Dental practitioners' experiences on the usefulness of restorative materials in Finland 1992-1996

OBJECTIVE: To analyse general dentists' choice of restorative materials in Finland, where the use of amalgam has significantly decreased and the use of composites increased during the past 10 years. DESIGN AND SETTING: Postal survey in 1997 to a random sample of general dental practitioners mainly working with adult patients. MAIN OUTCOME MEASURES: Percentage distribution of dentists' opinions. RESULTS: The response rate was 82%. Tooth-coloured restorations were considered to be more time consuming, technically complicated and to have shorter life spans. Most dentists were not willing to return to the wide-scale use of amalgam restorations. CONCLUSIONS: The rapid changes in the restorative material selection have not resulted in serious problems in restorative therapy.     

An interactive, parallel, three-dimensional fast Fourier transform convolution dose calculation using a supercomputer

After cancer treatment in the head and neck area, mastication and speech are often affected. Some of the problems encountered can be solved by adequate dental rehabilitation. However, dental rehabilitation is often compromised for various reasons. The change in anatomy due to surgery often results in lack of denture-bearing mucosa. The effects of radiotherapy on the salivary glands and the mucosa result in dry oral tissue and diminished retention of removable dentures. Osseointegrated oral implants can help to solve these problems. Although implant treatment for patients with cancer of the head and neck is covered by the Dutch national health insurance, and there is therefore no financial obstacle, implants have not, so far, been widely used with these patients. In order to establish the possible reasons for this, an analysis was performed. Retrospective data on 95 consecutive patients were collected from records. The indication for the use of oral osseointegrated implants was reviewed. Analysis of the data showed that 45% did not need specific prosthetic rehabilitation. An indication for the use of osseointegrated implants was found in 25% of the patients. For various reasons, only 3% actually received implants. In striving to completely rehabilitate a cancer patient, the possible use of osseointegrated oral implants should be evaluated before the initial oncological treatment begins. The insertion of implants during the initial surgical procedure should be considered more often, with a view to reducing the number of surgical procedures.     

Affordable implant prosthetics using a screwless implant system

Many dentists have been reluctant to place dental implants because they have found that most implants are costly and time-consuming to place and have long-term maintenance problems. Most of these problems are caused by using screws to connect the abutment to the implant, the crown to the abutment or both. The use of a screwless implant system and conventional prosthetics, the author contends, can make implant dentistry affordable, versatile and easy to incorporate into all general dental practices.