The indications for direct resin composite restorations are nowadays extended due to the development of modern resin materials with improved material properties. However, there are still some difficulties regarding handling of resin composite material, especially in large restorations. The reconstruction of a functional and individual occlusion is difficult to achieve with direct application techniques. The aim of the present publication was to introduce a new "stamp"-technique for placing large composite restorations. The procedure of this "stamp"-technique is presented by three typical indications: large single-tooth restoration, occlusal rehabilitation of a compromised occlusal surface due to erosions and direct fibre-reinforced fixed partial denture. A step-by-step description of the technique and clinical figures illustrates the method. Large single-tooth restorations can be built-up with individual, two- piece silicone stamps. Large occlusal abrasive and/or erosive defects can be restored by copying the wax-up from the dental technician using the "stamp"-technique. Even fiber-reinforced resin-bonded fixed partial dentures can be formed with this intraoral technique with more precision and within a shorter treatment time. The presented "stamp"-technique facilitates the placement of large restoration with composite and can be recommended for the clinical use.
The present study reports on the surgical and prosthodontic rehabilitation of 46 patients, 31 male and 15 female, after resection of oral tumors. The treatment was carried out from 2004 to 2007 at the Department of Prosthodontics, University of Bern, with a follow-up time of 3 to 6 years. The average age at diagnosis was 54 years. 76% of all tumors were squamous cell carcinoma, followed by adenocarcinoma. Resection of the tumors including soft and/or hard tissues was performed in all patients. 80% of them additionally underwent radiotherapy and 40% chemotherapy. A full block resection of the mandible was perfomed in 23 patients, and in 10 patients, the tumor resection resulted in an oronasal communication. 29 patients underwent grafting procedures, mostly consisting of a free fibula flap transplant. To enhance the prosthetic treatment outcome and improve the prosthesis stability, a total of 114 implants were placed. However, 14 implants were not loaded because they failed during the healing period or the patient could not complete the final treatment with the prostheses. The survival rate of the implants reached 84.2% after 4 to 5 years. Many patients were only partially dentate before the tumors were detected, and further teeth had to be extracted in the course of the tumor therapy. Altogether, 31 jaws became or remained edentulous. Implants provide stability and may facilitate the adaptation to the denture, but their survival rate was compromised. Mostly, patients were fitted with removable prostheses with obturators in the maxilla and implant-supported complete dentures with bars in the mandible. Although sequelae of tumor resection are similar in many patients, the individual intermaxillary relations, facial morphology and functional capacity vary significantly. Thus, individual management is required for prosthetic rehabilitation.
INTRODUCTION:Even if a mortal incident occurs rarely in a dentists daily routine there is a chance of it. The entire team has to face a great challenge then. Stress and incertainty are leading to mistakes and cost precious time which is not given for treating due to emergency.MATERIAL:Usual emergencies helped developing emergency kits which should make it easy for the practise team to act right and aim orientated in case of emergency. Therefore the combination for an as much efficient as possible state of those kits has priority. Through these the acting procedures turn out easier and more secure.RESULT:The management in case of emergency could be highly improved through the developing of emergency kits. The acting procedures turn out easier and more secure. The possibility for mistakes decreases.
Halitosis is a widely spread condition. There are numerous causes. The aim of this study was to investigate the influence of fixed orthodontic appliances on the occurrence of halitosis. 55 patients in an orthodontic practice were monitored at three points in time after application of orthodontic appliance (T1: immediately after application, T2: 4 weeks after application, T3: 3 months after application). Monitoring included patient self-evaluation, plaque index, tongue coating index and organoleptic measurement. The subjective parameters taste, dry mouth and breath odor did not show statistical differences. However, with the presence of fixed orthodontic appliances, confidence when performing dental hygiene decreased statistically significantly (p = 0.003). Additionally, the tongue coating index showed a statistically significant difference between T1 and T2 (p = 0.012) as well as T1 and T3 (p ⟩ 0.001). Analogous results were found for organoleptic measurement (T1 and T2 [p = 0.002]; T1 and T3 [p ⟨ 0.001]) and plaque index (T1 and T2/ T3 [p ⟨ 0.001]). Fixed orthodontic appliances lead to a statistically significant increase of the plaque and tongue coating indices. A statistically significant increase was also observed with organoleptic measurement scores. The suspected positive correlation between halitosis and fixed orthodontic appliances was confirmed. Halitosis can be an important indicator of oral health during orthodontic treatment and can serve as a motivating factor for adequate patient oral health care maintenance.
The purpose of this study was to evaluate the present opinions and the knowledge of Swiss general dentists about current strategies to restore endodontically treated teeth. Between 2009 and 2011, a 17-item questionnaire was given to 95 general dentists at the beginning of continuing education courses related to this topic. The majority of dentists indicated that they restore more than 30 endodontically treated teeth per year. The decision for placing an intracanal post was mainly based on the amount of remaining tooth substance and the type of tooth (anterior tooth, premolar, molar, or abutment for fixed dental prostheses). Most respondents strove for a retention depth of at least two-thirds of the root length and a form-congruent fit between post and post space preparation. In terms of post type, metallic posts were predominantely used, while an increasing application of glass-fiber posts was registered. Regardless of the type of post, composite cements were the most commonly used luting materials. The prevailing strategies for the restoration of endodontically treated teeth are in part in accordance with the current literature. Disagreements with the literature are related to the post length, the desired post fit and the fact that metal screw posts are apparently still in use.
For dental care professionals, the availability and cleanliness of reusable instruments is of major importance. In order to guarantee a proper reprocessing (cleaning, sterilization) of each instrument and ensure optimum safety for the patients, a single instrument traceability solution can be implemented. The RFID (Radio Frequency Identification) technology is the only approach that can provide a fully automated identification of instruments, and a precise monitoring throughout the reprocessing cycle. It consists in integrating a miniature electronic component (RFID tag) to each instrument able to communicate with a transmitter located at a relatively close distance and capable of uniquely identifying each element in any given container, even when closed. In 2011, a pilot project was implemented in collaboration with the Division of Dentistry (SMD) of the University of Geneva and the central sterilization of the Geneva University Hospitals (HUG). This project has demonstrated the applicability and usefulness of RFID technology for tracking reusable dental instruments. In particular, the time saved by the operators and the massive risk reduction when compared to the possible errors during the process of manual identification are two major elements that justify the implementation of an RFID-based instrument traceability solution.
The purpose of this study was to determine factors that affected oral health-related quality of life (Oral Health Related Quality of Life = OHRQoL) in patients with removable dentures (RD). Quality of life was evaluated by using the Geriatric Oral Health Assessment Index (GOHAI). We analysed data of 250 patients aged 63 ± 11.6 years. After excluding patients lacking relevant analysis data, 243 patients remained in the study, including 129 males and 114 females. Relevant parameters for good OHRQoL were: patient satisfaction with their RD (r = -0.317), higher age (r = 0.222), greater number of remaining teeth (r = 0.357), higher income (r = 0.175), higher frequency of dental visits (r = -0.212), tobacco abstinence (r = -0.181), and residence in a rural area (r = -0.420). Also, marital status had an impact on OHRQoL. Widowed and married patients showed the highest values and unmarried patients the lowest. Frequently mentioned problem areas considered within the survey were: the patient's fear of further tooth loss, concerns about functional aspects such as the decrease in chewing efficiency and dissatisfaction with the aesthetics of the dental prostheses. The results showed that the OHRQoL is apparently not only influenced by dental factors, but also by psychosocial and economic factors, the relevance of which would have to be shown in further studies.
Antiresorptive therapy is prescribed in particular for the treatment of osteoporosis as well as for the treatment of tumor-induced hypercalcemia and metastatic bone disease. As a consequence, osteopathologies such as bisphosphonate-related osteonecrosis of the jaws (BRONJ) may occur. In 2008, our department reported on BRONJ in a paper that provided dental clinicians with information on diagnostics, therapy, and prevention (Dannemann et al., Schweizer Monatsschrift für Zahnmedizin, Vol. 118, 2/2008). During the last 8 years, new findings have emerged concerning potential etiologies, modes of therapy, and the use of additional antiresorptive therapies. For example, an important point for colleagues in dental practice is the now common intravenous administration of bisphosphonates in osteoporosis patients, which may lead to uncertainty when assessing risk in these patients. For this reason, this article provides an update of the above mentioned publication and gives dental clinicians an updated guideline concerning risk assessment in patients undergoing antiresorptive therapy. In this context, a risk assessment algorithm is presented. The pathogenesis, diagnosis, therapy, and prevention of BRONJ and oral implantation in patients receiving antiresorptive therapy are addressed with regard to the current literature. Finally, we present two example cases.
The aim of this retrospective study was to evaluate the periodontal therapy performed in the undergraduate curriculum (master level) at the School of Dental Medicine at the University of Basle, Basle, Switzerland. Patients diagnosed with advanced chronic or aggressive periodontitis were included in the study, provided that they were ≤40 years of age at the initial examination and had undergone a non-surgical periodontal therapy (scaling and root planing). In the 19 patients included, a statistically significant improvement of oral hygiene (plaque index; p = 0.015) and a reduction of inflammatory parameters (bleeding index; p = 0.009; bleeding on probing⁺; p < 0.0001) were documented during supportive periodontal therapy (SPT). Sites with moderate (PD ≥5 mm; p < 0.0001 and PD ≥6 mm; p = 0.001) and high probing depths (PD ≥7 mm; p = 0.002) were significantly reduced in number, while PD <5 mm (p = 0.014) increased. Counts of single- and multi-rooted teeth could largely be maintained. The periodontal therapy in the undergraduate curriculum is a valuable treatment option for periodontally diseased patients.
Orofacial pain often causes special difficulties to patients and dentists. Numerous differential diagnoses require the utilization of a coordinated diagnostic concept. Often, multiple causes lead to the need for a complex treatment plan. Impacted third molars are a potential cause of a variety of complications. Caries, pulp necrosis, and periapical infection are some of the infrequent causes of such pain. The presented case shows just such a constellation, resulting in primarily "unclear" orofacial pain. A diagnostic sequence generally leads to the correct diagnosis and thereby allows for fast and effective therapy. This shows how important structured diagnostics are, especially in cases of "unclear" pain.
In dentistry, antibiotics are prescribed both for prophylactic and therapeutic purposes. Their unwarranted use, however, may lead to the selection of resistant microorganisms. The aim of this study was to evaluate the indications and the extent of antibiotic prescription by dentists in Switzerland. A questionnaire was sent to 800 dentists during the winter of 2008/2009. Responses to the questionnaire were received from 20% of them. Many respondents indicated that they tried to prescribe antibiotics in a selective and cautious manner. Nevertheless, uncertainties existed regarding the indications. For example, the frequency of prescribing an antibiotic when it was not absolutely necessary was related to the respondents' uncertainty regarding the correct diagnosis and therapy. Not surprisingly, two-thirds of the respondents would prefer to have precise guidelines for the use of these drugs.
Zirconia is currently extensively used in medicine, especially in orthopedic surgery for various joint replacement appliances. Its outstanding mechanical and chemical properties have made it the "material of choice" for various types of prostheses. Its color in particular makes it a favored material to manufacture dental implants. A literature search through Medline enables one to see zirconia's potential but also to point out and identify its weaknesses. The search shows that zirconia is a biocompatible, osteoconductive material that has the ability to osseointegrate. Its strength of bonding to bone depends on the surface structure of the implant. Although interesting, the studies do not allow for the recommendation of the use of zirconia implants in daily practice. The lack of studies examining the chemical and structural composition of zirconia implants does not allow for a "gold standard" to be established in the implant manufacturing process. Randomized clinical trials (RCT) are urgently needed on surface treatments of zirconia implants intended to achieve the best possible osseointegration.
Since the introduction of cone beam computed tomography (CBCT), this 3-dimensional diagnostic imaging technique has been established in a growing number of fields in dental medicine. It has become an important tool for both diagnosis and treatment planning, and is also able to support endodontic treatments. However, the higher effective dose of ionizing radiation compared to conventional 2-dimensional radiographs is not justifiable in every case. CBCT allows for a more precise diagnosis of periapical lesions, root fractures as well as external and internal resorptions. Concerning the utility of CBCT in treatment planning decisions, the gain of information through 3-dimensional imaging for any of these pathologies has to be evaluated carefully on an individual basis. Moreover, radioopaque materials such as root canal filling and posts often create artefacts, which may compromise diagnosis. The aim of this review is to summarize the possibilities and limits of CBCT imaging in endodontology as well as introduce guidelines for daily clinical practice. Furthermore, the article presents possible therapeutic advantages of preexisting CBCT scans for root canal treatments.
OBJECTIVES:Skiing and snow-boarding are winter sports with risk of dental trauma. The aim of the present study was to investigate the use of protective gear and the occurrence of dental trauma in amateur winter sports on ski slopes.MATERIALS AND METHODS:A total of 500 skiers and snowboarders (345 skiers, 110 snow-boarders, and 45 who rode both) were interviewed using a standardized questionnaire during one winter season (from January to April 2008). Sustained injuries and use of protective gear (including mouthguards) were assessed.RESULTS:Of the 500 interviewed, eleven (9 m, 2 f; 2.2%) had sustained dental trauma while skiing or snowboarding. Frequent riders were most susceptible to dental trauma (p < 0.001). 165 (33%) have sustained a skiing or snow- boarding accident at least once, males more often than females (p = 0.031). Protective gear was used by 337 (67.4%), helmet, back and wrist protectors being worn most often. Snow-boarders were generally protected best (p < 0.001). All riders who had sustained an accident (n = 124; 75.1%) wore protective gear at the time of the interview (p = 0.009). Only two of eleven who had sustained dental trauma wear a mouthguard now for winter sports.CONCLUSION:The results show that skiing and snowboarding pose only a small risk for dental trauma.
The aim of this randomized, controlled clinical study was to compare the short-term effects of nonsurgical periodontal therapy with the additional administration of systemic antibiotics (AB) and the same therapy with additional photodynamic therapy (PDT) in the treatment of patients with aggressive periodontitis (AP). Thirty-six patients with AP received full-mouth nonsurgical periodontal treatment (SRP) and were then randomly divided into two groups of 18 subjects each. Group AB received amoxicillin and metronidazole three times a day for 7 days. Group PDT received two applications of PDT on the day of SRP as well as at follow-up after 7 days. The following clinical parameters were measured at baseline and 3 months after therapy: plaque index (PLI), bleeding on probing (BOP), probing depth (PD), gingival recession (GR), and clinical attachment level (CAL). After 3 months, PD was significantly reduced in both groups (from 5.0±0.8 mm to 3.2±0.4 mm with AB, and 5.1±0.5 mm to 4.0±0.8 mm with PDT; both p<0.001), while AB revealed significantly lower values compared to PDT (p = 0.001). In both groups, GR was not significantly changed. CAL was significantly reduced in both groups (PDT: 5.7±0.8 mm to 4.7±1.1 mm; p=0.011; AB: 5.5±1.1 mm to 3.9±1.0 mm; p<0.001) and differed significantly between the groups (p=0.025). The number of residual pockets (PD ≥4 mm) and positive BOP was reduced by AB from 961 to 377, and by PDT from 628 to 394. Pockets with PD ≥7 mm were reduced by AB from 141 to 7, and by PDT from 137 to 61. After 3 months, both treatments led to statistically significant clinical improvements. The systemic administration of antibiotics, however, resulted in significantly higher reduction of PD and a lower number of deep pockets compared to PDT.
Root perforations as a possible complication during a root canal treatment may increase the risk of failure for the affected tooth. The influencing factors include: the location and the size of the perforation, a potential microbial colonization of the endodontic system, the time lapse between the occurrence of the perforation and repair, and the filling material. Decontamination at the perforation site and in the remaining root canal system is essential for long-term success. For most cases, an orthograde retreatment with perforation repair represents a reasonable causal-based approach. This case report documents the treatment of a maxillary incisor with extensive apical periodontitis and iatrogenic root perforation in a 14-year-old patient. Three years after retreatment, perforation repair and coronal restoration with composite the follow-up shows a successful treatment outcome.
